Anterior Pituitary Research Articles

Male reproductive phenotypes of genetically altered laboratory mice (Mus musculus): a review based on pertinent literature from the last three decades.

Laboratory mice (Mus musculus) are preferred animals for biomedical research due to the close relationship with humans in several aspects. Therefore, mice with diverse genetic traits have been generated to mimic human characteristics of interest. Some genetically altered mouse strains, on purpose or by accident, have reproductive phenotypes and/or fertility deviating from wild-type mice. The distinct reproductive phenotypes of genetically altered male mice mentioned in this paper are grouped based on reproductive organs, beginning with the brain (i.e., the hypothalamus and anterior pituitary) that regulates sexual maturity and development, the testis where male gametes and sex steroid hormones are produced, the epididymis, the accessory sex glands, and the penis which involve in sperm maturation, storage, and ejaculation. Also, distinct characteristics of mature sperm from genetically altered mice are described here. This repository will hopefully be a valuable resource for both humans, in terms of future biomedical research, and mice, in the aspect of the establishment of optimal sperm preservation protocols for individual mouse strains.

Gross morpho-biometry, histometry and immunohistochemical investigations of pituitary gland in the juvenile and adult male African giant rats (Cricetomys gambianus)

This work was designed to investigate the morphometry and immunohistochemical features of pituitary glands in the African Giant Rats (AGR). Adult and juvenile AGR were sacrificed and their brains harvested, and the pituitary glands were carefully dissected. The weight, length and width of brains and pituitary glands were subsequently measured. Sections were prepared and stained using Haematoxylin and Eosin (H&E), Cresyl-violet and periodic-acid-Schiff (PAS) for histological analysis. Immunohistochemical analysis was carried out with Glial-Fibrillary-Acidic-Protein (GFAP) and Ionized-Calcium-Binding-Adapter-Molecule 1 (Iba1). Grossly, the AGR pituitary gland is a somehow laterally extended, saddle-shaped organ that is dorso-ventrally flattened. The gray-coloured adenohypophysis (anterior-pituitary lobe) was bigger in size than the whitish neurohypophysis (posterior-pituitary lobe) on physical examination. Histometrically, the adenohypophyseal length was noticeably greater than that of neurohypophysis in both juvenile and adult. Similarly, the adenohypophyseal and neurohypophyseal width in adult were found to be more than that of juvenile. Also, the histological staining of the neurohypophysis and adenohypophysis were distinct. In the neurohypophysis, fibrous and protoplasmic pituicytes were observed among fibres and Herring-bodies. Chromophils and chromophobes were identified in the adenohypophysis and melanotrophs in the intermediate lobe. Immunohistochemistry showed pituicytes in the neurohypophysis, which was positive with GFAP-antibody. With Iba1-antibody, the neurohypophysis expressed a stronger positive immunolabelling to microglia as compared to macrophages in the adenohypophysis. In conclusion, the gross and microscopic characteristics of pituitary glands of the AGR are found to be similar to other rodents and mammals. We recommend further study to compare morphometrical parameters between male and females of this model.

Effects of Restraint Stress on Circulating Corticosterone and Met Enkephalin in Chickens: Induction of Shifts in Insulin Secretion and Carbohydrate Metabolism.

This study examined the effects of acute restraint stress in the presence or absence of naltrexone on the circulating concentrations of insulin, glucose, Met-enkephalin and corticosterone in 14-week-old chickens [design: 2 sex × 2 stress/non-stress × 2 +/- naltrexone]. In chickens (five male and five females per treatment) subjected to restraint for 30 min, there were increases in the plasma concentrations of corticosterone and Met-enkephalin. The plasma concentrations of insulin and glucose were also increased in the chickens during restraint. Moreover, there were increases in the plasma concentrations of insulin and glucose in the chickens. The patterns of expression of the proenkephalin gene (PENK) in both the anterior pituitary gland and the adrenal gland were very similar to that of plasma Met-enkephalin. There were relationships between the plasma concentrations of corticosterone, Met-enkephalin, insulin and glucose after 30 min of restraint. The effects of naltrexone treatment on both untreated and stressed chickens were also examined, with naltrexone attenuating the stress-induced increases in the plasma concentrations of corticosterone, Met-enkephalin and glucose but not in those of insulin. The present study demonstrates that stress increases insulin secretion in chickens but also induces insulin resistance.

Long-term outcomes and potential predictive recurrence factors after endonasal endoscopic surgical treatment of symptomatic Rathke's cleft cysts.

Although patients with symptomatic Rathke's cleft cysts (RCCs) receive surgical treatment, recurrence sometimes occurs after surgery. However, the mechanism underlying recurrence remains unclear. We evaluated the outcomes of RCC decompression over a long-term follow-up period. We retrospectively reviewed the medical records of 35 patients with symptomatic RCC who underwent endonasal endoscopic surgery (EES) at our institution between 2008 and 2023. Patients' characteristics, intraoperative findings, and postoperative follow-up outcomes were evaluated. A univariate regression model was used to identify the predictors of recurrence. The median patient age was 48.0years, and 74.2% of the patients were female. The mean follow-up duration was 94.7 ± 47.6months. Cyst content recurrence was observed in 15 patients (42.8%). Five patients (14.2%) with symptomatic recurrence underwent reoperation. Postoperative vision improved in all 23 patients (100%); headaches improved in 20 patients (90.9%). A new hormonal deficit occurred in two patients (5.7%). Complications included intraoperative cerebrospinal fluid (CSF) leak in 10 patients (28.5%), postoperative CSF leak in two patients (5.7%), permanent diabetes insipidus in two patients (5.7%), and postoperative infection in three patients (8.5%). Univariate analyses revealed that the position of the anterior pituitary lobe (p = 0.019) and preoperative visual disturbances (p = 0.008) significantly affected recurrence after surgery. Although EES was efficient, the recurrence rate was relatively high over a long-term period. The anterior pituitary lobe position and preoperative visual disturbances were significantly associated with recurrence. The anterior-inferior position can predict a high risk of recurrence before surgery.

Serum Prolactin Levels and Mortality in Adults Without Prolactinoma: A Meta-Analysis.

Prolactin (PRL) is a highly versatile, multifunctional hormone synthesized and secreted by lactotroph cells of the anterior pituitary. Its metabolic role has been extensively studied even in normoprolactinemic populations. Recently, a wealth of observational data have outlined the potential prognostic value of PRL in various clinical settings. This systematic review aims to systematically evaluate and quantitatively synthesize the association between serum PRL levels and risk of mortality in adults without prolactinoma. A systematic literature search was conducted up to June 10, 2023, to identify studies reporting the association of serum PRL levels with clinical outcomes of adults without prolactinoma. A random-effects meta-analysis was conducted to quantify the adjusted hazard ratios [(a)HRs] for all-cause and cardiovascular death (CVD) during follow-up. Twenty-eight studies were deemed eligible reporting the outcomes of adults without prolactinoma, in whom serum PRL levels were measured for risk-stratification. Fourteen studies reported appropriate data for meta-analysis encompassing a total of 23 596 individuals. Each unit of PRL increase was independently associated with increased risk of all-cause (pooled aHR = 1.17 [1.08-1.27]; I2 = 48%) and CV mortality (pooled aHR = 1.54 [1.14-2.09]; I2 = 89%). Individuals belonging to the highest PRL category had significantly higher risk for all-cause (pooled aHR = 1.81 [1.43-2.30]; I2 = 65%) and CV (pooled aHR = 1.59 [1.04-2.42]; I2 = 82%) mortality compared to their lowest-PRL category counterparts. The association between PRL levels and in-hospital death did not reach statistical significance. PRL levels seem to be an independent predictor for mortality. Further validation is warranted before its role as a risk-stratification tool can be delineated in clinical practice.

Current Insights in Prolactin Signaling and Ovulatory Function.

Prolactin (PRL) is a pleiotropic hormone released from lactotrophic cells of the anterior pituitary gland that also originates from extrapituitary sources and plays an important role in regulating lactation in mammals, as well as other actions. Acting in an endocrine and paracrine/autocrine manner, PRL regulates the hypothalamic-pituitary-ovarian axis, thus influencing the maturation of ovarian follicles and ovulation. This review provides a detailed discussion of the current knowledge on the role of PRL in the context of ovulation and ovulatory disorders, particularly with regard to hyperprolactinemia, which is one of the most common causes of infertility in women. Much attention has been given to the PRL structure and the PRL receptor (PRLR), as well as the diverse functions of PRLR signaling under normal and pathological conditions. The hormonal regulation of the menstrual cycle in connection with folliculogenesis and ovulation, as well as the current classifications of ovulation disorders, are also described. Finally, the state of knowledge regarding the importance of TIDA (tuberoinfundibular dopamine), KNDγ (kisspeptin/neurokinin B/dynorphin), and GnRH (gonadotropin-releasing hormone) neurons in PRL- and kisspeptin (KP)-dependent regulation of the hypothalamic-pituitary-gonadal (HPG) axis in women is reviewed. Based on this review, a rationale for influencing PRL signaling pathways in therapeutic activities accompanying ovulation disorders is presented.

Hidden in the caves: a new troglobitic species of Spaeleoleptes and the type species redescription (Opiliones, Laniatores)

The genus Spaeleoleptes was proposed by H. Soares in 1966 to accommodate the first Brazilian troglobitic species of harvestmen, Spaeleoleptes spaeleus H. Soares, 1966. In this work, we redescribe this species, including digital images of the type material and drawings of the male genitalia. Since its description, Spaeleoleptes has remained monotypic, and after 56 years, herein is described the second species of the genus, the troglobitic Spaeleoleptes gimli sp. nov. Both species share sexually dimorphic legs I and II with modified regions and swelling on the tibiae and patellae I and II; a penis with robust conductors covering all or part of the capsula interna and a capsula interna with two lateral projections. They are clearly separated by the shape of the modified region of the tibia; by the presence of an apical projection on the apical lamina of the pars distalis in S. spaeleus; and the lateral projections of the capsula interna, which is flattened in S. gimli. Spaeleoleptes gimli greatly increases the distributional range of the genus, as it is now recorded from caves located in two Brazilian phytophysiognomies from the Cerrado of Minas Gerais to the Caatinga of Bahia.

The impact of prolactin and vitamin D levels as a prognostic markers of female hair loss

A limited number of case reports seem to point the interaction between thinning hair and a vitamin D deficiency. This research looked at the relationship between prolactin levels and vitamin D levels in women with hair loss. The anterior pituitary gland secretes a polypeptide hormone called prolactin, which has a variety of biological effects, including the capacity to encourage growth and have a proliferative influence on human keratinocytes. Calcium homeostasis is affected by this hormone as a result of deficiency in vitamin D. This study was conducted on 75 patients during the period from November 2019 to March 2021. Serum prolactin and vitamin D levels were measured by chemiluminescence through an immunoassay (automated) and fluorescence Immunoassay (FIA) for vitamin D measurement. Serum prolactin levels were significantly elevated in pregnant women with hair loss compared with healthy controls. Vitamin D and serum prolactin levels had a remarkable positive correlation (r = 0.661, P 0.005). Prolactin and vit. D may play a part in hair loss in women.

Effect of Hyperprolactinemia on Bone Metabolism: Focusing on Osteopenia/Osteoporosis.

Prolactin is a hormone secreted from lactotroph cells in the anterior pituitary gland to induce lactation after birth. Hyperprolactinemia unrelated to lactation is a common cause of amenorrhea in women of a childbearing age, and a consequent decrease in the gonadotropin-releasing hormone (GnRH) by a high prolactin level can result in decreased bone mineral density. Osteoporosis is a common skeletal disorder characterized by decreased bone mineral density (BMD) and quality, which results in decreased bone strength. In patients with hyperprolactinemia, changes in BMD can be induced indirectly by the inhibition of the GnRH-gonadal axis due to increased prolactin levels or by the direct action of prolactin on osteoblasts and, possibly, osteoclast cells. This review highlights the recent work on bone remodeling and discusses our knowledge of how prolactin modulates these interactions, with a brief literature review on the relationship between prolactin and bone metabolism and suggestions for new possibilities.

Seasonality of Reproduction in a Subtropical Free-Living Finch Amandava amandava: Plasticity of Adenohypophyseal Gonadotropes, Lactotropes, and Thyrotropes

Introduction: This study sought to decipher the mechanism of transitions between life-history stages in a seasonally reproducing subtropical finch, Amandava amandava delineating the plasticity of the gonadotropes (LH cells), lactotropes (PRL cells), and thyrotropes (TSH cells) in the pituitary gland including the pars tuberalis, with regard to the in situ expression, morphological characteristics, and alteration in the plasma levels of hormones. Methods: Immunohistochemistry of LH, PRL, TSH cells, morphometry and densitometry of expressed hormones (Image J software analysis), and ELISA for plasma hormonal levels were performed. Results: LH, PRL, and TSH cells showed remarkable plasticity during the annual seasonal reproductive cycle. In the PT, all the 3 cell types were detected during the breeding phase, with additional detection of the TSH immunoreactivity during the pre-breeding and the PRL immunoreactivity during post-breeding phases. Pars distalis (PD) expressions and the plasma levels of the LH and TSH were at the peak during the breeding phase, but the PRL peak was during the post-breeding phase. In addition to PRL in the neurohypophysis and in the median eminence, hypothalamic PRL, and TSH were also elucidated. Conclusions: This study suggests activation of the gonadal axis by the PT TSH which might transduce seasonal cues, but not specifically photoperiod, in the birds of the tropics/subtropics. Post-breeding phase sustained high plasma TSH and peak plasma PRL might coordinate the transition to the non-breeding phase including the trigger of parental care as the later hormone assigned with. Hypothalamic TSH and PRL might influence events of seasonality through central modulation.

Pituitary neuroendocrine tumors with PIT1/SF1 co-expression show distinct clinicopathological and molecular features

Pituitary neuroendocrine tumors (PitNETs) are classified according to cell lineage, which requires immunohistochemistry for adenohypophyseal hormones and the transcription factors (TFs) PIT1, SF1, and TPIT. According to the current WHO 2022 classification, PitNETs with co-expression of multiple TFs are termed “plurihormonal”. Previously, PIT1/SF1 co-expression was prevailingly reported in PitNETs, which otherwise correspond to the somatotroph lineage. However, little is known about such tumors and the WHO classification has not recognized their significance. We compiled an in-house case series of 100 tumors, previously diagnosed as somatotroph PitNETs. Following TF staining, histopathological features associated with PIT1/SF1 co-expression were assessed. Integration of in-house and publicly available sample data allowed for a meta-analysis of SF1-associated clinicopathological and molecular features across a total of 270 somatotroph PitNETs. The majority (74%, 52/70) of our densely granulated somatotroph PitNETs (DGST) unequivocally co-expressed PIT1 and SF1 (DGST-PIT1/SF1). None (0%, 0/30) of our sparsely granulated somatotroph PitNETs (SGST) stained positive for SF1 (SGST-PIT1). Among DGST, PIT1/SF1 co-expression was significantly associated with scarce FSH/LH expression and fewer fibrous bodies compared to DGST-PIT1. Integrated molecular analyses including publicly available samples confirmed that DGST-PIT1/SF1, DGST-PIT1 and SGST-PIT1 represent distinct tumor subtypes. Clinicopathological meta-analyses indicated that DGST-PIT1 respond more favorably towards treatment with somatostatin analogs compared to DGST-PIT1/SF1, while both these subtypes show an overall less aggressive clinical course than SGST-PIT1. In this study, we spotlight that DGST with co-expression of PIT1 and SF1 represent a common, yet underrecognized, distinct PitNET subtype. Our study questions the rationale of generally classifying such tumors as “plurihormonal”, and calls for a refinement of the WHO classification. We propose the term “somatogonadotroph PitNET”.

P-49 Unexpected spontaneous evolution of a symptomatic Rathke's cleft cyst

Abstract Introduction Rathke's cleft cysts (RCCs) are relatively rare sellar and suprasellar lesions that arise from remnants of Rathke's pouch, an embryonic precursor to the anterior pituitary gland. These cysts are often found incidentally during neuroimaging studies for unrelated issues. Despite their non-neoplastic nature, RCCs can lead to a spectrum of clinical manifestations due to their potential to compress surrounding structures, including the pituitary gland, optic chiasm, and adjacent neurovascular structures. However, the majority of Rathke's cysts will remain asymptomatic and typically do not necessitate any medical intervention. Instances of spontaneous regression of these cysts are infrequent, and cases of regression occurring after a recurrence are exceptionally rare. Clinical Case The patient is a 57-year-old individual with a medical history of well-controlled type 2 diabetes and high blood pressure. Additionally, the patient had a history of right ocular trauma in 1989 resulting in a decrease of visual acuity. The patient presented with persistent chronic headaches, leading to the detection of a Rathke's cleft cyst as revealed by a pituitary MRI showing a cystic structure measuring 15×11 mm in the sellar region. The cyst displayed a predominant left-sided lateralization and was characterized by T1 hypointensity as well as T2 hyperintensity. No enhancement was observed on post-gadolinium contrast injection. The cyst exerted a mass effect on the optic chiasm. Hypophyseal axis assessment revealed intact function. Notably, the patient exhibited significant visual field impairment in the right eye, marked by loss of the superior, nasal, and inferior fields, while the right visual field remained unaffected. The patient was managed conservatively based on the rationale that the visual disturbances were attributed to the ocular trauma and not linked to the RCC. Follow-up hypothalamo-hypophysial MRI conducted in April 2023 demonstrated complete spontaneous regression of the Rathke's cleft cyst, with an improvement of his chronic headache. Conclusion The natural history of RCCs is multifaceted leading to heterogenous outcomes ranging from volume progression with hormonal deficiencies and/or visual disturbances to stability over time to even spontaneous involution. The precise mechanism underlying the latter remains unclear. One possible explanation could involve disruptions in the equilibrium between the secretion and absorption of the cystic fluid, or even the potential occurrence of cyst rupture. The potential for involution or stability of the cyst is influenced by the cyst size. The likelihood of spontaneous involution advocates for a conservative strategy in cases of symptomatic RCCs where headaches are the sole presenting symptom.

Assessment of Serum Prolactin Levels in Patients with Liver Disease: A Cross-sectional Study

Introduction: Prolactin is a hormone released from the anterior pituitary gland under tonic inhibitory control by dopamine. A decrease in dopamine levels is usually observed in decompensated liver disease, which could be due to its inhibition by the increased synthesis of false neurotransmitters. However, the level of serum prolactin in liver disease patients still remains disputed. Aim: To evaluate the serum prolactin levels in patients with liver disease of different aetiologies and compare them with healthy controls. Materials and Methods: The present cross-sectional study was conducted in the Department of Biochemistry from August 2021 to August 2022 at Amrita Institute of Medical Sciences (AIMS), Kochi, Kerala, India. A total of 100 patients with liver disease and 100 age- and gender-matched healthy controls were enrolled in the study. Serum prolactin was estimated using the Electro- Chemiluminescence Immuno Assay (ECLIA) technique. The serum prolactin levels were compared among patients with liver disease of different aetiologies and with healthy controls. Statistical analysis was carried out using the Mann-Whitney U test, Kruskal-Wallis test, and Dun Bonferroni test. Results: The median serum prolactin levels were significantly elevated in the cases {40.61 (29.13-70.24 ng/mL)} compared to the controls {17 (10.95-20.70 ng/mL)}, This p-value is correct as the median levels for cases is {40.61 (29.13-70.24 ng/mL)}. Comparison of prolactin levels showed no statistically significant difference based on the distribution of age and gender. In the present study, prolactin levels were found to be most prominent in patients with fatty liver disease. Conclusion: The serum prolactin level increased significantly in liver disease patients, particularly in patients with fatty liver. Hence, prolactin levels can be used as a useful predictive biomarker for fatty liver.

Pituitary stalk thickening in pediatric patients: an underrecognized diagnosis?

Pituitary stalk thickening (PST) is a rare condition in pediatric patients. Data on PST in Latin American pediatric populations are scarce. The aim of this study was to characterize a comprehensive cohort of pediatric patients diagnosed with PST in Chile between 2020 and 2022. Retrospective review of medical records from 2020 to 2022 of patients under 18 years old diagnosed with PST, defined as a pituitary stalk width ≥ 3 mm at the pituitary insertion and/or ≥ 4 mm at the optic chiasm. A literature review was also performed to compare the identified cases with previously published ones. Nine patients with PST were identified. Their mean age at diagnosis was 10.36 years (range 2.4-17 years). The patients' main manifestations were polydipsia and polyuria (100%) and poor growth (77.8%). Eight patients had germ cell tumors, while one patient had Langerhans cell histiocytosis. At the time of diagnosis, all patients had arginine vasopressin (AVP) deficiency, along with a deficiency in at least one anterior pituitary hormone. Germ cell tumor markers were negative in all patients. A biopsy-confirmed diagnosis was obtained in all cases. Four patients required a second biopsy. The frequency of PST due to germ cell tumors was four patients/year during the study period, which is twice the expected frequency in Chile. This study, characterizing the largest cohort of pediatric patients with PST in Latin America, found germ cell tumors to be the main etiology of this condition. It is important to focus diagnostic procedures on obtaining a correct diagnosis and promptly initiating appropriate treatment in patients with PST. Regional cooperation is essential for gathering data from larger cohorts to enhance our understanding of pediatric PST and improve patient outcomes.

Comparison of the use of Metyrapone and Osilodrostat for Cushing Disease: A Systemic Review

Introduction: Cushing disease is characterised by excessive production of adrenocorticotropic hormone (ACTH) from the anterior pituitary, which results in increased release of cortisol from the adrenal glands. Nearly 10 to 15 million people per year have been reported to have this rare disease. As of today, there are different therapies available. The chances of recurrence and severe side effects are high. Objectives: To overcome the recurrence and side effects, we compared the drugs metyrapone and osilodrostat (class 11 beta-hydroxylase inhibitors) for their safety, efficacy, and other pharmacological actions before Cushing's disease. Methodology: Nine electronic databases were searched regarding the drugs metyrapone and osilodrostat for the treatment of Cushing's disease using the keywords. A total of 14 case studies were collected, which show different results and conclusions. Results and discussion: Based on the comparison, both drugs exhibited the same mechanism of action, but administering metyrapone showed more severe side effects than osilodrostat. While osilodrostat has greater efficacy, reducing the cortisol level faster, and also, the drug osilodrostat has a prolonged half-life, allowing it to be used only twice daily compared to the drug metyrapone, which requires six times daily dosing. Conclusion: Based on this, we conclude that the drug osilodrostat has a greater advantage over the drug metyrapone and is also the best treatment option for Cushing's disease.

A Study Estimating the Serum TSH Levels in First Trimester Pregnant Women

Background Pregnancy is a physiological condition among women. Pregnancy brings about major changes in the hormonal levels. Thyroid stimulating hormone is a hormone produced by anterior pituitary. TSH provides the most common sensitive index to reliably detect thyroid function abnormalities.ObjectiveThe goal of this study was to estimate the levels of serum TSH at first trimester in pregnant women in the department of Biochemistry St. Johnrsquos Medical College amp Hospital and compare with the biological reference intervals as established in the laboratory. Methodology This retrospective study was conducted from January to December 2021 in the department of Biochemistry St. Johnrsquos Medical College amp Hospital. Lab data review of pregnant women has been analysed for serum TSH. The study included 228 pregnant women in their first trimester aged between 20 and 35 years. Serum TSH levels were measured using the ABBOTT ARCHITECT CI8200 through Chemiluminometric Immunoassay. The collected data underwent analysis and comparison to derive descriptive statistics.Result A total of 228 pregnant women in the first trimester fulfilling the inclusion criteria were included. Maternal age of the study population was 20-35 years. Among the pregnant women 12 5.3 women showed low values for TSH lt0.35 microIUMl 11 4.8 women showed higher values for TSH gt4.94 microIUmL and 205 89.9 showed normal TSH levels during first trimester. In this study the mean TSH level in pregnant women was found to be 1.94plusmn1.50 microIUmL. The median TSH levels was 1.51 microIUmL 2.5th and 97.5th percentiles P2.5-P97.5 0.23-5.86 microIUmL.Conclusion The observed connection between aberrant TSH serum levels during the first trimester and adverse pregnancy outcomes underscores the necessity for proactive screening. Identifying pregnant women with elevated or reduced TSH levels early on holds significant potential for preventing complications. The incorporation of such screening protocols can yield a range of benefits including timely interventions and enhanced management strategies to mitigate adverse outcomes. Our research contributes to the growing body of evidence supporting TSH screening during early pregnancy emphasizing its pivotal role in safeguarding maternal and foetal health.

A Rare Case of Hypophysitis Due to Tuberculosis with an Atypical Presentation of Normal Pituitary Markers

Abstract Hypophysitis developing secondary to tuberculosis is a very rare clinical entity. Hypophysitis occurs because of inflammation and it may affect the anterior, infundibulum, posterior, or entire pituitary gland. Here, we are presenting a case of a young male having tubercular meningitis who was taking antitubercular treatment for the last 2 months and was having disseminated tuberculosis. The patient presented with severe headache with fever and 4–5 episodes of vomiting. The patient presented with the affection of consciousness in the form of confusion, irritability, and disorientation. High-resolution CT thorax was suggestive of pulmonary tuberculosis (Koch’s) with centrilobular nodules and a tree-in-bud appearance. Magnetic resonance imaging brain showed prominent leptomeningeal enhancement with an enlarged pituitary gland with enlarged enhancing stalk suggestive of hypophysitis. The hypophysitis case developing secondary to tuberculosis as a very rare entity is discussed in this case report. This case is also an atypical presentation wherein the pituitary markers are normal in hypophysitis.

Recognizing the Diverse Clinical Presentations of Acromegaly: Insight from a Case Series

Purpose: Acromegaly is an endocrine disease due to growth hormone excess with slowly developing manifestations and diverse clinical presentations. There are chances that patients may present with common clinical problems and the underlying endocrine condition is overlooked and diagnosis is delayed. This case series will discuss the presentation, clinical features and investigations of four acromegaly cases to increase the clinical skills of physicians so that an early diagnosis is made and treatment is initiated early. Methods: This is an observational study, where a series of four acromegaly cases, who presented to medicine inpatients or outpatients of Sylhet Women’s Medical College, Bangladesh. They were analyzed through detailed clinical features and, investigation findings. MRI brain was used as the main tool for diagnosis. Serum levels of growth hormone, IGF-1, TSH, ACTH, and prolactin were assessed in all. Other anterior pituitary hormone assays were selectively done. Ocular examinations were performed on all patients. Conclusion: Though a case series has lower value as medical evidence than systematic reviews and randomized clinical trials, it can help in generating future protocols of studies. This series emphasizes that a keen clinical eye of the physician can help in early diagnosis of acromegaly and thus an early MRI of brain based on clinical suspicion can ensure early treatment and prevent cardiovascular complications.

Morphological and molecular characterization of Mylonchulus laocaiensis sp. n. (Nematoda: Mylonchulidae) from Vietnam.

Mylonchulus laocaiensis sp. n. recorded from Vietnam, is described and illustrated, and its phylogenetic relationship within the Mylonchulidae family and Mononchida order are analysed. The new species is characterized by medium body size (L = 1.0-1.5 mm); buccal cavity goblet shaped, 26-29 × 14-16.5 μm or 1.8 (1.7-1.9) times as long as wide; posterior position of dorsal tooth apex (79%-88% from the base of buccal cavity); a small subventral tooth present on subventral wall; pars refringens vaginae with faint and small (2.5 × 1.7 μm) teardrop-shaped pieces, short pars distalis vaginae; male with short spicules (54-57 μm) with rounded head. The molecular data (18S and 28S rDNA) are provided for the new species.

Panhypopituitarism due to Sheehan’s Syndrome in a Patient with Recurrent Hyponatremia: Case Report from Nepal

Introduction: Panhypopituitarism, deficiency of all pituitary hormones (anterior pituitary hormones: adrenocorticotropic hormone, thyroid-stimulating hormone, luteinizing hormone, follicle-stimulating hormone, prolactin, growth hormone; posterior pituitary hormones: oxytocin, vasopressin). Sheehan’s syndrome also known as postpartum hypopituitarism is one of the causes of panhypopituitarism, which is characterized by hypopituitarism due to necrosis of pituitary gland secondary to massive postpartum hemorrhage. In this case, a 50 years female presented with the history of vomiting and loss of appetite since 2 years with severe hyponatremia, and decreased pituitary hormones levels in laboratory findings with significant obstetric history is diagnosed with Sheehan’s Syndrome.