secondary hypothyroidism
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2021 ◽  
Vol 12 (1) ◽  
pp. 78-82
Author(s):  
Lubna Naznin ◽  
Susane Giti ◽  
SK Md Jaynul Islam ◽  
Khandaker Rokshana Akhter ◽  
Shamoli Yasmin ◽  
...  

Cushing syndrome results from chronic exposure to excess cortisol. Nodular adrenal hyperplasia is usually bilateral and has only a few case reports of unilateral presentation. Biochemically it is presented as hyperaldosteronism or as Cushing’s syndrome. Here, we are reporting a 17-year-old female presenting with weight gain over 5 months and uncontrolled hypertension. Biochemically she was found to have diabetes mellitus, secondary hypothyroidism and hypogonadotrophic hypogonadism due to Cushing’s syndrome of adrenal origin. Unilateral adrenal adenoma/hyperplasia in right adrenal gland was evident by radiology. Histopathological examination was done after laparoscopic adrenalectomy showed nodular adrenocortical hyperplasia in right adrenal mass. Following surgery, clinical features of the patient improved notably. Cushing syndrome due to unilateral nodular adrenocortical hyperplasia is a rare entity. Biochemical evaluation of hypothalamo-pituitary-adrenal axis, radiological evidence and histopathology are the important armaments can guide to final diagnosis. BIRDEM Med J 2022; 12(1): 78-82


Author(s):  
Jia-Sheng Ju ◽  
Tao Cui ◽  
Jing Zhao ◽  
Jian-Liang Chen ◽  
Hai-Bing Ju

This meta-analysis was to analyze the clinical presentation, magnetic resonance imaging (MRI) characteristics, and the management of Lymphocytic hypophysitis (LYH). Meta-analysis showed that the percentage of women in LYH patients was 78%. LYH was associated with pregnancy in 15% of the female patients, with headache (49%) and symptoms of central diabetes insipidus (CDI) (45%) being the most frequent presentation. In 24 % of the LYH patients, there was an association with another autoimmune disease. The incidence of secondary hypogonadism, secondary hypoadrenalism, secondary hypothyroidism, and growth hormone deficit was 54%, 49%, 43%, and 22%, respectively. Pituitary contrast enhancement (63%), symmetrical pituitary enlargement (60%), thickening of the pituitary stalk (58%), sella mass or suprasellar extension (58%), and loss of posterior pituitary hyperintensity (50%) were typical MRI findings. Regarding LYH treatment, the percentage of patients who had observation or hormone replacement, steroid therapy, and surgery was 43%, 36%, and 34%, respectively.


2021 ◽  
Author(s):  
Fernando Candanedo-Gonzalez ◽  
Javier Rios-Valencia ◽  
Dafne Noemi Pacheco-Garcilazo ◽  
Wilfredo Valenzuela-Gonzalez ◽  
Armando Gamboa-Dominguez

Hypothyroidism is a common endocrine disorder resulting of low levels of thyroid circulating hormones. The prevalence in the general population varies between 0.3% and 3.7%. Presents as clinical or subclinical disease based on presence of symptoms and levels of serum TSH and free thyroxine and T4, respectively. Hypothyroidism has numerous etiologies, some of them are originated on the thyroid itself and some others are of extrathyroid origin, with variable manifestations. Classified as primary, secondary, tertiary and peripheral. Thyroid autoimmune disease is the principal cause. A new class of drugs against cancer, like the anti-CTLA-4 and anti-PD-L1/PD1 therapies have been associated with primary or secondary hypothyroidism. Endocrine disorders can be difficult to diagnose based only on morphological features because endocrine manifestations are caused primarily by a hormonal imbalance. Hypothyroidism may have a higher risk of morbidity and mortality. Finally, myxedematous coma is the main complication of terminal stages hypothyroidism.


2021 ◽  
Vol 49 ◽  
Author(s):  
Yu. G. Krivosheeva ◽  
I. A. Ilovayskaya

Rationale: According to the recent epidemiological studies, prevalence of pituitary tumors amounts to 1 per 865 to 2688 adults. The prevalence rates of hypopituitarism in pituitary macroadenomas are highly variable and comprise 37% to 85% among newly diagnosed non-functioning pituitary adenomas (NFPA). There is virtually no data on the prevalence of hypopituitarism in the cohort of newly diagnosed macroadenomas secreting prolactin and somatotropic hormone.Aim: To assess the prevalence of hypopituitarism in patients with pituitary macroadenomas with various hormonal activities and to identify its potential risk factors.Materials and methods: We analyzed data from 293 patients with pituitary macroadenomas with various hormonal activities: NFPA (n = 121), prolactinomas (n = 59), and somatotropinomas (n = 113). The patients had been examined before any treatment was commenced.Results: The prevalence rate of hypopituitarism was 59/121 (39.9%) among the patients with NFPA, 18/59 (27.3%) among those with prolactinomas, and 19/113 (14%) among those with somatotropinomas (р < 0.001). The symptoms of chiasmal compression and chiasmal syndrome were significantly more prevalent in the patients with hypopituitarism, than in those without it in all subgroups. The relative risk of hypopituitarism in the patients with chiasmal compression was 2.10 for NFPA (95% confidence interval (CI) 1.50–2.95, р = 0.003), 1.667 for prolactinomas (95% CI 1.29–2.18, р = 0.005), and 1.45 for somatotropinomas (95% CI 1.56–2.48, р = 0.001). The relative risk of hypopituitarism in the patients with chiasmal syndrome was 1.66 for NFPA (95% CI 1.26–2.18, р = 0.009), 2.08 for prolactinomas (95% CI 1.60– 2.69, р = 0.001), and 1.97 for somatotropinomas (95% CI 1.56–2.48, р = 0.005). The NFPA subgroup had the highest rate of hypothyroidism (36/59, 61.0%), whereas the prolactinoma subgroup had the highest rate of secondary hypogonadism (34/59, 57.6%); however, hypogonadism is one of the manifestations of persistent pathological hyperprolactinemia typical for prolactinomas. In the somatotropinoma subgroup, secondary hypothyroidism was found in 11/19 (57.9%) of the patients.Conclusion: Identification of hypopituitarism before any treatment depended on the type of hormonal activity of a pituitary tumor and was most frequent in NFPA. The risk factors for hypopituitarism were chiasmal compression, chiasmal syndrome, vertical diameter of the pituitary tumor, and its volume. Secondary adrenal insufficiency, being the most hazardous component of hypopituitarism, manifested most rarely.


2021 ◽  
Vol 49 ◽  
Author(s):  
D. S. Mikhaylova ◽  
L. K. Dzeranova ◽  
O. Yu. Rebrova ◽  
E. A. Pigarova ◽  
L. Ya. Rozhinskaya ◽  
...  

Background: At present, surgical intervention is a  major treatment strategy for pituitary adenomas. It is commonly complicated with water and electrolyte imbalance. The prevalence of post-surgical central diabetes insipidus (CDI) may amount to 30%; however, its risk factors have not been established.Aim: To assess the rates and nosological distribution of CDI after transnasal adenomectomy and to identify its risk factors.Materials and methods: This retrospective study included 96 patients aged 20 to 65 years (median [Q1; Q3] 43  [34.5; 53.5]), who had transnasal adenomectomy in 2010–2011  due to Cushing's disease, acromegaly, prolactinoma, non-functioning pituitary adenoma. All patients underwent clinical examination and laboratory work-up before and after surgery. Their post-surgical course was assessed for 5  to 7  years. Depending on identified manifestations, the patients were categorized into the permanent CDI (n=15) and transient CDI (n=34); 47 patients had no CDI.Results: Cushing's disease (odds ratio (OR) 6.1, 95%  confidence interval (CI) 2.3–16.1), secondary adrenal insufficiency (OR 6.8, 95%  CI 2.6– 18.3) and adrenocorticotropic hormone levels of˂15.8 pg/mL (OR 5.0, 95% CI 1.9–13.5), microadenoma (OR 4.5, 95%  CI 1.7–11.5) promote transient postoperative CDI, whereas macroadenoma decrease this risk (OR 0.2, 95%  CI 0.1–0.5). The transient CDI was also more common in patients with secondary hypothyroidism, cortisol level of˂200  nmol/L, adenoma's volume at magnetic resonance imaging of<0.83 cm3  at trend level and more rare in patients with acromegaly and loss of tropic hormones before surgery at trend level as well. No significant risk factors were identified for permanent CDI, but it could be more often associated with secondary hypothyroidism, absence of any adenoma at magnetic resonance imaging and pituitary injury during the surgery and less frequent in patients with macroadenomas at trend level. Conclusion: The proportion of permanent postoperative CDI was 16% (95% CI 9–24), and that of the transient form 35%  (95%  CI 25–45). ˂0.83 cm3  at trend level and more rare in patients with acromegaly and loss of tropic hormones before surgery at trend level as well. No significant risk factors were identified for permanent CDI, but it could be more often associated with secondary hypothyroidism, absence of any adenoma at magnetic resonance imaging and pituitary injury during the surgery and less frequent in patients with macroadenomas at trend level.Conclusion: The proportion of permanent postoperative CDI was 16% (95% CI 9–24), and that of the transient form 35%  (95%  CI 25–45). Cushing's disease, microadenoma, development of secondary adrenal insufficiency and adrenocorticotropic hormone levels of˂15.8 pg/mL after surgery increase the probability of transient CDI, whereas macroadenoma does decrease this risk. No significant risk factors were identified for permanent CDI. 


2021 ◽  
Author(s):  
Ullah Hafiz Muhammad Zubair ◽  
Sioned Davies ◽  
Sadiqi Rana Muhammad ◽  
Lawrence Cozma

2021 ◽  
Vol 2 (14) ◽  
Author(s):  
Taha M. Taka ◽  
Chen Yi Yang ◽  
Joshua N. Limbo ◽  
Alvin Y. Chan ◽  
Jordan Davies ◽  
...  

BACKGROUND Spindle cell oncocytoma (SCO) of the pituitary gland is an extremely rare nonfunctional World Health Organization grade I tumor. SCOs are often misdiagnosed as nonfunctional pituitary adenomas on the basis of preoperative imaging. They are often hypervascular and locally adherent, which increases hemorrhage risk and limits resection, leading to increased risk of recurrence. The authors report a case of SCO treated at their institution and provide a review of the current literature. OBSERVATIONS SCO of the pituitary gland can be a rare cause of progressively growing pituitary tumors that presents similarly to nonfunctional pituitary adenoma. Endoscopic transsphenoidal resection of the tumor by a multidisciplinary team allowed total resection despite local adherence of the tumor. Postoperatively, the patient’s visual symptoms improved with persistence of secondary adrenal insufficiency and secondary hypothyroidism. LESSONS Careful resection is needed due to SCO’s characteristic hypervascularity and strong adherence to minimize local structure damage. Long-term follow-up is recommended due to the tendency for recurrence.


Author(s):  
Luis Jesuino Oliveira Andrade ◽  
Luisa Correia Matos de Oliveira ◽  
Gabriela Correia Matos de Oliveira

Introduction: The mechanisms by which hepatitis C virus (HCV) infection induces autoimmune thyroiditis (AIT) have been studied, and it was suggested that inflammatory cytokines during HCV infection would change the thyroperoxidase (TPO) signaling cascade and thyroglobulin (Tg) determining autoimmune thyroid disease.Objective: To show the signaling pathway, of TPO and Tg, and their potential targets mediated HCV in individuals with hepatitis C.Methods: The mapping of the signaling pathway was based on a review study approach and performed using the automatic annotation server of the Kyoto and Genome Encyclopedia (KEGG). PathVisio is free software for analysis and design of open source routes, and was used for the graphic representation of the signaling pathway.Results: The contigs were extracted from the KEGG database and their mapped transcription represents the signaling pathway of the main biomolecules that triggers the AIT. The action of HCV, or its treatment can trigger AIT that is characterized by the presence of autoantibodies against TPO and Tg. In AIT, autoreactive CD4 + T lymphocytes recruit B cells and CD8 + T cells in the thyroid. The progression of the disease leads to the death of thyroid cellsand hypothyroidism.Conclusion: HCV or its treatment activates several signaling pathways with thyroid cells damage resulting in AIT and secondary hypothyroidism to cellular apoptosis.


2021 ◽  
Vol 23 (Supplement_4) ◽  
pp. iv14-iv14
Author(s):  
Desiree Seguna ◽  
Scott Akker ◽  
James Ahlquist ◽  
Aparna Pal ◽  
Antonia Brooke ◽  
...  

Abstract Aims Objective: Active acromegaly is associated with increased mortality. While surgery is the mainstay of treatment, it is not always curative. In selected cases, CyberKnife stereotactic radiosurgery (CK SRS) can be used as adjuvant treatment in patients with persistent disease. Method Methodology: Biochemical response was measured using serum IGF-1 levels, calculated as a percentage of the upper limit of normal (% ULN). Levels were recorded prior to treatment, at 6-12 months post-treatment and at the most recent follow-up. Anterior pituitary hormone deficits were assessed before and after treatment. Tumour size was followed-up using MRI. Results 10 patients (7 male, mean age 36 yrs [+/- 12.6, SD]) with acromegaly were treated with CK SRS. 9 were treated following failure to attain biochemical remission with TSS. 1 had primary CK SRS. 2 had previous conventional fractionated external beam radiotherapy. Median tumour diameter was 6 mm (IQR 5.2-10.5 mm), with cavernous sinus invasion in 2 cases. The dose was 20-24Gy/1#. 4 patients were on dopamine agonist, 4 on somatostatin analogue and 2 on pegvisomant. Mean follow-up 31.6 months (+/- 13.5 months, SD). Median IGF-1 % ULN was 146% pre-treatment (IQR 126.5-208.5), 109% at 6-12 months (IQR 76.5-131%) and 71% (IQR 59-91%) at last follow-up. Mean radiological follow-up 16.6 months (+/- 15.9 months, SD). No cases showed tumour enlargement. One patient developed secondary hypothyroidism. Side-effects: headache (7 patients), blurred vision (1 patient), fatigue/nausea (1 patient). No new visual fields defects, cranial nerve palsies, cerebrovascular events or secondary tumours. Conclusion Conclusions: CK SRS appears safe and effective in selected patients with acromegaly, when there is failure to attain biochemical cure with surgery and in patients intolerant or resistant to medical treatment.


PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255678
Author(s):  
Stefanie Kitzmann ◽  
Katrin Hartmann ◽  
Yury Zablotski ◽  
Anna Rieger ◽  
Ralf Mueller ◽  
...  

Background Pituitary dwarfism (PD) in German Shepherd dogs (GSD) is a rare endocrinopathy. Cause and inheritance of the disease are well characterized, but the overall survival time, presence of concurrent diseases, quality of life (QoL) and influence of different treatment options on those parameters is still not well investigated. The aim of this study was to obtain data regarding the disease pattern of GSD with PD and to investigate the impact of treatment. Methods 47 dogs with dwarfism (presumably PD) and 94 unaffected GSD serving as controls were enrolled. Data were collected via a standardized questionnaire, which every owner of a participating dog had completed. Dogs with PD were grouped based on three categories of treatment: Group 1 (untreated), group 2 (treated with levothyroxine), group 3 (treated with thyroxine and progestogens or with growth hormone (GH)). Groups were compared using One-Way-Anova, Kruskal-Wallis test or Wilcoxon-rank-sum test. Categorical analysis was performed using Two-Sample-Chi-Squared-test. Results Dogs treated with thyroxine and gestagen or GH were significantly taller and heavier compared to all other dogs with PD. Quality of life was best in dogs with PD treated with thyroxine and similar to unaffected GSD. Treatment increased survival time in dogs with PD independent of the treatment strategy. Dogs receiving thyroxine and progestogens or GH did not develop chronic kidney disease (CKD). Conclusion GSD with PD should be treated at least for their secondary hypothyroidism to increase survival time. Additional treatment with progestogens or GH improves body size and seems to protect against the occurrence of CKD.


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