scholarly journals Wrong Biochemistry Results: Two Case Reports and Observational Study in 5310 Patients on Potentially Misleading Thyroid-stimulating Hormone and Gonadotropin Immunoassay Results

2002 ◽  
Vol 48 (11) ◽  
pp. 2023-2029 ◽  
Author(s):  
Adel AA Ismail ◽  
Paul L Walker ◽  
Julian H Barth ◽  
Kryzsztof C Lewandowski ◽  
Rick Jones ◽  
...  
Keyword(s):  
Adverse Effect ◽  
Observational Study ◽  
Early Identification ◽  
Prospective Observational Study ◽  
Case Reports ◽  
Clinical Care ◽  
Thyroid Stimulating Hormone ◽  
The Common ◽  
Almost All ◽  
Stimulating Hormone

Abstract Background: Immunoassays are used in almost all medical and surgical specialties, but they suffer from interference from proteins such as antibodies in some patients’ sera. Such interferences are usually reported in the literature only as case reports after the introduction of a new assay. Methods: We undertook a prospective observational study on 5310 patients for whom the common immunoassay tests for thyroid-stimulating hormone (TSH) and/or gonadotropins were requested. All TSH and gonadotropin results were critically assessed for a mismatch between the clinical details and analytical results to identify samples suspected of analytical unreliability. These were tested further by three approaches to screen for interference. Results: From the 5310 sets of results, 59 patients’ samples were identified as suspect and were tested further. Analytically incorrect results were found in 28 (0.53% of the total studied). The magnitude of interference varied, but in 23 of 28 patients (82%), it was considered large enough to have a potentially adverse effect on cost and/or the clinical care of these patients. Two cases, described in detail, illustrate the adverse effect of error on patient care and cost, and the second highlights the difficulties and limitations of current approaches for identifying interference and inaccuracy in immunoassays. Conclusions: Because millions of TSH/gonadotropin tests are carried out in UK hospital laboratories alone, our data suggest that thousands of patients could be adversely affected by errors from interferences. Early identification of interference in cases with unusual results could be valuable.

scholarly journals CUSHING DISEASE MASQUERADING AS GLAUCOMA

2019 ◽  
Vol 5 (5) ◽  
pp. e290-e293
Author(s):  
Yumiko Tsushima ◽  
Lubna Bashir Munshi ◽  
Charit Taneja ◽  
Se-min Kim
Keyword(s):  
Adrenocorticotropic Hormone ◽  
Case Reports ◽  
Elevated Serum ◽  
Serum Cortisol ◽  
Thyroid Stimulating Hormone ◽  
Pituitary Hormone ◽  
Cushing Disease ◽  
Corticosteroid Administration ◽  
Late Night ◽  
Stimulating Hormone

Objective: Glaucoma is a well-recognized side effect of corticosteroids. However, steroid-induced glaucoma typically refers to that caused by exogenous corticosteroid administration. Glaucoma secondary to endogenous overproduction of corticosteroids has only been reported in a few case reports. We aim to bring attention to glaucoma as a rare but important manifestation of endogenous hypercortisolism. Methods: Patient history, physical exam, laboratory results, and imaging studies were reviewed. Results: We report a case of glaucoma as the initial presentation of Cushing disease (CD). The patient was diagnosed with glaucoma 16 months prior to his endocrinology evaluation. At our initial encounter, the patient had a cushingoid appearance. Levels of 24-hour urinary cortisol and late-night salivary cortisol were elevated. Serum cortisol was not suppressed by 1 mg of dexamethasone overnight, but it was suppressed by 8 mg of dexamethasone. Adrenocorticotropic hormone was also elevated. All other pituitary hormone axes were unremarkable (thyroid-stimulating hormone, free thyroxine, follicle-stimulating hormone, luteinizing hormone, growth hormone, prolactin, and insulin-like growth factor). Pituitary magnetic resonance imaging suggested a small adenoma (2 to 3 mm); therefore, the patient underwent inferior petrosal sinus sampling. The results were consistent with CD. Transsphenoidal resection was performed and final pathology confirmed an adrenocorticotropic hormone-positive adenoma. Hypercortisolism and intraocular pressures improved after the surgery. Conclusion: Glaucoma can lead to irreversible blindness if left untreated or uncontrolled. However, endogenous hypercortisolism-induced glaucoma can be reversed with treatment of the underlying CD. Thus, heightened awareness of extraocular manifestations of secondary causes of glaucoma such as endogenous hypercortisolism is necessary in order to promote prompt evaluation and treatment.

scholarly journals A vital region for human glycoprotein hormone trafficking revealed by an LHB mutation

2016 ◽  
Vol 231 (3) ◽  
pp. 197-207 ◽  
Author(s):  
Iulia Potorac ◽  
Adolfo Rivero-Müller ◽  
Ashutosh Trehan ◽  
Michał Kiełbus ◽  
Krzysztof Jozwiak ◽  
...  
Keyword(s):  
Luteinizing Hormone ◽  
Pubertal Development ◽  
Gene Mutations ◽  
Thyroid Stimulating Hormone ◽  
Beta Subunits ◽  
Glycoprotein Hormones ◽  
Glycoprotein Hormone ◽  
Pubertal Delay ◽  
The Common ◽  
Stimulating Hormone

Glycoprotein hormones are complex hormonally active macromolecules. Luteinizing hormone (LH) is essential for the postnatal development and maturation of the male gonad. Inactivating Luteinizing hormone beta (LHB) gene mutations are exceptionally rare and lead to hypogonadism that is particularly severe in males. We describe a family with selective LH deficiency and hypogonadism in two brothers. DNA sequencing of LHB was performed and the effects of genetic variants on hormone function and secretion were characterized by mutagenesis studies, confocal microscopy and functional assays. A 20-year-old male from a consanguineous family had pubertal delay, hypogonadism and undetectable LH. A homozygous c.118_120del (p.Lys40del) mutation was identified in the patient and his brother, who subsequently had the same phenotype. Treatment with hCG led to pubertal development, increased circulating testosterone and spermatogenesis. Experiments in HeLa cells revealed that the mutant LH is retained intracellularly and showed diffuse cytoplasmic distribution. The mutated LHB heterodimerizes with the common alpha-subunit and can activate its receptor. Deletion of flanking glutamic acid residues at positions 39 and 41 impair LH to a similar extent as deletion of Lys40. This region is functionally important across all heterodimeric glycoprotein hormones, because deletion of the corresponding residues in hCG, follicle-stimulating hormone and thyroid-stimulating hormone beta-subunits also led to intracellular hormone retention. This novel LHB mutation results in hypogonadism due to intracellular sequestration of the hormone and reveals a discrete region in the protein that is crucial for normal secretion of all human glycoprotein hormones.

scholarly journals Molecular regulation of follicle-stimulating hormone synthesis, secretion and action

2018 ◽  
Vol 60 (3) ◽  
pp. R131-R155 ◽  
Author(s):  
Nandana Das ◽  
T Rajendra Kumar
Keyword(s):  
Molecular Mechanisms ◽  
Follicle Stimulating Hormone ◽  
Thyroid Stimulating Hormone ◽  
Α Subunit ◽  
Physiological Regulation ◽  
Hormone Synthesis ◽  
The Common ◽  
Blocking Antibodies ◽  
Recombinant Human Fsh ◽  
Stimulating Hormone

Follicle-stimulating hormone (FSH) plays fundamental roles in male and female fertility. FSH is a heterodimeric glycoprotein expressed by gonadotrophs in the anterior pituitary. The hormone-specific FSHβ-subunit is non-covalently associated with the common α-subunit that is also present in the luteinizing hormone (LH), another gonadotrophic hormone secreted by gonadotrophs and thyroid-stimulating hormone (TSH) secreted by thyrotrophs. Several decades of research led to the purification, structural characterization and physiological regulation of FSH in a variety of species including humans. With the advent of molecular tools, availability of immortalized gonadotroph cell lines and genetically modified mouse models, our knowledge on molecular mechanisms of FSH regulation has tremendously expanded. Several key players that regulate FSH synthesis, sorting, secretion and action in gonads and extragonadal tissues have been identified in a physiological setting. Novel post-transcriptional and post-translational regulatory mechanisms have also been identified that provide additional layers of regulation mediating FSH homeostasis. Recombinant human FSH analogs hold promise for a variety of clinical applications, whereas blocking antibodies against FSH may prove efficacious for preventing age-dependent bone loss and adiposity. It is anticipated that several exciting new discoveries uncovering all aspects of FSH biology will soon be forthcoming.

scholarly journals Monitoring, evaluation and comparison of adverse effect profile of ciprofloxacin and ofloxacin in acute bacterial exacerbation of chronic bronchitis patients attending pulmonology department of tertiary care teaching hospital: a prospective observational study

2018 ◽  
Vol 7 (4) ◽  
pp. 729
Author(s):  
Sankar K. ◽  
S. G. S. Rajesh Reddy V.
Keyword(s):  
Adverse Effect ◽  
Observational Study ◽  
Chronic Bronchitis ◽  
Teaching Hospital ◽  
Prospective Observational Study ◽  
Tertiary Care ◽  
Acute Bronchitis ◽  
Adverse Effect Profile ◽  
Chi Square ◽  
Tertiary Care Teaching Hospital

Background: In 2016, FDA recommended that “serious side effects associated with flouroquinolones generally outweigh the benefits for the patients with acute sinusitis, acute bronchitis and uncomplicated UTI”. Throughout India the most commonly used flouroquinolones for above conditions are Ciprofloxacin, Ofloxacin, and Levofloxacin. In this scenario, the present study was undertaken to monitor, evaluate and compare the adverse effect profile of Ciprofloxacin and Ofloxacin in acute exacerbation of chronic bronchitis patients.Methods: Prospective, observational study done in 200 patients of tertiary care teaching hospital. The patients diagnosed with, acute bronchitis treated with Ciprofloxacin 500mg BD or Ofloxacin 400mg BD for 7 days were included in the study. The study duration was 6 months. ADR causality assessment was done with Naranjo algorithm. Statistical test applied was chi- square test.Results: 63 ADR were reported in Ofloxacin group and 19 ADR in Ciprofloxacin group. Insomnia was most frequent ADR (40%) in patients treated with Ofloxacin. There is high incidence of ADRs in ofloxacin group. chi square test showed this difference is statistically significant (p<0.05). Insomnia was significantly higher in ofloxacin group (p<0.05).Conclusions: In India frequently used and misused antimicrobials are fluoroquinolones. The present study concluded that no serious ADRs but ofloxacin group of patients have shown increased incidence of ADRs associated with CNS especially Insomnia. However, further large scale, multi-centric studies are needed to confirm these results. 

scholarly journals Semi-Rigid Pneumatic Ureteroscopicremoval of Ureteric Stone; Seven Years Experience At Nepalgunj Medical College

2017 ◽  
Vol 13 (2) ◽  
pp. 10-12 ◽  
Author(s):  
Naresh Man Shrestha
Keyword(s):  
Shock Wave ◽  
Observational Study ◽  
Shock Wave Lithotripsy ◽  
Prospective Observational Study ◽  
Multiorgan Failure ◽  
Ureteric Stone ◽  
Medical College ◽  
Ureteral Trauma ◽  
The Common ◽  
Different Levels

Background: The present study aimed to report the outcomes of ureteroscopy (URS) treatment of ureteric stone with semi-rigid pneumatic ureteroscopic lithotripsy.Method: This was a prospective observational study of the patients who underwent ureteroscopic removal of ureteric stone in the department of surgery, urology unit, Nepalgunj Medical College from January 2009 to July 2015. All patients underwent urereroscopic removal of stones located at different levels of the ureter using semi-rigid 8/9.8 Fr ureteroscope.Result: 1251 patients with ureteric stones who underwent URS during the study period. Out of 1251 patients, in 1211 (96.80%) stone was removed in first setting, 10(0.79%) patients needed second setting of URS to remove stones. The overall failure rate was 1.59%. The common complications of URS observed were perforations of the ureteric wall (20%), retropulsion of ureteric stone into kidney (35%) and urosepsis (45%) which necessitated ureterolithotomy, Extra Corporeal Shock Wave Lithotripsy (ESWL) and antibiotic therapy, respectively. Two (0.15%) patients died and the cause was urosepsis with multiorgan failure in both.Conclusion: Most of the ureteric stone can be removed in a single setting of URS. However, some complications such as, ureteral trauma, difficulty in fragmentation of a stone, retropulsion of stone into the kidney and a fatal urosepsismay occur in few cases. Therefore, URS is a useful modality to remove the ureteric stones despite its few complications.JNGMC Vol. 13 No. 2 December 2015, page: 10-12

scholarly journals Lithium and the thyroid

1996 ◽  
Vol 20 (6) ◽  
pp. 354-355 ◽  
Author(s):  
Carol Paton ◽  
Dominic Beer
Keyword(s):  
Thyroid Disease ◽  
Adult Population ◽  
Thyroid Stimulating Hormone ◽  
Lifetime Risk ◽  
Thyroid Autoantibodies ◽  
Thyroid Disorders ◽  
The Common ◽  
Stimulating Hormone

The common thyroid disorders are all autoimmune in origin, with the lifetime risk of thyroid disease being 1–2%. Thyroid autoantibodies are present in 9% of the adult population and 12.7% of women, with the frequency rising steeply in women over 45 years of age (Myers & West, 1987). In addition, 20% of the over 60–year-olds have an abnormal (raised) thyroid stimulating hormone (TSH). The presence of both raised TSH and thyroid autoantibodies is associated with the development of clinical hypothyroidism at the rate of 5% per year (Myers & West, 1987).

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