scholarly journals Resolution of Abnormal Gonadotropin Secretion After Surgical Cure in Men With ACTH-Dependent Cushing Syndrome

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A634-A635
Author(s):  
Skand Shekhar ◽  
Joselyne Tessa Tonelu ◽  
Gordon B Cutler ◽  
Lynnette K Nieman ◽  
Janet Elizabeth Hall
Keyword(s):  
Cushing Syndrome ◽  
Tertiary Care ◽  
Pulse Amplitude ◽  
P Value ◽  
Curative Surgery ◽  
Gonadotropin Secretion ◽  
Gnrh Secretion ◽  
Free Cortisol ◽  
Before And After ◽  
Surgical Cure

Abstract Background: Hypothalamic-pituitary-gonadal (HPG) dysfunction is known to occur in male patients with Cushing Syndrome (CS) but the underlying mechanisms of HPG dysfunction remain unclear. We performed frequent blood sampling and GnRH stimulation tests to assess gonadotropin secretion in males before and after surgical cure of CS. Methods: We evaluated eight males age 32.5±12 years (mean ± SD) enrolled for surgical cure of ACTH-dependent CS at a tertiary care research center. Urinary free cortisol (UFC) was measured before and after surgery. Blood was sampled every 20 minutes for 24-hours with measurement of LH and FSH, before and 2 weeks to 160 weeks (median 80 weeks) after surgery. Patients received 100 μg of gonadotropin releasing hormone (GnRH) iv with measurement of LH and FSH at 0, 10 and 20 min before and 15, 30, 45, 60, 120 and 180 min after administration. Non-normative data was log-transformed before analysis using paired two-tail t-tests. A p-value of <0.05 was considered significant. Gonadotropin values are expressed in U/L as equivalents of the 2nd International Preparation of human menopausal gonadotropins with normal adult male ranges of 6-26 and 5-25 IU/L for LH and FSH, respectively. Results: Mean UFC was elevated ~ 6 times above the upper normal limit before surgery and returned to the reference range after surgery. 24-hour LH rose from 7.82 ± 1.48 preoperatively to 13.07 ± 2.96 IU/L (mean ± sem) after surgery (p=0.026) while mean FSH was unchanged (8.48 ± 1.51 vs 6.92 ± 1.29, p=0.37). LH pulse frequency, a marker of pulsatile GnRH secretion, recovered from a subnormal value of 6.88 ± 0.55 pulses/24 hr before to 12.13 ± 0.72 pulses/24 hr after surgery (p<0.0001) while LH pulse amplitude did not change (6.47 ± 1.21 vs 4.76 ± 0.88 IU/L, p=0.21). In response to GnRH there was a robust increase in LH that was not affected by curative surgery for CS (27.0 ± 7.2 vs 21.2 ± 7.6 IU/L; p=0.14) as was also the case for FSH (3.7 ± 1.2 vs 2.3 ± 0.5 IU/L; p=0.48), consistent with the absence of an effect of CS on gonadotroph responsiveness to LHRH. Conclusion: In men with Cushing Syndrome, hypogonadism is associated with inhibition of endogenous GnRH secretion but preservation of the pituitary response to GnRH. Hypothalamic suppression of the HPG axis is reversible after cure of CS.

Non-responsiveness of serum gonadotropins and testosterone to pulsatile GnRH in hemochromatosis suggesting a pituitary defect

1993 ◽  
Vol 128 (4) ◽  
pp. 351-354 ◽  
Author(s):  
Lise Duranteau ◽  
Philippe Chanson ◽  
Joelle Blumberg-Tick ◽  
Guy Thomas ◽  
Sylvie Brailly ◽  
...  
Keyword(s):  
Single Pulse ◽  
Serum Testosterone ◽  
Pulse Amplitude ◽  
Pulse Frequency ◽  
Gonadotropin Secretion ◽  
Pulsatile Gnrh ◽  
Serum Lh ◽  
Before And After ◽  
Gnrh Therapy ◽  
Lh Secretion

We investigated the potential pituitary origin of gonadal insufficiency in hemochromatosis. Gonadotropin secretion was studied in seven patients with hemochromatosis and hypogonadism, before and after chronic pulsatile GnRH therapy. Pulsatile LH secretion was studied before (sampling every 10 min for 6 h) and after 15-30 days of chronic pulsatile GnRH therapy (10-12 μg per pulse). Prior to GnRH therapy, all the patients had low serum testosterone, FSH and LH levels. LH secretion was non-pulsatile in four patients, while a single pulse was detected in the remaining three. Chronic pulsatile GnRH administration did not increase serum testosterone levels; similarly, serum LH levels remained low: neither pulse frequency nor pulse amplitude was modified. We conclude that hypogonadism in hemochromatosis is due to pituitary lesions.

scholarly journals Quality of Life of Adults Before and After Strabismus Surgery at a Tertiary Care Eye Centre of Kathmandu, Nepal

2017 ◽  
Vol 16 (1) ◽  
pp. 14-18
Author(s):  
Sabina Shrestha ◽  
Aparajita Manoranjan ◽  
Sushan Man Shrestha
Keyword(s):  
Quality Of Life ◽  
Tertiary Care ◽  
Strabismus Surgery ◽  
P Value ◽  
Health Related Quality ◽  
Before And After ◽  
Related Quality ◽  
Health Related ◽  
Adult Strabismus

Introduction: Strabismus affects the quality of life of adults both in functional and psychosocial aspect of life. This study was conducted to compare the health related quality of life in adults before and after strabismus surgery.Methods: It was a prospective quantitative study conducted in Nepal Eye Hospital from Sep 2015 to July 2016. Thirty one adult participants with strabismus undergoing strabismus surgery completed the study. Twenty open ended adult strabismus questionnaire (AS-20) were used to assess the health related quality of life of adults before and one month after strabismus surgery.Results: The overall median score of adult strabismus questionnaire for quality of life improved from 68.75 (Interquartile range (IQR 25) to 91.25 (IQR 17.5) after strabismus surgery (p value < 0.00). Similarly, the median function subscale and median psychosocial subscale also improved from 72 (IQR 25) to 95 (10) and from 55 (IQR 37.5) to 90 (IQR 15) respectively after surgery. Conclusion: The quality of life of adult strabismic patients improved significantly after stabismus surgery.

scholarly journals The Hypothalamic-Pituitary-Thyroid Axis in Cushing Syndrome before and after Curative Surgery

2020 ◽  
Author(s):  
Skand Shekhar ◽  
Raven McGlotten ◽  
Sunyoung Auh ◽  
Kristina I Rother ◽  
Lynnette K Nieman
Keyword(s):  
Thyroid Function ◽  
Cushing’S Syndrome ◽  
Cushing Syndrome ◽  
Cushing's Syndrome ◽  
Curative Surgery ◽  
Central Hypothyroidism ◽  
Duration Of Symptoms ◽  
Before And After ◽  
Pituitary Thyroid Axis ◽  
Thyroid Axis

Abstract Background We do not fully understand how hypercortisolism causes central hypothyroidism or what factors influence recovery of the hypothalamic-pituitary-thyroid axis. We evaluated thyroid function during and after cure of Cushing’s syndrome (CS). Methods We performed a retrospective cohort study of adult patients with CS seen from 2005 – 2018 (cohort 1, c1, n=68) or 1985 – 1994 (cohort 2, c2, n=55) at a clinical research center. Urine (UFC) and diurnal serum cortisol (F: ~8AM and ~midnight (PM)), morning triiodothyronine (T3), free thyroxine (FT4) and thyroid stimulating hormone (TSH) (c1) or hourly TSH from 1500-1900h (day) and 2400-04000h (night) (c2), were measured before and after curative surgery. Results While hypercortisolemic, 53% of c1 had central hypothyroidism (low/low normal fT4 + unelevated TSH). Of those followed long-term, 31% and 44% had initially subnormal FT4 and T3, respectively, which normalized 6—12 months after cure. Hypogonadism was more frequent in hypothyroid (69%) compared to euthyroid (13%) patients. Duration of symptoms, AM and PM F, ACTH, and UFC were inversely related to TSH, FT4 and/or T3 levels (r -0.24 to -0.52, P &lt;0.0001 to 0.02). In c2, the nocturnal surge of TSH (mIU/L) was subnormal before (day 1.00±0.04 vs night 1.08±0.05, p=0.3) and normal at a mean of 8 months after cure (day 1.30±0.14 vs night 2.17±0.27, p=0.01). UFC &gt;1000 μg /day was an independent adverse prognostic marker of time to thyroid hormone recovery. Conclusions Abnormal thyroid function, likely mediated by subnormal nocturnal TSH, is prevalent in Cushing’s syndrome and is reversible after cure.

scholarly journals EFFECTIVENESS OF NEURAL MOBILIZATION AND STRETCHING EXERCISE FOR THE MANAGEMENT OF SCIATICA

2014 ◽  
Vol 3 (2) ◽  
pp. 11-15
Author(s):  
Sidra Zahid ◽  
Ghazala Noor Nizami
Keyword(s):  
Conventional Therapy ◽  
Controlled Trial ◽  
Treatment Options ◽  
Tertiary Care ◽  
P Value ◽  
Below The Knee ◽  
Pain Disability ◽  
Before And After ◽  
Group A ◽  
Group B

OBJECTIVE To find out the effectiveness of neural mobilization and stretching exercise for the management of sciatica BACKGROUND Sciatica is described as pain, radiating to the leg below the knee joint and caused by irritation of the sciatic nerve or nerve trunk. There are many treatment options for the management of sciatica, including stretching exercise and neural mobilization. MATERIAL AND METHODS This study was a Randomized Controlled Trial. 94 patients from physical therapy OPD of tertiary care hospitals, were participated in this study. Hence, 47 patients were randomly allocated into each group A and B. Before and after the nine treatment sessions, both groups were assessed with VAS, SLR ROM and Quebec back pain disability scale. In group A, neural mobilization with conventional therapy (heat and TENS) was applied, while stretching exercise with same conventional therapy was applied to group B. RESULTS It was observed that both treatments were helpful in reducing the symptoms. The analysis showed significant improvement (p-value <0.05) in the SLR to 60.851o±6.86oand Quebec score to 23.617±3.125, after the stretching exercise. Hence, both treatments were equally effective in reducing pain (p-value >0.05). CONCLUSION Stretching exercise is more effective in the improvement of SLR and disability. Furthermore, both techniques are helpful in the management of pain. KEY WORDS Sciatica, Stretching, Neural Mobilization, Straight Leg Raising, Visual Analogue Scale, TENS.

scholarly journals SAT-449 Factors Associated with Reduced Thyroid Hormones in Cushing Syndrome Patients Before and After Surgical Cure

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Skand Shekhar ◽  
Raven McGlotten ◽  
Lynnette K Nieman
Keyword(s):  
Thyroid Hormones ◽  
Thyroid Function ◽  
Cushing Syndrome ◽  
Hormone Secretion ◽  
Free T4 ◽  
Curative Surgery ◽  
Duration Of Symptoms ◽  
Free Cortisol ◽  
Hpt Axis ◽  
Pearson Correlations

Abstract Background: Hypercortisolemia adversely affects thyroid hormone secretion. We previously described the temporal pattern of thyroid function recovery in 23 patients (1). However, the factors leading to suppression and recovery of the hypothalamic-pituitary-thyroid (HPT) axis in Cushing’s syndrome (CS) are not fully understood. We performed two separate studies to investigate these factors. Methods: In study 1, we examined patients (pts, n=62) with CS who underwent curative surgery and recorded their serum morning and evening cortisol, ACTH, tumor volume and duration of symptoms and 24-hour urine free cortisol (UFC) at baseline and the morning serum free T4, TSH and T3 at six-month intervals after cure. Data were log-transformed and Pearson correlations were performed. Linear mixed models were used to study factors that predict recovery of thyroid function. In study 2, we examined the diurnal variation of TSH by performing hourly TSH measurement between 3—7 PM and 12—4 AM on a cohort of pts (n=45) before surgery. Wilcoxon Signed-Rank method was used for comparisons of mean TSH across time and Pearson correlations were performed on log-transformed data. P values &lt;.05 were considered significant. Results: Study 1: In this larger cohort, we confirmed previous findings of suppressed or low normal fT4 and TSH values with active hypercortisolism, with normalization after cure that reflected changes in the T3:TSH, fT4:TSH and T3:fT4 ratios. There were inverse linear correlations between log10 UFC, serum AM and PM cortisol; and log10 TT3, fT4 and TSH before surgery. Independent negative prognosticators of circulating fT4 recovery included UFC greater than 1000mcg/day (nl: 3.5—45mcg/day), duration of symptoms of less than one year, and ACTH levels greater than 60pg/mL(nl: 5—45pg/mL) Study 2: The nocturnal (12 - 4AM) TSH surge was reduced, so that the difference in day and night TSH values was not statistically significant; this contrasts with the 30—50% nocturnal TSH increase above daytime values seen in healthy subjects. There was an inverse relationship between UFC and nocturnal TSH, daytime TSH and TBG values, but there was no direct relationship between UFC and percent changes in nocturnal TSH values. Conclusions: Our findings suggest that a deficit in TSH stimulation of the thyroid gland may explain the reduction in T3 and T4 levels. There is a dose-response relationship between various measures of hypercortisolemia and both thyroid hormones and the pattern of TSH secretion. Finally, the severity of hypercortisolism correlates with a longer time to recovery of the HPT axis in pts with CS after curative surgery. 1. Shekhar S et al. HPG and HPT Axes in Cushing Syndrome. J Endocr Soc, 3 S1, April May 2019

scholarly journals Cerebral Hemodyanamics in Stable Preterm Infants Before and After Packed Cell Transfusion

2020 ◽  
Author(s):  
Chinmay Chetan ◽  
Nyein Zaw ◽  
Pradeep Suryawanshi ◽  
Nishant Banait ◽  
Prince Pareek ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Tertiary Care ◽  
Peak Systolic Velocity ◽  
Resistive Index ◽  
Interquartile Range ◽  
P Value ◽  
Care Hospital ◽  
Doppler Study ◽  
Diastolic Velocity ◽  
Before And After

Abstract BACKGROUND In a year around 3.5 million preterm deliveries occur in India alone. Some of these babies will require packed cell volume (PCV) transfusion. There is a paucity of robust data on effect of blood transfusions on the cerebral hemodynamic from India. This study was done to see the effect of PCV transfusion on blood flow velocities and resistive index (RI) of anterior cerebral artery (ACA) in stable preterm infants. METHOD A prospective observational study was conducted in a tertiary care hospital in Pune, India. All stable preterm infants (<37 weeks) receiving PCV transfusion were enrolled. USG Doppler study of ACA was done before and after PCV transfusion. Peak systolic velocity (PSV), end-diastolic velocity (EDV) and RI were measured pre and post PCV transfusion. RESULTS Thirty infants were included in the study, with median gestation age of 28.8 [interquartile range {IQR}, 27-30.55] weeks and median birth weight of 970 [interquartile range {IQR}, 869.5-1190] grams. There was a significant decrease in PSV pre and post PCV transfusion - 58.46 (±18.44) cm/sec and 46.34 (±13.93) cm/sec respectively (p value <0.001). Changes in RI and EDV were non-significant.CONCLUSION PCV transfusion significantly decreased PSV, reflecting improved cerebral oxygenation, and decreased cardiac output after correction of anaemia. Laboratory threshold for PCV transfusion in stable preterm infants are not known. USG Doppler study has the potential to provide one of the objective criteria for PCV transfusion in these infants though large scale randomized controlled trials are needed to prove its efficacy.

scholarly journals Effectiveness of Integrated Teaching Module among Final Year Medical students

2016 ◽  
Vol 06 (02) ◽  
pp. 024-026
Author(s):  
Akshatha Rao Aroor ◽  
Dileep K. S. ◽  
Rama Prakasha Saya ◽  
Sudheendra Rao
Keyword(s):  
Medical Students ◽  
Medical Curriculum ◽  
Teaching Method ◽  
Tertiary Care ◽  
General Medicine ◽  
P Value ◽  
College Hospital ◽  
Before And After ◽  
The Mean ◽  
A Prospective Study

AbstractBackground: Didactic lectures and the current practice of teaching in Medical colleges has many limitations. Correlation and integration of knowledge into practice becomes difficult in the absence of integrated teaching at appropriate levels in medical curriculum.Aim: To assess the effectiveness of the vertical integrated teaching method among the final year MBBS students and to study the attitude towards integrated teaching. Materials and Methods: This is a prospective study conducted among 102 final year MBBS students at a tertiary care medical college hospital in South India. The teaching was implemented by the active participation of faculty from the departments of Physiology, Pathology and General Medicine on a single topic. Students' knowledge about the subject before and after the session was evaluated by a questionnaire of 20 questions (Pre-test and Post-test). The mean score before and after the session was compared using the paired't' test. The students were also asked to give their feedback about the usefulness of this method in improving their knowledge.Results: The mean scores before and after the session were 8.8± 2.87 and 16.88±1.23 (p value < 0.001). Majority of the students (97.1%) opined the need for integrated teaching to be a part of medical curriculum. Most of them (54.9%) felt the need for integrated teaching to be conducted monthly. On self-grading the knowledge on a scale of 1 to 10 before and after the session, the mean scores were 4.73±1.84 and 7.83±1.86 respectively (p value < 0.001). Conclusion: The integrated teaching was found to be an effective method of teaching. Medical students had a positive attitude towards integrated teaching.

scholarly journals The evaluation of effectiveness of separate kangaroo mother care ward on implementation of kangaroo mother care in tertiary care hospital: a before and after study

2019 ◽  
Vol 6 (3) ◽  
pp. 1239
Author(s):  
Bhowmik A. ◽  
Gargi G. ◽  
Nandy M.
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Newborn Care ◽  
Kangaroo Mother Care ◽  
Care Practice ◽  
P Value ◽  
Care Hospital ◽  
New Born ◽  
Before And After ◽  
Care Ward

Background: Kangaroo mother care (KMC) is a standard of care for preterm and low birth weight babies. To implement KMC in institutional care it was often practiced inside intensive care unit and also in separate ward. In present study authors have tried to evaluate effect of separate kangaroo mother care ward on implementation of kangaroo mother care in tertiary care hospital.Methods: Uncontrolled study before and after establishment of separate kangaroo mother care ward comparing kangaroo mother care in sick new-born care unit versus kangaroo mother care in separate ward.Results: In separate ward, as compared to kangaroo mother care practice in sick newborn care unit, mean (SD) duration of kangaroo mother care increased from 5.3 (1.6) to 11.4 (7.4) hours/day (95%CI 5.0-7.1, p value <0.0001). Mean (SD) weight gain increased from 10.7 (7.0) g/day to 13.7 (11.1) g/day (95% CI 1.0-4.8, p value <0.0024). Incidence of sepsis diminished from 14.0% to 28.9% (95% CI 6.4-23, p value <0.0006). Exclusive breast-feeding rate at discharge (42.3% vs. 57.3%) (95% CI 4.8- 24.9, p value <0.0041) and follow up (49.4% vs. 65.0%) (95% CI 1-29.4, p value <0.0378) increased. Mortality also decreased in this group of patients (8.6% vs.2.3%) (95% CI-1.6-11.4, p value <0.0082).Conclusions: Kangaroo mother care ward is better place than sick new born care unit for providing kangaroo mother care in tertiary care hospital.

scholarly journals A prospective study of clinicoepidemiology, metabolic and hormonal profile of women with hirsutism in Konaseema region of Andhra Pradesh

2021 ◽  
Vol 10 (10) ◽  
pp. 3875
Author(s):  
M. Smitha
Keyword(s):  
Insulin Resistance ◽  
Cushing Syndrome ◽  
Mean Value ◽  
P Value ◽  
Hormonal Profile ◽  
Number Of Patients ◽  
Menstrual Irregularities ◽  
Before And After ◽  
The Mean ◽  
A Prospective Study

Background: Hirsutism is defined as presence of excess coarse hairs appear in male pattern in women.There is various aetiology of hirsutism like Idiopathic hirsutism, PCOS, androgen secreting ovarian tumours, menopause, CAH, Cushing’s syndrome, drugs which increases testosterone level, insulin resistance and tumour secreting androgen. We have designed present study with an aim to study the clinicoepidemiology, metabolic and hormonal profile of women with hirsutism in Konaseema region of Andhra Pradesh.Methods: All patients with hirsutism attending gynaecology outpatient department were selected for study based on inclusion and exclusion criteria. After that patient were examined clinically, BMI was calculated for each patient. Patients were clinically evaluated for signs of excess androgen secretion, Cushing syndrome, metabolic syndrome and hyperprolactinemia. Modified Ferriman-Gallwey scoring system was used for evaluating and quantifying hirsutism.Results: The mean Fasting plasma insulin12.42±2.41 (mIU/dl), the mean of HOMA-IR was 3.14±1.18. The mean value of dehydroepiandrosteronesulphate (DHEAS) 355.78±15.41 mcg/dl. There was statistically significant reduction in modified Ferriman-Gallwey scoring in before and after treatment (12.38± 1.55 vs. 9.62±1.6), the p value was 0.00001. The number of patients with menstrual irregularities were reduced from 63.3% to 20% after treatment and this difference is statistically significant (p=0.04).Conclusions: Hirsutism is associated with insulin resistance and DHEAS concentration was high. Modified Ferriman-Gallwey score was significantly reduced and there was significant weight loss and improvement in menstrual irregularities after treatment.

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