PITUITARY DISORDER

In this case report we describe a 38 year-oldfemale with galactorrhea several months after the birth of an anencephalic child. She had hyperpolactemia and imaging of the pituitary gland revealed a midline defect and a nasopharyngeal mass compatible with a meningo-(hypophyso-) encephalocele and possibly an ectopic teratoma or desmoid. She was treated with dopamine agonists for 10 years and after cessation of therapy her prolactin levels remain normal. The nasopharyngeal mass remained unchanged over time and there were no signs of hypopituitarism. The hyperprolactinemia at presentation was probably caused by earlier pregnancy and stalk dysfunction due to traction by the mass. With decline of pituitary size, after starting dopamine agonists, the traction probably reduced resulting in a normal prolactin level. Our patient was warned against manipulation in de nose, because this could damage the meningo-encephalocele. An MRI will be preformed every 2 years to monitor changes in de mass.

Sheehan's syndrome is a postpartum hypopituitarism state caused by necrosis of the pituitary gland. It is usually the result of severe hypotension or shock caused by massive hemorrhage during or after delivery. Sheehan's syndrome symptoms are often subtle and hence it is diagnosed late. Herein, we report a case of a 41-year-old woman who developed severe postpartum hemorrhage after childbirth that required a total abdominal hysterectomy to control bleeding at the age of 36 years. Since then, she has progressively developed symptoms of headache, general fatigue, and malaise, and finally presented with pancytopenia for investigations. Anemia is a well-known hematological association with Sheehan's syndrome while pancytopenia is rarely reported. However, complete recovery of pancytopenia was observed after the treatment. Pancytopenia (due to bone marrow failure to produce cells) is a serious finding in clinical practice that causes significant stress as it may point to a diagnosis of malignancy (mainly leukemia) and other serious disorders. Despite being a rare cause, a high index of suspicion is required from the physicians in women with pancytopenia, in order to look for a possible treatable cause of pancytopenia (like Sheehan's syndrome), if the common causes were excluded.

Panic patients have many functional deficiencies in the hypothalamic-pituitary-adrenal (HPA) axis. Previous studies have shown changed pituitary gland volume in some psychiatric disorders that have functional deficiencies in the HPA axis. However, to date no study has evaluated the pituitary gland volume in patients with panic disorder (PD). We investigated the pituitary gland volume in patients with PD (n = 27) and ageand sex-matched healthy controls (n = 27), using 1.5-T magnetic resonance imaging in this study. Analysis showed that patients with PD had significantly smaller pituitary volume compared to healthy subjects. Patients with agoraphobia especially had a significantly smaller pituitary volume than patients without agoraphobia. There was a significant relationship between the pituitary volume and both the severity of symptoms and the illness duration in the patient group. The results show that patients with PD have reduced pituitary volume, which may reflect the functional abnormalities seen in this disorder. These findings may help us better understand the pathology of PD.

Pituitary stalk interruption syndrome is a rare congenital abnormality of the pituitary that is responsible for anterior pituitary deficiency. It is characterized by a classic triad of interrupted pituitary stalk, absent or ectopic posterior pituitary, and anterior pituitary hypoplasia or aplasia. Clinical presentation varies according to age. In adults it presents as short stature and anterior pituitary deficiency. Without early diagnosis and treatment, mortality and morbidity in these patients is high. Early diagnosis and treatment of this rare disease can prevent permanent short statue of the patient. We report the first case of pituitary stalk interruption syndrome from Pakistan. A 17-year-old Pakistani young man presented with short stature and underdeveloped secondary sexual characters. His siblings and parents were healthy, with normal height. An examination showed his blood pressure was 90/60mmHg, and his height, weight, and body mass index were 142cm, 34.5kg, and 17.10kg/m2...

BackgroundPrimary pituitary NK-/T-cell lymphomas are extremely rare pathologies and there is only limited information about their clinical course, treatment and prognosis.Case presentationWe present a case of a 78-year-old patient with a sellar nodular mass. After onset of symptoms with productive cough, hoarseness, swallowing disorder and recurrent fever her condition rapidly deteriorated. Open biopsy through a right pterional approach was performed and histopathological evaluation revealed an EBV-associated NK/ T-cell lymphoma. High-dose corticosteroid therapy was initiated. However the patient passed away 37 days after admission due to respiratory insufficiency. ConclusionWe describe an unusual case of EBV-associated NK-/T-cell lymphoma of the CNS manifesting as a pituitary gland tumor. This particular entity presented with a pronounced aggressive local tumor growth with lethal outcome.

Objective: To find out frequency and demographic profile of endocrine disorders in patients admitted in endocrinology ward at Services Hospital Lahore. Methods: The cross-sectional study was conducted at Services Hospital Lahore in Punjab, Pakistan. The study included 105 patients admitted in Endocrinology Ward. Data used was secondary and it was collected via medical record from June, 2018 to January, 2019. All information pertaining to patients was kept confidential. Ethical Review Committee permission was undertaken with final approval from Head of Department. Results: Demographic characteristics of patients included age, gender, and showed majority to be middle- aged females. The number of female cases were 65.71% (n = 69), while male cases were 34.29% (n = 36). The average age of all the patients was 40.62 ± 16.52. Majority of the patients with 76.19% (n = 80) cases were reported with having glucose homeostasis disorders with 65.71% (n = 69) cases having diabetes mellitus and 1...

Serum concentrations of prolactin, FSH, LH, androstenedione (A) 11-0-hydroxyandrostenedione (11lA). dehydroepiandrostenedione (DHA), dehydroepiandrostenedione sulfate (OHAS), and cortisol (F) were quantified in blood from 106 children from 2 to 12 years of age, and in adults. Prolactin (Prl), cortisol, and ll-l-hydroxyandrostenedione showed no significant changes during these years. Androstenedione was present in relatively high concentrations at the youngest ages and increased gradually, while FSH and LH rose peripubertally in years 11 and 12. In contrast, dehydroepiandrosterone and its sulfate showed a progressive increase with age in boys and girls and a 2-phase increase in girls. The greatest relative change in the OHAS concentrations occurred between ages 2 and 5 in girls. These data indicate that significant changes in adrenal androgen (D M) secretion occur well before the gonadal changes of puberty in both sexes. Furthermore, since the A ' steroids (A and 11-0-OH A) were high at ages 2-5, and constant with approaching puberty, whereas the A5 steroids (DHA and D M S) increased with age beginning with relatively low values, the A4/A5 ratio decreased with age. This suggests early prominence of 3-6-01 isomerase dehydrogenase activity. We also conclude that children ages 2 through 12 have normal adult Prl levels, and these concentrations do not change in parallel with adrenal androgen development. ROLE OF WPOKALEMIA IN VASCULAR RESISTANCE M ANGIO-I1 (AII) .

Serum concentrations of prolactin, FSH, LH, androstenedione (A) 11-0-hydroxyandrostenedione (11lA). dehydroepiandrostenedione (DHA), dehydroepiandrostenedione sulfate (OHAS), and cortisol (F) were quantified in blood from 106 children from 2 to 12 years of age, and in adults. Prolactin (Prl), cortisol, and ll-l-hydroxyandrostenedione showed no significant changes during these years. Androstenedione was present in relatively high concentrations at the youngest ages and increased gradually, while FSH and LH rose peripubertally in years 11 and 12. In contrast, dehydroepiandrosterone and its sulfate showed a progressive increase with age in boys and girls and a 2-phase increase in girls. The greatest relative change in the OHAS concentrations occurred between ages 2 and 5 in girls. These data indicate that significant changes in adrenal androgen (D M) secretion occur well before the gonadal changes of puberty in both sexes. Furthermore, since the A ' steroids (A and 11-0-OH A) were high at ages 2-5, and constant with approaching puberty, whereas the A5 steroids (DHA and D M S) increased with age beginning with relatively low values, the A4/A5 ratio decreased with age. This suggests early prominence of 3-6-01 isomerase dehydrogenase activity. We also conclude that children ages 2 through 12 have normal adult Prl levels, and these concentrations do not change in parallel with adrenal androgen development. ROLE OF WPOKALEMIA IN VASCULAR RESISTANCE M ANGIO-I1 (AII) .

Background: Trans-sphenoidal surgery is the recommended initial therapy in patients with acromegaly. Early cure rate is 80-90% for microadenomas and <50% for macroadenomas. The goal is a serum IGF-1 that is normal for age and gender with GH <1mcg/L by immunoradiometric or chemiluminescent assays.

Recombinant human growth hormone (rhGH) has been in use for 30 years, and over that time its safety and efficacy in children and adults has been subject to considerable scrutiny. In 2001, a statement from the GH Research Society (GRS) concluded that &#39;for approved indications, GH is safe&#39;; however, the statement highlighted a number of areas for on-going surveillance of long-term safety including; cancer risk, impact on glucose homeostasis and use of high dose pharmacological rhGH treatment. Over the intervening years, there have been a number of publications addressing the safety of rhGH with regard to mortality, cancer and cardiovascular risk and the need for longterm surveillance of the increasing number of adults who were treated with rhGH in childhood. Against this backdrop of interest in safety, the European Society of Paediatric Endocrinology (ESPE), the GRS and the Pediatric Endocrine Society (PES) convened a meeting to reappraise the safety of rhGH. The ouput of the ...

Giant prolactinomas are a rare entity; during pregnancy, the risk for complications associated with these tumors is higher. Here, we report a case of a young woman who had an invasive, giant prolactinoma post resection with residual disease who became pregnant. This patient was treated with cabergoline to prevent tumor expansion in pregnancy, resulting in the uneventful delivery of a healthy baby boy.

Objective: The Growth Hormone (GH) Research Society (GRS) convened a workshop to address important issues regarding trial design, efficacy, and safety of long-acting growth hormone preparations (LAGH). Participants: A closed meeting of 55 international scientists with expertise in GH, including pediatric and adult endocrinologists, basic scientists, regulatory scientists, and participants from the pharmaceutical industry. Evidence: Current literature was reviewed for gaps in knowledge. Expert opinion was used to suggest studies required to address potential safety and efficacy issues. Consensus process: Following plenary presentations summarizing the literature, breakout groups discussed questions framed by the planning committee. Attendees reconvened after each breakout session to share group reports. A writing team compiled the breakout session reports into a draft document that was discussed and revised in an open forum on the concluding day. This was edited further and then circulated to attendees from academic

Recombinant human GH (rhGH) has been in use for 30 years, and over that time its safety and efficacy in children and adults has been subject to considerable scrutiny. In 2001, a statement from the GH Research Society (GRS) concluded that 'for approved indications, GH is safe'; however, the statement highlighted a number of areas for ongoing surveillance of long-term safety, including cancer risk, impact on glucose homeostasis, and use of high dose pharmacological rhGH treatment. Over the intervening years, there have been a number of publications addressing the safety of rhGH with regard to mortality, cancer and cardiovascular risk, and the need for long-term surveillance of the increasing number of adults who

Background Pituitary adenomas co-secreting GH, Prolactin and ACTH are rare. Clinical Case A 38-year-old male with a past medical history of depression and type 2 diabetes mellitus was seen in the endocrinology clinic for an evaluation of acromegaly. In the preceding four years, the patient had experienced an enlargement of his hands and feet, hyperhidrosis, development of an underbite, snoring, daytime somnolence, erectile dysfunction, headaches, and blurry vision. His visual fields were normal. Physical exam: BP 137/85, BMI 39 kg/m2. He had coarse facial features, acral changes of his hands and feet, and wide spacing of his teeth. There was a notable absence of facial plethora, abdominal obesity with thin extremities, proximal muscle weakness, purple abdominal striae, and galactorrhea. Initial laboratory results: GH 16.9 ng/mL (0.05-3 ng/ml), IGF-1 1,109 ng/mL (82-242 ng/mL), Prolactin (PRL) 96.9 ng/ml (5-20 ng/ml), testosterone 34 ng/dL (200-1000 ng/dL), LH 2.3 miu/ml (1.4–12 miu/...

master Gland issUe toPic Barač A, Jerković I. Management of pituitary tumors in pregnancy. pp. 66 -72 Pituitary tumors account for about 10-15 % of all intracranial neoplasms. Adenomas are the most common type of pituitary tumors. There are various options for treating pituitary tumors, such as surgery, medication therapy or radiotherapy. The treatment of choice depends on the size and functionality of the tumor. The first line of treatment for patients with pituitary prolactinomas are dopamine agonists, while the treatment of choice for non-functioning macroadenomas, acromegaly and Cushing's disease is surgery. The hypothalamic-pituitary-gonadal axis is frequently compromised in patients with pituitary tumors, resulting in amenorrhea and impaired fertility in women. Advancements in treatment have made conception and pregnancy possible for women with pituitary adenomas.

Endocrine disorders can influence the haemostatic balance. Abnormal coagulation test results have been observed in patients with abnormal hormone levels. Also unprovoked bleeding or thrombotic events have been associated with endocrine disease. The aim of the present review is to summarise the available evidence on the influence of common endocrine disorders on the coagulation system, and their possible clinical implications. We focus on thyroid dysfunction, hyper-and hypocortisolism and growth hormone disturbances, while other endocrine disorders are only briefly discussed. In the published literature a clear bleeding diathesis has only been associated with overt hypothyroidism, mainly mediated by an acquired von Willebrand syndrome. A clinically relevant hypercoagulable state may be present in patients with hyperthyroidism, hypercortisolism or abnormal growth hormone levels, but adequate prospective clinical studies are lacking. Also effects of pheochromocytoma, hyperprolactinaemia and hyperaldosteronism on the coagulation system have been described. It is apparent that unprovoked bleeding and thrombotic episodes can be secondary to endocrine disorders.

Drug addiction is a damaging national and social problem in Bangladesh affecting the economically productive groups. An estimated 1.7 million people are drug users in the country .Drug users, especially injecting drug users (IDU) present a tremendous potential for transmission of blood borne viruses, including hepatitis B virus(HBV) hepatitis C virus (HCV) and human immunodeficiency (HIV) virus.They may exchange these viral infections among them through their needle/syringe sharing habits and may spread to uninfected low risk population through their high risk sexual behaviour or by donating blood professionally.

Pituitary abscess is an uncommon pituitary lesion. Its clinical diagnosis can be difficult to distinguish from other pituitary lesions. This pathology is characterised by vague symptoms of headaches, generalised tiredness and hypopituitarism manifestations. A history of recent meningitis, paranasal sinusitis or head surgery can be a suggestive of the source of infection.A 20-year-old man was admitted to neurosurgery department with complain of headache, fatigue, polyuria, polydipsia, blurred vision and sexual dysfunction. MRI of the head revealed a suprasellar mass that was centrally hyperintense lesion on T2-weighted images with peripheral hypointensity and isointense centrally on T1 images with peripheral hyperintensity images. Treatment of this lesion pituitary abscess was surgical drainage of the pituitary area through a trans-sphenoidal approach and broad spectrum antibiotic therapy with ceftriaxone, metronidazole and vancomycin for 6 weeks. The patient continues to have pituit...

To the Editor, We thank Virú-Loza and Chávez-Nomberto for highlighting some of the limitations and concerns raised in the discussion section of our paper, "Safety and Efficacy of Pediatric Growth Hormone Therapy: Results From the Full KIGS Cohort" (1), and agree with their conclusion "that longer follow-up and adequate comparisons are needed to have better information on whether or not there is a higher incidence

Purpose: Apoptotic protease-activating factor-1 (APAF-1) and cathepsin B are important functional proteins in apoptosis; the former is involved in the intrinsic (mitochondrial) pathway, while the latter is associated with both intrinsic and extrinsic pathways. Changes in the expression of apoptosome-related proteins could be useful indicators of tumor development since a priori defects in the mitochondrial pathway might facilitate the inception and progression of human neoplasms. Our aim was to evaluate the profiles of APAF-1 and cathepsin B in relation with other molecules involved in apoptosis/proliferation and to correlate them with the aggressive behavior of invasive pituitary adenomas. Materials and methods: APAF-1 and cathepsin B were assessed in tissue samples from 30 patients with pituitary adenomas, of which 16 were functional adenomas and 22 were invasive adenomas. Results: A positive relationship between high proliferation and invasiveness was observed in invasive pituitary adenomas when compared to their noninvasive counterparts (Ki-67 labeling index-4.72% versus 1.75%). Decreased expression of APAF-1 was recorded in most of the invasive adenomas with a high proliferation index, while the cathepsin B level was elevated in this group. We have noticed a negative correlation between the low level of APAF-1 and invasiveness (63.63%; P0.01); at the same time, a positive correlation between cathepsin B expression and invasiveness (59.09%; P0.01) was found. In all, 81.25% out of the total APAF-1-positive samples were cathepsin B negative (P0.01); 76.92% out of the total cathepsin B-positive samples were APAF-1-negative (P0.01). These results were reinforced by an apoptosis protein array examination, which showed inhibition of the extrinsic apoptotic pathway in an invasive pituitary adenoma. Conclusion: A bidirectional-inverted relationship between APAF-1 and cathepsin B expressions was noticed. One might hypothesize that shifting the balance between mediators of cell death could result in changes in tumor behavior.

A 49-yr-old woman with a large pituitary tumor leading to visual loss and galactorrheaamenorrhea was submitted to transcranial pituitary surgery, when a clinically nonfunctioning pituitary adenoma was partially removed. Histopathology and immunohistochemistry confirmed the diagnosis of "non-secreting atypical adenoma." At that time, serum and urinary free cortisol were normal, with low T4 levels and hyperprolactinemia. The patient was discharged on thyroxine and bromocriptine and treated with conventional radiotherapy. Two years later, she presented high free urinary cortisol levels and a positive ACTH response to desmopressin testing on dexametasone 2 mg overnight. A pituitary biopsy confirmed aggressive growth as well as positive immunoreactivity for ACTH, p53, Ki-67, and c-erb-B2. The patient was then treated with radiosurgery on ketoconazole therapy. The overall clinical, laboratory, and pathological data suggest a transition from a clinically nonfunctioning to a hypersecreting ACTH-producing tumor. Putative mechanisms of tumor transformation and the possibility of a silent corticotropinoma evolving into clinical Cushing´s syndrome are discussed.

Objective: To find out frequency and demographic profile of endocrine disorders in patients admitted in endocrinology ward at Services Hospital Lahore. Methods: The cross-sectional study was conducted at Services Hospital Lahore in Punjab, Pakistan. The study included 105 patients admitted in Endocrinology Ward. Data used was secondary and it was collected via medical record from June, 2018 to January, 2019. All information pertaining to patients was kept confidential. Ethical Review Committee permission was undertaken with final approval from Head of Department. Results: Demographic characteristics of patients included age, gender, and showed majority to be middle- aged females. The number of female cases were 65.71% (n = 69), while male cases were 34.29% (n = 36). The average age of all the patients was 40.62 ± 16.52. Majority of the patients with 76.19% (n = 80) cases were reported with having glucose homeostasis disorders with 65.71% (n = 69) cases having diabetes mellitus and 1...

Adrenal insufficiency can result from primary disorder of the adrenal gland or occurs secondarily due to deficiency in adrenocorticotropic hormone (ACTH) or corticotropin-releasing hormone (CRH). To prevent adrenal crisis, it is thus important to test the remaining function of the adrenal gland. Tests for the function of the hypothalamicpituitary-adrenal (HPA) axis are also useful for examining localization of disease causing adrenal insufficiency. Generally, the insulin tolerance test (ITT) is useful for examining the HPA axis in both hypothalamic and pituitary diseases; however, ITT has a number of disadvantages. The growth hormone-releasing peptide (GHRP)-2 test may be a useful tool for diagnosing secondary adrenal insufficiency such as hypothalamic disorder and pituitary damage. In the present study, we examined the diagnostic usefulness of the GHRP-2 test as a substitute for ITT in hypopituitarism. We showed that patients with significant ACTH response to ITT also had significant response to the GHRP-2 test, while patients with no significant ACTH response to ITT also had no significant response to the GHRP-2 test. These data suggest that the GHRP-2 test may be a useful diagnostic tool for secondary adrenal insufficiency such as hypothalamic disorder and pituitary damage.

A 36-year-old man presented with drooping of both eyelids and diminution of vision in both eyes for 7 days, preceded by fever and headache for 15 days. He had diplopia, accentuated in looking forward. He did not complain of difficulty in mastication, impaired swallowing, weakness in any limb or fluctuations in symptoms. The patient's history was negative for head trauma, anticoagulants and other drugs or endocrinopathy. A general physical survey revealed bilateral gynaecomastia. He had bilateral vision loss, visual acuity being 6/24 in right eye and 6/36 in left eye. Right pupil was dilated with sluggish reaction and left pupil was mildly dialated with impaired reaction. The patient had bilateral ptosis which was more marked in left eye. On primary gaze, left eye was abducted and externally rotated (figure 1). Adduction and upward movements of both eyeballs were restricted (figure 2). Thus, he had a partial right oculomotor (third

Sheehan syndrome, also called postpartum hypopituitarism, is primarily caused by ischemic necrosis of the pituitary resulting from a complicated pregnancy. As the clinical presentations occur years after the complication, it is difficult to diagnose this condition. In this report, we discuss the case of a 35-year-old female with altered mental status, generalized edema, and loss of appetite. The condition was complicated due to the comorbidities of multiple medical conditions such as massive pericardial effusion and untreated jaundice. Her anorexic condition perfectly masked the malnourished appearance of the patient. After multiple laboratory tests and diagnostic imaging, the empty sella turcica of the patient propounded Sheehan syndrome. Replacement of the deficient hormones improved her condition after two weeks. Patients with complicated pregnancy history should be advised for diagnostic imaging early in life to appropriately manage Sheehan syndrome. A delay in diagnosis can have significant health and financial loss. Hormone replacement therapy is the only viable option as there is no cure to treat necrosed pituitary.

Certain pituitary imaging abnormalities are a specific indicator of hypopituitarism. The objective of this study is to compare phenotypical features with radiological findings in patients with congenital growth hormone deficiency (GHD). Magnetic Resonance imaging (MRI) was performed in 103 patients [72 with Isolated GHD (IGHD) and 31 with Combined Pituitary Hormone Deficiency (CPHD)]. Images were assessed for the following abnormalities: (1) small/absent anterior pituitary, (2) thin or interrupted pituitary stalk (PSA), and (3) Ectopic posterior pituitary (EPP), and (4) others. Radiological findings were correlated with the clinical and biochemical parameters. MRI abnormalities were observed in 48.6% patients with IGHD, 93.5% with CPHD. Jaundice, hypoxia, hypoglycemia and breech deliveries were more common in EPP/PSA group. EPP/PSA was observed in 87.1% patients with severe GHD (peak GH \ 3 lg/L) as compared to 12.9% with mild to moderate GHD (peak GH: 3-10 lg/L). Amongst CPHD, EPP/PSA was present in 80% of subjects with associated hypocortisolism ± hypothyroidism as compared to 18.2% of subjects with hypogonadism. Over a mean follow up period of 4.5 years, 5.4% of subjects with IGHD and abnormal MRI progressed to CPHD while none of those with normal MRI progressed. This study emphasizes a significant clinico-radiological correlation in Asian Indian GHD patients. MRI abnormalities in the hypothalamic pituitary area, especially EPP/PSA are more common in patients with CPHD and severe GHD. Among CPHD, EPP/PSA predicts association with hypothyroidism or hypocortisolism. IGHD with MRI abnormality may evolve into CPHD.

A variety of endocrine disorders can occur in pregnancy. The pathology of most of these disorders is due to autoimmune, tumour or iatrogenic causes. In this review we discuss in detail less common disorders than, for example, diabetes mellitus and thyroid disease. The review includes parathyroid, adrenal and pituitary gland disorders.

The authors sincerely apologise for errors in Table 3 of their paper titled above published in the journal, volume 162, number 3, pages 453–475. The errors occur in the data presented for the study by Musolino & Bronstein 2001 (and not Musolino et al. 2001 as published). The table with the correct data is published in full below:

McCune Albright syndromeis a rare disorder that presents with multiple endocrine abnormalities. We report the case of a 24-year-old woman who presented with right lower limb pain, with no preceding trauma or fracture. On examination she was noted to have coarsened facial features, acral enlargement, bitemporal hemianopia, galactorrhoea and multiple café-au-lait macules. She gave history of precocious puberty, having attained menarche at 7 years of age. Biochemical investigations revealed hyperprolactinaemia, with unsuppressed growth hormone levels following a glucose load and subclinical hyperthyroidism. Technetium-99m methylene diphosphonate bone scan showed polyostotic fibrous dysplasia, MRI of the brain showed a pituitary macroadenoma. Thus she was diagnosed to have McCune Albright syndrome with multiple endocrine manifestations. She was treated with parenteral zoledronate for her bony lesions and initiated on cabergoline for plurihormonal pituitary macroadenoma. She is planned t...

To the Editor, We thank Virú-Loza and Chávez-Nomberto for highlighting some of the limitations and concerns raised in the discussion section of our paper, "Safety and Efficacy of Pediatric Growth Hormone Therapy: Results From the Full KIGS Cohort" (1), and agree with their conclusion "that longer follow-up and adequate comparisons are needed to have better information on whether or not there is a higher incidence

Objective: To find out frequency and demographic profile of endocrine disorders in patients admitted in endocrinology ward at Services Hospital Lahore. Methods: The cross-sectional study was conducted at Services Hospital Lahore in Punjab, Pakistan. The study included 105 patients admitted in Endocrinology Ward. Data used was secondary and it was collected via medical record from June, 2018 to January, 2019. All information pertaining to patients was kept confidential. Ethical Review Committee permission was undertaken with final approval from Head of Department. Results: Demographic characteristics of patients included age, gender, and showed majority to be middle- aged females. The number of female cases were 65.71% (n = 69), while male cases were 34.29% (n = 36). The average age of all the patients was 40.62 ± 16.52. Majority of the patients with 76.19% (n = 80) cases were reported with having glucose homeostasis disorders with 65.71% (n = 69) cases having diabetes mellitus and 1...

Endocrine disorders can influence the haemostatic balance. Abnormal coagulation test results have been observed in patients with abnormal hormone levels. Also unprovoked bleeding or thrombotic events have been associated with endocrine disease. The aim of the present review is to summarise the available evidence on the influence of common endocrine disorders on the coagulation system, and their possible clinical implications. We focus on thyroid dysfunction, hyper-and hypocortisolism and growth hormone disturbances, while other endocrine disorders are only briefly discussed. In the published literature a clear bleeding diathesis has only been associated with overt hypothyroidism, mainly mediated by an acquired von Willebrand syndrome. A clinically relevant hypercoagulable state may be present in patients with hyperthyroidism, hypercortisolism or abnormal growth hormone levels, but adequate prospective clinical studies are lacking. Also effects of pheochromocytoma, hyperprolactinaemia and hyperaldosteronism on the coagulation system have been described. It is apparent that unprovoked bleeding and thrombotic episodes can be secondary to endocrine disorders.

Acute onset neuropsychiatric manifestations in hypopituitarism are uncommon. We report a case of a 60-year-old man who was a follow-up case of macroprolactinoma with hypopituitarism for the last 9 years. He was on medical treatment with cabergoline, thyroxine and depot testosterone. During the last 2 years he was non-adherent to medications especially cabergoline. He was hospitalised for 2 days through emergency services following acute onset psychosis. His pituitary hormone profile was suggestive of adrenal insufficiency, secondary hypothyroidism and hypogonadism. MRI of the hypothalamic pituitary region revealed a pituitary macroadenoma which was larger in size compared to the previous scan. Further, this lesion was compressing on the adjoining structures including optic chiasma. The patient was treated with intravenous fluids, hydrocortisone and thyroxine replacement therapy. With this treatment he completely recovered from psychosis within 48 h.

Pituitary stalk interruption syndrome is a rare congenital abnormality of the pituitary that is responsible for anterior pituitary deficiency. It is characterized by a classic triad of interrupted pituitary stalk, absent or ectopic posterior pituitary, and anterior pituitary hypoplasia or aplasia. Clinical presentation varies according to age. In adults it presents as short stature and anterior pituitary deficiency. Without early diagnosis and treatment, mortality and morbidity in these patients is high. Early diagnosis and treatment of this rare disease can prevent permanent short statue of the patient. We report the first case of pituitary stalk interruption syndrome from Pakistan. A 17-year-old Pakistani young man presented with short stature and underdeveloped secondary sexual characters. His siblings and parents were healthy, with normal height. An examination showed his blood pressure was 90/60mmHg, and his height, weight, and body mass index were 142cm, 34.5kg, and 17.10kg/m2...

In March 2011, the Acromegaly Consensus Group met to revise and update the guidelines on the diagnosis and treatment of acromegaly complications. The meeting was sponsored by the Pituitary Society and the European Neuroendocrinology Association and included experts skilled in the management of acromegaly. Complications considered included cardiovascular, endocrine and metabolic, sleep apnea, bone diseases, and mortality. Outcomes in selected, related clinical conditions were also considered, and included pregnancy, familial acromegaly and invasive macroadenomas. The need for a new disease staging model was considered, and design of such a tool was proposed.

Pituitary apoplexy is caused by haemorrhage or infarction of the pituitary gland. Presenting signs and symptoms often include severe headache, visual disturbance, ophthalmoplegia, altered consciousness and impaired pituitary function. The management of pituitary apoplexy has very rarely been described during pregnancy and there is no existing data for further pregnancies of affected women. We present a case of a woman with a recurrent pituitary apoplexy due to haemorrhages in a pituitary adenoma in her third and fourth pregnancies. In both pregnancies, the pituitary apoplexy was managed conservatively, but due to therapy-resistant headaches, a preterm delivery was implemented.

Drug addiction is a damaging national and social problem in Bangladesh affecting the economically productive groups. An estimated 1.7 million people are drug users in the country .Drug users, especially injecting drug users (IDU) present a tremendous potential for transmission of blood borne viruses, including hepatitis B virus(HBV) hepatitis C virus (HCV) and human immunodeficiency (HIV) virus.They may exchange these viral infections among them through their needle/syringe sharing habits and may spread to uninfected low risk population through their high risk sexual behaviour or by donating blood professionally.

Central Diabetes Insipidus (CDI) in adults is most commonly occurs as a result of hypothalamo-pituitary surgery, head injury or various inflammatory and infiltrative disorders. CDI with mass lesions in the sellar-suprasellar area occurs due to infiltrative disorders like lymphoma, Langerhan's cell histiocytosis, and inflammatory disorders like hypophysitis, mass lesions like germinoma, craniopharyngioma and even metastases. Treatment and correct diagnosis depends on histopathology. Rosai-Dorfman Disease (RDD) is a rare disorder of unknown etiology characterized by abnormal proliferation of histiocytes. Extra nodal involvement is found in 40-50% of cases; with Central nervous system (CNS) involvement being uncommon hence in majority of instances intracranial disease is not suspected. Due to paucity of the reported cases, optimal treatment options are not known. We report a young female who presented with CDI, hyperprolactinemia and other features of hypopituitarism along with systemic manifestations including nodal and skeletal involvement. The patient was treated with combination of surgical debulking followed by oral glucocorticoid for 6 months with gratifying results.

Lymphocytic hypophysitis is an unusual inflammatory lesion that is caused by autoimmune destruction of the pituitary gland. We report a case of 42-year-old man who presented with a 6-month history of severe headache, blurred vision in the right eye, hearing loss, polyuria, polydipsia, and impotence. Medical history showed that he and his mother had osteopetrosis. The results of the physical examination and laboratory tests showed that secondary hypothyroidism, hypogonadism, and hypocortisolism had developed. Central diabetes insipidus was diagnosed by water deprivation test. MRI of the sella showed pituitary enlargement with symmetrical suprasellar expansion, compression of the chiasma, thickened infundibulum, and involvement of both bilateral cavernous sinuses and clivus. Hormonal substitution with hydrocortisone, levothyroxine, and DDAVP resulted in rapid improvement of all symptoms and signs. Transsphenoidal biopsy was diagnostic of lymphocytic hypophysitis. In spite of extensive...

Background Trans-sphenoidal surgery is the recommended initial therapy in patients with acromegaly. Early cure rate is 80-90% for microadenomas and &lt;50% for macroadenomas. The goal is a serum IGF-1 that is normal for age and gender with GH &lt;1mcg/L by immunoradiometric or chemiluminescent assays. Clinical Case A 71-year old male who consulted for diabetes management was eventually worked up for acromegaly He presented with coarsened facial features, hoarse voice, frontal bossing and enlarged hands and feet. Medical history includes hypertension, hepatosplenomegaly, colonic polyposis, obstructive sleep apnea and nasal septal deviation post-repair. Laboratory tests showed elevated IGF-1 (566.15, n: 91-282 ng/ml) and non suppressed GH after 75g OGTT (50.1, n&lt;2.47 ng/mL). Pituitary hormonal profile showed normal prolactin (98.13, n: 86-324 mIU/L), TSH (1.63, n: 0.27-4.2 uIU/ml), FT4 (17.78, n: 12-22 pmol/L), ACTH (35, n: 7.2-63.3 pg/mL), Cortisol (387.4, n: 172-497 nmol/L), LH (...

BACKGROUND Common variable immunodefi ciency (CVID) is the form of antibody defi ciency with the highest prevalence in clinical practice, affecting children and adults to an equal extent. The main feature is the hypogammaglobulinaemia due to impaired maturation of B cells. Mechanisms such as abnormalities in the function of cells involved in cellular immunity (T cells, dendritic cells), and alterations in the secretion of various cytokines are also common to cases of CVID. Approximately 70-80% of patients are diagnosed based on a previous history of recurrent sinus, lung and gastrointestinal infections. The diagnosis is made after all other known causes of humoral defects have been excluded. 1 2 Moreover, approximately 20% of CVID patients are diagnosed of any autoimmune disease concurrent during lifetime. The pathogenic mechanism of this autoimmunity is not well understood, because it is unclear how antibodies are produced against various organs in patients with immunoglobulin defi ciency. The most common autoimmune diseases associated with CVID are: immune thrombocytopenic purpura, autoimmune haemolytic anaemia and polyarthritis (rheumatoid arthritis-like). Cases of pernicious anaemia, infl ammatory bowel disease, Sjögren's disease, vitiligo and autoimmune hepatitis have also been described. Even 5% of those affected may develop noncaseating granulomas in solid organs like lungs, liver or spleen. In addition, there is an increased risk of malignancies, most frequently haematological and gastric tumours. 1 3 Here we present a patient with CVID, who may develop neurohypophyisitis. We searched via Pubmed any other case reports using the key words 'CVID', 'autoimmunity', 'autoimmune endocrinopathies associated to CVID' in English. We did not found any other adult case with neurohypophyisitis and CVID.

Recombinant human growth hormone (rhGH) has been in use for 30 years, and over that time its safety and efficacy in children and adults has been subject to considerable scrutiny. In 2001, a statement from the GH Research Society (GRS) concluded that &#39;for approved indications, GH is safe&#39;; however, the statement highlighted a number of areas for on-going surveillance of long-term safety including; cancer risk, impact on glucose homeostasis and use of high dose pharmacological rhGH treatment. Over the intervening years, there have been a number of publications addressing the safety of rhGH with regard to mortality, cancer and cardiovascular risk and the need for longterm surveillance of the increasing number of adults who were treated with rhGH in childhood. Against this backdrop of interest in safety, the European Society of Paediatric Endocrinology (ESPE), the GRS and the Pediatric Endocrine Society (PES) convened a meeting to reappraise the safety of rhGH. The ouput of the ...

Diagnosis of secondary adrenal insufficiency and GH deficiency requires evaluation by dynamic stimulation tests in most cases. Although insulin tolerance test (ITT) is accepted as the gold-standard test for the evaluation of both hypothalamo-pituitary-adrenal (HPA) and (GH)-IGF-1 axes, the test is cumbersome. In clinical practice, low-dose adrenocorticotrophic hormone (ACTH) stimulation test is a sensitive, safe and easily applicable alternative to ITT. Although it takes more time, glucagon stimulation test (GST) is also a good alternative to ITT and can evaluate both axes. The primary aim of this study was to compare the ITT, low-dose ACTH and GSTs in the evaluation of HPA and GH-IGF-1 axes in patients with pituitary disorders and to evaluate the repeatability of all three tests. ITT, low-dose ACTH and GSTs were performed in all 129 patients, and the tests were repeated in 66 of these patients. Erciyes University Medical School, Department of Endocrinology. One hundred and twenty-n...