Neuroendocrine Symptoms Research Articles

The relationship between fibromyalgia and major depressive disorder: a comprehensive review

ABSTRACTObjective: A large body of evidence suggests that the relationship between major depressive disorder (MDD) and fibromyalgia (FM) is complex. Improved understanding of this relationship promises to provide clinicians with better assessment and treatment options for both disorders.Method: This paper reviews research on the prevalence, etiology and pathogenesis, clinical characterization, and treatment of FM and MDD, as well as studies that examined the relationship between these disorders. Studies were identified via PubMed literature search.Results: Our findings point to substantial similarities in neuroendocrine abnormalities, psychological characteristics, physical symptoms and treatments between FM and MDD. However, currently available findings do not support the assumption that MDD and FM refer to the same underlying construct or can be seen as subsidiaries of one disease concept.Conclusion: New methodological and theoretical approaches may lead to a better understanding of the link between FM and MDD, and to more effective psychological and psychopharmacological therapies for FM patients. In the meantime, clinicians should carefully screen for a history of MDD in patients with FM.

Repeated social defeat in female pigs does not induce neuroendocrine symptoms of depression, but behavioral adaptation

The aim of this study was to develop an animal model of major depression. Since two thirds of depressive patients are women, it is important to develop specific female animal models of depression. We therefore determined the consequences of chronic social defeat in individually housed prepubertal female pigs confronted with a dominant, older pig. Repeated defeat increased the salivary cortisol level, measured immediately after the confrontations, but this effect diminished after repeated confrontations. Neither organ weights nor the number of glucocorticoid (GR) and mineralocorticoid (MR) receptors in the ventral hippocampus were affected by repeated defeat. Serotonin turnover in the dorsal hippocampus was also unaffected. Behavioral analysis revealed that across confrontations, the pigs reduced the time spent actively attacking the dominant pigs, whereas the time increased in which the pigs passively underwent aggression and/or actively avoided aggression. Therefore, we conclude that the repeated social defeat paradigm does not induce long-lasting depression-like neuroendocrine effects as a consequence of behavioral adaptations (changes in the fighting strategy) in the young female pigs.

Non-Functional Retroperitoneal Paraganglioma Mimicking an Ovary Mass: A Case Report

The paraganglioma is rare neuroendocrine tumor arising from paraganglionic tissue and most cases show characteristic endocrinological symptoms that are caused by catecholamine secretion. We report here on a case of nonfunctioning retroperitoneal paraganglioma that did not show any neuroendocrine symptoms, and this was misdiagnosed as ovarian tumor by ultrasonography and CT.

Microsurgical treatment of nonmeningeal tumors of the cavernous sinus

To analyze the differential diagnosis of and effectiveness of surgical treatment on nonmeningeal tumors of cavernous sinus. The clinical data, including clinical manifestations, diagnosis and differential diagnosis, operative procedure, and treatment results of 67 cases of nonmeningeal tumors of cavernous sinus, 32 males and 35 females, aged 41 +/- 16, who underwent microsurgical treatment were analyzed respectively. The main clinical presentation included cranial nerve paralysis (47 cases, 70.1%), neuroendocrine symptoms (11 cases, 16.4%), eye pain (9 cases, 13.6%), proptosis (7 cases, 10.6%), limb weakness (5 cases, 7.5%), headache, dizziness, lethargy, and temporal lobe epilepsy (4 cases each), and epistaxis (1 case). All patients had CT and/or MRI scanning before operation. Twenty-six patients had DSA examination and balloon occlusion test (BOT). All patients underwent orbito-zygomatico-pterional craniotomy. Twenty cases were operated on via intradural approach, 33 cases via epidural approach, and 14 cases via epidural/intradural combination approach most of which suffered from invasive pituitary adenoma and dumbbell type trigeminal neurinoma. Pathological examination revealed that hemangioma (24 cases), trigeminal schwannoma (18 cases), and invasive pituitary adenomas (11 cases) comprised the majority of tumors; the remaining tumor types were chordoma, chondroma, chondromyosarcoma, chondrofibroma, dermoid tumor, malignant nerve sheath tumor, metastatic tumor, and lymphoma. In the intradural approach group, total tumor removal was achieved in 8 cases (40%), and 7 (35%) cases and 5 (25%) cases had subtotal and partial resection respectively. In the epidural approach group, 27 cases (81.8%) had total tumor removal, while 1 case (3.0%) had subtotal and 5 cases had partial excision of the tumor. In the epiduro-transdural approach group 10 cases (71.4%) achieved total resection and 4 cases (28.6%) had subtotal resection. Postoperative follow-up lasting 6 months to 10 years showed that the pre-operative central nervous system symptoms recovered in 39 cases (58.2%). The aggressive or new symptoms mainly included paralysis of oculomotor nerve (13 cases, 19.4%), trigeminal nerve (9 cases, 13.4%), and abduct nerve (9 cases, 13.4%). Depending on pathologic type and growth pattern of the tumor, extended middle skull base epidural or epidural-transdural approach is selected. Such techniques can offer satisfactory outcome, protecting the cranial nerve functions and removing the tumor to the maximum extent.

Medical management of hypopituitarism in patients with pituitary adenomas.

Hypopituitarism is a disease complex with variable clinical manifestations. Recent studies have improved our understanding of its pathophysiology, particularly in patients with pituitary adenomas. In that setting, hypopituitarism was previously considered a permanent and irreversible process, requiring life-long hormone replacement therapy. While this could be true in some instances, recent data demonstrated recovery of pituitary function in a large number of patients with hypopituitarism following surgical decompression. Mechanical compression of portal vessels and the pituitary stalk, by the expanding adenoma was postulated to be the predominant mechanism causing hypopituitarism in this setting. Since portal vessels also provide blood supply to the anterior lobe, ischemic necrosis of portions of the pituitary can occur as a result of increased and prolonged compression by the expanding adenoma. Recent data demonstrated increases in intrasellar pressure (ISP) in patients with pituitary macroadenomas, particularly those with hypopituitarism. The data showed that ISP measurements correlated positively with the serum prolactin levels but not with tumor sizes. It is postulated that increased ISP has predominant role in the pathogenesis of hypopituitarism in patients with pituitary adenomas while. The increase in ISP results in decreased blood flow through the portal vessels and the pituitary stalk. The latter will result in diminished delivery of hypothalamic hormones to the anterior pituitary and may also cause ischemia and/or necrosis in some portions of the normal gland. Recovery of pituitary function can thus be anticipated after surgical decompression, in patients who have viable pituitary cells. Understanding the pathophysiology of hypopituitarism and recognizing the probability for recovery of function should be emphasized in the management of patients with this disease. An important aspect of the management is patients' education about their disease, including the use of medic alert identification. The managing physician should appreciate the variable clinical manifestations of the disease and the possible occurrence of other associated neuroendocrine, neurological and neuro-ophthalmologic signs and symptoms. Treatment of hypopituitarism should not be rigid but instead, always individualized. Management should take into consideration the patients' age, sex, education, original disease process and clinical history.

Current approaches and perspectives in the therapy of medullary thyroid carcinoma.

Medullary thyroid carcinoma (MTC) is a neuroendocrine tumor derived from parafollicular cells. At present, surgery is the most important treatment for MTC. We describe the current approaches of MTC treatment (surgery, chemotherapy, radiation therapy, and biologic therapy). MTC is currently approached surgically in the main part through total thyroidectomy and compartment-oriented microdissection of cervicomediastinal lymph nodes. Substitutive l-thyroxine administration together with close clinical monitoring and the measurement of basal and stimulated serum calcitonin are subsequently performed. Radiotherapy and chemotherapy play a marginal role in advanced MTC. Recently, it has been found that somatostatin analogs and type I interferon are able to control the neuroendocrine symptoms induced by advanced MTC and that they provide clinical benefit by improving the lifestyle of these patients. Although these agents are poorly active in inducing a shrinkage in tumor mass, the combined use of different biologic agents and cytotoxic drugs needs to be explored in advanced MTC. However, at present, surgery is the only curative treatment for MTC.

Pineal Region Cavernoma. Case Report

A 45-year-old male presented with a rare pineal region cavernoma. Magnetic resonance (MR) imaging confirmed the preoperative diagnosis. The tumor was totally excised. The patient was subsequently cured. Analysis of 15 reported cases found a slight female preponderance. The second and third decades were the most common age group. The course of pineal cavernomas can be complicated by hemorrhage, occlusion of cerebrospinal fluid pathways, and focal neurological and neuroendocrine symptoms but no specific clinical features. However, MR imaging has high sensitivity and the specificity for the diagnosis of pineal cavernoma. Total microneurosurgical excision is the treatment of choice, and patients had an excellent outcome. Stereotactic biopsy can be potentially dangerous because of the risk of hemorrhage. The use of radiosurgery requires evaluation of long-term risks and safe dose levels. Total excision of the pineal cavernoma using microsurgical techniques is the choice of treatment in young and healthy patients since there is an increased risk of recurrent hemorrhage and progressive neurological decline. A conservative approach is preferred in older patients.

Recent advances in the diagnosis and treatment of central nervous system germ-cell tumours.

Primary germ-cell tumors of the central nervous system are rare neoplasms that are seen primarily in the pediatric age group. Because of their frequent location in the pituitary and suprasellar regions, they present with typical neuro-ophthalmologic and neuroendocrine symptoms. Sophisticated imaging and surgical biopsy allow precise anatomic definition, but only allow an approximate guess of the tumor histopathology. Tumor markers in the serum and cerebrospinal fluid are extremely helpful in the diagnosis and monitoring of response to treatment when they are detectable. Because of the deleterious effects of irradiation on neurocognitive and neuroendocrine functioning, we have looked at strategies that either reduce or eliminate radiation exposure. Large, randomized, prospective, cooperative trials in the future will be the only way to identify subgroups of patients that may benefit from particular treatment strategies.

Cytokines, "depression due to a general medical condition," and antidepressant drugs.

Activation of the immune system during various medical conditions produces neural, neuroendocrine, and behavioral effects. The psychological and physiological effects of immune activation resemble many characteristics of depression. The essential features of depression are depressed mood and loss of interest or pleasure in all, or almost all activities (anhedonia). Several associated symptoms are also present, including, appetite disturbance, change in body weight, sleep disturbance, psychomotor disturbance, fatigue, loss of energy, and difficulty in thinking or concentrating (DSM-IV, 1994). Depression is also characterized by specific alterations in the functioning of neurochemical and neuroendocrine systems, including monoaminergic systems and the hypothalamic-pituitary-adrenal (HPA) axis (Brown, Steinberg, & van Praag, 1994; Holsboer, 1995). Most of these psychological and neuroendocrine symptoms appear both in humans and animals during diseases that involve immune activation. Based on these findings, and on several additional lines of evidence that will be presented below, we have recently argued that immune activation is involved in the etiology and symptomatology of depression associated with various medical conditions (Yirmiya, 1997).

Congestive heart failure. Towards a comprehensive treatment.

Heart failure constitutes an increasing health hazard with major demands on health care resources. Recent major advances in drug treatment have yet to be translated into increased survival of heart failure patients in the community at large. Failure of diagnosis is a major factor in delaying early and adequate treatment. Echocardiography probably provides the most reliable and inexpensive instrument to confirm the diagnosis and pinpoint the mechanical components of the syndrome. The targets for therapeutic intervention may be categorized (i) haemodynamic, neuroendocrine and metabolic disorders (ii) symptoms and quality of life, (iii) morbidity and mortality risks. Symptoms and quality of life are the prime concerns of the physician in the treatment in the individual patient. Selection of anti-heart failure drugs used should be based on knowledge of the impact on the pathophysiological disorders and on the morbidity and mortality risks. Diuretics, vasodilators and ACE-inhibitors are now accepted as standard treatment, particularly when used in combination. Controversy continues to surround the efficacy of digitalis glycosides; they improve symptoms in some patients but their impact on morbidity and mortality risks is still uncertain. Even with standard treatments, may practical therapeutic questions remain, one of which is what is the most efficacious dose of each anti-heart failure drug which, when used in combination, will give the maximum improvement in quality of life and greatest extension of survival? Despite available treatment with diuretics, digitalis, vasodilators and ACE-inhibitors, the morbidity and mortality risks of congestive heart failure remain high. None of these drug groups significantly modulates the excessive excitation of the sympathoadrenal system, one of the two major neuroendocrine hazards of heart failure. For this reason, amongst the many newer drugs in development, the beta-adrenoceptor antagonists hold considerable promise as the next step towards a more comprehensive treatment of congestive heart failure.

Insulin-associated modulation of neuroendocrine counterregulation, hypoglycemia perception, and cerebral function in insulin-dependent diabetes mellitus: evidence for an intrinsic effect of insulin on the central nervous system.

Evidence for an intrinsic effect of insulin on the central nervous system is accumulating. To test the hypothesis that insulin per se may modulate neuroendocrine counterregulation, hypoglycemia perception, and cerebral function in insulin-dependent diabetes mellitus, we examined 27 patients without any sign of classical autonomic neuropathy or evidence of so-called hypoglycemia unawareness. We used the hyperinsulinemic (0.67 vs. 2.00 mU/kg.min), stepped hypoglycemic (5.6/3.5/2.4/2.0 mmol/L) clamp technique to assess the patient's awareness of and response to equivalent hypoglycemic stimuli under different degrees of physiological hyperinsulinemia (approximately 270 vs. approximately 810 pmol/L) after an overnight euglycemic clamp (5.6 mmol/L). Simultaneously, the patient's cerebral function was assessed from his electrophysiological activity and neuropsychological skills. Higher degrees of physiological hyperinsulinemia caused enhanced neuroendocrine response (adrenaline, P < 0.05; noradrenaline, P < 0.03; GH, P < 0.02; beta-endorphin, P < 0.03; ACTH, P = 0.12; cortisol, P = 0.06; PRL, P = 0.08) and symptom awareness (total symptoms, P < 0.04; autonomic symptoms, P < 0.02; neuroglycopenia symptoms, P < 0.05; sweating, P < 0.05; heart pounding, P < 0.02; trembling, P < 0.01; lack of concentration, P < 0.02) to occur. Deteriorations of electrophysiological activity (middle latency auditory-evoked potentials, P < 0.04; Pa peak latencies, P < 0.05; Pa-V interpeak latencies, P = 0.08) and neuropsychological skills (Stroop test, P < 0.05; trail making, P = 0.12) were more pronounced the higher the insulin level, but at similar blood glucose concentrations. We conclude that insulin-associated modulation of neuroendocrine counterregulation, hypoglycemia perception, and cerebral function may occur in insulin-dependent diabetes mellitus, which indicates an intrinsic effect of insulin on the human brain.

A further parametric study of imipramine in an animal model of depression

We have proposed that chronic stress may produce motivational, behavioral, and neuroendocrine symptoms in rats resembling endogenous depression in humans. The chronic stress model has proved responsive to chronic treatment by antidepressant drugs. Two issues concerning this effect remain unresolved, these being; the requirement of drug chronicity, and treatment outcome to different drug doses. The present experiment examined both issues in a factorial design in which vehicle and two doses of the tricyclic antidepressant imipramine were varied across 2 treatment periods; acute (1 hr) and chronic (3 weeks). Both factors were found to significantly interact with treatment outcome, suggesting that chronic treatment is necessary for recovery and that this outcome is dependent upon drug level.