Hormone Monitoring Research Articles

The effects of amiodarone on thyroid function in pediatric and adolescent patients.

Amiodarone-induced thyroid dysfunction is well established. The present review discusses recent literature related to the effects of amiodarone on the thyroid gland and thyroid function in pediatrics. Current guidelines in adults treated with amiodarone recommend baseline thyroid function testing followed by initiation of thyroid hormone monitoring after 3 months on therapy. Two retrospective studies to evaluate amiodarone-induced thyroid dysfunction in children and young adults reveal thyroid dysfunction as soon as 2 weeks after amiodarone initiation with a greater percentage of pediatric patients developing amiodarone-induced hypothyroidism rather than thyrotoxicosis. Although additional studies are needed to determine if AIH is associated with negative impact on growth and neurocognitive development, what is clear is that in both adults and pediatrics, there is low compliance with recommended side effect-monitoring guidelines. Pediatric patients are at similarly high risk to develop amiodarone-induced thyroid dysfunction as are adults. It is hoped that through improved education of providers and patients further research into the incidence, the potential risks of amiodarone therapy and the potential benefits of thyroid hormone replacement therapy in patients with AIH will be investigated and reported.

Thyroid hormone alterations in critically and non-critically ill patients with SARS-CoV-2 infection.

ObjectiveFollowing the evolution of COVID-19 pandemic, reports pointed on a high prevalence of thyroiditis-related thyrotoxicosis. Interpretation of thyroid tests during illness, however, is hampered by changes occurring in the context of non-thyroidal illness syndrome (NTIS). In order to elucidate these findings, we studied thyroid function in carefully selected cohorts of COVID-19 positive and negative patients.DesignCohort observational study.MethodsWe measured TSH, FT4, T3 within 24 h of admission in 196 patients without thyroid disease and/or confounding medications. In this study, 102 patients were SARS-CoV-2 positive; 41 admitted in the ICU, 46 in the ward and 15 outpatients. Controls consisted of 94 SARS-CoV-2 negative patients; 39 in the ICU and 55 in the ward. We designated the thyroid hormone patterns as consistent with NTIS, thyrotoxicosis and hypothyroidism.ResultsA NTIS pattern was encountered in 60% of ICU and 36% of ward patients, with similar frequencies between SARS-CoV-2 positive and negative patients (46.0% vs 46.8%, P = NS). A thyrotoxicosis pattern was observed in 14.6% SARS-CoV-2 ICU patients vs 7.7% in ICU negative (P = NS) and, overall in 8.8% of SARS-CoV-2 positive vs 7.4% of negative patients. In these patients, thyroglobulin levels were similar to those with normal thyroid function or NTIS. The hypothyroidism pattern was rare.ConclusionsNTIS pattern is common and relates to the severity of disease rather than SARS-CoV-2 infection. A thyrotoxicosis pattern is less frequently observed with similar frequency between patients with and without COVID-19. It is suggested that thyroid hormone monitoring in COVID-19 should not differ from other critically ill patients.

Endocrine monitoring after severe hypercalcemia due to primary hyperparathyroidism. In search of lost…MEN 2A?

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Non-Invasive Reproductive Hormone Monitoring in the Endangered Pygmy Hog (Porcula salvania).

Simple SummaryThe pygmy hog is one of the world’s rarest suids and classified as an endangered species. Efforts are being made to breed them in captivity and reintroduce them into the wild. In this study, we examined reproductive hormones in captive pygmy hogs using a non-invasive method by collecting 785 fecal samples from five females and two males for 12 months. High-pressure liquid chromatography was performed to examine the presence of immunoreactive progesterone and testosterone metabolites in the fecal samples. We standardized and validated enzyme immunoassays (EIA) for fecal progesterone and testosterone metabolites. Using progesterone EIA, we were able to detect pregnancies in four females and estimate the relevant gestation period. We also recorded 172 births from the captive breeding center and found strong seasonality patterns in births. In males, fecal testosterone metabolite concentrations were higher in the breeding season than in the non-breeding season as evidenced by elevated testosterone concentrations during breeding season. A significant difference in fecal progesterone metabolites concentration was observed between non-pregnant and pregnant females. This study can directly help in monitoring the reproductive status of reintroduced hogs both in the wild and in conservation breeding programs in India and elsewhere.The pygmy hog (Porcula salvania), until recently was classified as a critically endangered suid facing the threat of extinction due to habitat degradation. Efforts are being made to protect the pygmy hog from extinction and breed them in captivity under the Pygmy Hog Conservation Programme (PHCP). However, very little information is available on the reproductive physiology of pygmy hogs. Therefore, the present study aims to standardize enzyme immunoassays (EIAs) for monitoring pregnancy and reproductive status using progesterone and testosterone metabolites. A total of 785 fecal samples were collected from five females and two males over a period of one year from the PHCP Research and Breeding Centre, Guwahati, Assam. High-pressure liquid chromatography (HPLC) analysis revealed the presence of immunoreactive progesterone and testosterone metabolites in feces. Mating was observed in all five females, and four of them gave birth successfully. We were able to detect pregnancy using fecal progesterone metabolites. The mean gestation period, based on mating and parturition, was estimated to be 153.25 days from the four females studied. The breeding center recorded 172 births between 1996 and 2000 and found strong seasonal patterns in the birth rate, with most of the births occurring between May and June. In the males, fecal testosterone metabolites were significantly higher in the breeding season than in the non-breeding season. This is the first study on the subject and will help with future breeding programs in other captive breeding centers and with reproductive monitoring of reintroduced populations.

A Case of Parathyroid Adenoma Three Decades Post Radioactive Iodine Therapy: Is It Just a Coincidence or Real Risk?

Abstract Background: External radiation to the head and neck is a known risk factor for the development of parathyroid adenoma. But the incidence is very rare in internal radiation recipients. Here we describe a case of parathyroid adenoma after 30 years of radioactive iodine therapy for Graves’ disease. Clinical Case: A 50-year-old female presented during an annual visit with progressive fatigue, polyuria, polydipsia, nocturia, muscle weakness, and some memory impairment. She had a past medical history of Graves’ disease treated with radioactive iodine therapy 30 years ago with subsequent hypothyroidism, controlled essential hypertension, asthma, and obesity BMI 32.5 kg/m2. There was no history of nephrolithiasis, fractures, pituitary tumor, or acid reflux. Family history was noted for thyroid diseases, no calcium issues or hyperparathyroidism. Neck examination did not reveal any thyromegaly or palpable nodule. Laboratory tests showed calcium 11.4 mg/dL (8.6-10.3), ionized calcium 6.1 mg/dL (4.2-5.4), parathyroid hormone 213.9 pg/mL (12-88), total vitamin D 22 ng/mL (31-100), TSH 0.47 uIU/mL (0.34-3.00), Free T4 1.1 ng/dL (0.6-1.6), creatinine 0.7 mg/dL (0.6-1.2), eGFR >60 ml/min/1.73 m2, 24-hr urine calcium 405 mg (40-350). Bone density revealed T-score -4.9 at the lumbar spine, -2.8 at the total hip, -3.1 at the femoral neck, and -2.9 at distal 1/3 radius. Neck ultrasound showed atrophy of the thyroid gland with a lobulated hypoechoic area measuring up to 1.3 x 0.9 x 0.9 cm without internal blood flow at posterior inferior to the right lobe of the thyroid gland. Parathyroid SPECT/CT scan revealed no evidence of parathyroid adenoma. The hypoechoic lesion was suspected to be a lymph node according to imaging studies. However, according to laboratory and bone density results, we suspected primary hyperparathyroidism in which the patient required surgery due to current symptoms. The patient underwent surgery with an intraoperative finding of a nodule at the superior of the right parathyroid gland. A frozen section of the nodule was sent which confirmed parathyroid adenoma. The gland, weighted 483 mg, was removed with subsequent improvement of intraoperative parathyroid hormone level from 238.5 pg/mL to 26.5 pg/mL. Follow up calcium was at 9.5 mg/dL. The patient was supplemented with calcium and vitamin D afterward. Her symptoms improved significantly. Conclusion: Hypercalcemia in a patient with prior history of radioactive iodine therapy should raise concern for parathyroid adenoma. Imaging of the parathyroid gland should be cautiously interpreted with laboratory tests as it could be a false negative. Due to patient met criteria for surgery, the surgical approach should be pursued for both diagnostic confirmation and definite treatment. Intraoperative parathyroid hormone monitoring is beneficial in equivocal imaging and in reflecting successful resection of uniglandular disease.

The Stability of TSH, and Thyroid Hormones, in Patients Treated With Tablet, or Liquid Levo-Thyroxine.

Approximately, 5% of the population is affected by hypothyroidism, mainly women and persons aged more than 60 years. After the diagnosis of hypothyroidism the usual therapy is tablet levothyroxine (L-T4), with a monitoring of the thyroid-stimulating hormone (TSH) level in primary hypothyroidism every 6–8 weeks and L-T4 is adjusted as necessary to reach an euthyroid state. Once TSH is stabilized in the normal range, it is recommended to conduct annual testing in the treated subjects to warrant suitable replacement. More recently advances regarding L-T4 treatment are the introduction of new oral formulations: the liquid solution, and soft gel capsule. The soft gel capsule permits a quick dissolution in the acid gastric pH. The liquid preparation does not require an acid gastric environment. Many pharmacokinetic studies demonstrated a more rapid absorption for the liquid L-T4, or capsule, than with tablet. Many studies have shown that the liquid, or capsule, formulations can overcome the interaction with foods, drugs or malabsorptive conditions, that are able to impair the tablet L-T4 absorption. Lately studies have suggested that liquid L-T4 can permit to maintain more efficiently normal TSH levels in hypothyroid patients in the long-term follow-up, than tablet L-T4, both in patients with malabsorptive states, and in those without malabsorption. Further large, prospective, longitudinal studies are needed to evaluate the stability of TSH, in hypothyroid patients treated with different L-T4 formulations.

Outcomes in patients with and without intraoperative parathyroid hormone testing for primary hyperparathyroidism: A retrospective observational analysis

ObjectivesThe use of intraoperative parathyroid hormone (ioPTH) monitoring has been recommended as an adjunct to improve likelihood of successful parathyroid surgery. We sought to compare the surgical outcomes as well as operative times and associated costs in patients with and without ioPTH in the setting of co-localizing studies for primary hyperparathyroidism. MethodsA retrospective review was conducted of patients undergoing surgery for nonfamilial primary hyperparathyroidism at a single institution from January 2013 to April 2019. Patients with a suspected single adenoma that co-localized on sestamibi and ultrasound were included resulting in 141 patients, of which 110 (78%) had ioPTH testing (group 1) while 31 (22%) did not (group 2). Time driven activity-based cost (TDABC) analysis was performed incorporating physician and staff compensation and anesthetic usage to determine the cost differential between groups. Study DesignRetrospective chart review. ResultsIn group 1, the use of ioPTH prompted re-exploration in 2 patients (1.8%). In both cases, the initial gland identified was normal parathyroid and persistent elevation of ioPTH resulted in additional dissection and removal of the adenoma. All but two group 1 patients had normal post-operative calcium levels at last follow up for an overall success rate of 97.3%. One group 2 patient (3.2%) was found to have recurrent hyperparathyroidism 33 months later with an adenoma identified in the same location as the initial excision. Otherwise all group 2 patients were eucalcemic at last follow-up for an overall success rate of 96.8%. The average time for the procedure in group 1 was 91.7 ± 28.1 minutes compared to 52.3 ± 16.9 minutes in group 2 (p<0.001). Mean TDABC for group 1 was $900.93 ± 261.49 compared to $487.52 ± 157.93 for group 2 (p<0.001). ConclusionsIn patients with co-localizing sestamibi scan and ultrasound and concordant operative findings, the use of ioPTH did not improve the success rate of minimally invasive parathyroid surgery, while increasing operative times and cost.

Wearable Biosensors: An Alternative and Practical Approach in Healthcare and Disease Monitoring.

With the increasing prevalence of growing population, aging and chronic diseases continuously rising healthcare costs, the healthcare system is undergoing a vital transformation from the traditional hospital-centered system to an individual-centered system. Since the 20th century, wearable sensors are becoming widespread in healthcare and biomedical monitoring systems, empowering continuous measurement of critical biomarkers for monitoring of the diseased condition and health, medical diagnostics and evaluation in biological fluids like saliva, blood, and sweat. Over the past few decades, the developments have been focused on electrochemical and optical biosensors, along with advances with the non-invasive monitoring of biomarkers, bacteria and hormones, etc. Wearable devices have evolved gradually with a mix of multiplexed biosensing, microfluidic sampling and transport systems integrated with flexible materials and body attachments for improved wearability and simplicity. These wearables hold promise and are capable of a higher understanding of the correlations between analyte concentrations within the blood or non-invasive biofluids and feedback to the patient, which is significantly important in timely diagnosis, treatment, and control of medical conditions. However, cohort validation studies and performance evaluation of wearable biosensors are needed to underpin their clinical acceptance. In the present review, we discuss the importance, features, types of wearables, challenges and applications of wearable devices for biological fluids for the prevention of diseased conditions and real-time monitoring of human health. Herein, we summarize the various wearable devices that are developed for healthcare monitoring and their future potential has been discussed in detail.

The effect of chronic kidney disease on intraoperative parathyroid hormone: A linear mixed model analysis

BackgroundReduced creatinine clearance is an indication for surgery in asymptomatic primary hyperparathyroidism, and a significant proportion of patients undergoing parathyroidectomy have chronic kidney disease. The purpose of this study was to evaluate the kinetics of intraoperative parathyroid hormone decline during parathyroidectomy in patients who have chronic kidney disease compared with those with who have normal renal function. MethodsThis is a single-center, retrospective study of patients with primary hyperparathyroidism undergoing parathyroidectomy (n = 646). Patients were grouped based on estimated glomerular filtration rate greater than (normal renal function) or less than (chronic kidney disease) 60 mL/min/1.73m2. All patients had intraoperative parathyroid hormone monitoring and ≥6-month postoperative serum studies to confirm surgical cure. Intraoperative parathyroid hormone kinetic curves were analyzed using a linear mixed model. ResultsDespite similar pre-excision values, patients with chronic kidney disease had significantly higher intraoperative parathyroid hormone values at 5 minutes (76 vs 58 pg/mL, P = .02) and 10 minutes (54 vs 37 pg/mL, P = .004) postexcision. No significant difference was observed in whether patients met Miami criterion by 5 minutes (chronic kidney disease 71%, normal renal function 78%, P = .255) or by 10 minutes (chronic kidney disease 95%, normal renal function 96%, P = .751) postexcision. Using a linear mixed model, glomerular filtration rate did not have a significant effect on the change in intraoperative parathyroid hormone over time. ConclusionPatients with chronic kidney disease had significantly higher postexcision intraoperative parathyroid hormone levels. However, renal function did not affect the change in intraoperative parathyroid hormone over time, nor did renal function ultimately affect the likelihood of meeting the Miami criterion. Intraoperative parathyroid hormone monitoring remains useful in this population, although additional time points may be needed to observe normalization of values.

Ensuring Public Health: Monitoring of Hormone Residues in Poultry Meat

The study’s main purpose of addressing the problem of hormone content in poultry meat is to analyze the literature and such an official approach as state monitoring for 2017-2020. Research has shown that hormones have not been used in poultry farming for more than 50 years in the EU, the USA, Canada and other countries. In addition, there are strict international laws, including in Ukraine, on the control of the use of hormones in poultry to ensure public health. The urgency of solving the scientific problem is that despite the above, in the literature for the last decades there are reports based on consumer surveys (from 40 to 60%) on the negative impact of poultry meat on the content of hormones on their health. This negatively affects the consumption and image of poultry producers. Such trends are observed, including in Ukraine. This encourages the provision of scientifically sound information on this issue. The study of the content of hormones in poultry meat in the article is carried out in the following logical sequence: the analysis of international scientific literature on the content of hormones in poultry meat, as well as data from the State Statistics Service of Ukraine on the trend of poultry consumption and increased demand among consumers for this type of meat. In addition, the article analyzes the official data of state monitoring of residual hormones in poultry meat. The following methods became the methodological tools of the conducted research: analysis of literature sources for 10 years, the period of research of the state monitoring is chosen 2017-2020. The object of the study was the biased attitude of some consumers to the safety of poultry meat in terms of hormones, which arose as a result of the spread of the myth of the use of hormones in poultry. The subject of the research was the analysis of current literature data and the results of official national monitoring of the content of hormones in poultry meat. Research shows that as a result of constant strict official controls on the use of hormones in poultry and the inefficiency of their use for poultry producers, the latter amount of hormones is at a minimum physiological level that does not harm public health. Our state monitoring studies show proper state control and provide guarantees to consumers in the consumption of safe poultry meat. The results of this study can be useful for consumers, scientists, and students in the field of food safety and our country as a whole to disseminate scientifically sound information in the field of state control over food safety.

Using reproductive technologies to assess the development of secondary sexual characteristics, ovarian senescence and hermaphroditism in the endangered mountain yellow-legged frog Rana muscosa.

Anurans can display a host of intriguing sexual syndromes, including hermaphroditism and sex reversal. Using a multifaceted approach for diagnosing and characterising hermaphroditism in the endangered anuran species Rana mucosa , we tracked changes in female reproductive status using hormone monitoring, ultrasound examinations, individual life history, fertilisation records and post-mortem findings. Seven individuals originally sexed as females developed secondary male sexual characteristics, behaviour and hormone profiles and, in some cases, had testicular tissue despite having previously laid eggs. Our results suggest that reproductive technologies can shed light on life history patterns and reproductive anomalies that may affect endangered anuran survival.

Degradation of Temminck's pangolin (Smutsia temminckii) scales with a keratinase for extraction of reproductive steroid hormones

Hormone monitoring in keratinous tissues has become increasingly popular. The insoluble keratin materials are generally pulverised before hormone extraction; however, this is difficult for thicker keratin structures like baleen plates or hooves. A new method, involving the use of keratinase, allows enzymatic digestion of keratin and hormone analysis in the resulting suspension. Pangolins are unique mammals covered in keratinous scales, which are one of the reasons these animals are extensively trafficked. This study aimed to investigate the suitability of Temminck's pangolin scales as hormone matrix for quantifying reproductive steroids. A protocol was developed to digest scales with a keratinase before measuring hormone concentrations. This method can be used to investigate the reproductive endocrinology of Temminck's pangolins but may also be extended to the other extant pangolin species.•Keratinase digests Temminck's pangolin scales and reproductive steroid metabolite concentrations are measurable in the resulting suspension.•Isopropanol is an ideal washing solvent for scales to remove surface contaminants and scale sample mass should be standardised to allow comparisons.•Any section of a scale and scales from any pangolin body region can be used as samples for hormone quantification.

The Role of Urinary LH and FSH in the Diagnosis of Pubertal Disorders.

Background:Various hormonal parameters used to differentiate between different causes of pubertal disorders are invasive, cumbersome, and has variable sensitivity and specificity. Thus, the use of a noninvasive test like urinary gonadotropin for the diagnosis of pubertal disorders will offer a significant advantage.Objective:To study the role of urinary gonadotropins (uLH, uFSH) for the diagnosis of various pubertal disorders and in the monitoring of Gonadotrophin releasing hormone, Hypothalamic-pituitary-gonadal (GnRHa) therapy in patients with central precocious puberty (CPP).Materials and Methods:We evaluated 35 healthy children and 96 patients with disorders of puberty out of which 31 cases had early puberty and 65 cases had delayed puberty. We used Spearman's correlation coefficient to evaluate the correlation between the serum and urinary gonadotropins. We used Mann–Whitney U test (for 2 groups) and Kruskal–Wallis test (for > 2 groups) to compare the median urinary and serum gonadotropins of different groups.Results:The urinary gonadotropins correlated strongly with serum gonadotropins in both healthy controls and individuals with pubertal disorders. The uLH level of ≥0.76 IU/L had 100% sensitivity and specificity to differentiate CPP from peripheral precocious puberty, whereas uLH level of ≥1.07 IU/L had 100% sensitivity and specificity for differentiating CPP from PT. In patients with delayed puberty, uFSH of ≥20.51 IU/L had 94.7% sensitivity and 91.3% specificity for the diagnosis of Hyper-Hypo cases and uLH level of ≥0.5 IU/L had sensitivity of 96.2% and specificity of 85% to differentiate constitutional delay in growth and puberty from hypogonadotropic-hypogonadism. In CPP patients on GnRHa therapy, the uLH level of ≥0.13 IU/L had 100% sensitivity and 86.7% specificity to identify those who had nonsuppressed serum LH levels.Conclusion:The urinary gonadotropins can be used as a reliable noninvasive test for the diagnosis of various pubertal disorders and also for monitoring of CPP patients on GnRHa therapy.

Selection of parathyroidectomy methods for primary hyperparathyroidism according to concordance between ultrasonography and MIBI scan results.

Determination of appropriate operative methods for primary hyperparathyroidism (PHPT) is difficult when localisation results are discordant between imaging studies. The aim of this study was to compare the efficacy of focused parathyroidectomy (FP) and bilateral neck exploration (BNE) according to the concordance in localisation results. One hundred and ninety-one patients who underwent a PHPT operation at Asan Medical Center between 2000 and 2010 were divided into two groups according to the concordance in findings between neck ultrasonography (USG) and sestamibi (MIBI) scan. Differences in clinicopathological features and surgical outcomes between the concordant (n=137) and discordant (n=54) groups were analysed. FP and BNE did not show significant differences in postoperative persistent hyperparathyroidism rates. Although intraoperative parathyroid hormone (IOPTH) monitoring was not performed in this study, the cure rates of PHPT using only USG and MIBI scans were satisfactorily high, at 98.5% in the concordant group and 96.3% in the discordant group. The cure rates of FP and Unilateral exploration in single-negative USG and MIBI scans were 100%. Multiple lesions and hyperplasia were more common in the discordant group. In cases where it is difficult to apply IOPTH, FP without IOPTH is feasible in patients showing concordant or single-negative detection on USG and MIBI scans, whereas BNE is recommended in cases of discordance or double-negative results on imaging studies, to prevent recurrence or persistent disease. Appropriate selection of parathyroidectomy methods according to the concordance in USG and MIBI scans might produce good results without any difference in recurrence.

A practical method for storage, preservation and transportation of anuran urine samples using filter paper for hormone analysis

Anurans (frogs and toads) expelled urine when handled and it could provide insights into their physiological status. However, storage, preservation and transportation are often challenging. The study aimed to standardize and validate a field method for short-term storage and preserve of anuran urine samples using Whatman filter papers. To examine the efficacy of storage conditions and type of papers, urinary based enzyme immunoassays were used to measure progesterone and testosterone hormone metabolites. High-Performance Liquid Chromatography was performed and revealed immunoreactive progesterone and testosterone metabolites in the urine samples. Urinary hormone metabolites concentration stored in filter paper at room temperature and control samples stored in -20°C for the same period were similar. Whatman grade 50 was found to be more suitable for storage of hormones than grade 3 paper for the experiments performed.•A cheap and simple storage method for storage of anuran urine in field conditions using filter papers.•Anuran urine could be preserved and transported under ambient conditions without significant changes and loss of hormones.•This method would facilitate the endocrine monitoring of anurans in remote areas where limited logistics are available.

Non-invasive hormone monitoring as a robust method for determining adrenocortical activity in injured, emaciated and oil-contaminated African penguins undergoing rehabilitation

Anthropogenic activity is a major driver of seabird injury and mortality in the 21st century. Although most seabirds perish within the natural environment as a result of human activities, some are rescued and admitted to rehabilitation centres. Despite the considerable number of admissions, little is known regarding the physiological response seabirds have to specific admission reasons and the rehabilitation process. In this study, we aimed to determine the effect of injury, emaciation, oiling, individual removal from the natural environment and the rehabilitation process on the physiological stress response of the African penguin (Spheniscus demersus). Urofaecal samples were collected from African penguins throughout a three-stage rehabilitation process and quantified for glucocorticoid metabolites (ufGCM). The three stages included an initial ICU crate stage (Stage 1), an ICU pen stage (Stage 2) and a rehabilitation stage (Stage 3). Data were analysed using a generalised linear model in order to determine the effect of admission reason, age and rehabilitation stage (Stage 1, 2 and 3) on ufGCM levels. Although the model indicated that only Stage 1 was a significant driver of adrenocortical activity in the study population, ufGCM levels of injured and emaciated animals within Stage 1 were considerably higher than those of birds with any other admission reason across all stages. This is the first study examining the causes and effect of rehabilitation on the physiological stress response in African penguins. Enhanced care and attention should be given to rescued individuals, especially during the first stage of rehabilitation, to reduce perception of additional stressors and thus increase the chance of full recovery.

Assessing puberty in female cheetahs (Acinonyx jubatus) via faecal hormone metabolites and body weight.

With fewer than 7500 cheetahs remaining in the wild, ex situ cheetah populations serve as an insurance policy against extinction and a resource to study species' biology. This study aimed to identify the age of pubertal onset in ex situ female cheetahs using non-invasive faecal steroid hormone monitoring and body weights. Faecal samples from nine female cheetahs were collected two to three times weekly from 2 to 36months of age and body weights were recorded every 3months. Faecal oestrogen metabolites (FOM) and faecal glucocorticoid metabolites (FGM) were analysed using enzyme immunoassays and samples were categorised into 6-month intervals to compare endocrine characteristics. Faecal hormone and body weight data were analysed using generalised linear mixed models. Age was a significant predictor of mean and baseline FOM concentrations, number of FOM peaks, mean and maximum FOM peak concentrations and the number of cycles. Female cheetahs aged 24-30months exhibited a marked rise in mean FOM concentration and the number of FOM peaks and cycles increased with age until 24-30months. Females attained adult body weight by 21months of age. Mean and baseline FGM concentrations were highest at the 0-6 and 12-18months of age groups and did not follow the same FOM patterns. Based on body weight data, the FOM concentrations and peak patterning, females were considered pubertal from 24 to 30months of age. Characterisation of cheetah puberty has direct and significant implications for the improvement of management and reproductive success of cheetahs under human care. This information is particularly informative for identifying important windows of development, littermate dispersal and breeding introductions.

Гормональний моніторинг функції жовтого тіла, трофобласта і плаценти при одноплідній вагітності в жінок із різними видами безплідності в анамнезі

Purpose — to investigate hormonal monitoring of the function of the corpus luteum, trophoblast and placenta in pregnant women with a history of various types of infertility. Materials and methods. We have studied hormonal parameters from 8 to 14 weeks of pregnancy in 420 women. The study of hormonal parameters was carried out in three groups (six subgroups): Group I — pregnant women with a history of endocrine infertility: Ia — 50 patients after IVF, Ib — 50 patients who became pregnant on their own after conservative and surgical treatment of infertility, but without IVF; Group II — pregnant women with a history of inflammatory infertility: IIa — 100 patients after IVF, IIb — 100 patients who became pregnant independently after conservative and surgical treatment of inflammatory infertility, but without IVF; Group III — pregnant women with a history of combined infertility, inflammatory genesis with endocrine, IIIa — 30 patients after IVF, IIIb — 30 patients who became pregnant on their own after conservative and surgical treatment of combined infertility, but without IVF. A study of the content of placental hormones in the dynamics of pregnancy at 7–10 and 11–14 weeks was carried out: estradiol (E2), progesterone, human chorionic gonadotropin (β-hCG) and pregnancy-associated plasmoprotein (PAPP-A). Determination of E2, progesterone was carried out by the enzyme-linked immunosorbent assay using standard kits of the Delfia system on a 1420 Victor 2 analyzer from Perken Elmer (USA). β-hCG and PAPP-A were determined by the immunochemiluminescent method using test systems manufactured by Siemens. Results. We carried out hormonal monitoring of the corpus luteum and trophoblast function and analyzed the results of fetal biochemical markers in 276 pregnant women. The data obtained indicate that in the period of 7–10 weeks of pregnancy, the concentration of progesterone was significantly higher in women after IVF relative to the indicators of patients with natural conception. At this stage of pregnancy, the level of progesterone did not depend on the form of infertility. Similar changes were observed with respect to estradiol levels. So the level of estradiol in pregnant women of 7–10 weeks during natural pregnancy was ≈5.0 nmol/L, while the same level of estradiol in pregnant women with one fetus after IVF was 8.4±1.1 nmol/L. The progesterone/estradiol ratio was virtually the same across the groups. The level of estradiol and progesterone in the blood of women at 11–14 weeks of gestation also practically did not differ, and did not depend on the form of infertility and the method of conception. It should be especially noted that at 11–14 weeks there was a decrease in the progesterone/estradiol ratio, which represents a progressive pronounced relative progesterone deficiency and hyperestrogenism in women with infertility. The indicators were especially low in pregnant women of groups I and III, who had endocrine and combined infertility in the anamnesis. We also investigated the indicators of β-hCG and PAPP-A in pregnant women 11–14 weeks. by groups, as classic markers of screening for congenital malformations of the fetus and the risk of complications of pregnancy. So the level of PAPP-A in pregnant women did not significantly differ in groups, both from the method of conception and the type of infertility in the anamnesis. The level of β-hCG in pregnant women 11–14 weeks of singleton pregnancy after IVF is significantly higher than in women with natural conception. The highest rates were in the group after combined infertility. Conclusions. The level of hormones: estradiol and progesterone in pregnant women after IVF at 7–10 weeks was higher than in women with a history of infertility during natural conception. Already at 11–14 weeks, the same indicators in the same groups did not differ. After natural conception, the rate of increase in estradiol significantly outpaced the increase in progesterone levels in pregnant women with a history of infertility. The concentration of PAPP-A in the first trimester in pregnant women after IVF did not significantly differ from those in women with natural conception. The content of β-hCG at 11–14 weeks in groups of pregnant women after IVF was 1.5–2 times higher. The highest rates were in pregnant women with a history of concomitant infertility. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: estradiol, progesterone, β-hCG, PAPP-A, pregnancy after infertility.

Bilateral adrenal neuroblastoma: clinical presentation, diagnostic and therapeutic approaches, treatment results

Bilateral adrenal neuroblastoma (BANB) is a very rare entity. It is more common in young children and has certain clinical features. Patients with BANB have a more favorable prognosis than patients with unilateral adrenal neuroblastoma (NB). The article presents an analysis of 29 cases of BANB in children who underwent treatment at the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology. This study is supported by the Independent Ethics Committee and approved by the Academic Council of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology. The analysis was performed for the period from April 2012 to December 2018. Bilateral adrenal involvement was diagnosed on the basis of analysis/assessment of the results of all relevant imaging and instrumental tests. Additionally, we performed a retrospective analysis of the findings of computed tomography, magnetic resonance imagining, and scintigraphy with 123I-metaiodobenzylguanidine (123I-MIBG). In view of 123I-MIBG scintigraphy sensitivity threshold, and in order to confirm the diagnosis, imaging findings were reviewed by an experienced radiologist. The patients received therapy in accordance with the risk-adapted NB-2004 protocol. Here, we analyzed the details of clinical presentation of the disease, age at the time of diagnosis, time from the disease onset to diagnosis, the presence or absence of life-threatening symptoms (LTS) and adrenal insufficiency, the aspects of patient management (including special aspects of surgical treatment), and treatment results. The median age at the time of diagnosis was 1.9 months. The patients were divided into 3 groups: children with localized BANB; children with true stage 4 disease; children with stage 4S disease. Most patients had metastatic NB, whereby stage 4S cases prevailed (55%, n = 16). Given the low sensitivity of MIBG scintigraphy for the detection of small tumours (less than 2 cm), one should use a comprehensive approach to the assessment of the results of imaging and instrumental tests in patients with BANB in order to confirm bilateral involvement. At diagnosis, about half of the patients with BANB (48%) had clinical symptoms associated with the presence of a retroperitoneal tumour mass and massive hepatomegaly because of liver metastases. Thirty-four percent of patients developed LTS. One of the typical features of BANB was the frequent development of adrenal insufficiency (in 41% of cases) caused by bilateral adrenal involvement, and this should be taken into account when performing diagnostic investigations and providing treatment to patients. Since bilateral radical resection is associated with the inevitable development of adrenal insufficiency, surgical treatment should be determined on an individual basis. Bilateral adrenalectomy is not generally recommended and can be undertaken after an interdisciplinary discussion in case of unfavourable course of the disease (e.g. in case of recurrence). Even if patients with BANB develop certain complications or events (progression) their prognosis is still good. The three- and five-year event-free survival rates in patients with BANB were 86 ± 6.4%. The three- and five-year overall survival rates were 100%. The analysis of patients with BANB showed that they have a more favourable course of the disease, and this may serve as grounds for assigning such patients into a special group. In view of the degree of tumour extension, the specifics of staging, and frequent development of adrenal insufficiency, standard check-ups should be complemented by endocrine monitoring, and surgical approaches should be chosen on an individual basis.

Effects of Lupron and surgical castration on fecal androgen metabolite concentrations and intermale aggression in capybaras (Hydrochoerus hydrochaeris).

To curb agonistic interactions in a bachelor group of three male capybaras (Hydrochoerus hydrochaeris), a single dose of leuprolide acetate (Lupron®) was used in an attempt to chemically sterilize the males. Concurrently, fecal androgen metabolite (FAM) concentrations were quantified via enzyme immunoassay to monitor changes in testosterone production after injection of the gonadotropin-releasing hormone agonist. When Lupron proved ineffective in suppressing intraspecific aggression, surgical castration was performed on two males, with continued noninvasive endocrine monitoring. In all three capybaras, FAM concentrations increased initially as a result of the luteinizing hormone surge, but then decreased significantly following chemical sterilization. Surgical castration resulted in further, persistent declines in FAM concentrations in two males, while the third, intact male demonstrated a rise in FAM to pre-Lupron concentrations at 8.5 and 9.5-month postadministration. Despite successful suppression of sperm and testosterone production, intermale aggression continued, ultimately necessitating separation of the animals and transfer to other holding institutions. Under this set of conditions, a single Lupron dose was inadequate for suppressing intraspecific aggression in a group of three males with a pre-established history of aggression.