Showing papers in "Endocrinologist in 2008"

Matrix Metalloproteinases (MMP)-1, -2, and -9 Gene Polymorphism in Papillary Thyroid Cancers (PTC)

Abstract: :Matrix metalloproteinases (MMPs) can affect early events in carcinogenesis and tumor invasion and/or metastasis. In this study we attempt to explain the relationship of the MMP-1, -2, and -9 gene polymorphism with prognostic factors in papillary thyroid cancer patients.Our study included 42

Novel Therapy: Insulin, Heparin, and Octreotide in the Treatment of Hypertriglyceridemia, Dramatic Results

Abstract: Profound hypertriglyceridemia (HTG) is uncommon and often associated with acute pancreatitis. HTG may result from congenital disorders, metabolic diseases, and medications among other causes. The acute management of HTG is not clear, although the combination of insulin and heparin has shown efficacy. Octreotide, a somatostatin analog, has been mildly efficacious in pancreatitis. We present a case of profound HTG and pancreatitis-treated combination of insulin and heparin with octreotide and compare this to previous reports.

Warfarin Toxicity and Exacerbation of Thyrotoxicosis Induced By Radioactive Iodine Therapy for Gravesʼ Disease

Abstract: Described here is a patient who developed a severe exacerbation of his thyrotoxicosis and warfarin toxicity shortly after radioactive iodine (RAI) therapy for Graves' disease. Although not often seen, these are serious complications of RAI therapy. Patients who could be harmed by exacerbation of thyrotoxicosis, such as those who are severely thyrotoxic, elderly, or with cardiovascular disease, would likely benefit from a course of antithyroid drug therapy that renders them clinically and biochemically euthyroid before RAI therapy as well as from the preventive measure of treatment with a beta-blocker. Our patient also illustrates the interaction between thyroid hormone levels and warfarin requirements. Hyperthyroid patients are more sensitive to warfarin and, therefore, require a smaller dose of warfarin than when they are euthyroid. Close monitoring is necessary in patients receiving warfarin who experience changes in thyroid function to prevent the potentially lethal occurrence of a thromboembolic or hemorrhagic event because of inappropriate warfarin dosage.

Pulmonary Hypertension in Graveʼs Disease

Abstract: Pulmonary arterial hypertension (PAH) is characterized by pulmonary artery systolic pressure (PASP) >35 mm Hg or mean >30 mm Hg with exercise. Etiology is divided into primary or secondary causes. Common causes of secondary PAH are myocardial or valvular disease, obstructive or restrictive lung disease, sleep apnea, left ventricular dysfunction, pulmonary embolism, and connective tissue disorders. The association between PAH and hyperthyroidism was first reported in an autopsy case in 1980. We report here the case of a patient with reversible pulmonary hypertension associated with Grave's disease managed only with medication. An association between Grave's disease and pulmonary hypertension was established here when other causes of pulmonary hypertension were ruled out and the patient had significant hemodynamic and symptomatic improvement after normalization of thyroid function.

Hyperprolactinemia Due to Macroprolactin: A Commonly Unrecognized Phenomenon Causing Misdiagnosis and Mismanagement

Abstract: Macroprolactin is a frequently unrecognized phenomenon giving rise to inaccurate diagnosis in an estimated 10% of cases of hyperprolactinemia in the United States. This has been associated with unnecessary investigation and inappropriate treatment including pituitary exploration. Simple laboratory procedures can be adapted to routinely screen hyperprolactinemic sera for macroprolactin. Therefore, it is timely to alert endocrinologists, gynecologists, and all those involved in the management of hyperprolactinemia to macroprolactin, its frequent occurrence and its ready recognition. Demand by clinicians to establish routine screening of hyperprolactinemic sera for the presence of macroprolactin will be useful in leading to adoption of routine screening procedures necessary for the appropriate recognition of the phenomenon.

Growth Hormone Therapy and Risk of Malignancy

Abstract: :Growth hormone (GH) therapy is widely used for the treatment of GH deficiency, as it improves body composition, bone density, and cholesterol levels and may decrease death Although it is referred by some as the “sweet syringe of youth,” its role in the healthy elderly is still controversia

Thyroid Abscess as a Complication of Fine-Needle Aspiration Biopsy

Abstract: :Thyroid abscess is a rare condition with a dramatic clinical course. Most commonly, thyroid abscess develops in a multinodular goiter. Rarely, the infection is iatrogenic. This report describes an abscess developing after fine-needle aspiration biopsy. The infectious agent was Escherichia c

Mechanisms of Hypothalamic-Pituitary Injury After Oncologic Disease

Abstract: Hypopituitarism is a common complication of brain tumors as a consequence of the tumor itself or as a side effect of therapies used in treating the tumor. The mechanism by which such injury occurs is not well understood. Hypothalamic/pituitary damage may follow tumor invasion or anatomic shift in critical brain structures related to pressure from tumor mass, hydrocephalus, surgical traction, ischemia/reperfusion, hemorrhage, vascular damage or stenosis, autoimmune response to injured cells, radiation necrosis, and radiation-induced DNA damage with altered cellular repair mechanisms. Endocrine deficiency is related to the dose of cranial radiation. Other determinants of sensitivity are poorly understood. Growth hormone deficiency is often the first deficiency recognized, but sometimes thyrotropin deficiency occurs first, followed by precocious puberty and adrenocorticotropin deficiency. Gonadotropin deficiency is often recognized in adults first because altered growth velocity is no longer available as a signal. Approaches used to reduce pituitary injury include delay in the use of irradiation until an older age, or choice of other types of irradiation such as conformal radiation, stereotactic radiosurgery, or proton beam therapy. The full manifestation of hypothalamic/pituitary dysfunction can unfold over several decades. At a minimum, annual monitoring of endocrine status is indicated.

Multifetal Pregnancy May Increase the Risk for Severe Maternal and Neonatal Vitamin D Deficiency

Abstract: Vitamin D deficiency is prevalent in pregnant women. This deficiency could be exaggerated in multifetal pregnancies by the increased demand on maternal stores of vitamin D. We present 2 cases in which hypocalcemia and secondary hyperparathyroidism occurred in 2 sets of twins from mothers with vitamin D deficiency. The first mother had gastric bypass surgery and Crohn disease. The second mother had no apparent cause of vitamin D deficiency. Both women had iron deficiency anemia and lived in Northeastern United States. We speculate that in twins, the demand for 25-hydroxyvitamin D by 2 fetuses could deplete the 25-hydroxyvitamin D stores in a mother.

Levels of High-Sensitivity C-Reactive Protein, Leptin, and Resistin in Patients With Overt Hypothyroidism and Subclinical Hypothyroidism

Abstract: Hypothyroidism is associated with an increased risk for obesity and cardiovascular diseases. Resistin and leptin exert proinflammatory actions by activating a specific receptors which are expressed in human endothelial cells. The aim of the study was to investigate whether the relations between the leptin, resistin, and high-sensitivity C-reactive protein (hs-CRP), which is a marker of low-grade inflammation, in patients with subclinical (SH) and overt hypothyroidism (OH). The levels of leptin, resistin, and hs-CRP were measured in 25 patients with OH, 30 patients with SH, and in 25 healthy subjects, using enzyme-linked immunosorbent assay method. The leptin and resistin levels in patients with OH and SH were similar to those in the control group. The hs-CRP level in OH group was significantly higher than SH and control groups (P

The Effect of Thyroid Gland Palpation and Fine Needle Aspiration Biopsy on Serum Thyroid Hormoneand Thyroglobulin Levels

Abstract: :The objective of this study is to evaluate the possible effect of thyroid palpation and fine needle aspiration biopsy on serum thyroid hormones and thyroglobulin in patients with several thyroid diseases. We measured serum free T4, free T3, TSH, and thyroglobulin levels at baseline, 5 and 6

Use of Clinical and Laboratory Data for Prediction of Gravesʼ Disease 1-Year Remission After 12 Months of Treatment With Antithyroid Drugs

Abstract: Objective: Treatment of Graves' disease (GD) with antithyroid drugs (ATD) leads to remission of the disease in approximately half of patients treated for at least 6 months. The overall relapse rate is high. Prognostic features that predict a remission after medical treatment are still a matter of controversy in the literature. The aim of this study is to evaluate the uuse of clinical and laboratory data for predicting a remission of GD after 12 months of treatment with ATD. Methods: The study included 46 previously untreated patients who were treated for 12 months and followed for at least 12 months after drug withdrawal. Results: Remission was observed in 25 patients and there was only 1 relapse. Greater duration of symptoms before the beginning of medical treatment, large goiter and high baseline levels of serum free T4, total T3, TRAb, and TPOAb were associated with a decreased remission rate. Individuals who presented a thyroid-stimulating hormone measurement Conclusion: Our results confirm that the rate of lasting remissions of GD treated with ATD is relatively low. Initial goiter size, duration of symptoms and baseline T3, free T4, TRAb, and TPOAb can select a subgroup of patients with GD who will most likely benefit from antithyroid drug treatment as a first choice.

Tumoral calcinosis: An unusual etiology

Abstract: Tumoral calcinosis (TC) is a disorder of enhanced renal tubular phosphate reabsorption resulting in hyperphosphatemia and ectopic calcifications. Gene analyses have confirmed that destabilizing mutations within fibroblast growth factor-23 (FGF23) and GalNAc transferase-3 (GALNT3) are responsible for heritable TC. Herein, we present a patient with phenotypic and biochemical features of TC, whose evaluation revealed no mutations in either the FGF23 or GALNT3 genes and normal circulating C-terminal and intact FGF23 concentrations. The patient is a 12-year-old African American man with ectopic, subcutaneous mineral deposits, with a diagnosis of tumoral calcinosis based on collective clinical features. Plasma FGF23 concentrations were determined using both an assay that measures full-length FGF23 and one that recognizes the C-terminal portion. Gene analysis was performed on DNA isolated from peripheral WBCs. The patient's calcium and PTH concentrations were normal. Serum phosphorus concentrations ranged 5 to 6.7 mg/dL. 1,25-Hydroxy vitamin D levels were elevated. FGF23 C-terminal fragment concentrations were 53.79 RU/mL (reference interval 55 ± 50 RU/mL) and intact FGF23 concentrations were 11 pg/mL (reference interval 28 ± 2.2 pg/mL). Gene analysis showed no mutations in either FGF23 or GALNT3 genes. Reported cases of TC due to FGF23 and GALNT3 mutations have similar clinical and laboratory features. Our patient has most of the “classic” TC phenotypic features, but has normal circulating levels of C-terminal and intact FGF23, and no detected mutations of either the FGF23 or GALNT3 genes. Therefore, our case likely represents a new, yet undetermined, cause of TC.

Somatic Mutation of RET Proto-Oncogene in Sporadic Medullary Thyroid Carcinoma: Report of a Case and Review of the Literature

Abstract: Medullary thyroid carcinoma (MTC) occurs as a sporadic form or as an autosomal dominant inherited familial disorder. Germ-line mutations of the RET proto-oncogene are known to be a cause of familial forms. Even in apparently sporadic cases, however, somatic mutations of RET are detected in 23% to 69% of cases. The most common somatic mutation observed in sporadic MTC is an amino acid substitution (from methionine to threonine) at codon 918. A few other mutations have been reported sporadically. Here we report a case of sporadic MTC whose tumor showed somatic mutation of RET at codon 634 (from cysteine to arginine). A 60-year-old woman was admitted for examination of a neck mass. Her calcitonin level was extremely high and ultrasonography and neck computerized tomography showed a 2-cm mass with heterogeneous internal density. Genetic analysis of her DNA from peripheral blood showed no mutation of the RET gene. The patient underwent successful total thyroidectomy. Pathologic and immunohistochemical study were compatible with MTC. Genetic analysis of the tumor tissue showed the C634R mutation in RET gene. The C634R somatic mutation, one of the most frequent mutations observed in germ-lines in multiple endocrine neoplasia 2A, might have contributed to the tumorgenesis in this sporadic MTC. Cases of MTC with somatic mutations of C634R in the RET gene are rare. Here we report the precise clinical data and clinical course of this rare MTC and we review the reported MTCs with somatic mutations of the RET gene.

TSH and TPOAB as predictors of thyroid disease in diabetic patients

Abstract: We tested the values of antithyroid peroxidase antibody and thyrotropin levels for the development of thyroid dysfunction in 109 diabetic patients. Baseline thyrotropin level was a predictor of thyroid dysfunction in diabetic patients, excluding nodular disease. The antithyroid peroxidase antibody had no predictive value for thyroid dysfunction.

A Woman With Pituitary Mass Presenting as Oligoamenorrhea and Later With Acute Renal Failure

Abstract: Idiopathic granulomatous hypophysitis is an uncommon disorder. Its association with retroperitoneal fibrosis has not been described previously, although both possibly share an autoimmune etiology. We report one such case.

Pheochromocytoma: “the Great Mimic”: Thrombosis of Portal Vein and Splenic Vessels as First Presentation of Pheochromocytoma

Abstract: Pheochromocytoma is a tumor of the adrenal medulla that secretes catecholamines (noradrenaline and adrenaline). The clinical presentation is characterized by paroxysmal hypertension, tachycardia, headache, and sweating. Pheochromocytoma is associated with neurofibromatosis type 1. We report the case of a woman with neurofibromatosis type 1 and bilateral adrenal pheochromocytomas who presented with thrombosis of the portal vein, thrombocytosis, hepatic infarct, and stenosis of celiac artery. To our knowledge this is the first report of this constellation of findings as the presenting clinical picture of pheochromocytoma.