Hormonal Assessment Research Articles

Pituitary microadenoma in children and adolescents: Minireview of literature and symptomatic case series

Pituitary microadenomas in children and adolescents represent a rare yet clinically significant entity, with a prevalence of up to 1 per million children and constituting only a small fraction of pediatric intracranial neoplasms. This minireview synthesizes current literature to provide an insightful overview of the epidemiology, clinical presentation, management, and outcomes of these tumors. Pituitary microadenomas are categorized as either functioning or nonfunctioning, with the former being less common in children than adults. Functioning microadenomas, such as prolactinomas, growth hormone-secreting adenomas, and ACTH-secreting adenomas, present with symptoms linked to hormonal overproduction, while nonfunctioning adenomas are often asymptomatic. Clinical presentations vary with tumor type, with common symptoms including amenorrhea, galactorrhea, gynecomastia, and headaches. Diagnosis relies heavily on hormonal assessments and MRI, with stable courses often observed in non-functioning microadenomas. We report 6 cases which were presented with variable endocrine abnormalities. Management strategies are tailored based on the tumor’s functionality and size. Medical therapy, primarily dopamine agonists, is preferred for functioning adenomas, while transsphenoidal surgery is reserved for symptomatic or non-responsive cases. Radiotherapy is considered as a third-line option. Outcomes are generally favorable, with high response rates to medical therapy and successful surgical resections. However, recurrence and long-term hormonal imbalances pose challenges, necessitating vigilant long-term follow-up. Current research is oriented towards enhancing diagnostic accuracy, understanding genetic contributions, and optimizing treatment to minimize long-term developmental impacts. This review underscores the necessity for a nuanced approach in the diagnosis and management of pediatric pituitary microadenomas, highlighting the importance of ongoing research and follow-up for optimal patient care.

Menstrual Cycle, Glucose Control and Insulin Sensitivity in Type 1 Diabetes: A Systematic Review

The correlation between the menstrual cycle and glucose control in type 1 diabetes has been the focus of several studies since the 1920s, but a few critical aspects made it particularly challenging to reach conclusive evidence. The aim of this systematic review is to reveal more solid information about the impact of the menstrual cycle on glycaemic outcomes and insulin sensitivity in type 1 diabetes and highlight the less researched areas. The literature was searched by two authors independently using PubMed/MEDLINE, Embase and Scopus (last search on 2 November 2022). The retrieved data did not allow us to perform a meta-analysis. We included 14 studies published between 1990 and 2022, with sample sizes from 4 to 124 patients. We found a wide heterogeneity in the definition of the menstrual cycle phases, glucose metrics, techniques for determining insulin sensitivity, hormonal assessment and other interfering factors considered, with an overall high risk of bias. There is no conclusive evidence, and published data do not allow us to achieve quantitative results. In a subset of patients, a possible worsening of insulin sensitivity and hyperglycaemia in the luteal phase could be observed. From the clinical standpoint, a cautious strategy based on patient-specific patterns can be considered until new, solid evidence is obtained.

The Relationship Between Insulin Resistance and Obesity and Serum Anti-Mullerian Hormone Level in Chinese Women with Polycystic Ovary Syndrome: A Retrospective, Single-Center Cohort Study.

Anti-Mullerian hormone (AMH) is vital in the pathophysiological process of polycystic ovary syndrome (PCOS). The exact relationship between obesity and insulin resistance (IR) with AMH levels remains unclear. A retrospective, single-center cohort study of 220 women with PCOS who underwent physical, endocrine, and metabolic assessments were performed. Patients were grouped by age, body mass indices (BMI), Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), and different phenotypes. Pearson correlation analysis assessed the correlation between AMH and HOMA-IR, BMI, and other PCOS indicators, and multiple linear regression analysis was performed to determine factors influencing AMH. In 220 patients with PCOS, serum AMH levels decreased with age and were significantly higher in the IR group than in the non-IR group (P < 0.01). AMH increased significantly in anovulatory patients with hyperandrogenemia and/or polycystic ovary, with no significant difference between obese and non-obese individuals. AMH levels correlated positively with luteinizing hormone (LH), LH/follicular stimulating hormone (FSH), testosterone, fasting insulin (FINS), and HOMA-IR levels; negatively with age and BMI levels (P < 0.05) and weakly with fasting plasma glucose in the classical PCOS phenotype (r=0.148, P < 0.05). Regression analysis showed that age, testosterone, FINS, LH, LH/FSH, and BMI influenced AMH levels (P < 0.05). Chinese women with PCOS-IR showed associations with greater AMH levels. AMH levels correlated positively with HOMA-IR levels and negatively with BMI. AMH combined with BMI and HOMA-IR levels may help determine PCOS severity.

The therapeutic effect of melatonin on female offspring ovarian reserve and quality in BALB/c mice after exposing their mother to methamphetamine during pregnancy and lactation.

Nowadays, methamphetamine (METH) abuse as a psychotropic drug is increasing. There is insufficient information about its adverse effects on the ovarian reserve of the next generation. Herein, we tried to investigate the effect of METH abuse during pregnancy and lactation and, subsequently, the therapeutic effect of melatonin on ovarian reserve in offspring. In the present study, BALB/c pregnant female mice were divided into 3 groups: Control, Saline, and METH (5mg/Kg). METH was injected during pregnancy and lactation, and the female offspring of each group was divided into 2 subgroups: A) treated with 10 mg/kg Melatonin daily until puberty (6 weeks old) and B) received distilled water. The animals were sacrificed at 6 weeks of age, and blood samples were collected for hormonal assessments; the right ovaries were removed and fixed for TUNEL and Hematoxylin & Eosin staining, and the left ovaries were removed and stored for gene expression and oxidative stress evaluation. In the MTEH group, two indicators of ovarian reserve (including anti-Müllerian hormone (AMH) and primordial follicle, and Cyclin D1 (CCND-1) and proliferating cell nuclear antigen (PCNA) genes expression significantly decreased, and the oxidative stress and apoptosis significantly increased in comparison with other groups. After lactation in the MTEH group, melatonin treatment significantly improved the ovarian reserve and gene expression and declined apoptosis and oxidative stress. METH abuse during pregnancy and lactation decreased ovarian reserve in offspring. The administration of melatonin as an anti-oxidant agent after lactation can counteract the adverse effects of METH on offspring ovaries.

Mixed corticotropic and somatotropic pituitary adenoma: A case report

Multi-secreting pituitary adenomas are relatively rare. The mixed somatotropic and corticotropic pituitary adenoma is very rare. The most widely described association is that coupling hypersecretion of GH and prolactin. We report the case of a patient with a pituitary adenoma bi-secreting GH and ACTH. He was a 28-year-old patient admitted for pituitary tumor syndrome, cushing syndrome. The hormonal assessment found a dependent ACTH cushing syndrome. The other hypothalamohypophysial axes were without abnormality. The hypothesis of a pituitary adenoma was raised. The brain scan confirmed the diagnosis by showing a macroadenoma with supra-sellar development with infiltration of the cavernous sinus. After trans-sphenoidal surgery, there was a complete regression ofcushing syndrome. The pathology examination showed a pituitary adenoma; at immunohistochemistry cells expressing anti-ACTH and anti - GH antibodies with KI 67 at 1%.

Adrenal incidentaloma: A case report of Pheochromocytoma (PCC) with atypical radiological features

Abstract Introduction Adrenal incidentaloma (AI) is an adrenal lesion ≥ 1 cm discovered accidentally during an imaging technique not aimed to assess the adrenal gland (1). Most AIs are benign and nonfunctioning, about 20% are functioning in form of hypercortisolism, hyperaldosteronism, pheochromocytoma (PCC) or sex steroid overproduction (2). Computed Tomography (CT) scan is vital in differentiating adenoma from non-adenoma. Triphasic CT adrenal protocol (TCTAP) with absolute percentage washout (APW) has good sensitivity and specificity in diagnosis of AI. Here we present a case of PCC with atypical CT features. Clinical Case A 45 years old male patient presented with abdominal pain, abdominal US revealed a right suprarenal mass of 55 mm and referred to endocrinologist for further management. During assessment, the patient had attacks of hypertension, no cushingoid features, BMI was 35 kg/m2 and his blood pressure 180/120 mmHg. Normetanephrine was very high (1016.9 pg/mL), cortisol (10.1 μg/dL), suppressible serum cortisol (1.7 μg/dL), normal DHEA-S (110 μg/dL) and ACTH was 13 pg/mL. Aldosterone, renin, aldosterone/renin ratio (ARR), Metanephrine, K+ are normal. TCTAP showed a homogenous 51×46 mm right adrenal mass of a native Hounsfield units (HU) of 25, portal phase HU of 86, delayed phase (at 15 minute) HU of 36 and APW was 81%, which are features consistent with lipid poor adenoma (LPA) rather than PCC or carcinoma. The patient referred to surgery, right adrenalectomy had been done after good preparation and the diagnosis of PCC had been confirmed by histopathological (HP) and immunohistochemical (IHC) staining. TCTAP used to differentiate adenomatous from non-adenomatous AI with good sensitivity and specificity (3). PCC is an uncommon with variable clinical presentation ranging from severe symptoms to very mild and even sometimes discovered incidentally as AI with about 1.5–14% of all cases of AIs (1). PCC has heterogeneous texture, variable sizes, native HU &amp;gt; 10, avid enhancement and slow washout (4). The present AI was homogenous, has a native HU of 25 and has avid enhancement at portal phase reaching to 86 HU, but the APW was 81% which is atypical for PCC, making lipid poor adenoma at the top list of differential diagnoses. Hormonal assessment revealed the diagnosis of PCC which was confirmed by histopathological (HP) and immunohistochemical (IHC) staining. An American study showed that two of eight PCCs have an APW &amp;gt; 60%, but both of these cases have native HU&amp;lt; 10 and the APW had been calculated at 10 minutes (5). Coincided with our patient and our protocol of 15-minute APW calculation, Yoon et al presented a case of PCC with native HU of 37, portal phase HU of 127 and delayed phase HU of 62 HU with APW of 72% (6). Conclusion PCC is serious condition, could be asymptomatic and may be presented with a typical radiological feature, so biochemical and hormonal assessment is a cornerstone in management of AI.

Prospective-Controlled Assessment of Stress Hormones and Pain In Patients Undergoing Myomectomy as Performed by Laparoscopy Against Laparotomy

Prospective-Controlled Assessment of Stress Hormones and Pain In Patients Undergoing Myomectomy as Performed by Laparoscopy Against Laparotomy

Replacing animal-derived components in in vitro test guidelines OECD 455 and 487

The evaluation of single substances or environmental samples for their genotoxic or estrogenic potential is highly relevant for human- and environment-related risk assessment. To examine the effects on a mechanism-specific level, standardized cell-based in vitro methods are widely applied. However, these methods include animal-derived components like fetal bovine serum (FBS) or rat-derived liver homogenate fractions (S9-mixes), which are a source of variability, reduced assay reproducibility and ethical concerns.In our study, we evaluated the adaptation of the cell-based in vitro OECD test guidelines TG 487 (assessment of genotoxicity) and TG 455 (detection of estrogenic activity) to an animal-component-free methodology. Firstly, the human cell lines A549 (for OECD TG 487), ERα-CALUX® and GeneBLAzer™ ERα-UAS-bla GripTite™ (for OECD TG 455) were investigated for growth in a chemically defined medium without the addition of FBS. Secondly, the biotechnological S9-mix ewoS9R was implemented in comparison to the induced rat liver S9 to simulate in vivo metabolism capacities in both OECD test guidelines. As a model compound, Benzo[a]pyrene was used due to its increased genotoxicity and endocrine activity after metabolization. The metabolization of Benzo[a]Pyrene by S9-mixes was examined via chemical analysis.All cell lines (A549, ERα-CALUX® and GeneBLAzer™ Erα-UAS-bla GripTite™) were successfully cultivated in chemically defined media without FBS. The micronucleus assay could not be conducted in chemically defined medium due to formation of cell clusters. The methods for endocrine activity assessment could be conducted in chemically defined media or reduced FBS content, but with decreased assay sensitivity. The biotechnological ewoS9R showed potential to replace rat liver S9 in the micronucleus in FBS-medium with A549 cells and in the ERα-CALUX® assay in FBS- and chemically defined medium.Our study showed promising steps towards an animal-component free toxicity testing. After further improvements, the new methodology could lead to more reproducible and reliable results for risk assessment.

Behavioral and hormonal assessment of stress in foals (Equus caballus) throughout the weaning process.

This study had the aim to demonstrate the midterm effects (three weeks) of weaning on foals' welfare. For this purpose, foals' behavioral changes and fecal levels metabolites of cortisol were evaluated. The observations took place at the state stud farm of Baden-Wuerttemberg in Germany. Ten foals (six colts and four fillies) were observed from one day before weaning up until three weeks after weaning. Weaning was divided into three blocks, the first in September, the second in October, and the last in November. The behavioral observation was done during an eight-hour period between 7:00 a.m. and 5:00 p.m. The observer documented the exact behavior shown by the foal every five minutes during the eight hours. To scale the stress experienced by the foal, the glucocorticoid metabolite 11,17-dioxoandrostane was measured with the 11-oxoetiocholanolone enzyme immunoassay, which allows assessing the foal's plasma cortisol level changes throughout the trail through fecal samples. All foals displayed a distinct hormonal stress response to the weaning process through increased fecal cortisol metabolite levels. Their body posture distribution took a shift from mainly moving before weaning to mainly standing during the three weeks after weaning. Compared with the day before weaning, the foals showed less active behavior and significantly increased their resting behavior. Regarding the overall resting behavior, the weaned foals initially increased their time spent resting in a lying position during daytime and then started to decrease the time lying. After weaning, the foals showed a significant increase in resting while standing. In conclusion, the foals showed an expected behavioral development and an expected curve of cortisol metabolite values throughout the study. However, it seemed that the changes had not returned "back to normal" at three weeks after weaning. Therefore, we suggest that weaned foals need a minimum of three weeks to acclimate to the new situation.

NFC-Powered Implantable Device for On-Body Parameters Monitoring With Secure Data Exchange Link to a Medical Blockchain Type of Network.

Implantable devices represent the future of remote medical monitoring and administration of both chemical and physical therapies to the patients. Although some of these devices are already in the market, the security mechanisms deployed inside them to withstand deliberate external influence are still decades away from the robust digital data security schemes employed in modern distributed networks these days. Medical data theft, spoofing, and disclosure pose serious threats that can ultimately lead to individual and social stigmas or even death. In this article, we present a small-form and batteryless implantable device with acquisition channels for biopotential (30-dB gain and 16-Hz bandwidth), arterial pulse oximetry, and temperature (0.12°C accuracy) recordings, suitable for cardiovascular, neuronal, and endocrine parameters assessment. The proposed device is powered by the near-field communication (NFC) interface with an external mobile phone, with a power consumption of 0.9 mW and achieving the full operation for distances close to 1 cm under the skin. In situ encryption of the acquired physiological signals is performed by a lightweight and short-term symmetric-key distribution scheme with data stream hopping, in order to ensure secure data transference over the air between the patient and trusted entities only, complemented by data storage, processing, and recovery through a medical blockchain type of network that involves the main stakeholders inside a medical community.

PS-BPR03-11: A CASE OF MALIGNANT PHASE HYPERTENSION ASSOCIATED WITH PRIMARY ALDOSTERONISM

Background: Primary aldosteronism is associated with low plasma renin levels, while malignant phase hypertension is generally associated with raised renin activity. Therefore, these two conditions are at opposite ends of the renin spectrum, so in theory their co-existence would be unusual. Case presentation: We present a case of a 41-year-old male with uncontrolled hypertension on multiple antihypertensive drugs. He discontinued these drugs for three days, thereafter he admitted to our hospital with congestive heart failure and acute ischemic stroke. He manifested malignant phase hypertension (blood pressure 216/130 mmHg; Keith-Wagener IV) accompanying renal dysfunction (serum creatinine 2.4 mg/dL), high plasma aldosterone concentration (PAC, 221 pg/mL) and mildly elevated plasma renin activity (PRA, 3.0 ng/mL/hr). A computed tomography did not reveal the presence of adrenal mass. After the treatment for congestive heart failure, the reassessment for endocrine causes of hypertension showed high level of PAC (468 pg/mL) and low level of PRA (0.2 ng/mL/hr), resulting in a high PAC/PRA ratio under the treatment with angiotensin-converting enzyme inhibitor. Adrenal venous sampling (AVS) confirmed the excessive aldosterone secretion from bilateral adrenal glands. Given these findings, we diagnosed him with idiopathic aldosteronism. After an addition of the mineralocorticoid receptor antagonist, he could keep his blood pressure under control. Conclusions: PRA in patients with primary aldosteronism could be increased under the conditions in which renin release from the kidney is overstimulated by glomerular ischemia, leading to an incorrect diagnosis of primary aldosteronism. Repeated endocrine assessment including the measurement of PRA and PAC should be considered to reveal the cause of malignant phase hypertension.

Evaluation of Neuroendocrine Dysfunction Following Acute Aneurysmal Subarachnoid Hemorrhage

Background and Aim: In the management of aneurysmal subarachnoid hemorrhage (aSAH), endocrine dysfunction is infrequently considered. Pituitary (neuroendocrine) dysfunction is highly prevalent after aSAH, leading to residual symptoms such as decreased cognition and quality of life. Although hypopituitarism following SAH may present with non-specific subtle symptoms, it can lead to potentially serious consequences if left undiagnosed. Methods and Materials/Patients: This study was performed to observe the incidence and pattern of neuroendocrine alterations in cases of acute aSAH. A total of 25 patients with acute SAH within 7 days of ictus were included in this prospective study, and an endocrine assessment was performed. The pituitary axes were evaluated for possible dysfunctions, including somatotropic, gonadotropic, corticotropic, and thyrotropic axes. Results: A total of 25 SAH cases (10 males and 15 females; mean age 55.24 years) were included in the study. Aneurysms were more commonly found in the anterior circulation (n=22) than in the posterior circulation (n=3). Most of the patients presented with the Hunt-Hess grade of 1, followed by grades 3, 2, and 4, respectively. Growth hormone deficiency (48%) was the most common pituitary dysfunction, followed by adrenocorticotrophic hormone (24%), gonadotropins (FSH/LH) (24%), and thyroid stimulating hormone (16%) deficiencies, respectively. Single pituitary axis neuroendocrine dysfunction was noted in 9 patients (36%) and multiple pituitary axes dysfunction was observed in 8 patients (32%). Overall, 17 patients (68%) had neuroendocrine dysfunction in single or multiple pituitary hormone axes. Conclusion: Neuroendocrine dysfunction in acute aSAH is 68%. Accordingly, 32% of the participants had single-axis pituitary dysfunction and 36% had multiple axes pituitary dysfunction. The most common endocrine dysfunction is growth hormone deficiency (48%), followed by adrenocorticotrophic hormone, gonadotropins (LH &amp; FSH), and thyroid stimulating hormone. Therefore, it is suggested to include hormonal evaluation in the management of acute SAH for better clinical outcomes.

Hair-Based Assessment of Sex Steroid Hormones in Patients with Anorexia Nervosa.

Anorexia nervosa (AN) is a complex psychiatric disorder accompanied by a variety of endocrine effects. Altered levels of the sex steroid hormones progesterone and dehydroepiandrosterone (DHEA) have been shown to occur in patients with AN using short-term hormonal measurement methods based on blood, saliva, and urine samples. However, since sex steroid hormone levels fluctuate during the menstrual cycle, these measurement methods require a great deal of effort due to the need to collect multiple samples in order to correctly determine the basal level of sex hormones. In contrast, hair-based assessments provide a marker of accumulated longer-term hormone exposure using a single, non-invasive sample. The aim of this study was to investigate sex steroid hormone levels via hair-based assessments in acutely underweight AN in comparison with healthy, age-matched, female control participants. Additionally, we compared progesterone and DHEA hair levels longitudinally during inpatient treatment in AN. Collected hair samples were analyzed using liquid chromatography-mass spectrometry (LC-MS/MS) to determine a monthly hormone level of progesterone and DHEA. Our results indicate that DHEA hair hormone levels were similar across groups but progesterone was suppressed in underweight AN compared with healthy controls. In the longitudinal design, no significant change in hair hormone levels during partial weight restoration in patients with AN was observed. Our findings suggest that hair analysis can be used to detect suppressed progesterone levels in severe AN, and that progesterone does not increase during short-term weight restoration.

A Narrative Review on the Potential Relationship between Fertility and Hypothyroidism

Reproduction is important evolutionary process that is necessary for the maintenance of life. Human fertility depends on a number of endocrine factors, one of which includes the regulation of thyroid hormone. The thyroid's role in neurocognitive and fetal development is of key importance. Any disruption in the regulation of the thyroid gives rise to a thyroid disorder. The underactivity of this gland will lead to a condition known as hypothyroidism. The prevalence of hypothyroidism is way more in females, especially during their reproductive period. Infertility in males is also a key concern nowadays. The prevalence of infertility in males is one of the concerning topics for the couple as a whole. The hormonal assessment serves as a guide for the evaluation of fertility. The metabolic activity of iodine in the regulation of thyroid normal function is very essential. The present narrative review aims to evaluate thyroid hormone physiology, hypothyroidism, the major types of hypothyroidism, its correlation with fertility, and with the patients that are suffering from polycystic ovarian syndrome. This review article will discuss the iodine association with hypothyroidism and its potential role in fertility. It will aim to provide a precise understanding of associated thyroid disorders that are majorly linked with male infertility.

Pituitary Stem Interruption Syndrome (SITP) diagnosed in childhood in a case at the Center Hospitalier Universitaire de Libreville (CHUL)

Interrupted pituitary stalk syndrome (PITS) is a hypothalamic-pituitary morphological abnormality characterized by a slender or absent pituitary stalk, anterior pituitary hypoplasia, and ectopic posterior pituitary. Hormonal assessment and imaging are crucial for the diagnosis, early management can improve the child's stature prognosis. We report the case of an 8-year-old child seen in endocrinology consultation for growth retardation. His medical history revealed acute fetal distress at birth, neonatal jaundice, and numerous consultations in early childhood for this anomaly. The clinical examination found a statural delay of -3DS, bilateral cryptorchidism, with small testicles. The hormonal balance found multiple pituitary deficits and Magnetic Resonance Imaging showed an absence of the pituitary stalk, anterior pituitary hypoplasia, and ectopia of the posterior pituitary. Deficient hormone supplementation was instituted. This case relates the typical picture of hypopituitarism by the absence of the pituitary stalk in a context where the disease is probably underdiagnosed due to lack of technical support in sub-Saharan Africa and little known. This explains the diagnostic error in our case, moreover, it allows us to pay particular attention to the meticulous monitoring of the growth of children who have presented perinatal anomalies, and the multidisciplinary exploration in the event of growth disorders.

The effect of L-carnitine administered to pregnant mice on reproductive performance of female offsprings

Carnitine was detected at the beginning of the previous. In the last 30 years, interest in the metabolism and functions of carnitine has steadily increased. Carnitine plays an essential role in fatty acid metabolism by facilitating the transport of long-chain free fatty acids into the mitochondrial matrix, making them available for β-oxidation, which is the most efficient metabolic pathway for energy production. The present study was performed to determine the effects of L-carnitine administered to pregnant mice on some parameters of reproductive performance for their female offspring. Sixty healthy female mice (age: 6 weeks) were used in this study, and divided into two equal groups including control group (mothers administered distilled water during gestation period)and treated group (mothers administered 1 mg/Kg L-carnitine during gestation period). Blood samples were taken from their female offspring for assessment of serum hormones (FSH, LH and E2). Also, weight of reproductive system for female offspring was recorded, and then histological sections were prepared for the uterus and ovary to measure the diameters uterine gland and ovary, in addition to measure endometrial thickness. Significant elevation (P&lt;0.01) was observed in the levels of serum gonadotropins (FSH and LH) and E2 for the treated group as compared to the control group. Weight of female reproductive system for the treated group was highly significant increased (P&lt;0.01) as compared to the control group. Also, significant increment (P&lt;0.05) was noticed in the thickness of endometrium for the treated as compared to the control group. Similarly, diameters of ovary and uterine glands for treated group were increased significantly (P&lt;0.05) when compared to the control group. Conclusion: Administration low doses of L-carnitine to pregnant mice have positive effects on reproductive performance of their female offspring. Further studies are recommended to investigate effects of L-carnitine to pregnant mice on oogenesis for their female offspring.

Extra-pseudocapsular Transnasal Transsphenoidal Resection of Pituitary Macroadenoma: Technique Note and Evaluation of Endocrine Function

In this study, we investigated the surgical technique and endocrine assessment of pituitary function of patients with macroadenoma treated by extra-pseudocapsular transnasal transsphenoidal surgery (ETTS). Clinical data of 144 patients with pituitary macroadenomas in the same surgical group at the Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology were retrospectively analyzed from January 2019 to June 2021. Based on the results of the endocrinological evaluation and MRI examinations before and after surgery, the fluctuation of pituitary function and the extent of resection were analyzed. Multiple Logistic regression analysis was used to determine the predictors affecting postoperative tumor residual. Among the 144 patients with pituitary macroadenomas, 72 (50.0%) were female and 72 (50.0%) were male, the median age was 50 years, 26 (18.1%) had invasiveness grade 0, 46 (31.9%) had grade I, 57 (39.6%) had grade II, and 15 (10.4%) had grade III according to Lu's classification method. Based on observation during surgery, 37 cases (25.7%) had no pseudocapsule, 54 cases (37.5%) had incomplete pseudocapsule, and 53 cases (36.8%) had intact pseudocapsule. In addition, 91 (63.2%) patients had total resection, 39 (27.1%) had subtotal resection, and 14 (9.7%) had partial resection. As for anterior pituitary function, 13 of 19 hypothyroid patients had recovery after surgery, with a remission rate of 68.4%. Eighteen of the 26 decreased cortisol patients got back to normal, with a remission rate of 69.2%. A total of 27 of 51 patients with hypogonadism improved, with a remission rate of 52.9%. Univariate and multivariate analyses indicated that gender, tumor size, and invasiveness were predictors of postoperative residual in patients (P<0.05). The results showed that ETTS is an effective treatment modality for restoring the function of pituitary gland of the patients with macroadenomas. Tumor size and invasiveness are predictors of the extent of surgical resection and postoperative residual of macroadenomas.

Factors associated with metabolic complications in patients with polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) affects 4–20% of reproductive aged women. In the literature, it has been shown that PCOS can be associated with insulin resistance (IR) and metabolic syndrome (MS). The aim of the study was to identify which factors (hormonal, metabolic, clinical or sonographic) were associated with MS and IR in women with PCOS. We conducted a retrospective cohort study of 1,040 women with PCOS, aged from18 to 43 years, who consulted at the Lille University Hospital between 2008 and 2020. The examinations performed included: clinical characteristics, hormonal assessment of ovarian reserve and antral follicular count by vaginal ultrasound, androgen assay, glucose tolerance parameters and lipids. The evaluation of IR was performed according to HOMA (IR if HOMA ≥ 2). When BMI increased within one category, the risk of developing MS raised (OR: 2.80; 95% CI: 2.013–3.918). The presence of IR also increased the risk of developing MS (OR: 3.99; 95% CI: 2.757–5.802). Conversely, SHBG was negatively associated with MS. When the BMI category increased, the risk of developing IR increased (OR: 2.90; 95% CI: 2.12–3.96). The risk of developing IR increased with increasing testosterone (OR: 4.399; 95% CI: 2.68–7.22). Conversely as SHBG and androstenedione decreased, the risk of having an IR was higher. There was no significant association between the occurrence of MS and intrinsic PCOS factors indicating ovarian dysfunction. This study has shown that only clinical characteristics (age, BMI) and metabolic parameters as IR were associated with PCOS. Among biological parameters only SHBG were associated. The link between MS and PCOS is therefore probably not related to ovarian factors, but rather to metabolic parameters. The association between IR and ovarian parameters as testosterone and androstenedione, confirms the close link between insulin and ovarian function.

Perioperative fluctuation and overall evaluation of adenohypophyseal hormone secretion in patients with nonfunctioning pituitary adenoma.

Perioperative adenohypophyseal hormone assessment can improve therapeutic strategies and be used to evaluate the prognosis of pituitary adenomas. An individual hormone level does not entirely reflect the pituitary gland. Thus, this study aimed to analyze perioperative hormonal changes and propose a normalized method to facilitate overall assessment of the adenohypophysis. The authors retrospectively analyzed 89 male patients with nonfunctioning pituitary adenoma (NFPA) who underwent transsphenoidal surgery. Preoperative clinical data, imaging data, and perioperative hormone levels of the anterior pituitary gland were evaluated. Hormone values were rescaled using minimum-maximum normalization. The sum of the normalized hormone levels was defined as the total hormonal rate (THR). Preoperative findings indicated correlations among different adenohypophyseal hormones. Luteinizing hormone (p = 0.62) and adrenocorticotropic hormone (p = 0.89) showed no significant changes after surgery, but growth hormone levels increased (p < 0.001). On the contrary, the levels of thyroid-stimulating hormone (p < 0.001), follicle-stimulating hormone (p = 0.02), and prolactin (p < 0.001) decreased. THR indicated a significant postoperative reduction in adenohypophyseal function (p = 0.04). Patients with postoperative hypopituitarism had significantly lower THR than those without (p = 0.003), with an area under the curve of 0.66. For NFPAs that presented with normal preoperative hormone levels, THR was a good clinical predictor of immediate postoperative hypopituitarism, with an area under the curve of 0.74. The normalized synthesis index of hormones is a novel and clinically valuable method used to reflect adenohypophyseal secretion. Compared with individual hormones, these results indicated that THR can facilitate the analysis of general hormone levels despite various fluctuations in adenohypophyseal hormones. THR may also contribute to the effective prediction of short-term surgery-induced hypopituitarism.

Autonomous Aldosterone Secretion in Patients with Adrenal Incidentaloma.

In recent years, research has emphasized the significance of mild clinical and biochemical presentations of primary aldosteronism (PA) that do not meet current diagnostic criteria of the syndrome. In this study, we assessed the prevalence of autonomous aldosterone (Ald) secretion (AAS), defined as a positive (&gt;1.2 ng/dL/mIU/L) Ald-to-renin ratio (ADRR) combined with unsuppressed Ald (&gt;4 ng/dL), and its associations with blood pressure (BP), cardiac function, and common carotid artery (CCA) intima-media thickness (IMT) in patients with incidentally discovered adrenal adenomas (AI), who were either normo- or hypertensive but had no other cardiovascular disease. Among 332 AI patients hospitalized between November 2018 and December 2019, 63 study participants were recruited (26 normo- and 37 hypertensive), who underwent hormonal examinations, 24 h ambulatory BP measurement, transthoracic echocardiography, and CCA IMT assessment without altering chronic medications. AAS was found in approximately 25% of subjects (seven normo- and nine hypertensive); urinary aldosterone excretion (UAldE) exceeded 10 ug/day in none of the subjects. The left ventricular mass index correlated positively with UAldE in non-diabetic patients (n = 50), and negatively with renin in those without beta blocker therapy (n = 38). The study shows that a pragmatic approach to hormonal assessment (no chronic therapy modification) may reveal patients with AAS. Screening for this subclinical PA presentation is probably more effective with a permissive ADRR than UAldE in such a setting.