scholarly journals Uncontrolled diabetes as a rare presenting cause of pituitary apoplexy

2019 ◽  
Vol 12 (2) ◽  
pp. bcr-2018-228161
Author(s):  
Ashima Mittal ◽  
Sanat Mishra ◽  
Karamvir Yadav ◽  
Rajesh Rajput
Keyword(s):  
Pituitary Apoplexy ◽  
Field Testing ◽  
Sudden Onset ◽  
Thyroid Stimulating Hormone ◽  
Normal Serum ◽  
Serum Prolactin ◽  
Pupillary Reflex ◽  
Uncontrolled Diabetes ◽  
The Right ◽  
Stimulating Hormone

Pituitary apoplexy is a rare endocrine emergency. The extent to which hyperglycaemia is a contributory risk factor in the precipitation of pituitary apoplexy is not known. A 38-year-old man with poorly controlled diabetes presented to the emergency department with sudden onset of nausea and headache with drooping of his right eyelid for about 4 days. On physical examination, he had orthostatic hypotension, ptosis of the right eye, lateral and downward positioning of the eye and absent pupillary reflex. Visual field testing of the left eye revealed superolateral quadrantanopia. MRI of the brain showed pituitary macroadenoma with necrosis. Investigations showed hyperglycaemia, decreased T3, T4 with normal Thyroid stimulating hormone (TSH), low serum Leutinizing hormone (LH), Follicle stimulating hormone (FSH), testosterone and low normal serum prolactin levels. About 21% of non-functioning pituitary adenomas present with apoplexy as was seen in our patient. It is likely that his uncontrolled diabetes precipitated this episode of apoplexy as hyperosmolarity and dehydration, caused by hyperglycaemia can lead to changed pituitary microvascular environment increasing the risk of pituitary infarction.

Endocrine Aspects of Kidney Disease

2020 ◽  
Author(s):  
Marcin Adamczak ◽  
Piotr Kuczera ◽  
Andrzej Wiecek
Keyword(s):  
Chronic Kidney Disease ◽  
Growth Hormone ◽  
Kidney Disease ◽  
Kidney Diseases ◽  
Thyroid Stimulating Hormone ◽  
Normal Serum ◽  
Serum Prolactin ◽  
Clinical Consequences ◽  
Synthesis And Degradation ◽  
Insulin Like Growth Factors

Kidneys play the major role in the synthesis and degradation of several hormones. Different coexisting conditions such as inflammation, malnutrition and metabolic acidosis and applied treatment may also cause endocrine abnormalities in chronic kidney disease (CKD) patients. A tendency towards decreased thyroxin and triiodothyronine with normal serum concentrations of reversed triiodothyronine (as opposed to other chronic non-thyroid, non-kidney diseases) and thyroid stimulating hormone are observed. As far as the somatotopic axis is concerned, in CKD normal serum concentration of growth hormone and its effector – the insulin-like growth factor are observed. Nevertheless, due to the phenomenon of GH/IGF-1 “resistance” CKD patients usually present a phenotype resembling GH deficiency. Serum prolactin concentrations are often elevated in CKD women and men. This leads to the dysregulation of the pituitary-gonadal axis causing hypogonadism and it’s clinical consequences regardless of patient’s gender. The alterations in hormones of gonadal origin caused by uremia, together with hyperprolactinemia lead to the development of sexual dysfunction and infertility in men and women. The alterations of thyroid, pituitary gland and gonads associated with CKD are discussed in this chapter. This review contains 4 tables, and 64 references. Keywords: chronic kidney disease, hypothyroidism, hyperthyroidism, growth hormone, recombinant human GH, insulin-like growth factors, hemodialysis

Posttraumatic Anterior Hypopituitarism—Revisited: The Role of TRH Provocative Release of Prolactin in the Confirmation of Anterior Pituitary Damage

PEDIATRICS ◽  
1977 ◽  
Vol 59 (6) ◽  
pp. 948-950
Author(s):  
David R. Brown ◽  
J. Michael McMillin
Keyword(s):  
Pituitary Gland ◽  
Anterior Pituitary ◽  
Thyroid Stimulating Hormone ◽  
Anterior Pituitary Gland ◽  
Serum Prolactin ◽  
Pituitary Insufficiency ◽  
Closed Head Trauma ◽  
One Year ◽  
Stimulating Hormone

We have previously reported a case of anterior pituitary insufficiency in a 14-year-old girl following closed head trauma.1 Endocrine evaluation one year after her accident revealed hypopituitarism manifested by cachexia, hypothyroidism, hypogonadism, and hypoadrenocorticism. Laboratory studies demonstrated deficiencies of adrenocorticotropic hormone, thyroid-stimulating hormone (TSH), growth hormone, and gonadotropic hormones (follicle-stimulating hormone and luteinizing hormone). We postulated that her hypopituitarism was due to anterior pituitary gland destruction rather than stalk section or hypothalamic damage. We have recently measured her serum prolactin concentrations following provocative stimulation with thyrotropin-releasing hormone (TRH), and these results strengthen the evidence for direct anterior pituitary gland destruction and provide a more complete delineation of her endocrinologic function.

Effect of Recombinant Human Erythropoietin (R-Huepo) Therapy on Plasma Ft3, FT4, TSH, FSH, LH, free Testosterone and Prolactin Levels in Hemodialysis Patients

1992 ◽  
Vol 15 (10) ◽  
pp. 585-589 ◽  
Author(s):  
M. Yeksan ◽  
N. Tamer ◽  
M. Cirit ◽  
S. Türk ◽  
G. Akhan ◽  
...  
Keyword(s):  
Free Testosterone ◽  
Hemodialysis Patients ◽  
Thyroid Stimulating Hormone ◽  
Sexual Disorders ◽  
Serum Prolactin ◽  
Control Group ◽  
Dialysis Session ◽  
Free Triiodothyronine ◽  
Human Erythropoietin ◽  
Stimulating Hormone

The aim of this study was to evaluate the effect of r-HuEPO treatment on free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), free testosterone and prolactin levels in uremic hemodialysis patients. Twenty-four uremic hemodialysis patients were given r-HuEPO with a dose 60 U/kg as intravenous bolus injection at the end of each dialysis session. Once the hematocrit value of the patient had reached a range of 30-35%, the dose was adjusted so as to keep the hematocrit levels constant. Twenty uremic dialysis patients were taken as control group. The above-mentioned hormone levels of patients and control group were determined before and 4 months after r-HuEPO treatment. After the treatment, serum prolactin levels significantly decreased in both sexes (36.8 ± 7.8 vs 22.9 ± 6.3 ng/ml and 78.3 ±13.3 vs 37.4 ± 10.4 ng/ml male and female, respectively). FT3 and FT4 significantly increased (1.17 vs 1.67 pg/ml, p<0.05, and 0.64 vs 0.084 ng/dl, p<0.05, respectively). TSH levels increased but those changes were not significant. There was no change in the level of any hormone in the control group. Also, the sexual functions of eight male patients treated with r-HuEPO improved and menstruation started again in four female patients. We concluded that r-HuEPO treatment especially decreases prolactin level in uremic hemodialysis patients. It is conceivable that correction of elevated prolactin levels could improve sexual disorders in these patients.

scholarly journals Misleading results from immunoassays of serum free thyroxine in the presence of rheumatoid factor

1997 ◽  
Vol 43 (6) ◽  
pp. 957-962 ◽  
Author(s):  
Anthony G W Norden ◽  
Rodwin A Jackson ◽  
Lorraine E Norden ◽  
A Jane Griffin ◽  
Margaret A Barnes ◽  
...  
Keyword(s):  
Thyroid Hormone ◽  
Rheumatoid Factor ◽  
Equilibrium Dialysis ◽  
Thyroid Stimulating Hormone ◽  
Normal Serum ◽  
Free Thyroxine ◽  
Free Triiodothyronine ◽  
Serum Free ◽  
Serum Free Thyroxine ◽  
Stimulating Hormone

Abstract A novel interference with measurements of serum free thyroxine (FT4) caused by rheumatoid factor (RhF) is described. We found misleading, sometimes gross, increases of FT4 results in 5 clinically euthyroid elderly female patients with high RhF concentrations. All 5 patients had high FT4 on Abbott AxSYM® or IMx® analyzers. “NETRIA” immunoassays gave misleading results in 4 of the 5 patients; Amerlex-MAB® in 2 of 4 patients; AutoDELFIA®in 2 of the 5; and Corning ACS-180® and Bayer Diagnostics Immuno 1® in 1 of the 5. BM-ES700® system results for FT4 in these women remained within the reference range. Results for serum T4, thyroid-stimulating hormone, free triiodothyronine, thyroid-hormone-binding globulin, and FT4 measured by equilibrium dialysis were normal in all 5 patients. Drugs, albumin-binding variants, and anti-thyroid-hormone antibodies were excluded as interferences. Addition to normal serum of the RhF isolated from each of the 5 patients increased the apparent FT4 (Abbott AxSYM). Screening of 83 unselected patients demonstrated a highly significant positive correlation between FT4 (Abbott AxSYM) and RhF concentrations. Discrepant, apparently increased FT4 with a normal result for thyroid-stimulating hormone should lead to measurement of the patient’s RhF concentration.

scholarly journals Stress response of rats to handling and experimental procedures

1980 ◽  
Vol 14 (3) ◽  
pp. 267-274 ◽  
Author(s):  
K. Gärtner ◽  
D. Büttner ◽  
K. Döhler ◽  
R. Friedel ◽  
J. Lindena ◽  
...  
Keyword(s):  
Heart Rate ◽  
Follicle Stimulating Hormone ◽  
Serum Glucose ◽  
Thyroid Stimulating Hormone ◽  
Serum Prolactin ◽  
Concentration Profiles ◽  
Male Adult ◽  
Blood Characteristics ◽  
Leucine Arylamidase ◽  
Stimulating Hormone

The effects were observed of moving male, adult Han:Sprague rats in their cages or of exposure to ether for 1 min on the plasma concentration profiles of 25 blood characteristics linked with stress and shock reactions. 5 min after the stress serum prolactin, corticosterone, thyroid-stimulating hormone, follicle-stimulating hormone, luteinizing hormone, triiodothyronine and thyroxin levels were elevated 150-500% compared with those in blood collected within 100 s of entering the animal room. Heart rate (telemetrically recorded), packed cell volume,, haemoglobin and plasma protein content were 10-20% elevated 2-10 min after cage movement or 2-20 min after ether confrontation over those of controls sampled within 50 s, indicating circulatory and microcirculatory shock reactions. Serum glucose, pyruvate and lactate concentrations rose by 20-100% 1-5 min after cage movement and 1-15 min after ether exposure. Phosphate, calcium, urea, apartate and alanine transferases, alkaline phosphalase and leucine arylamidase were not altered significantly by either stressor, while potassium and bound glycerol fell for 1 min and 5-20 min respectively. The presence of a familiar animal attendant working in the room without touching the cages did not markedly affect the blood characteristics being studied.

Low but detectable serum thyroid-stimulating hormone concentrations in ambulant subjects not receiving thyroxine

2003 ◽  
Vol 40 (6) ◽  
pp. 639-642 ◽  
Author(s):  
S Chatterjee ◽  
BP O'Malley ◽  
DE Price ◽  
AM Fielding ◽  
R Aitken
Keyword(s):  
Reference Range ◽  
Thyroid Stimulating Hormone ◽  
Normal Serum ◽  
Third Generation ◽  
Assay Sensitivity ◽  
Free Thyroid Hormones ◽  
Isotope Scanning ◽  
Detectable Serum ◽  
Serum Tsh ◽  
Stimulating Hormone

Background: In laboratories employing 'front-line' sensitive thyroid-stimulating hormone (TSH) measurement, it is generally accepted that a fully suppressed serum TSH concentration (third-generation assay) alongside normal serum concentrations of free thyroid hormones indicates subclinical hyperthyroidism. However, other explanations are often provided for low but detectable serum TSH concentrations, such as drug effects or non-thyroidal illness. Methods: We investigated 25 consecutive ambulant individuals, identified over an 18-month period as having low but not fully suppressed TSH concentrations (third-generation assay; sensitivity 0.003 mIU/L) with additional free thyroxine (T4), free tri-iodothyronine (T3) and thyroid microsomal antibody estimations and thyroid isotope scanning (technetium). Results: Concentrations of serum hormones (median, inter-quartile range) were: TSH, 0.23, 0.17-0.26 mIU/L (reference range 0.34-5.6 mIU/L); free T4, 14.6, 10.6- 17.6 pmol/L (reference range 10-25 pmol/L); free T3, 6.1, 5.7-6.6 pmol/L (reference range 4.5-7.5 pmol/L). Thyroid antibodies were negative in all but one individual. On isotope scanning, nine individuals had hot nodules and ten individuals had multinodular goitres (MNG). Of the six with normal scans, ultrasound scanning showed a definite MNG ( n = 1) and early MNG ( n = 2). Conclusions: A low but detectable serum TSH concentration, obtained using a third-generation assay, found in an ambulant individual, is frequently a pointer to underlying thyroid disease.

Subclinical hypothyroidism

2019 ◽  
Vol 12 (3) ◽  
pp. 131-135
Author(s):  
Adam Grice
Keyword(s):  
Cardiovascular Disease ◽  
Subclinical Hypothyroidism ◽  
Thyroid Stimulating Hormone ◽  
Normal Serum ◽  
Overt Hypothyroidism ◽  
Thyroid Peroxidase ◽  
Autoimmune Thyroid ◽  
Thyroid Peroxidase Antibodies ◽  
Increased Risk ◽  
Stimulating Hormone

Subclinical hypothyroidism is a common condition associated with a raised thyroid-stimulating hormone and a normal serum free thyroxine that affects about 10% of females over 55 years in age. The most common cause is autoimmune thyroid disease, with 2.5% of patients with subclinical hypothyroidism progressing to clinically overt hypothyroidism each year. The rate of progression is higher in patients with anti-thyroid peroxidase antibodies and higher levels of thyroid-stimulating hormone. Only a small proportion of patients with subclinical hypothyroidism have symptoms, and although there is some debate in the literature about which patients should be treated, the National Institute for Health and Care Excellence clinical knowledge summaries give clear recommendations. There is an increased risk of cardiovascular disease in patients with subclinical hypothyroidism; it is uncertain whether treatment with levothyroxine reduces this risk. When deciding whether to treat subclinical hypothyroidism consider the patient’s age, symptoms, presence of anti-thyroid peroxidase antibodies, thyroid-stimulating hormone levels and risk factors such as cardiovascular disease.

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