OBJECTIVE: Adrenal insufficiency due to hypopituitarism can lead to severe hyponatremia with potentially fatal consequences. Prompt diagnosis and adequate hormonal replacement therapy are essential to block an otherwise unfavorable course and to re-establish a healthy life. Unfortunately, this condition is often misdiagnosed. DESIGN: Case report. SETTING: Intensive Care Unit of ...

OBJECTIVE: To assess the risk of pheochromocytoma in patients with borderline-elevated urine or plasma metanephrine levels. DESIGN: Retrospective review. SETTING: University tertiary care center. PATIENTS: Forty-two consecutive patients with adrenal incidentalomas (defined as adrenal tumors identified during routine imaging for another condition) who were treated at the UCSF (University of ...

Hypothalamic-pituitary (HP) sarcoidosis has 2 main endocrine manifestations: diabetes insipidus and hyperprolactinemia. We conducted the current study to investigate pituitary dysfunction and perform imaging of the HP area in patients both immediately following diagnosis and after treatment. The study included 6 men and 3 women, with a mean age of ...

A retrospective study was performed on all patients with congenital adrenal hyperplasia (CAH) who were followed up at the King Hussein Medical Center (KHMC), Amman, Jordan, during the period from January 1996 to June 2006. The aim was to evaluate the clinical features, special problems, and corrective interventions for these ...

Primary adrenal lymphoma (PAL) is a rare extranodal non-Hodgkin's lymphoma. The majority of the patients are elderly men with bilateral adrenal involvements. The optimal treatment of PAL has not been well established currently. We herein report on a patient with primary bilateral adrenal lymphoma and adrenal crisis that treated with ...

CONTEXT: The unexpected observation of a normal GH peak in 22% of young adults with childhood-onset GH deficiency (GHD) and ectopic neurohypophysis has raised questions about the criteria defining GHD in young adults and whether patients with subsequent increases in GH secretion nonetheless have a subtle form of GHD. OBJECTIVE: ...

Recent investigations have provided evidence for a high prevalence of pituitary dysfunction in patients with subarachnoid haemorrhage (SAH). However, apart from one study, all of the previous data were obtained from retrospective studies. To our knowledge there is no previously reported study in which pituitary function was investigated in the ...

INTRODUCTION: The physiological role of prolactin (PRL) in male sexual function has not been completely clarified. AIM: The aim of this study is the assessment of clinical features and of conditions associated with hyperprolactinemia in male patients consulting for sexual dysfunction. METHODS: A consecutive series of 2,146 (mean age 52.2 ...

BACKGROUND: GH may be beneficial in treating patients with end-stage renal disease (ESRD). However, the efficacy and safety of GH could be compromised by the potential for accumulation in the circulation. OBJECTIVE: The objective was to investigate the pharmacokinetics and safety of GH treatment in ESRD patients. DESIGN: This was ...

OBJECTIVE: The conventional replacement therapy in Addison's disease (AD) does not restore the normal diurnal cortisol rhythm. We explored the feasibility and safety of continuous s.c. hydrocortisone infusion (CSHI) as a novel mode of glucocorticoid replacement therapy. DESIGN AND METHODS: Seven patients with AD were treated with CSHI in an ...

PRIMARY OBJECTIVE: To determine whether cognitive and behavioural disorders observed in TBI patients are due to hormonal deficits or to the brain injury itself. Research design: Transversal, between-group design. METHODS AND PROCEDURES: Studied 22 severe TBI patients (GCS < 8): 11 had isolated GH deficiency and 11 did not. Prepared ...

AIMS: To describe functional status (FS), general health (GH) and symptom distress (SD) from admission to 1 year post-SCT and to identify medical, demographic, and/or patient-reported outcome variables associated with patient-perceived GH. MATERIAL AND METHODS: Forty-one patients (27 women) with a median age of 44 (18-65) years answered three questionnaires ...

OBJECT: Patients with adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas may require a bilateral adrenalectomy to treat their Cushing's disease. Approximately one third of these patients, however, will experience progressive enlargement of the residual pituitary adenoma, develop hyperpigmentation, and have an elevated level of serum ACTH. These patients with Nelson's syndrome can ...

Primary hyperaldosteronism (PH), resulting in hypokalaemic hypertension, may be due to an aldosterone-producing adenoma (APA) or bilateral zona glomerulosa hyperplasia. Six patients with suspected PH were identified at the University Hospital of the West Indies and standardized screening was carried out. Plasma renin activity (PRA) and serum aldosterone concentrations (SAC) ...

Hyperprolactinemia is often observed in lymphocytic hypophysitis (LYH). To clarify the possible autoimmune pituitary involvement in patients with apparently idiopathic hyperprolactinemia we investigated the presence of antipituitary antibodies (APA) in hyperprolactinemic patients with idiopathic hyperprolactinemia and in those with prolactinoma. Sixty-six hyperprolactinemic patients (52 F, 14 M age range 28-42 ...

Functional adrenal insufficiency (FAI) is associated with increased mortality and is defined as subnormal cortisol production during acute severe illness. After screening 200 adult patients admitted in the medical emergency unit of Mulago Hospital, Kampala, Uganda, 113 critically ill HIV-infected adults not receiving corticosteroids were enrolled after obtaining informed consent ...

OBJECTIVE: To estimate the prevalence and predictive factors of hypopituitarism following traumatic brain injury (TBI). DESIGN: A cross-sectional cohort study. PATIENTS: One hundred and four hospitalized TBI patients (26F/78M), median age 41 (range 18-64) years, body mass index (BMI) 25 (17-39) kg/m(2); severity: mild [Glasgow Coma Scale (GCS) score 13-15) ...

CONTEXT: The role of somatostatin analogues (SSTa) in the treatment of acromegaly. OBJECTIVE: To evaluate the antihormonal and antitumour efficacy of long-term (up to 18 years) primary treatment with SSTa in patients with GH-secreting pituitary adenoma responsive to SSTa. DESIGN: An open, prospective, single-centre, clinical study. PATIENTS: Thirty-six acromegalic patients, ...

INTRODUCTION: The aim of this study was to evaluate the correlation between biochemical hyperandrogenemia and body mass index in patients with amenorrhea as the main clinical presenting symptom. METHODS: Among 136 patients presenting with secondary or primary amenorrhea, hyperandrogenemia was found to be the hormonal cause of this specific type ...

We describe a Japanese brother and sister with Martsolf syndrome. They had short stature, severe mental retardation, cataract, hypogonadism, craniofacial dysmorphism, and bone and joint symptoms including scoliosis, lax finger joints, and talipes valgus. Previously undescribed findings included proximal femoral epiphyseal dysplasia reminiscent of Legg-Calve-Perthes disease in both patients, and ...

AIM: To evaluate the relationship between pituitary size, PIT1 and PROP1 genotype, and the severity of childhood onset growth hormone deficiency (coGHD). PATIENTS: Forty-four patients with coGHD (34 M; 9.7 +/- 4.1 years): severe isolated (SI) GHD (n = 14); partial isolated (PI) GHD (n=13); multiple pituitary hormone deficiencies (MPHD) ...

OBJECTIVE: We studied posterior pituitary function in 27 patients with Sheehan's syndrome and 14 controls. DESIGN: All patients were investigated by water deprivation test and 26 of them by 5% hypertonic saline infusion test. None of the patients had symptoms of diabetes insipidus and all patients were on adequate glucocorticoid ...

INTRODUCTION: Barbiturate coma is the second tier measure recommended by guidelines to treat post-traumatic refractory intracranial pressure. Systemic hypotension is its most important side effect. Recent evidence suggests that low-dose corticosteroid therapy may be used in a subset of patients with traumatic brain injury (TBI) to avoid hypotension. We evaluated ...

Fibroblast growth factor (FGF)23 is a hormone that regulates serum phosphate and 1,25-dihydroxyvitamin D levels. Hyperphosphatemia is sometimes observed in patients with acromegaly while the detailed mechanism of this abnormal phosphate metabolism remains to be elucidated. We have measured FGF23 levels in 18 patients before and after the surgery for ...

Background: The incidence of phaeochromocytomas in Europe and the USA is well documentea. From Africa, including Ethiopia, there are few reports on the disease. This paper describes 12 cases of phaeochrocytomas managed in Tikur Anbessa Hospital Addis Ababa between 1981 and 2001 inclusive. Methods: A retrospective study of 40 patients ...

OBJECTIVE: Endoscopic third ventriculostomy (ETV) is a standard procedure for the treatment of obstructive hydrocephalus in children. Main part of the procedure is the perforation of the third ventricle floor (tuber cinereum). This structure is part of the hypothalamic-pituitary neuronal network of cerebral endocrine regulation. There are no systematic data ...

Acquired PRL deficiency occurs when the anterior pituitary is functionally destroyed, and it usually accompanies other pituitary hormone deficiencies. We retrospectively investigated in an outpatient endocrine clinic of a major tertiary medical center the prevalence and clinical characteristics of acquired PRL deficiency in patients with diseases of the hypothalamic-pituitary axis. ...

Many factors may be involved in the growth and gonadal dysfunction of Fanconi anemia (FA). OBJECTIVE: To evaluate the (1) relationship between FA presentation, including genital abnormalities and pituitary stalk interruption syndrome (PSIS), (2) markers of growth hormone (GH) deficiency and gonadal function, and (3) factors influencing final height and ...

CONTEXT: Patients with Cushing's syndrome (CS) have a mortality rate four times higher than age- and sex-matched subjects, mainly due to cardiovascular events. Serum osteoprotegerin (OPG) levels are increased in patients with cardiovascular disease and/or excess bone resorption. OBJECTIVE: The aim of the study was to assess serum OPG and ...

Rathke's cleft cyst becomes symptomatic in a few cases. Increasing experience has identified previously unrecognized clinical effects including pituitary dysfunction. This study retrospectively investigated eight patients with Rathke's cleft cyst manifesting as hyponatremia and treated surgically with histological confirmation to clarify the mechanism of hyponatremia. All patients suffered from physical ...

OBJECTIVE: The etiological diagnosis of ACTH-dependent Cushing's syndrome is often a problem. In fact, no endocrine or radiological examination can conclusively distinguish the ectopic from the pituitary source of disease. The aim of our study was to evaluate the role of stimulation and suppression endocrine tests in the diagnostic and ...

Hypoadrenocorticism is caused by a lack of endogenous glucocorticoid and mineralocorticoid. These deficiencies can cause a myriad of clinical signs. This disease is uncommon and its clinical presentation is similar to many much more commonly recognized diseases such as renal failure and various gastrointestinal disorders. Severely affected patients may present ...

CONTEXT: Increased mortality in patients with pituitary tumors after surgical treatment has been reported. However, it is unknown to what extent excess mortality is caused by pituitary tumors and their treatment in general and to what extent by previous exposure to hormonal overproduction. OBJECTIVE: The aim of the study was ...

BACKGROUND/AIM: Despite combined therapy consisting of surgery, external X-ray, and medical therapy, a significant number of acromegaly patients continue to have uncontrolled growth hormone (GH) secretion and active disease. These patients, particularly those with large or invasive tumors, require additional therapy to decrease their GH levels. Our aim was to ...

INTRODUCTION: Unilateral adrenal hyperplasia (UAH) is a rare, surgically correctable cause of primary hyperaldosteronism (PH). We report 2 cases and review the literature for cases of PH secondary to UAH successfully treated via surgery. METHODS: Two cases of UAH treated at our institution were retrospectively reviewed. In addition, we reviewed ...

OBJECTIVE: The aim of this study was to determine the correlation between the expression of somatostatin receptors by immunohistochemistry and the percent suppression of GH levels in the octreotide suppression test. PATIENTS AND METHODS: Twenty-two patients with acromegaly who underwent an octreotide suppression test before surgery were studied. We performed ...

OBJECTIVE: LHX4 and HESX1 are important in early stages of pituitary development and their mutations can be associated with an ectopic posterior lobe (EPL) in the pituitary of patients with hypopituitarism. The EPL can be located at the median eminence or at the path of the pituitary stalk. The aim ...

BACKGROUND: The differential diagnosis of adrenocorticotropin (ACTH)-dependent Cushing's syndrome (CS) remains a challenging issue for clinical endocrinologists. In this respect, bilateral inferior petrosal sinus sampling (BIPSS) appears to be the most sensitive and specific test. Here, we report our 15-year experience of analyzing the performance of BIPSS, both in the ...

The German Pegvisomant Observational Study (GPOS) was created immediately after marketing authorisation was received in Germany for Somavert (pegvisomant) for the treatment of patients with acromegaly. In August 2006, the database underwent its fifth interim analysis of 263 patients, the vast majority of whom previously had insufficient disease control with ...

OBJECTIVE: To investigate the pattern of pituitary-adrenal responses to human corticotropin-releasing hormone (hCRH) in critically ill patients and to examine the relation between responses and clinical outcome. DESIGN AND SETTING: Prospective study in consecutive critically ill patients in a general intensive care unit in a teaching hospital. PATIENTS: The study ...

Pituitary volumes were shown to be abnormally large in pre- or first-psychotic episode patients and abnormally reduced in established schizophrenia by magnetic resonance imaging (MRI) studies. We present here the results of the second ever published MRI study exploring pituitary size in a large population of patients with chronic schizophrenia ...

When evaluating delayed puberty, it is essential to determine the underlying cause. This can be done with history and physical exam as well as basal gonadotropin levels, bone age, and further testing as indicated. When the cause is hypogonadism, an underlying condition should be treated if present; otherwise lifelong hormonal ...

CONCLUSION: Patients with severe nasal polyposis (NP) and a high steroid consumption have a high prevalence of glucocorticoid-induced osteoporosis and secondary adrenal insufficiency. OBJECTIVES: To evaluate the risk of complications of the medical treatment in patients presenting with the diagnosis of NP. PATIENTS AND METHODS: This was a prospective study. ...

CONTEXT: Hypogonadotropic hypogonadism (HH) can occur at any stage of life as an isolated congenital or acquired abnormality or within a more generalized pituitary or hypothalamic impairment. However, the defect in patients with idiopathic HH is still unknown. OBJECTIVE: The aim of this study was to investigate the prevalence of ...

Relative adrenal insufficiency is frequent in patients with severe sepsis and is associated with hemodynamic instability, renal failure, and increased mortality. This study prospectively evaluated the effects of steroids on shock resolution and hospital survival in a series of 25 consecutive patients with cirrhosis and septic shock (group 1). Adrenal ...

BACKGROUND: Adrenal venous sampling (AVS) is used in the workup of primary hyperaldosteronism (PA). The purpose of this study was to determine the success rate of AVS and to examine the decision-making process after "less than ideal" AVS. METHODS: A total of 60 patients underwent 62 AVS for PA. Biochemical ...

A recent study reported that 77% of patients with septic shock had relative adrenal insufficiency. However, all patients were mechanically ventilated and received high-dose inotropes. In addition, at least 24% had prior exposure to etomidate, a drug known to suppress adrenal function. We studied the incidence of relative adrenal insufficiency ...

The purpose of this study is to prospectively evaluate the cortisol response and determine the relative adrenal insufficiency after return of spontaneous circulation (ROSC). METHODS: This is a prospective cohort study describing the prevalence of relative adrenal insufficiency in consecutive patients admitted to an intensive care unit following ROSC (>24 ...

Present transfusion protocols have increased the life expectancy of patients with beta-thalassemia major, but siderosis is a major clinical complication of the treatment. Short stature and hypogonadism are extremely frequent in patients with thalassemia. To investigate the influence of age at the onset of blood transfusion, iron chelation therapy, and ...

BACKGROUND: Acromegaly, which may be present in patients with McCune-Albright syndrome (MCAS), in association with café-au-lait spots, precocious puberty, and fibrous dysplasia, is often difficult to treat surgically because skull base bone dysplasia prevents the removal of the pituitary adenoma. Somatostatin analogs (SAs) generally give only partial responses. The use ...