Anterior Pituitary Hormone Levels Research Articles

Chronic Lead Exposure Impairment of Hypothalamic-Pituitary-Gonadal Axis in Adult Male Wistar Rats: Biochemical and Histomorphological Evidence

Introduction: The upsurge in male infertility has been associated with impaired hypothalamic-pituitary-gonadal (HPG) axis. There is a dearth of conclusive empirical data as to the deleterious impacts of heavy metal intoxication on male reproductive functioning through the HPG axis. Objective: This study seeks to elucidate the possible effects of chronic lead exposure on HPG signalling activities via biochemical and histopathological assessment. Experimental Section/Material and Methods: Forty adult male Wistar rats were randomised into four experimental groups (n=10). Group A, the control group received standard feed and water ad libitume. In Groups B, C and D, animals were orally administered lead acetate at concentrations of 2.5% 3.0% and 3.5%, respectively, using a stock solution of 150mg/kg once daily for 35 days. After the treatment period, all animals were fasted overnight and euthanized by cervical dislocation. Blood levels of anterior pituitary hormones (FSH and LH) were analysed using standard methods. Statistical analyses was done on graph pad prism. Testicular tissue was processed routinely for histopathological analyses using different stains. Results: Hormonal assays showed no significant changes in follicle-stimulating hormone (FSH) and luteinizing hormone (LH) (p>0.05) levels across groups. However, histological examination revealed alterations in testicular architecture, including disrupted spermatogonia cell arrangement and reduced Sertoli cell numbers, indicative of adverse effects on spermatogenesis. Conclusion: Chronic lead exposure adversely affects testicular histomorphology in adult male Wistar rats, potentially impacting reproductive function. While hormonal levels remain relatively unaffected, alterations in testicular structure suggest a direct impact on gonadal functions at a cellular level.

Anterior and Posterior Pituitary Function in Patients with Sheehan Syndrome - Combining the use of Insulin Tolerance Test and Copeptin Assay.

Sheehan syndrome (SS) typically involves the loss of anterior pituitary cells and rarely affects the posterior pituitary. The water deprivation test (WDT) is the gold standard for diagnosing central diabetes insipidus (CDI), but it is cumbersome. Serum copeptin measurements are an alternative for CDI diagnosis. In this study, we measured hypoglycaemia-stimulated serum copeptin in SS patients to assess posterior pituitary function alongside anterior pituitary hormone levels. This study recruited 43 patients with SS on stable hormonal replacement except for growth hormone (GH), 18 patients with CDI, and 19 body mass index (BMI) and parity-matched controls. All patients with SS and four patients with CDI underwent an insulin tolerance test (ITT), and hypoglycaemia-stimulated copeptin levels were measured at 0, 30, 45, and 90 minutes after insulin injection. The mean serum copeptin level among patients with SS (26.01 ± 12.41 pmol/L) was significantly lower than that in healthy controls (31.92 ± 7.85 pmol/L) and higher than that in patients with CDI (1.81 ± 0.14 pmol/L). Using pre-defined cut-offs for CDI, basal serum copeptin <2.69 pmol/L and stimulated levels <4.92 pmol/L for complete central DI, and basal copeptin levels >2.69 pmol/L and stimulated copeptin <4.92 pmol/L for partial central DI, 9.2% (n = 4) of patients with SS had CDI, of which half had complete CDI and half had partial CDI. A significant number of patients with SS who are on hormone replacement therapy show involvement of the posterior pituitary, despite not displaying symptoms.

FRI311 GnRH Agonist Induced Pituitary Apoplexy In A Patient With Gonadotropinoma

Abstract Disclosure: I. Madahar: None. S. Khan: None. L. Hergenroeder: None. B. Skaff: None. A. Haider: None. Introduction: GnRH therapy is commonly employed in patients with advanced prostate cancer. It acts as an agonist that binds to pituitary GnRH receptors. It acts via desensitization, downregulating FSH and LH production, and ultimately decreasing testicular steroidogenesis. Initial administration leads to transient stimulation of the pituitary which leads to elevated FSH and LH levels and increased production of estrogen and testosterone with eventual downregulation of the overall pathway. Case description: 80-year-old male with a past history of atrial fibrillation and OA was diagnosed with prostate cancer. Prostate adenocarcinoma Gleason score 7 (4+3) grade 3 was diagnosed by needle core biopsy five months prior to presentation. CT chest, abdomen, pelvis, and bone scan did not show evidence of metastatic disease. A week prior to starting Lupron therapy he was started on bicalutamide therapy. He received a dose of leuprolide (Elligard) as part of his chemoradiation therapy for his cancer. The patient went golfing after the treatment and within four hours he started noticing headaches and retroorbital pain. Headaches were sharp in quality, intensity 9 out of 10, and associated with nausea and vomiting. He later developed right-sided ptosis and double vision which progressively worsened after the next few hours. An initial CT scan of the head showed an enlarging pituitary mass which was followed MRI of the brain with and without contrast showed an enlarged pituitary mass and right cavernous sinus effacement of the optic chiasm. Anterior pituitary hormone functions were ordered, and the patient was started on stress-dose steroids. Transsphenoidal pituitary resection was done which the patient tolerated well pathology showed pituitary adenoma with pituitary apoplexy and the immunoprofile was compatible with gonadotroph adenoma. The adenoma cells were positive for synaptophysin, cam 5.2, GATA3, and FSH. A repeat MRI of the Sella three months after surgery showed a 9 mm nodule in the right aspect of the Sella. Anterior pituitary hormone levels done prior to surgery showed an IGF- 1 level of 204 ng/ml (Z score 1.5 SD). TSH and free T4 were in the normal range. Hydrocortisone was tapered and stopped 6 weeks after transsphenoidal surgery. Discussion: Lupron levels reach maximum concentration four hours after intramuscular administration. Initial pituitary stimulation by leuprolide administration causes the increased metabolic activity of the underlying adenoma which outgrows its blood supply, thus developing ischemic necrosis and subsequent hemorrhage. The majority of pituitary apoplexy develops in patients with previous undiagnosed pituitary adenomas. Should patients get central imaging to screen for pituitary macroadenoma before Lupron treatments to prevent this potentially life-threatening complication? Presentation: Friday, June 16, 2023

Alterations in neuroendocrine axes in brain-dead patients.

To identify changes in anterior pituitary gland hormone levels in brain-dead patients and alterations in free triiodothyronine (fT3), free thyroxine, cortisol, testosterone, and estradiol levels. Ten postmenopausal women and 22 men with brain death (BD) were included. Thefirst blood sample for determination of hormones (pre-BD) was collected when the clinician observed the first signs of BD. The second blood sample (BD day) was drawn after BD certification. Female patients exhibited lower follicle-stimulating hormoneand prolactin levels pre-BD and luteinizing hormone, follicle-stimulating hormone, and prolactin levels on BD day than the age-matched controls. Male patients' sex hormone levels were similar to those of the age-matched controls, except for testosterone levels, which were low in both consecutive measurements. All gonadotropins and prolactin levels were above the tests' lower detection limits (LDLs), except for one male patient with gonadotropin levels below the LDLs of the tests. Estradiol levels in both sexes ranged from normal to elevated. FT3 levels were significantly decreased in the two measurements. Thyroid-stimulating hormone (TSH)levels were low in eight patients and all low TSH levels were above the test's LDL. The remaining patients had normal or elevated TSH levels. The median adrenocorticotropic hormone (ACTH) and cortisol levels were within normal limits. All cortisol and ACTH levels were above the tests' LDLs, except for one patient with ACTH levels below the LDL in both measurements. This study supports the hypothesis that the anterior pituitary gland continues to function in the brain-dead state.

Correlation analysis of anterior pituitary hormone and tumor size in patients with pituitary adenomas

Objective: To summarize the correlation between anterior pituitary function and tumor size in patients with different hormone-secreting pituitary adenomas. Methods: This was a retrospective case series study. The clinical data of 1 946 patients with pituitary adenoma hospitalized in the First Medical Center of Chinese PLA General Hospital from January 1, 2005, to December 31, 2020, were collected. The correlation between tumor size and anterior pituitary hormone levels was analyzed using Spearman rank correlation analysis in different types of pituitary adenomas. Results: The median age of the 1 946 patients was 45.1 years, of which 857 (44.0%) were men. The maximum tumor diameter of the patients [M (Q1, Q3)] was 22 (14, 30) mm. Tumor size in nonfunctioning adenomas (n=1 191) was negatively correlated with adrenocorticotropic hormone (ACTH) (r=-0.11, P<0.001), growth hormone (r=-0.13, P<0.001), and luteinizing hormone (men: r=-0.26, P<0.001, women: r=-0.31, all P<0.001). The tumor size of somatotropic adenomas (n=297) was positively correlated with growth hormone (r=0.46, P<0.001), but negatively correlated with male testosterone (r=-0.41, P<0.001). The tumor size of ACTH-secreting pituitary adenomas (n=155) was positively correlated with the ACTH level at 8∶00 AM (r=0.25, P<0.001); however, no correlation was found with cortisol at 8∶00 AM (P>0.05). The tumor size of prolactinomas (n=303) was positively correlated with the prolactin level (men: r=0.34, P=0.001; women: r=0.13, P=0.070). Conclusions: The correlation between the function of the anterior pituitary and size of the tumor depends on the cellular origin of the pituitary adenoma and specific type of hormone secretion. In somatotroph adenomas, ACTH-secreting pituitary adenomas, and prolactinomas, there is a positive correlation between tumor size and level of hormones secreted by the corresponding tumors. In patients with nonfunctioning adenomas, the tumor size was negatively correlated with the hormone levels of the pituitary-adrenal and pituitary-growth hormone axes.

Vitamin D Status Determines the Impact of Metformin on Gonadotropin Levels in Postmenopausal Women.

Metformin was found to decrease elevated levels of anterior pituitary hormones. Its impact on lactotrope secretory function was absent in women with vitamin D insufficiency. This study investigated whether vitamin D status determines metformin action on overactive gonadotropes. We compared the effect of six-month metformin treatment on the plasma levels of gonadotropins, TSH, prolactin, ACTH, estradiol, free thyroid hormones, IGF-1, and 25-hydroxyvitamin D, as well as on glucose homeostasis markers between three matched groups of postmenopausal women at high risk for diabetes: untreated subjects with vitamin D insufficiency (group A), untreated women with normal vitamin D status (group B), and individuals receiving vitamin D supplementation with normal 25-hydroxyvitamin D levels (group C). Only in groups B and C did metformin reduce FSH levels and tend to decrease LH levels, and these effects correlated with baseline gonadotropin levels, baseline 25-hydroxyvitamin D levels, and the improvement in insulin sensitivity. Follow-up gonadotropin levels were higher in group A than in the other two groups. The drug did not affect circulating levels of TSH, prolactin, ACTH, estradiol, free thyroid hormones, IGF-1, or 25-hydroxyvitamin D. The obtained results suggest that the impact of metformin on gonadotropin secretion in women after menopause is determined by vitamin D status.

Prolactin-secreting Pituitary Macro-adenoma Presenting with Mass Effects, Hormonal Deficiencies, and Neurogenic Diabetes Insipidus: A Case Report and Review of Literature

To report and review a case of prolactin-producing pituitary tumor presenting with mass effects, hormonal deficiency, and neurogenic diabetes insipidus in a nulliparous woman of Afro-Caribbean descent. The patient presented with dull-aching headaches associated with worsening vision, nausea, and vomiting. The patient also complained of polyuria, nocturia, thirst, polydipsia, and weight gain. Physical examination showed bilateral visual field defects, while investigations revealed hypernatremia and elevated plasma osmolality but decreased urine sodium concentration, osmolality, and specific gravity.&#x0D; Results of the hormonal profile showed high plasma prolactin levels, a low plasma concentration of the antidiuretic hormone, and decreased levels of other anterior pituitary hormones. Imaging revealed a large, uncalcified, cystic pituitary mass extending into adjacent structures and compressing the optic chiasm and internal carotid artery. The outcome of the water deprivation and desmopressin administration tests were consistent with neurogenic diabetes insipidus, and a diagnosis of prolactin-producing pituitary macroadenoma with mass effects, hormonal deficiencies, and neurogenic diabetes insipidus was made. The patient was commenced on medical treatment and referred for histopathological diagnosis and definitive treatment. This report highlights the coexistence of neurogenic diabetes insipidus with a prolactin-producing pituitary macroadenoma presenting with mass effects.

Myo-Inositol Potentiates the Inhibitory Effect of Metformin on Prolactin Levels

Introduction: Metformin was found to reduce elevated levels of anterior pituitary hormones. Its thyrotropin-lowering effect was more pronounced in individuals receiving myo-inositol. The aim of the present study was to investigate whether the concomitant supplementation of myo-inositol determines the impact of metformin on prolactin levels. Methods: The study population consisted of two groups of women with mild-to-moderate hyperprolactinemia. Group 1 included 24 individuals receiving myo-inositol preparations (2 g daily for at least 6 months), while 24 inositol-naïve women belonged to group 2. Both groups were matched for age, insulin sensitivity, and prolactin concentration. For the following 6 months, all women were treated with metformin (1.7 daily). Plasma glucose levels, the homeostatic model assessment of insulin resistance ratio (HOMA-IR), glycated hemoglobin, as well as plasma levels of total prolactin, monomeric prolactin, thyrotropin, free thyroid hormones, adrenocorticotropic hormone, and insulin-like growth factor-1 were measured at baseline and after 6 months of metformin treatment. Results: Metformin reduced plasma glucose, HOMA-IR, and glycated hemoglobin in both study groups, but this effect was more pronounced in group 1 than group 2. Treatment-induced changes in total and monomeric prolactin levels were significant only in group 1. There were no differences between follow-up and baseline values of thyrotropin, free thyroxine, free tri-iodothyronine, adrenocorticotropic hormone, and insulin-like growth factor-1. Treatment-induced changes in prolactin concentration correlated with baseline prolactin levels, baseline values of HOMA-IR, and the impact of treatment on HOMA-IR. Discussion: The obtained results suggest that myo-inositol supplementation potentiates the inhibitory effect of metformin on prolactin levels in women with hyperprolactinemia.

Myo-Inositol Enhances the Inhibitory Effect of Metformin on Gonadotropin Levels in Postmenopausal Women

Objectives: Metformin decreased circulating levels of anterior pituitary hormones and its effect on thyrotropin concentration was found to be stronger in individuals receiving myo-inositol. Phospholipids containing inositols are precursors of second messengers of several hormones, including gonadotropins and insulin. The aim of the current study was to investigate whether the concomitant use of myo-inositol changes the effect of metformin on gonadotropin levels. Design: A prospective observational study. Participants/Materials, Setting, and Methods: This study, conducted at a university-affiliated medical center, included two groups of postmenopausal women with prediabetes, matched for age, FSH and LH levels, and insulin sensitivity: women taking myo-inositol preparations for at least 6 months (group A, n = 23) and women not receiving inositol preparations (group B, n = 23). All participants were treated with metformin (850 mg twice daily) for the following 6 months. At the beginning and at the end of the study, we assessed plasma glucose, insulin, FSH, LH, thyrotropin, prolactin, adrenocorticotropic hormone, insulin-like growth factor-1, estradiol, and glycated hemoglobin. Results: The impact of metformin on glucose levels, the homeostatic model assessment 1 of insulin resistance ratio, and glycated hemoglobin was more pronounced in group A than in group B. Metformin administered with myo-inositol reduced both FSH and LH. No significant changes in gonadotropin levels were observed in women receiving only metformin. The impact on FSH and LH levels correlated with their baseline concentrations and with the degree of improvement in insulin sensitivity. Levels of the remaining hormones did not change throughout the study. Limitations: The most important limitation of the study is a relatively small number of participants. Moreover, the study protocol does not allow to conclude whether similar effects are observed in premenopausal women. Conclusions: Myo-inositol may enhance the inhibitory effect of metformin on gonadotropin production in postmenopausal women.

OR08-5 Associations Between Signal Transducer and Activator of Transcription (STAT) Mutations and Galactorrhea

Abstract Background Prolactin (PRL) is responsible for the development of mammary glands and milk production. STAT1 and STAT3 are genes that express transcription factors that mediate PRL's intracellular signaling, but an association between their function and galactorrhea has not yet been identified. Here we describe three patients with somatic STAT mutations and galactorrhea. A 27-year-old woman with hyper-IgE syndrome (Job's Syndrome) due to a STAT3 deletion mutation (p.Val463del) associated with recurrent infections reported thin, white, bilateral discharge with breast manipulation beginning in adolescence. She did not have spontaneous leakage or pain. At presentation, PRL was slightly elevated to 27.9 (ref. 2.0-25.0 mcg/L) with otherwise normal levels of anterior pituitary hormones. She was not on any drugs known to cause hyperprolactinemia. MRI showed a 5×4 mm microadenoma without any mass effect. A 32-year-old woman also with Job's syndrome due to a heterozygous loss-of-function STAT3 mutation (p.R382Q) associated with recurrent infections and papillary thyroid cancer described unilateral, chronic, thin, white nipple discharge with light touch of her right breast for "as long as she could remember." She had a history of breast abscesses, but at presentation there was no evidence of abscess or infection. PRL was 15.1 mcg/L, and other anterior pituitary hormones were normal. MRI showed a structurally normal pituitary. A 22-year-old woman with a STAT1 activating mutation (p.E235A) associated with recurrent infections, autoimmune hypothyroidism, T1DM, and hypogonadotropic hypogonadism requiring pubertal induction at age 12y reported bilateral galactorrhea starting at age 18y. A white, milky discharge could be expressed with light manipulation, but no discharge was produced spontaneously. PRL was 16.2 mcg/L with serial dilution and has consistently been in the reference range. Anterior pituitary evaluation was normal except for elevated TSH of 12.5 (ref. 0.27-4.2) consistent with autoimmune hypothyroidism. MRI revealed a diffusely enlarged pituitary gland (12mm in the cranio-caudal dimension) without focal hypo-enhancement. Conclusions It is known that PRL signaling involves the JAK/STAT pathway, and an analysis of human milk cells showed upregulated STAT3 and downregulated STAT1 during lactation (PMID 26909879). These three cases provide clinical evidence for a mechanistic connection between STAT signaling and galactorrhea and suggest that STAT3 and STAT1 function in opposite directions to regulate lactation. In our cases, increased STAT1 or decreased STAT3 activity are associated with normal-PRL, inducible galactorrhea. Beyond understanding the specific intracellular signaling pathways leading to galactorrhea, these observations may be utilized for developing therapies for those with impaired lactation. Presentation: Saturday, June 11, 2022 12:30 p.m. - 12:45 p.m.

ODP289 A rare case of COVID-19 vaccine-associated pituitary apoplexy

Abstract Background The occurrences of pituitary apoplexy following COVID-19 vaccination had only been reported twice. We present the case of a 24-year-old female who developed pituitary apoplexy following the second dose of an AstraZeneca COVID-19 vaccine. Clinical Case A 24-year-old female presented with sudden onset of severe frontal headache, a day after receiving her second AstraZeneca vaccine dose. She denied other symptoms including blurring of vision, eye pain and diplopia. On admission, her blood pressure was 120/80 mmHg, with no evidence of postural hypotension. She was overweight with a BMI of 29kg/m2. Confrontational visual field assessment was normal with no evidence of bitemporal hemianopia. An MRI of the pituitary showed a heterogenous enhancement of the pituitary gland, extending to the suprasellar region, measuring approximately 1.1cm×1.6×1.9cm (AP×W x CC) with features suggestive of pituitary apoplexy with mass effect to the optic chiasm and cavernous portion of the left ICA. Pituitary hormonal tests results showed normal anterior pituitary hormone levels, with the exception of insulin-like growth factor-1 (IGF-1) at a level of 417 ng/ml. Overnight dexamethasone test was performed and showed suppressed cortisol level of 48.4 nmol/L. Growth hormone suppression test resulted in suppressed GH level of &amp;lt;0.1ng/ml in the presence of hyperglycemia. Pituitary hypophysitis was considered because of the more likely age group and the typical presentation of severe headache. In the context that the headache had started shortly after the administration of the second dose of COVID-19 vaccine, this potentially could have been the trigger for the occurrence of pituitary apoplexy She was treated with high dose steroids and the headache improved. A follow up pituitary MRI showed a significant 50% reduction in the size of the pituitary mass. To date, this report would be the third linking COVID-19 vaccination and pituitary apoplexy. The first one occurred in a 44-year-old man, who presented with sudden onset of blurring of vision 3 days following the second dose of COVID-19 vaccine. His MRI showed a suprasellar mass with optic chiasm. His endoscopic transsphenoidal resection of the pituitary tumor showed focal hemorrhage and necrosis of pituitary adenoma cells. The second case occurred in 37 years old lady 5 days following the dose of Astra Zeneca vaccine. MRI finding showed consistent with pituitary apoplexy . Conclusion This report highlights a rare complication of the COVID-19 vaccine that could cause pituitary apoplexy. Possible explanation could be due to vascular dysfunction secondary to the overwhelming immunological response. Reference Jaggi, S. and S. Jabbour, Abstract #1001394: A Rare Endocrine Complication of the COVID-19 Vaccine. Endocrine Practice, 2021. 27(6): p. S116-S117 Piñar-Gutiérrez, A., P. Remón-Ruiz, and A. Soto-Moreno, CASE REPORT: Pituitary apoplexy after COVID-19 vaccination. Medicina clinica, 2021. Presentation: No date and time listed

Hypercortisolism on the background of recovery of COVID-19 (сase report)

Damage to the lung tissue is a predominant complication of the viral disease COVID-19. Recently, there have been complications from other organs, including highly vascularized endocrine glands. Regarding the adrenal glands, there are reports of their damage with a decrease in their function. Сhanging the function of the adrenal glands (AG) in patients with or after COVID-19 is important. A few adrenal autopsy studies in patients have revealed vascular thrombosis, cortical lipid degeneration, ischemic necrosis, parenchymal infarcts, and other lesions leading to a decrease in AG function. The central mechanism of adrenal dysfunction through hemorrhage and necrosis of the pituitary gland is also possible. This paper presents a rare case of the development of hypercortisolism in a young woman after recovering from COVID-19. Based on high ACTH levels (157 and 122pg/ml), a negative nocturnal dexamethasone test, and high 24-hour urinary free (daily) cortisol excretion rates, we tentatively suspected Cushing’s disease. Chromogranin A was within the normal range of 21.35 (reference value &lt;100). Other tests showed an elevated dihydrotestosterone level of 780.6 pg/ml (reference values 24–368 pg/ml). The levels of other anterior pituitary hormones tested were within the normal range. According to clinical guidelines, the drug of choice for the short-term treatment of this disease is steroidogenesis inhibitors— ketoconazole. The effectiveness of such a treatment regimen was previously brought to light by others. In our case, ketoconazole was prescribed at a dose of 400 mg 2 times a day and cabergoline (dostinex) at an initial dose of 1 mg per day. Given the low levels of vitamin D in the blood serum, it was recommended to continue taking vitamin D at a dose of 4000 IU per day. It was recommended to control blood laboratory parameters— serum cortisol, ACTH, AST, ALT, electrolytes, 25(OH)D, blood glucose level after 2 months and decide on further tactics for managing the patient.

Case 299.

History A 32-year-old woman presented to an ophthalmologist for bilateral blurry vision. She underwent MRI of the brain and orbits, which showed a focal abnormality within the pituitary gland. The patient was referred to an endocrinologist for further evaluation. Review of systems and physical examination by the endocrinologist revealed no symptoms or signs of endocrine dysfunction. Anterior pituitary hormone levels, including growth hormone, prolactin, thyroid stimulating hormone, follicular stimulating hormone, luteinizing hormone, and adrenocorticotropic hormone, were normal. Dynamic contrast-enhanced MRI of the sella and pituitary gland (Figs 1-3) and subsequent CT of the anterior skull base (Figs 4, 5) were performed.

Clinical Course and Management of Pembrolizumab-Associated Isolated Adrenocorticotrophic Hormone Deficiency: A New Case and Literature Review

Hypophysitis is rarely reportedin patients receiving pembrolizumab-only immunotherapies. Since the clinical presentation is usually as isolated adrenocorticotrophic hormone (ACTH) deficiency, patients may be misjudged as having clinical symptoms due to cancer or chemotherapy. A 49-year-old male with laryngeal cancer applied to our clinic just after the tenth cycle of his pembrolizumab treatment, with weakness andnausea/vomiting. Serum morning cortisol and ACTH were 0.47mcg/dl and 10.1pg/ml, respectively; the remaining anterior pituitary hormone levels were normal. Pituitary MRI revealed mild glandular enlargement and loss of posterior pituitary bright-spot. All symptoms and signs improved with low-dose prednisolone. This is the second reported case of pembolizumab-associated isolated ACTH deficiency having abnormal pituitary MRI findings as we have reviewed all reported cases in the literature.

Evaluation of anterior pituitary hormonal profile in patients with first seizure of tonic-clonic and temporal lobe epilepsies in Al-Zahra hospital of Isfahan, Iran, during 2014-2016: comparison of hormonal profiles in 2 types of epilepsy

Background and aims: Temporal lobe and tonic-clonic seizures are the most common types of epilepsy. It is a disease that disrupts the regulation of the hypothalamic pituitary adrenal (HPA) axis. The disturbance in the regulation of this axis affects the secretion of hormones from the anterior pituitary. Due to the different origins of these 2 types of epilepsy listed above, this study aimed to examine their differences in the level of anterior pituitary hormones. Methods: This cross-sectional study was conducted in Al-Zahra hospital of Isfahan, Iran, from 2014 to 2016. A total of 36 patients with the idiopathic first seizure were selected for the examination including 20 patients with tonic-clonic seizure and 16 patients with temporal lobe seizure. The diagnosis of epilepsy was confirmed by a neurologist along with electroencephalogram (EEG) findings. The levels of anterior pituitary hormones including thyroid-stimulating hormone (TSH), adrenocorticotrophic hormone (ACTH), GH (growth hormone), follicle-stimulating hormone (FSH), luteinizing hormone (LH) and PRL (prolactin) were measured and compared using ELISA method in both groups. Results: The results indicated that all the anterior pituitary hormones except TSH and ACTH had higher means in the temporal lobe epilepsy than in the tonic-clonic epilepsy, but a significant difference (mean ± SD) was reported only in GH (4.59±2.95) (2.55±1.87) (P&lt;0.005) and FSH (19.4±14.06) (4.34±2.37) (P&lt;0.033) respectively in the temporal lobe and tonic-clonic seizures. Meanwhile, there was a significant relationship between seizure, regardless of its type, and the level of growth hormone and FSH. Conclusion: In the future, hormonal changes may be used as an adjunct to diagnose the type of epilepsy. More studies are required to confirm the findings.

Akromegali hastalarında nodüler tiroid hastalığı ve metabolik parametreler ile ilişkisi

Aim: The high prevalence of nodular goiter in patients with acromegaly is well known. Insulin -like growth factor -1 ( IGF-1) has been claimed to be one of the etiologic factors. The aim of the study was to evaluate the incidence of thyroid lesions in our acromegalic patients and to analyze possible factors influencing thyroid nodule development, especially insulin resistance and hormonal parameters. Material and Methods: Sixty patients with acromegaly, 32 females, and 28 males, with a mean age of 52.7 ± 10 .0 years without known thyroid disease were included . Age and sex matched 100 control subjects also included in the study. Waist and hip circumference, weight, and height, fasting blood glucose , postprandial blood glucose , insulin , thyroid function tests , thyroid autoantibodies , lipid profile , IGF -1, growth hormone , other anterior pituitary hormone levels were measured in all patients. Magnetic Resonance Imaging (MRI) and thyroid ultrasonography ( US) was performed in all patients. Thyroid nodule volume and thyroid volume were calculated. Results: Thirty- five ( 58.3%) patients with acromegaly had thyroid nodules according to (% 25) in control group (p< 0,0001) . There were significant differences in BMI, thyroid volume, fasting glucose and TSH levels between patients and controls. After regression analysis , thyroid volume was associated with insulin, waist circumference , HOMA - IR, LDL - cholesterol and the size of the pituitary adenoma ( p < 0.05) or diabetes occurrence. During the logistic regression analysis , the presence of nodules was strongly associated with luteinizing hormone ( LH ) ( p <0.02) and HDL - cholesterol levels (p<0.05). Nodule volume were significantly associated with LH level ( p< 0.05) , ACTH ( beta = -0.51 , p< 0.01) , plasma cortisol ( beta= 0.965 , p < 0.05), free T4 (beta= 0.522, p<0.05), the size of adenoma (beta= 0.615, p<0.05) in the r egression analysis. Conclusion: The prevalence of nodules in acromegalic patients were found to be higher than usual prevalence. In addition to IGF-1, other hormones and insulin resistance might play an important role in thyroid volume, nodule volume, and nodule formation mechanism in patients with acromegaly.

Gender differences in hormonal statuses of patients with esophageal squamous cell carcinoma.

85 Background: Esophageal squamous cell carcinoma (ESCC) is 4-8 times more frequent in men than in women, with poorer prognosis. The purpose of the study was to analyze systemic and local hormonal statuses in patients with ESCC in dependence on their gender. Methods: The study included 34 ESCC (G2, рT1-2N0-1M0) patients: 21 men and 13 women. 11 men (52.4%) had lymph node metastases. Levels of sex steroids – total (T) and free (fT) testosterone, progesterone (P4), estradiol (E2), estrone (E1), prolactin (PRL), LH, FSH and sex steroid-binding globulin (SSBG) – were studied in the peripheral blood, tumor and resection line by the standard RIA and ELISA methods. Results: Men showed a decrease in the blood T concentration by 1.4 times, P4 by 2 times, and E2 increase by 2.5 times, while women showed 1.3 times increase in T and 2 times decrease in P4. Metastases in men were accompanied by an increase in blood levels of anterior pituitary hormones: PRL by 2.5 times, LH by 2.3 times and FSH by 2.2 times compared to patients without metastases. Analysis of the local saturation with sex hormones in visually unchanged esophageal tissues of ESCC patients did not reveal any significant gender difference. However, women were characterized by a higher content of anterior pituitary hormones, PRL, LH and FSH, in esophageal tissues compared to men. Men with metastases showed local hyper-androgenization of tumor and surrounding tissues, as the fT to E1 ratio was increased. Conclusions: The results confirmed the data on T-stimulation of malignant growth in the esophagus and the possible protective effect of estrogens. The free testosterone to estrogens ratio in esophageal tissues can probably serve as one of prognostic factors for the disease course.

Acute hormonal findings after aneurysmal subarachnoid hemorrhage – report from a single center

ABSTRACTPurpose: The aim was to assess anterior pituitary hormone levels during the acute phase of aneurysmal subarachnoid hemorrhage (aSAH) and analyze the possible association with the clinical condition and outcome. Material and methods: Forty patients with aSAH whose aneurysm was secured by endovascular coiling were enrolled. Basal secretions of cortisol, testosterone, luteinizing hormone (LH), prolactin (PRL), and sex hormone binding globulin (SHBG) levels were measured up to 14 days after the incident. Results: The main finding was that hypocortisolism was rare whereas testosterone deficiency was common in male patients. Furthermore, various other hormone deviations were frequent and there was wide interindividual variability. We found no association between delayed cerebral ischemia (DCI), outcome of the patients or aneurysm location, and hormone abnormalities, while both Hunt & Hess and Fisher grade were associated with low PRL levels. Hunt & Hess 5 was associated with low PRL concentration when compared to grades 1 (OR = 4.81, 95% CI 1.15–20.14, p = 0.03), 3 (OR 7.73, 95% CI 1.33–45.01, p = 0.02), and 4 (OR = 6.86 95% CI 1.28–26.83, p = 0.02). Fisher grade 4 was associated with low PRL concentration when compared to grades 3 (OR 3.37, 95% CI 1.06–10.73, p = 0.03) and 2 (OR 9.71, 95% CI 1.22–77.10, p = 0.04). Conclusion: Deviations from normal and huge interindividual differences are common in hormone levels during the acute phase of aSAH. Routine assessment of anterior pituitary function in the acute phase of aSAH is not warranted. During the follow-up in the outpatient clinic, hormone concentrations were not measured, which would have brought a more long-term perspective into our findings.

Changes of anterior pituitary function in patients with central nervous system infection

Objective To investigate changes and clinical significance of serum anterior pituitary hormone levels in patients with central nervous system infection. Methods Forty-five cases suffering from central nervous system infection at the department of Neurosurgery, Henan Provincial People's Hospital were enrolled in this study. All of patients received the laboratory tests of adrenocorticotrophic hormone (ACTH), cortisol, thyroid stimulating hormone (TSH), free triiodothyronine (FT3), free tetraiodothyronine (FT4), growth hormone (GH), insulin-stimulation factor-1 (IGF-1), gonadal hormone within 24 h of admission. On the third day post-infection and one month after infection curing, ACTH, cortisol, TSH, FT3, FT4, GH, IGF-1, prolactin prolactin (PRL) , follicle stimulating hormone (FSH), and luteinizing hormone (LH) were determined. Results During the acute phase, 18 patients (40.00%) showed apparent anterior pituitary hormone deficiencies, including 4 patients (8.89%) with corticotropic insufficiency, 5 patients (11.11%) with thyroid insufficiency, 7 patients (15.56%) with somatotropic deficiency [5 cases (11.11%) with low IGF-1], and 2 patients (4.44%) with low PRL [one cases (2.22%) with low FSH and LH]. On 18 cases, 16 cases (88.89%) with anterior pituitary hormone deficiencies resolved and 2 patients (4.44%) had corticotropic insufficiency one month after infection curing. Conclusion Pituitary insufficiency may occur in a considerable number of patients after acute infection. And the majority may reversible after infection recovery. Key words: Central nervous system infection; Anterior pituitary; Hormone

Adenohypofyz�rne horm�ny krvnej plazmy kr�likov po expoz�cii marhulov�ch semien in vivo

The present study describes possible changes in plasma levels of anterior pituitary hormones induced by bitter apricot (Prunus armeniaca L.) seeds in young female rabbits in vivo. Prunus armeniaca L. is an important medicinal edible plant species commonly known as “apricot”. The apricot is a member of the Rosaceae and subfamily Prunoideae. It is one of the most delicious and commercially traded fruits in the world. Apricot kernel is the inner part of the seed of the apricot fruit. The kernel is used to produce oil and other chemicals used for medicinal purposes. The seeds are potentially useful in human nutrition and for treatment several diseases especially cancer. In the present study apricot seeds were mixed with feed at different doses 0, 60, 300, 420 mg*kg-1 of body weight. ELISA was used to determine the levels of follicle stimulating hormone (FSH), luteinizing hormone (LH) and prolactin (PRL). 58- days application of apricot seeds did not affect the concentration (P≥0.05) of PRL, LH in blood plasma. Significant (P≤0.01) inhibition of FSH levels induced by the seeds was found at the dose of 420 mg*kg-1 but not at 60 and 300 mg*kg-1 of body weight. These results are suggesting that the natural substances present in apricot seeds may be involved in mechanisms of ovarian folliculogenesis.