BT-09 Anhidrosis in neurohypophyseal germinoma treated with CBDCA and VP-16

Introduction: Acquired generalized anhidrosis (AGA) is the disease with non-congenital, non-segmented diffuse sweating dysfunction and is associated with neurological signs and dysautonomia except for anhidrosis. Here we have experienced 2 cases of AGA in the patient with neurohypophyseal germinoma after carboplatin (CBDCA) plus etoposide (VP-16) (CARE) therapy. Relationship of AGA to neurohypophyseal germinomas and their treatment is discussed. Cases: We experienced two young (26 y/o and 27 y/o) female neurohypophyseal germinoma cases of anhidrosis. They received CARE as chemotherapy and whole ventricular irradiation. They showed heat retention 2 to 3 years after initial treatment without recurred germinoma. Because acetylcholine sweating test was negative and skin biopsy revealed normal sweat gland structure, the diagnosis of acquired idiopathic generalized anhidrosis (AIGA), idiopathic pure sudomotor failure subtype, was initially made. After steroid pulse therapy, sweat function recovered partially and completely. Discussion: AIGA and germinoma are both rare diseases. So, the present 2 cases have similar clinical settings, that anhidrosis may not be idiopathic but secondary. Affected responsible site of anhidrosis in the present cases is thought to be acetylcholine receptor in the sweat cells. The present cases did not have any known disease with anhidrosis and did not receive any medication which cause anhidrosis written in the statement of the virtues of a medicine. Commonly used drugs in both cases are infusion solutions, CARE and related drugs, hormone stimulating test agents. Recently anhidrosis is reported in a case of cancer of unknown primary tumor site after using CBDCA and PTX. Both of the present cases are used CBDCA, which may cause anhidrosis. Conclusion: CBDCA may attributed to the occurrence of AGA based on hypothalamic vulnerability.

Early Detection of Peripheral Neuropathy in Type II Diabetes Mellitus by SUDOSCAN

Backgrounds: Sudomotor dysfunction is one of the earliest neurophysiologic abnormalities to manifest in distal small fiber neuropathy. SUDOSCAN ® was developed to provide a non invasive, quick, simple and quantitative measurement of sweat function. The aim of this study is to evaluate the value of SUDOSCAN in the diagnosis of neuropathy and its early detection. Methods: This is a case control study was conducted from March 2014 to December2014 on type2 diabetic patient in the center of diabetes and endocrine disease in AL-Najaf . Sweat function was evaluated by measuring the electrochemical skin conductance (ESC) of the hands and feet. Results: 100 patients with type 2 diabetes mellitus including 55 patients with peripheral neuropathy and 45 patients without peripheral neuropathy were involved in this case control study. Hands and feet conductance were lower in patients with type 2 diabetes with peripheral neuropathy when compared to patients with type 2 diabetes without neuropathy (with p value less than 0.001 for hands mean electrochemical skin conductance and feet mean electrochemical skin conductance). Conclusions: SUDOSCAN is a promising, screening tool to detect neuropathy in patients with diabetes mellites. This is a very simple test, easy-to-perform that can be done in the clinical setting in 3–5 min.

Autonomic thermoregulatory dysfunction in neurofibromatosis type 1

ABSTRACT Objective Neurofibromatosis type 1 (NF1) causes neural and cutaneous disorders and reduced exercise capacity. Exercise/heat exposure increasing internal temperature must be compensated by eccrine sweat function and warmed skin vasodilation. We suspected NF1 could adversely affect eccrine sweat function and/or vascular thermoregulatory responses (VTR). Methods The eccrine sweat function and VTR of 25 NF1 volunteers (14 males, 11 females; 16–57 years old) were compared with 23 non-NF1 controls matched by sex, age, height and weight (CG). Sweating was induced by 1) pilocarpine 1% iontophoresis (PILO); and 2) by passive heating (HEAT) via the lower third of the legs being immersed in 42°C water for one hour. Previously established eccrine sweat function and VTR protocols were used. Results The NF1 group showed: a) lower sweat rate than the CG group during PILO; b) a smaller diastolic pressure decrease; and c) higher tympanic temperatures than controls during HEAT (p < 0.05). Conclusion Reduced sweating and vascular thermoregulatory responses suggest autonomic dysfunction in NF1 individuals.

Quick and Simple Evaluation of Sudomotor Function for Screening of Diabetic Neuropathy

Objective. The aim of this study was to compare SUDOSCAN, a new device to evaluate sweat function (reflecting peripheral small C-fiber status), with conventional measures of peripheral and cardiac neuropathy in patients with type 2 diabetes. Methods. 265 diabetic patients were tested for symptoms and clinical signs of neuropathy using Michigan Neuropathy Screening Instrument (MNSI), vibration perception threshold (VPT) using biothesiometer, and cardiac autonomic neuropathy (CAN) using Ewing’s protocol. Sudomotor function was investigated with SUDOSCAN through measurement of electrochemical skin conductance (ESC) of hands and feet. Lower ESC is suggestive of sudomotor dysfunction. Results. Lower ESC at feet was significantly associated both with increasing symptoms (MNSI A) and increasing score on physical abnormalities (MNSI B). Lower ESC at feet was also significantly associated with increasing VPT by biothesiometry (P<0.01), and with higher number of abnormal CAN results (P<0.05). ESC was associated with postural fall in blood pressure (sympathetic abnormality) (P<0.05), but not with heart rate variability (HRV) tests (parasympathetic abnormalities). Conclusions. Sudomotor dysfunction testing may be a simple test to alert physicians to peripheral nerve and cardiac sympathetic dysfunction. Ease of performance could make it useful in a busy diabetic clinic. Further studies with hard clinical outcomes are indicated.