High Growth Hormone Research Articles

IGF1R is a mediator of sex-specific metabolism in mice: Effects of age and high-fat diet.

We aimed to investigate the short and long-term metabolic consequences of IGF1R systemic gene deficiency in mice. UBC-CreERT2, Igf1rfl/fl mutant mice were used to suppress IGF1R signaling in adult tissues by inducing postnatal generalized Igf1r deletion with tamoxifen. Animals were analyzed at two different ages: i) 13-weeks old young mice, and ii) 12-months old middle-aged mice. In addition, the effects of 10 weeks-long high-fat diet (HFD) were investigated in middle-aged mice. Young IGF1R-deficient mice were insulin-resistant, with high IGF1, growth hormone (GH) and IGFBP3, as well as low IGFBP2 circulating levels. Males also presented increased triglycerides in liver. In contrast, middle-aged mice did not clearly show all of these alterations, suggesting possible compensatory effects. Middle-aged IGF1R-deficient male mice were able to counteract the negative effects induced by aging and HFD in adiposity, inflammation and glucose metabolism. A metabolic sexual dimorphism dependent on IGF1R was observed, especially in middle-aged mice. These results demonstrate that IGF1R is involved in metabolic homeostasis, with effects modulated by diet-induced obesity and aging in a sex dependent manner. Thus, IGF1R deficiency in mice is proposed as a useful tool to understand metabolic alterations observed in patients with IGF1R gene deletions.

Predictive factors for recovery from adult growth hormone deficiency after transsphenoidal surgery for nonfunctioning pituitary adenoma.

Recovery from adult growth hormone deficiency (AGHD) after transsphenoidal surgery (TSS) has not been well discussed because of the lack of examinations including pituitary provocation tests (PPTs) before and after the procedure. This study aimed to evaluate the growth hormone (GH) axis function of patients with nonfunctioning pituitary adenoma (NFPA) via pre- and postoperative PPTs. Moreover, the predictive factors for recovery from AGHD after TSS were validated to facilitate surgery for AGHD in patients with NFPA. In total, 276 patients (median age 60.0 years) who underwent TSS for NFPA were included in this study. PPTs were performed before and 3 months after TSS. Then, the relationships between recovery from AGHD after TSS and clinical, surgical, and hormonal factors, including peak GH level based on PPTs, were evaluated statistically. In this study, 114 patients were diagnosed with preoperative AGHD. Approximately 25.4% recovered from AGHD after TSS. In contrast, among the 162 patients without preoperative AGHD, 13 (8.0%) had newly developed postoperative AGHD. The predictive factors for recovery from AGHD were younger age, female sex, initial TSS, and high peak GH level based on preoperative PPT. According to the receiver operating characteristic curve analysis, patients who were aged ≤ 62.2 years and had a peak GH level of ≥ 0.74 μg/L based on preoperative PPT were likely to recover from AGHD (sensitivity: 82.8%, specificity: 72.9%, and area under the curve: 0.8229). AGHD caused by NFPA can improve after initial TSS among young patients with certain peak GH levels assessed by preoperative PPT. Whether TSS for NFPA can promote recovery from AGHD is worth considering in some patients.

Growth hormone associated with treatment efficacy of immune checkpoint inhibitors in gastric cancer patients.

BackgroundImmune checkpoint inhibitors (ICIs) combined with chemotherapy have been widely employed to improve the outcome of gastric cancer patients. In the present study, the impact of posttreatment growth hormone (GH) levels on the treatment efficacy of ICIs for advanced gastric cancer (AGC) patients was assessed.MethodsSeventy-five AGC patients treated with anti-PD-1 antibodies at The Fourth Hospital of Hebei Medical University were involved. We divided AGC patients into two groups as high-GH group and low-GH group based on the GH level. Immunotherapy efficacy was assessed in terms of objective response rate, disease control rate (DCR), progression-free survival (PFS), and overall survival (OS) based on the National Comprehensive Cancer Network Guidelines. The enumeration data were compared by χ 2 test or Fisher’s exact test. Survival curves were drawn by the Kaplan–Meier method, and comparisons between the curves were made using the log-rank test. Multivariate survival analysis was performed using a Cox proportional hazards model.ResultsThe higher GH levels were associated with a lower DCR of ICIs with a DCR of 30.0% in the high-GH group and 53.3% in the low-GH group (P = 0.046). The subsequent univariate analysis showed that a high GH level was associated with both shorter PFS (P = 0.016) and shorter OS at the borderline statistical level (P = 0.052) in AGC patients treated with ICIs. Cox model analysis also proved that the GH level was an independent risk factor for the outcome of AGC patients (PFS: P = 0.013, HR, 2.424, 95% CI, 1.202–4.890; OS: P = 0.014, HR, 3.301, 95% CI, 1.279–8.519).ConclusionsThe post-treatment GH level might be a predictor for ICIs treatment in AGC patients.

Growth hormone modulates Trypanosoma cruzi infection in vitro

ObjectiveChagas disease (CD) is caused by the protozoan parasite, Trypanosoma cruzi. It affects 7 to 8 million people worldwide and leads to approximately 50,000 deaths per year. In vitro and in vivo studies had demonstrated that Trypanosoma cruziinfection causes an imbalance in the hypothalamic-pituitary-adrenal (HPA) axis that is accompanied by a progressive decrease in growth hormone (GH) and prolactin (PRL) production. In humans, inactivating mutations in the GH receptor gene cause Laron Syndrome (LS), an autosomal recessive disorder. Affected subjects are short, have increased adiposity, decreased insulin-like growth factor-I (IGFI), increased serum GH levels, are highly resistant to diabetes and cancer, and display slow cognitive decline. In addition, CD incidence in these individuals is diminished despite living in highly endemic areas. Consequently, we decided to investigate the in vitro effect of GH/IGF-I on T. cruzi infection. DesignWe first treated the parasite and/or host cells with different peptide hormones including GH, IGFI, and PRL. Then, we treated cells using different combinations of GH/IGF-I attempting to mimic the GH/IGF-I serum levels observed in LS subjects. ResultsWe found that exogenous GH confers protection against T. cruzi infection. Moreover, this effect is mediated by GH and not IGFI. The combination of relatively high GH (50 ng/ml) and low IGF-I (20 ng/ml), mimicking the hormonal pattern seen in LS individuals, consistently decreased T. cruzi infection in vitro. ConclusionsThe combination of relatively high GH and low IGF-I serum levels in LS individuals may be an underlying condition providing partial protection against T. cruzi infection.

A, The EXPLORING THE ALLELOPATHIC EFFECT OF CINNAMOMUM VERUM ON EMERGENCE AND SEEDLING GROWTH OF WILD PEA (Pisum sativum subsp. elatius)

Crop plants release biochemicals into surrounding environment that help in obtaining maximum yield of crop by acting bioherbicide at high concentration and plant growth hormone at low concentration. Therefore, this study was planned at Department of Agronomy in Weed Science Laboratory, University of Agriculture Faisalabad during Winter 2018 to evaluate the allelopathic effects of Cinnamomum verum (Dalchini) on weed Wild Pea (Pisum sativum subsp. elatius) and determination and quantification Phenolic compound present in aqueous extract of bark of C. verum. The experiment was laid out under completely randomized design (CRD) having three replications. The aqueous extract of C. verum was used on wild pea seeds at different concentrations (2.5%, 5%, 10%, 20%, 40% and 80%). Data regarding seed germination and seedling growth (shoot length, root length, shoot fresh weight, root dry weigh) of weed was recorded following standard procedures. C. verum extract at higher concentration act as bioherbicide and produced inhibitory effects on Pisum sativum subsp. elatius. while at low concentration it shows hermetic effect and promoted the emergence and seedling growth. Among different Phenolic compound (Syringic acid, p-crumeic, Ferulic acid, Quercetion and Gallic acid) determine in aqueous extract of barck of C. verum Maximum Quercetion (12.3 %) and minimum Syringic acid (0.60 %) was found. Therefore, it was concluded from this study that aqueous extract of C. verum can be used as bioherbicide for biocontrol of weed at higher concentration (80 %) while at lower concentration (10%) as growth promoter.

The role of growth hormone and IGF-1 in retinopathy: a prospective study of retinopathy in patients with acromegaly and impaired fasting glucose

AimsTo investigate the effects of the growth hormone (GH)/insulin-like growth factor-1 (IGF-1) axis on the incidence and progression of retinopathy.MethodsWe enrolled 91 patients with acromegaly and 123 subjects with impaired fasting glucose (IFG) between 2008 and 2016 to examine the incidence and prevalence of retinopathy. Patients attended follow-ups in our clinics and underwent examinations according to the national guidelines for diabetes management. Both cohorts attended follow-ups until June 2019.ResultsBoth groups had similar HbA1c, cholesterol, and blood pressure levels. However, patients with acromegaly had higher GH (8.05 ± 16.18 vs. 0.78 ± 1.25 ng/mL) and IGF-1 (547.0 ± 342.1 vs. 146.7 ± 51.4 ng/mL) levels than in subjects with IFG. During the follow-up period, 8 patients (8.8%) with acromegaly and 12 patients (9.8%) with IFG developed some degree of retinopathy. Three patients with acromegaly and two with IFG progressed to proliferative retinopathy. Patients with acromegaly had the same incidence of non-proliferative retinopathy (odds ratio [OR] 0.830; 95% CI 0.318–2.164) and a non-statistically significantly higher incidence of proliferative retinopathy (OR 2.461; 95% CI 0.404–14.988).ConclusionThe data reveals that GH and IGF-1 might play a crucial role in the development of proliferative retinopathy and influence its progression. Therefore, we suggest screening patients with acromegaly should be similar to diabetes patients.

Factors affecting sarcopenia in older patients with chronic diseases.

Sarcopenia is an age-related disease characterized by a progressive loss of systemic muscle mass and/or decreased muscle strength and physical function. The occurrence of sarcopenia in patients with chronic diseases will not only cause further deterioration of diseases and adverse clinical outcomes, but also lead to high medical cost, suggesting a necessity and a great significance to explore the associated factors of sarcopenia in chronic patients in order to improve their quality of life. This study aimed to investigate factors affecting sarcopenia among older hospitalized patients with chronic diseases. A total of 121 older patients with chronic diseases admitted to the Department of Geriatrics of Affiliated Kunshan Hospital of Jiangsu University from May 2019 to April 2021 were enrolled. According to the diagnostic criteria of sarcopenia formulated by the Asian Working Group for Sarcopenia (AWGS), the subjects were divided into a sarcopenia group (n=57) and a non-sarcopenia group (n=64). We analyzed the associated factors including bone mineral density, nutritional biomarkers, hormone levels and inflammatory cytokines. Compared to the non-sarcopenia group, the sarcopenia group was of older average age (P<0.001), exhibited a lower body mass index (BMI) (P<0.001), a lower bone mineral density (BMD) of the femoral neck (P<0.01), and a higher incidence of osteoporosis. In terms of hematology, the sarcopenia group exhibited significantly lower serum iron and zinc levels (both P<0.05), a higher growth hormone (GH) level (P<0.05), a significantly lower IGF-1 level (P<0.01), and a lower level of iron (P<0.01). Poor nutritional status (assessed via measurement of albumin and prealbumin levels) positively correlated with sarcopenia (P<0.01). Sarcopenia is closely associated with aging, and has a close relationship with osteoporosis. Anemia, malnutrition, vitamin and trace element deficiencies, changes in hormone levels, and chronic inflammation are correlated with sarcopenia. Patients with these features above call for the screenig of sarcopenia. Additionally, these characteristics may help providing clues for further research on the pathogenesis and risk factors of sarcopenia, along with disease prevention and intervention.

A, The ALLELOPATHIC EFFECT OF CINNAMOMUM VERUM ON EMERGENCE AND SEEDLING GROWTH OF RADISH (Raphanus sativus)

Crop plants release biochemicals into surrounding environment that help in obtaining maximum yield of crop by acting bioherbicide at high concentration and plant growth hormone at low concentration. Therefore, this study was planned at Department of Agronomy in Weed Science Laboratory, University of Agriculture Faisalabad during Winter 2018 to evaluate the hermetic effects of Cinnamomum verum (Dalchini) on vegetable crop Radish (Raphanus sativus) and determination and quantification Phenolic compound present in aqueous extract of bark of C. verum. The experiments were laid out under completely randomized design (CRD) having three replications. The aqueous extracts of C. verum was used on radish seeds at different concentrations (2.5%, 5%, 10%, 20%, 40% and 80%). Data regarding seed germination and seedling growth (shoot length, root length, shoot fresh weight, root dry weigh) of radish were recorded following standard procedures. Results of our study revealed that at higher concentration act as bioherbicide and produced inhibitory effects on R. sativus while at low concentration it shows hermetic effect and promoted the seedling growth. aqueous extract showed concentration. Among different Phenolic compound (Syringic acid, p-crumeic, Ferulic acid, Quercetion and Gallic acid) determine in aqueous extract of barck of C. verum Maximum Quercetion (12.3 %) and minimum Syringic acid (0.60 %) was found. Therefore, it was concluded from this study that aqueous extract of C. verum can be used as bioherbicides at higher concentration to control weed while at low concentration as plant growth regulator.

Acromegaly without acral anomalies

Early recognition of a pituitary secretor tumor offers a better prognostic; thus acromegaly might be recognized before the actual clinical picture of acromegaly is detectable. This is a 59-year old, non-smoking female admitted for: post-operatory evaluation of acromegaly. The clinical evaluation is non-specific. One year prior she was diagnosed with acromegaly based on cerebral imaging assessment due to intermittent headache. She was treated with cabergoline a few months before neurosurgery was done; post-operatory panel showed complete remission of acromegaly. Prompt detection of the disease allowed the early intervention with a very good outcome. The remission of GH excess after neurosurgery depends on tumor size and practical experience of the surgeon. The longer time of high growth hormone levels exposure the higher is the risk of cardio-metabolic and oncologic complications.

Patient-Identified Problems and Influences Associated With Diagnostic Delay of Acromegaly: A Nationwide Cross-Sectional Study.

BackgroundInsidious-onset acromegaly may easily be overlooked by non-specialists of acromegaly and cause diagnostic delay. This study aims to examine the association between diagnostic delay and advice from doctors before any confirmed diagnosis and subsequent comorbidities, and elicit patient-perceived reasons for misdiagnoses.MethodsAn online nationwide cross-sectional study was conducted through China Acromegaly Patient Association. Growth Hormone (GH) and Insulin-like Growth Factor 1 (IGF-1) levels at diagnosis and cancerous, endocrine-metabolic, musculoskeletal, cardiovascular, respiratory, and psychiatric comorbidities were reported by patients. The association between diagnostic delay and pre-diagnostic advice from doctors as well as subsequent comorbidities after diagnosis were examined.ResultsIn total, 447 valid responses were collected. Overall, 58.8% patients experienced misdiagnoses, and 22.6% had diagnostic delay. Before arriving at any diagnosis, patients without treatment (adjusted odds ratio [AOR]: 3.66, 95% confidence interval [CI]: 1.30-10.33) or receiving treatment to symptoms only (AOR: 7.05, 95%CI: 4.09-12.17) had greater chance of being misdiagnosed, and hence had diagnostic delay. Patients believed insufficient specialists, limited awareness of acromegaly of non-specialists and poor doctor-patient communications were major reasons of misdiagnosis. Diagnostic delay were associated with higher GH level at diagnosis and endocrine-metabolic, musculoskeletal and cardiovascular comorbidities (all P<0.05).ConclusionsSuboptimal pre-diagnostic advice for patients, reflecting limited awareness of acromegaly among non-specialists, may delay the diagnosis and increase comorbidities. Feedbacks on the patients’ final diagnosis from specialists to non-specialists should be considered, and doctor-patient communication and clinical decision-making process should be improved. Comorbidities should be screened and monitored particularly for patients with diagnostic delay.

PSVI-2 Effects of natural capsicum extract as a substitute for chlortetracycline on growth performance, nutrient utilization, antioxidant status, immune function, and meat quality in broilers

Abstract A total of 168 one-day old broilers (average BW 46.4 ± 0.6 g) were selected to determine effects of natural capsaicin extract (NCE) as a substitute for chlortetracycline (CTC) on performance, antioxidant capacity, immune function and meat quality of broilers [Founded by NSFC (31772612)]. Broilers were randomly allotted into 3 dietary treatments (n = 7) including a corn-soybean meal basal diet (CON), a basal diet + 75 mg/kg CTC (CTC), and a basal diet + 80 mg/kg NCE (NCE). The experiment contained phase 1 (day 1 to 21) and 2 (day 22 to 42). Compared with CON, broilers from NCE showed higher average daily gain at all stages (P &amp;lt; 0.05). On day 42, organic matter, crude protein and gross energy digestibilities of broilers from NCE were higher than those from the other two groups (P &amp;lt; 0.05). Higher percentage of bursa of Fabricius was observed in broilers fed NCE diets compared with CON (P &amp;lt; 0.05). Trypsin and lipase activities in the pancreas of broilers from NCE were higher than those from CON (P &amp;lt; 0.05). Breast muscle of broilers fed NCE diets showed lower L* values compared with CON (P &amp;lt; 0.05). Broilers from NCE also showed higher levels of serum total antioxidant capacity, glutathione peroxidase, superoxide dismutase, lower levels of interleukin-1β and tumor necrosis factor-α compared with broilers offered CON diets (P &amp;lt; 0.05). Compared with CON, lower concentrations of serum urea-N, low-density lipoprotein cholesterol and total cholesterol, higher growth hormone level were observed in broilers fed NCE diets (P &amp;lt; 0.05). In conclusion, supplementing 80 mg/kg of NCE to diets could improve growth performance, nutrient digestibility, antioxidant and immune function, and meat quality of broilers. Moreover, broilers fed NCE diets exhibited similar growth performance and health status to those offered chlortetracycline (CTC) diets.

A, The Identifying the hermetic potential of khatami (Altheae officinalis) emergence and seedling growth of wild Pea (Pisum sativum subsp. elatius).

Crop plants release biochemicals into surrounding environment that help in obtaining maximum yield of crop by acting bioherbicide at high concentration and plant growth hormone at low concentration. Therefore, this study was planned at Department of Agronomy in Weed Science Laboratory, University of Agriculture Faisalabad during Winter 2018 to evaluate the allelopathic effects of A. officinalis on weed Wild Pea (Pisum sativum subsp. elatius). The experiments were laid out under completely randomized design (CRD) having three replications. The aqueous extracts of C. verum. were used on radish and wild pea seeds at different concentrations (2.5%, 5%, 10%, 20%, 40% and 80%). Data regarding seed germination and seedling growth (shoot length, root length, shoot fresh weight, root dry weigh) of weed were recorded following standard procedures. Results Reveals that the aqueous extract of A. officinalis at higher concentration (80%) act as bioherbicide and produced inhibitory effects on R. sativus result in Maximum time to 50% germination (6.70 days) and mean germination time (10.00 days) while minimum germination index (4.70), germination percentage (66.60%), shoot length (49.8 cm), root length (8.16 cm), shoot fresh weight (10.00g) and root fresh weight (10.361g). While at lower concentration (10%) it shows hermetic effect and produce maximum germination percentage (90.00%), shoot length (84.7 cm), root length (66.2 cm), shoot fresh weight (82.20 g), root fresh weight (58.30 g) and germination index (8.21%) minimum time to complete 50% germination (4.33 days) and mean germination time (5.49 days) growth. In A. officinalis among different phenolic compound minimum Syringic acid (0.60%) and maximum Quercetion (12.3%) compound was found. Therefore, it was concluded from this study that aqueous extract of officinalis can be used as growth promoter at lower concentration while at higher concentration for environmentally friendly control of weeds.

A, The EXPLORING THE ALLELOPATHIC AND HERMETIC EFFECT OF KHATAMI (Altheae officinalis) ON EMERGENCE AND SEEDLING GROWTH OF RADISH (Raphanus sativus)

Abstract Crop plants release biochemicals into surrounding environment that help in obtaining maximum yield of crop by acting bioherbicide at high concentration and plant growth hormone at low concentration. Therefore, this study was planned at Department of Agronomy in Weed Science Laboratory, University of Agriculture Faisalabad during Winter 2018 to evaluate the hermetic effects of Althaea officinalis L. (khatami) on vegetable crop Radish (Raphanus sativus) The experiments were laid out under completely randomized design (CRD) having three replications. The aqueous extracts of A. officinalis L. were used on radish different concentrations (2.5%, 5%, 10%, 20%, 40% and 80%). Data regarding seed germination and seedling growth (shoot length, root length, shoot fresh weight, root dry weigh) of radish were recorded using standard procedures. Results Reveals that the aqueous extract of A. officinalis at higher concentration (80%) act as bioherbicide and produced inhibitory effects on R. sativus result in Maximum time to 50% germination (4.68 days) and mean germination time (9.05 days) while minimum germination index (3.60), germination percentage (85.00%), shoot length (42.4 cm), root length (25.90 cm), shoot fresh weight (53.30 g) and root fresh weight (13.30 g). While at lower concentration (10%) it shows hermetic effect and produce maximum germination percentage (100.00%), shoot length (58.2 cm), root length (52.0 cm), shoot fresh weight (90.00g), root fresh weight (26.30 g) minimum time to complete 50% germination (3.36 days), germination index (6.00%) and mean germination time (5.73 days) growth. In A. officinalis among different phenolic compound minimum Syringic acid (0.60%) and maximum Quercetion (12.3%) compound was found. Therefore, it was concluded from this study that aqueous extract of officinalis can be used as growth promoter at lower concentration while at higher concentration for environmentally friendly control of weeds.

Morphological and molecular effects of overexpressed GH on mice mammary gland

Growth Hormone (GH) plays crucial roles in mammary gland development and growth, and its upregulation has been associated with breast cancer promotion and/or progression. To ascertain how high GH levels could promote mammary tissue oncogenic transformation, morphological characteristics and the expression of receptors involved in mammary growth, development and cancer, and of mitogenic mediators were analyzed in the mammary gland of virgin adult transgenic mice that overexpress GH.Whole mounting and histologic analysis evidenced that transgenic mice exhibit increased epithelial ductal elongation and enlarged ducts along with deficient branching and reduced number of alveolar structures compared to wild type mice. The number of differentiated alveolar structures was diminished in transgenic mice while the amount of terminal end buds (TEBs) did not differ between both groups of mice. GH, insulin-like growth factor 1 (IGF1) and GH receptor mRNA levels were augmented in GH-overexpressing mice breast tissue, as well as IGF1 receptor protein content. However, GH receptor protein levels were decreased in transgenic mice. Fundamental receptors for breast growth and development like progesterone receptor and epidermal growth factor receptor were also increased in mammary tissue from transgenic animals. In turn, the levels of the proliferation marker Ki67, cFOS and Cyclin D1 were increased in GH-overexpressing mice, while cJUN expression was decreased and cMYC did not vary.In conclusion, prolonged exposure to high GH levels induces morphological and molecular alterations in the mammary gland that affects its normal development. While these effects would not be tumorigenic per se, they might predispose to oncogenic transformation.

Suppression of hyperinsulinemia restores growth hormone secretion and metabolism in obese mice.

The well-balanced secretion between insulin and growth hormone (GH) is essential in regulating substrate metabolism, energy metabolism, and body composition. High insulin and low GH levels are often observed in obesity, contributing to reduced energy expenditure and further fat accumulation. Although suppression of hyperinsulinemia is proposed as a treatment for obesity, changes in GH secretion and energy metabolism following this treatment are not thoroughly studied. This leaves unexplained observations, such as unchanged lean mass following insulin reduction. In this study, high-fat diet-induced obese (DIO) and normal chow-fed lean mice on a C57BL/6J background were treated for 7 weeks with diazoxide (1250 mg/kg in food), a KATP channel opener that suppressed insulin secretion. Diazoxide treatment for 10 days was sufficient to increase pulsatile GH secretion in DIO mice before any significant body weight change. The restored insulin-GH balance in DIO mice was followed by improvement in substrate and energy metabolism in a prolonged treatment period (4-6 weeks), including reduced fat mass, increased lipid oxidation and energy expenditure, as well as improved insulin sensitivity and metabolic flexibility. These metabolic benefits occurred along with the changes in the expression level of genes regulated by the insulin-GH balance. When applying diazoxide to normal chow-fed normoinsulinemic lean mice, none of the above metabolic effects was observed, suggesting that the metabolic changes following diazoxide treatment were mediated through the suppression of hyperinsulinemia. These results suggest that suppression of hyperinsulinemia by diazoxide restores GH secretion and improves substrate and energy metabolism in DIO mice.

Densely granulated adenoma pattern is associated with an increased risk of obstructive sleep apnea in patients with acromegaly

To explore the prevalence of obstructive sleep apnea (OSA) and the association between the adenomagranulation patterns and OSA in patients with acromegaly. An overnight polysomnography (PSG) assessment was carried out on participants with acromegaly. Resultsclassified participantsinto anon-OSA group, mild to moderate OSA group, and severe OSA group. Morphological and biochemical analyses were performed. Demographic, clinical, biochemical, and polysomnographic data were compared among the three groups. Using logistic regression models, the risk of OSA in acromegalic subjects was estimated. OSA was reported in 36 of 49patients (74%) with acromegaly. Contrasted with the non-OSA group, OSA patients had a larger proportion of the densely granulated (DG) pattern. The OSA groups with DG acromegaly had a smaller maximum tumor diameter and Vol/2 than those with the sparsely granulated (SG) pattern. Furthermore, a higher growth hormone (GH) level (45.0 ± 36.9 vs 18.6 ± 15.8, P = 0.047) and GH index (28.4 ± 13.8 vs 6.6 ± 8.2, P = 0.003) were found in DG acromegaly patients with severe OSA. Additionally, there was a trend toward higher standardized insulin-like growth factor 1 (IGF-1) in patients with DG acromegaly than in those with SG acromegaly in the severe OSA group. After adjusting for potential confounding variables, the DG pattern was correlated with the risk of OSA (OR = 14.84, 95%CI 1.36-162.20, P = 0.027) in patients with acromegaly. The findings indicate that a high prevalence of OSA exists in patientswith acromegaly, and the DG pattern may be a risk factor for OSA in acromegaly.

Plurihormonal pituitary macroadenoma:\xa0 a case report

BackgroundPlurihormonal pituitary adenomas are a unique type of pituitary adenomas that secrete two or more pituitary hormones normally associated with separate cell types that have different immunocytochemical and ultrastructural features. Although they represent 10–15% of all pituitary tumors, only a small fraction of plurihormonal pituitary adenomas clinically secrete multiple hormones. The most common hormone combinations secreted by plurihormonal pituitary adenomas are growth hormone, prolactin, and one or more glycoprotein hormones. The most common hormonal symptom is acromegaly (50%). The aim of this case report is to bring awareness about this rare type of pituitary adenomas and to describe the unique presentation of our patient, even though plurihormonal pituitary adenomas are known mostly as a clinically silent tumors.Case presentationHerein, we describe an unusual case of plurihormonal pituitary adenoma with triple-positive staining for adrenocorticotropic hormone, growth hormone, and prolactin. The patient is a 65-year-old Egyptian woman who presented with mass effect symptoms of the pituitary tumor, which primarily manifested as severe headache and visual field defects. She also presented with some cushingoid features, and further analysis confirmed Cushing’s disease; slightly high prolactin and normal growth hormone levels were observed. She underwent transsphenoidal surgery and has been in remission thus far. Only a few cases have been reported in the literature, but none has exhibited silent acromegaly or mass effect symptoms as the initial presentation.ConclusionThis case highlights an unusual plurihormonal pituitary adenoma case with a rare combination of secreted hormones; mass effect symptoms were dominant, as were uncommon visual field defects. Our case further proves that immunohistochemical analyses of all pituitary hormones are needed to ensure correct diagnosis and to alert clinicians to the need for more rigorous follow-up due to the higher morbidity of these patients. Our case report approval number Federal Wide Assurance NIH, USA is FWA00018774 IRB registration number with OHRP/NIH is IRB00010471.

Clinical and hormonal findings in patients presenting with high IGF-1 and growth hormone suppression after oral glucose load: a retrospective cohort study.

ObjectiveHigh insulin-like growth factor 1 (IGF-1) and unsuppressed growth hormone (GH) levels after glucose load confirm the diagnosis of acromegaly. Management of patients with conflicting results could be challenging. Our aim was to evaluate the clinical and hormonal evolution over a long follow-up in patients with high IGF-1 but normal GH nadir (GHn < 0.4 μg/L according to the latest guidelines).DesignRetrospective cohort study.MethodsWe enrolled 53 patients presenting high IGF-1 and GHn < 0.4 μg/L, assessed because of clinical suspicion of acromegaly or in other endocrinological contexts (e.g. pituitary incidentaloma). Clinical and hormonal data collected at the first and last visit were analyzed.ResultsAt the first evaluation, the mean age was 54.1 ± 15.4 years, 34/53 were females, median IGF-1 and GHn were +3.1 SDS and 0.06 μg/L, respectively. In the whole group, over a median time of 6 years, IGF-1 and GHn levels did not significantly change (IGF-1 mean of differences: −0.58, P = 0.15; GHn +0.03, P = 0.29). In patients with clinical features of acromegaly, the prevalence of acromegalic comorbidities was higher than in the others (median of 3 vs 1 comorbidities per patient, P = 0.005), especially malignancies (36% vs 6%, P = 0.03), and the clinical worsening overtime was more pronounced (4 vs 1 comorbidities at the last visit).ConclusionsIn patients presenting high IGF-1 but GHn < 0.4 μg/L, a hormonal progression is improbable, likely excluding classical acromegaly in its early stage. However, despite persistently low GH nadir values, patients with acromegalic features present more acromegalic comorbidities whose rate increases over time. Close clinical surveillance of this group is advised.

Dietary Starch Concentration Affects Dairy Sheep and Goat Performances Differently during Mid-Lactation.

Simple SummaryIn order to favor milk production, this research suggests that the concentration of starch in the diet of dairy ewes in mid-lactation should be reduced, compared to early lactation, by introducing sources of highly digestible fiber. On the other hand, this type of diet is not adequate for dairy goats, which should maintain the use diets rich in starch, even in mid-lactation, to support milk yield, as well.Evolution of milk production, body reserves and blood metabolites and their relationships with dietary carbohydrates were compared in 30 Sarda dairy ewes and 26 Saanen dairy goats in mid-lactation. From 92 to 152 ± 11 days in milk (DIM), each species was allocated to two dietary treatments: high-starch (HS: 20.0% starch, on DM basis) and low-starch (LS: 7.8% starch, on DM basis) diets. In mid-lactating goats, the HS diet increased fat-corrected milk yield (FCM (3.5%); 2.65 vs. 2.53 kg/d; p = 0.019) and daily milk net energy (NEL; p = 0.025), compared to the LS diet. The body condition score (BCS) was not affected. In mid-lactating ewes, the LS diet increased FCM (6.5%) (1.47 vs. 1.36 kg/d; p = 0.008), and NEL (p = 0.008), compared to the HS diet. In addition, BCS was greater in HS than in LS ewes (3.53 vs. 3.38; p = 0.008). Goats had a higher growth hormone (GH) and lower insulin concentration than ewes (GH: 2.62 vs. 1.37 ng/mL; p = 0.04; insulin: 0.14 vs. 0.38 µg/L; p < 0.001 in goats and ewes, respectively). In conclusion, in mid-lactation, the two species responded differently to dietary carbohydrates, probably due to differences in the concentration of GH and insulin. The HS diet favored milk yield in goats and body reserve accumulation in ewes. In ewes, the partial replacement of starch with highly digestible fiber increased energy partitioning in favor of milk production.

Mortality in Acromegalic Patients: Etiology, Trends, and Risk Factors

Although acromegaly has been associated with increased mortality rates, evidence shows that the application of the recent treatment modalities has reduced the risk of death in these patients, being comparable with the general population. As a result of the changing trends regarding mortality, the aim is to review the current literature to create enough evidence about the recent trends of mortality in patients with acromegaly. Moreover, this review aims to identify the possible etiology and the related risk factors. Old studies have reported that cardiovascular complications were the major etiology for death among acromegalic patients. However, recent studies showed that malignancies-induced complications might be the leading factor, while other studies reported that cardiovascular complications are still the main culprit. Nonetheless, the recently estimated risk is similar to that in the general population. Studies reported a decrease in mortality rates among patients with acromegaly within the last decades, which is probably attributable to the recent changes in the management updates, the less frequent exposure to radiotherapy and focus on the common cardiovascular disorders associated with the disease. This review also found that exposure to radiotherapy, old age, hypopituitarism, active acromegaly, and high growth hormone (GH) levels are significant predictors of mortality in acromegalic patients. In conclusion, more effort should be made to decrease GH to favorable levels based on the recent guidelines.