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Roganovic J, Saric L, Segulja S, Dordevic A, Radosevic M. Panhypopituitarism caused by a suprasellar germinoma: A case report. World J Clin Cases 2024; 12:1844-1850. [PMID: 38660086 PMCID: PMC11036465 DOI: 10.12998/wjcc.v12.i10.1844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 01/31/2024] [Accepted: 03/15/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Suprasellar germinomas are rare intracranial tumors frequently associated with permanent endocrine disorders. We present the clinical picture, treatment, and complications of suprasellar germinoma at pediatric age which, besides being life-threatening, has lifelong endocrinological consequences. CASE SUMMARY A 12-year-old female patient was presented having had intensive headaches for three weeks and visual disturbances for six months. An ophthalmological examination revealed bilateral papilledema and a marked loss of vision. Emergency brain magnetic resonance imaging (MRI) showed a suprasellar tumor, involving the infundibulum and the optic chiasm, extending to the third ventricle. Laboratory tests confirmed decreased levels of thyroxine, cortisol, gonadotropins, and insulin-like growth factor 1. Maximal tumor reduction was performed, and immunohistopathology established the diagnosis of suprasellar germinoma. MRI of the spine and cerebrospinal fluid cytology confirmed the localized disease. Adjuvant chemotherapy and radiotherapy were performed according to the SIOP CNS GCT II protocol. A post-treatment MRI showed no residual tumor, but pituitary function had not recovered. Three and a half years after the end of the treatment, the patient is in a complete remission, requiring hormonal replacement therapy, continuous education, and psychological support. CONCLUSION This complex case highlights the importance of timely diagnosis, a multidisciplinary approach, and close follow-up in children with suprasellar germinomas.
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Affiliation(s)
- Jelena Roganovic
- Department of Pediatrics, Clinical Hospital Centre Rijeka, Rijeka 51000, Croatia
- Faculty of Medicine, University of Rijeka, Rijeka 51000, Croatia
| | - Lea Saric
- Faculty of Medicine, University of Rijeka, Rijeka 51000, Croatia
| | - Silvije Segulja
- Faculty of Health Sciences, University of Rijeka, Rijeka 51000, Croatia
| | - Ana Dordevic
- Department of Business Development, Jadran Galenski Laboratorij, Rijeka 51000, Croatia
| | - Mia Radosevic
- Faculty of Medicine, University of Rijeka, Rijeka 51000, Croatia
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Selzer C, Ott J, Dewailly D, Marculescu R, Steininger J, Hager M. Prolactin levels in functional hypothalamic amenorrhea: a retrospective case-control study. Arch Gynecol Obstet 2024; 309:651-658. [PMID: 37957366 PMCID: PMC10808163 DOI: 10.1007/s00404-023-07277-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE Functional hypothalamic amenorrhea (FHA) is due to hypothalamic dysregulation. Literature lacks data about prolactin in FHA women, although both prolactin levels and FHA are associated with stress. Moreover, polycystic ovarian morphology is common in FHA and there is an association between FHA and polycystic ovary syndrome. Thus, the aim of this study was to assess prolactin levels in FHA patients and controls with a special focus on factors influencing prolactin levels, that could be considered as "sensors" of the hypothalamic-pituitary dysregulation. METHODS In a retrospective cohort study, 140 women with clearly defined FHA were compared to 70 healthy, normally ovulating women matched for age. The main outcome parameter was prolactin. Factors associated with prolactin levels >â12 ”g/L were tested using a multivariable binary logistic regression model. RESULTS The median prolactin level was 11.5 ”g/L (interquartile range, IQR 7.5-14.4), which was similar to the control group (median 10.7, IQR 8.3-14.5; pâ=â0.065). Only two women had hyperprolactinemia (prolactinâ>â25 ”g/L; 1.4%). In a multivariable binary logistic regression model eating disorder (odds ratio, OR 0.206; pâ=â0.040), excessive exercise (OR 0.280; pâ=â0.031) and TSH (OR 1.923; pâ=â0.020) were significantly associated with prolactin levels >â12 ”g/L. CONCLUSION Women with FHA have similar prolactin levels to healthy age-matched individuals. Eating disorders and excessive exercise where associated with prolactin levels <â12 ”g/L, in contrast to TSH.
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Affiliation(s)
- Clara Selzer
- Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Johannes Ott
- Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
| | - Didier Dewailly
- Faculty of Medicine Henri Warembourg, University of Lille, Lille Cedex, France
| | - Rodrig Marculescu
- Department of Laboratory Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Johanna Steininger
- Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Marlene Hager
- Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
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Calandrelli R, Pilato F, Massimi L, D'Apolito G, Grimaldi A, Chiloiro S, Bianchi A, Gessi M, Gaudino S. Pediatric craniopharyngiomas: magnetic resonance imaging assessment for hypothalamus-pituitary axis dysfunction and outcome prediction. Pediatr Radiol 2024; 54:157-169. [PMID: 38019284 DOI: 10.1007/s00247-023-05814-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND In adamantinomatous craniopharyngiomas, tumor topographical categories, cystic component volume, and magnetic resonance signal intensity may impact prognosis. OBJECTIVE To identify magnetic resonance imaging (MRI) variables associated with pituitary-hypothalamic axis dysfunction and predictive of outcome in children with cystic adamantinomatous craniopharyngiomas. MATERIALS AND METHODS We evaluated 40 preoperative MRIs of adamantinomatous craniopharyngiomas to classify tumor topography, volume, and signal intensity of the cystic components and peritumoral edema. Volumes and normalized signal intensity minimum values were extracted from coronal T2-weighted images (nT2min). Radiological variables were compared to pituitary-hypothalamic axis dysfunction-related clinical data and surgical outcomes. RESULTS Adamantinomatous craniopharyngiomas were categorized into five topographic classes (12 patients, sellar-suprasellar; seven patients, pseudo-intraventricular; six patients, strict intraventricular; 14 patients, secondary intraventricular; one patient, not strict intraventricular). All cases exhibited a predominant (30 patients, 80%) or total (10 patients, 20%) cystic tumor component and displayed low nT2min percentage values compared to cerebrospinal fluid (42.3% [interquartile range 28.4-54.6%]). Significant associations between tumor topographic classes and pituitary dysfunction (P<0.001), and between peritumoral edema and hypothalamic dysfunction (P<0.001) were found. Considering extent of surgical removal and tumor relapse, volume of the cystic tumor component displayed a positive correlation (P=0.002; r=0.48; P=0.02; r=0.36), while nT2min intensity values exhibited a negative correlation (P=0.01; r=â-â0.40; P=0.028; r=â-â0.34). CONCLUSION Severe hypothalamic-pituitary axis dysfunction is associated with tumors along the pituitary stalk and peritumoral edema. Tumor invasion of the third ventricle, tight adherence to the hypothalamus, larger volumes, and lower nT2min intensity of the tumor cystic component are independent predictors of extent of adamantinomatous craniopharyngioma excision and recurrence.
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Affiliation(s)
- Rosalinda Calandrelli
- Radiology and Neuroradiology Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy.
| | - Fabio Pilato
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italia
- Research Unit of Neurology, Department of Medicine and Surgery, UniversitĂ Campus Bio-Medico, Rome, Italy
| | - Luca Massimi
- Pediatric Neurosurgery, UniversitĂ Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gabriella D'Apolito
- Radiology and Neuroradiology Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Alessandro Grimaldi
- Radiology and Neuroradiology Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Sabrina Chiloiro
- Pituitary Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- Endocrinology and Diabetes Unit, UniversitĂ Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Bianchi
- Pituitary Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- Endocrinology and Diabetes Unit, UniversitĂ Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Gessi
- Neuropathology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UniversitĂ Cattolica del Sacro Cuore, Rome, Italy
| | - Simona Gaudino
- Radiology and Neuroradiology Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
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4
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Duan SL, Du LK, Zheng L. Misdiagnosis of hypopituitarism as gastroenteritis: A case report. Shijie Huaren Xiaohua Zazhi 2023; 31:949-952. [DOI: 10.11569/wcjd.v31.i22.949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/09/2023] [Accepted: 11/19/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND The clinical manifestations of pituitary dysfunction are atypical, complex, and diverse, which can easily lead to misdiagnosis.
CASE SUMMARY A 72-years-old male patient was admitted to the hospital due to "intermittent diarrhea for more than 10 years". He has previously been diagnosed with gastroenteritis, and the efficacy of oral administration of "norfloxacin and smecta" was not satisfactory. During hospitalization, he had mental symptoms such as delayed response, drowsiness, and difficulty answering questions. Upon examination, thyroid hormone levels, sex hormone levels, and cortisol levels were significantly reduced. Pituitary magnetic resonance imaging showed empty sella and pituitary compression, indicating hypopituitarism. After receiving glucocorticoid treatment, the patient's consciousness returned to normal and his diarrhea disappeared.
CONCLUSION The clinical manifestations of hypopituitarism are atypical, complex, and diverse, which makes it prone to misdiagnosis and missed diagnosis. If not diagnosed and treated in a timely manner, pituitary crisis may occur, endangering patients' life. Hypofunction of the pituitary gland is not uncommon in clinical practice. For patients with dry and pale skin, poor elasticity or swelling, anemia, anorexia, constipation, hair loss, fear of cold, indifferent expression, low pitch, slow response, weakness, loss of appetite, nausea, vomiting, weight loss, slow heart rate, low heart sound, decreased blood pressure, hypoglycemia, etc., hypofunction of the pituitary gland should be considered.
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Affiliation(s)
- Sheng-Lei Duan
- Shaanxi Provincial Hospital of Traditional Chinese Medicine, Xi'an 710003, Shaanxi Province, China
| | - Lin-Ke Du
- Shaanxi Provincial Hospital of Traditional Chinese Medicine, Xi'an 710003, Shaanxi Province, China
| | - Lie Zheng
- Shaanxi Provincial Hospital of Traditional Chinese Medicine, Xi'an 710003, Shaanxi Province, China
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Chen X, Ye P, Wei D, Li QC, Li T. Hydrocortisone-induced blood pressure reduction in a patient with anterior pituitary hypofunction: a case report. Eur J Hosp Pharm 2023; 30:e31. [PMID: 36564159 PMCID: PMC10647873 DOI: 10.1136/ejhpharm-2022-003590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 12/12/2022] [Indexed: 12/25/2022] Open
Abstract
Hydrocortisone is widely used for the anti-inflammatory and immunosuppressive effects and physiological substitute of endogenous glucocorticoid. Allergic reaction to hydrocortisone is infrequent, but once it occurs, it can affect the disease profile or survival of patients. The present study reported a case of hydrocortisone-induced blood pressure reduction in a patient with anterior pituitary hypofunction due to allergic reaction. The patient was admitted with burns. Anterior pituitary hypofunction was diagnosed during hospitalisation owing to persistent hyponatremia. During hydrocortisone intravenous administration, blood pressure was decreased to 70/40âmmHg, accompanied with flushed face and vasodilation. According to World Health Organization Uppsala Monitoring Centre (WHO-UMC) causality assessment and Naranjo scale, there was a probable relationship of reduced blood pressure with hydrocortisone. To the best of our knowledge, we have presented the first case of an anaphylaxis reaction of blood pressure reduction following hydrocortisone administration in the anterior pituitary hypofunction patient.
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Affiliation(s)
- Xi Chen
- Department of Pharmacy, Chengdu Second People's Hospital, Chengdu, China
| | - Peng Ye
- Department of Endocrinology and Metabolism, Chengdu Second People's Hospital, Chengdu, China
| | - Dong Wei
- Department of Endocrinology and Metabolism, Chengdu Second People's Hospital, Chengdu, China
| | - Qin Chuan Li
- Department of Pharmacy, Chengdu Second People's Hospital, Chengdu, China
| | - Ting Li
- Department of Endocrinology and Metabolism, Chengdu Second People's Hospital, Chengdu, China
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Sim SY, Ahn MB. Continuous Glucose Monitoring: A Possible Aid for Detecting Hypoglycemic Events during Insulin Tolerance Tests. SENSORS (BASEL, SWITZERLAND) 2023; 23:6892. [PMID: 37571675 PMCID: PMC10422333 DOI: 10.3390/s23156892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/25/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023]
Abstract
The combined pituitary function test evaluates the anterior pituitary gland, while the insulin tolerance test evaluates growth hormone deficiencies. However, successful stimulation requires achieving an appropriate level of hypoglycemia. Close medical supervision for glucose monitoring is required during hypoglycemia induction and the test is often very tedious. In addition, a capillary blood sugar test (BST) and serum glucose levels may differ greatly. An alternative approach may be utilizing a continuous glucose-monitoring (CGM) system. We provide three cases in which CGM was successfully used alongside a standard BST and serum glucose levels during the combined pituitary function test to better detect and induce hypoglycemia. Three participants who were diagnosed with multiple pituitary hormone deficiencies during childhood were re-evaluated in adulthood; a Dexcom G6 CGM was used. The CGM sensor glucose and BST levels were simultaneously assessed for glycemic changes and when adequate hypoglycemia was reached during the combined pituitary function test. The CGM sensor glucose, BST, and serum glucose levels showed similar glucose trends in all three patients. A Bland-Altman analysis revealed that the CGM underestimated the BST values by approximately 9.68 mg/dL, and a Wilcoxon signed-rank test showed that the CGM and BST measurements significantly differed during the stimulation test (p = 0.003). Nevertheless, in all three cases, the CGM sensor mimicked the glycemic variability changes in the BST reading and assisted in monitoring appropriate hypoglycemia nadir. Thus, CGM can be used as a safe aid for clinicians to use during insulin tolerance tests where critical hypoglycemia is induced.
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Affiliation(s)
| | - Moon Bae Ahn
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea;
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Yang H, Fang B, Wang Z, Chen Y, Dong Y. The Timing Sequence and Mechanism of Aging in Endocrine Organs. Cells 2023; 12:cells12070982. [PMID: 37048056 PMCID: PMC10093290 DOI: 10.3390/cells12070982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/15/2023] [Accepted: 03/22/2023] [Indexed: 04/14/2023] Open
Abstract
The world is increasingly aging, and there is an urgent need to find a safe and effective way to delay the aging of the body. It is well known that the endocrine glands are one of the most important organs in the context of aging. Failure of the endocrine glands lead to an abnormal hormonal environment, which in turn leads to many age-related diseases. The aging of endocrine glands is closely linked to oxidative stress, cellular autophagy, genetic damage, and hormone secretion. The first endocrine organ to undergo aging is the pineal gland, at around 6 years old. This is followed in order by the hypothalamus, pituitary gland, adrenal glands, gonads, pancreatic islets, and thyroid gland. This paper summarises the endocrine gland aging-related genes and pathways by bioinformatics analysis. In addition, it systematically summarises the changes in the structure and function of aging endocrine glands as well as the mechanisms of aging. This study will advance research in the field of aging and help in the intervention of age-related diseases.
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Affiliation(s)
- He Yang
- Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, Ministry of Education, China Agricultural University, Beijing 100193, China
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, Department of Nutrition and Health, China Agricultural University, Beijing 100193, China
| | - Bing Fang
- Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, Ministry of Education, China Agricultural University, Beijing 100193, China
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, Department of Nutrition and Health, China Agricultural University, Beijing 100193, China
| | - Zixu Wang
- College of Veterinary Medicine, China Agricultural University, Beijing 100193, China
| | - Yaoxing Chen
- College of Veterinary Medicine, China Agricultural University, Beijing 100193, China
| | - Yulan Dong
- Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, Ministry of Education, China Agricultural University, Beijing 100193, China
- College of Veterinary Medicine, China Agricultural University, Beijing 100193, China
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8
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Agresta G, Campione A, Veiceschi P, Gallo D, Agosti E, Massimi L, Piatelli G, Consales A, Linsler S, Oertel J, Pozzi F, Tanda ML, Castelnuovo P, Locatelli D. Clinical and oncological outcomes in single-stage versus staged surgery for pediatric craniopharyngiomas: a multicenter retrospective study. J Endocrinol Invest 2022; 46:1219-1232. [PMID: 36550264 DOI: 10.1007/s40618-022-01993-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Craniopharyngiomas (CPGs) are aggressive brain tumors responsible of severe morbidity in children. The best treatment strategies are under debate. Our study evaluates surgical, pituitary, and hypothalamic outcomes of a tailored staged-surgical approach compared to a single-stage radical approach in children with CPGs. METHODS Multicenter retrospective study enrolling 96 children treated for CPGs in the period 2010-2022. The surgical management was selected after a multidisciplinary evaluation. Primary endpoint includes the inter-group comparison of preservation/improvement of hypothalamic-pituitary function, the extent of resection, and progression-free survival (PFS). Secondary endpoints include overall survival (OS), morbidity, and quality of life (QoL). RESULTS Gross Total Resection (GTR) was reached in 46.1% of cases in the single-stage surgery group (82 patients, age at surgery 9â±â4.7 years) and 33.3% after the last operation in the staged surgery group (14 patients age 7.64â±â4.57 years at first surgery and 9.36â±â4.7 years at the last surgery). The PFS was significantly higher in patients addressed to staged- compared to single-stage surgery (93.75% vs 70.7% at 5 years, respectively, pâ=â0.03). The recurrence rate was slightly higher in the single-stage surgery group. No significant differences emerged in the endocrinological, visual, hypothalamic outcome, OS, and QoL comparing the two groups. CONCLUSIONS In pediatric CPGs' surgical radicality and timing of intervention should be tailored considering both anatomical extension and hypothalamic-pituitary function. In selected patients, a staged approach offers a safer and more effective disease control, preserving psychophysical development.
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Affiliation(s)
- G Agresta
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Luigi Borri, 57, 21100, Varese, Italy.
- Head and Neck Surgery and Forensic Dissection Research Center, University of Insubria, Luigi Borri, 57, 21100, Varese, Italy.
| | - A Campione
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Luigi Borri, 57, 21100, Varese, Italy
- Head and Neck Surgery and Forensic Dissection Research Center, University of Insubria, Luigi Borri, 57, 21100, Varese, Italy
| | - P Veiceschi
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Luigi Borri, 57, 21100, Varese, Italy
- Head and Neck Surgery and Forensic Dissection Research Center, University of Insubria, Luigi Borri, 57, 21100, Varese, Italy
| | - D Gallo
- Endocrinology Unit, Department of Medicine and Surgery, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - E Agosti
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Luigi Borri, 57, 21100, Varese, Italy
- Head and Neck Surgery and Forensic Dissection Research Center, University of Insubria, Luigi Borri, 57, 21100, Varese, Italy
| | - L Massimi
- Pediatric Neurosurgery Unit, Institute of Neurosurgery, Catholic University Medical School, Rome, Italy
| | - G Piatelli
- Division of Neurosurgery, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - A Consales
- Division of Neurosurgery, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - S Linsler
- Klinik fĂŒr Neurochirurgie, UniversitĂ€tsklinikum des Saarlandes, Homburg, Germany
| | - J Oertel
- Klinik fĂŒr Neurochirurgie, UniversitĂ€tsklinikum des Saarlandes, Homburg, Germany
| | - F Pozzi
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Luigi Borri, 57, 21100, Varese, Italy
- Head and Neck Surgery and Forensic Dissection Research Center, University of Insubria, Luigi Borri, 57, 21100, Varese, Italy
| | - M L Tanda
- Endocrinology Unit, Department of Medicine and Surgery, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - P Castelnuovo
- Head and Neck Surgery and Forensic Dissection Research Center, University of Insubria, Luigi Borri, 57, 21100, Varese, Italy
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Varese, Italy
| | - D Locatelli
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Luigi Borri, 57, 21100, Varese, Italy
- Head and Neck Surgery and Forensic Dissection Research Center, University of Insubria, Luigi Borri, 57, 21100, Varese, Italy
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Song S, Qiu P, Wang H, Zhang D, Qi Q, Feng L. Low preoperative serum prealbumin levels and risk of postoperative complications after transsphenoidal surgery in nonfunctioning pituitary adenoma. Neurosurg Focus 2022; 53:E6. [PMID: 36455266 DOI: 10.3171/2022.9.focus22211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 09/20/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE In other specialties, malnutrition has been shown to be closely linked to postoperative complications. However, there is no research on the relationship between nutritional parameters and the complications of transsphenoidal pituitary surgery. This study was designed to identify the relationship between preoperative nutritional markers and postoperative complications in nonfunctioning pituitary adenomas. METHODS This observational study included 429 patients whose first transsphenoidal surgery was performed in Shandong Provincial Hospital between January 2015 and July 2020. Preoperative prealbumin, retinol-binding protein (RBP), the prognostic nutritional index, clinicopathological data, and postoperative complication data were collected to investigate outcomes. RESULTS After multivariable adjustment, preoperative prealbumin and RBP were inversely associated with risk of complication (p value for trend = 0.006, 0.021). The increase of preoperative serum prealbumin and RBP concentration may decrease the risk of postoperative intracranial infection and hyponatremia (both OR per SD increment, < 1; p < 0.05). The increase of preoperative prealbumin may also decrease the risk of diabetes insipidus (OR per SD increment, 0.591; p = 0.001), but similar results were not obtained for the RBP (p > 0.05). Prealbumin and RBP are both useful in predicting overall complications (area under the receiver operating characteristic curve [AUC] 0.749, 0.678), especially in intracranial infection (AUC 0.794, 0.738). However, the predictive value of prealbumin was better than that of RBP. CONCLUSIONS Low preoperative prealbumin or RBP concentrations may be associated with higher surgical risk, especially for intracranial infection. This study emphasizes the suggestion that preoperative prealbumin and RBP concentrations may be vital factors in predicting operative complications of nonfunctioning pituitary adenomas.
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Affiliation(s)
- Shuaihua Song
- 1Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong
| | - Peng Qiu
- 2Department of Neurosurgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong
| | - Haoran Wang
- 3Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong; and
| | - Di Zhang
- 1Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong
| | - Qianjin Qi
- 1Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong
| | - Li Feng
- 4Department of Clinical Nutrition, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
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10
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Susilo AFP, Tjandraprawira KD, Rachmawati A. Isolated growth hormone deficiency and amenorrhea - Case report. Ann Med Surg (Lond) 2022; 84:104909. [PMID: 36582894 PMCID: PMC9793238 DOI: 10.1016/j.amsu.2022.104909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/03/2022] [Accepted: 11/13/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction and importance Growth hormone (GH) deficiency is the most common hypopituitarism disorder. We highlight the challenges to its diagnosis and management in the setting of a developing country. Case description A 14-year-old came with a chief complaint of inability to menstruate. Menarche was at 12-years old, lasted 7 days, soaking 2 pads/day which discontinued shortly after. Thelarche was at 12-years-old and her breast is at Tanner stage 3. Her axillary and pubic hair are at Tanner stage 1. Height was 120 cm, weight 34.8 kg, height for age z-score < -3. Her lab results were normal for estradiol, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and prolactin. Bone age was suitable for age. Magnetic resonance imaging revealed pituitary gland hypoplasia (5.3 mm). A hormonal panel 3 years prior showed abnormally low GH level but normal cortisol and thyroid hormone levels. She was diagnosed with isolated growth hormone deficiency (IGHD) with delayed puberty. She was treated with medroxyprogesterone tablets once daily, after which her menstruation restarted. However, due to her economic background, she declined genetic tests, discontinued her medication and amenorrhea recurred. Clinical discussion Amenorrhea present after a brief menarche should alert gynaecologists of a possible multi-hormone disorder with an underlying structural abnormality. IGHD may be due to a structural abnormality, such as pituitary gland hypoplasia. Unfortunately, economic reasons prevented the patient from receiving optimal treatment. Conclusion IGHD rarely presents with a gynaecological complaint. Hormonal and genetic tests along with imaging should be undertaken. Growth hormone supplementation is the treatment of choice.
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11
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Arefhosseini S, Ebrahimi-Mameghani M, Najafipour F, Tutunchi H. Non-alcoholic fatty liver disease across endocrinopathies: Interaction with sex hormones. Front Endocrinol (Lausanne) 2022; 13:1032361. [PMID: 36419770 PMCID: PMC9676462 DOI: 10.3389/fendo.2022.1032361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/24/2022] [Indexed: 11/09/2022] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) has emerged as the most frequent chronic liver disease globally. NAFLD is strongly associated with metabolic syndrome and it has been recently suggested that to rename NAFLD as metabolic dysfunction-associated fatty liver disease (MAFLD). NAFLD has been studied in different endocrine axes and accumulating body of clinical and experimental studies have suggested that NAFLD is associated with polycystic ovarian syndrome (PCOS), hypopituitarism, growth hormone deficiency (GHD), hypogonadism and other endocrine disorders. In fact, endocrine dysfunction may be considered as the major contributor for the development, progression, and severity of NAFLD. In the present comprehensive review, we discussed the epidemiological and clinical evidence on the epidemiology, pathophysiology, and management of NAFLD in endocrine disorders, with an emphasis on the effects of sex-specific hormones/conditions as well as molecular basis of NAFLD development in these endocrine diseases.
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Affiliation(s)
- Sara Arefhosseini
- Student Research Committee, Department of Biochemistry and Diet Therapy, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehrangiz Ebrahimi-Mameghani
- Nutrition Research Center, Department of Biochemistry and Diet Therapy, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farzad Najafipour
- Endocrine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Helda Tutunchi
- Endocrine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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12
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Conti E, Harschnitz O. Human stem cell models to study placode development, function and pathology. Development 2022; 149:276462. [DOI: 10.1242/dev.200831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
ABSTRACT
Placodes are embryonic structures originating from the rostral ectoderm that give rise to highly diverse organs and tissues, comprising the anterior pituitary gland, paired sense organs and cranial sensory ganglia. Their development, including the underlying gene regulatory networks and signalling pathways, have been for the most part characterised in animal models. In this Review, we describe how placode development can be recapitulated by the differentiation of human pluripotent stem cells towards placode progenitors and their derivatives, highlighting the value of this highly scalable platform as an optimal in vitro tool to study the development of human placodes, and identify human-specific mechanisms in their development, function and pathology.
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Affiliation(s)
- Eleonora Conti
- Neurogenomics Research Centre, Human Technopole , Viale Rita Levi-Montalcini, 1, 20157 Milan , Italy
| | - Oliver Harschnitz
- Neurogenomics Research Centre, Human Technopole , Viale Rita Levi-Montalcini, 1, 20157 Milan , Italy
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13
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Zhang XC, Sun Y. Hypopituitary syndrome with pituitary crisis in a patient with traumatic shock: A case report. World J Clin Cases 2022; 10:7029-7036. [PMID: 36051123 PMCID: PMC9297421 DOI: 10.12998/wjcc.v10.i20.7029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 04/01/2022] [Accepted: 05/22/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Shock is among the most common conditions that clinicians face in intensive care unit (ICU), of which hypovolemic shock is encountered most frequently; some patients instead suffer from neurogenic, cardiogenic, or infectious forms of shock. However, there are additional types of shock from unusual causes that are often undiagnosed. Here, we report the case of a patient who was initially misdiagnosed with hypovolemic shock, but exhibited persistent hypotension because of continuous fluid replacement and vasoactive drug administration, and was eventually diagnosed with hypopituitarism with crisis.
CASE SUMMARY A 73-year-old Chinese man was admitted to the neurosurgery department following injury caused by a heavy object with symptoms of anemia and high fever. He was transferred to the ICU on the fourth day after hospitalization because of hypotension and unconsciousness. Blood analysis indicated that the patient was suffering from anemia and thrombocytopenia. Ultrasonography showed that there was no apparent abnormality in the cardiac structure but there was mild tricuspid regurgitation. Computed tomography revealed that there were signs of hemorrhage at the right basal ganglia; accordingly, hypovolemic shock, possibly septic shock, was initially considered. Even after routine treatment for shock, the hypotension remained severe. The patient was again thoroughly examined to investigate the underlying cause. The antishock therapy was supplemented with corticosteroids to counter potential hypopituitarism. The patient made a full recovery, and the blood pressure returned to normal.
CONCLUSION A case of pituitary adenoma with multiple injuries was identified. Because of hypopituitarism, functionality of the corresponding endocrine system was restricted, with the most pronounced manifestation being unstable blood circulation requiring hormone replacement therapy. Such cases are relatively rare but may occur if multiple injuries are sustained. The present case represents a reference for the clinical treatment of patients with multiple injuries.
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Affiliation(s)
- Xing-Cheng Zhang
- Department of Critical Care Medicine, The Second Affiliated Hospital, Anhui Medical University, Hefei 230601, Anhui Province, China
| | - Yun Sun
- Department of Critical Care Medicine, The Second Affiliated Hospital, Anhui Medical University, Hefei 230601, Anhui Province, China
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14
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Beckman EJ, Hovey S, Bondi DS, Patel G, Parrish RH. Pediatric Perioperative Clinical Pharmacy Practice: Clinical Considerations and Management: An Opinion of the Pediatrics and Perioperative Care Practice and Research Networks of the American College of Clinical Pharmacy. J Pediatr Pharmacol Ther 2022; 27:490-505. [DOI: 10.5863/1551-6776-27.6.490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/24/2021] [Indexed: 11/11/2022]
Abstract
Pediatric perioperative clinical pharmacists are uniquely positioned to provide therapeutic and medication management expertise at a particularly vulnerable transition of care from the preoperative space, through surgery, and postoperative setting. There are many direct-patient care activities that are included in the role of the pediatric perioperative pharmacist, as well as many opportunities to develop effective, optimized, and safe medication use processes. This article outlines many of the areas in which a pediatric perioperative clinical pharmacist may intervene.
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Affiliation(s)
- Elizabeth J. Beckman
- Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, KY (EJB)
| | - Sara Hovey
- Department of Pharmacy Practice, University of Illinois at Chicago, College of Pharmacy, University of Illinois Hospital, Chicago, IL (SH)
| | - Deborah S. Bondi
- Department of Pharmacy Services, University of Chicago Medicine, Chicago, IL (DSB, GP)
| | - Gourang Patel
- Department of Pharmacy Services, University of Chicago Medicine, Chicago, IL (DSB, GP)
| | - Richard H. Parrish
- Department of Biomedical Sciences, Mercer University School of Medicine, Columbus, GA (RHP)
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15
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Song S, Wang L, Qi Q, Wang H, Feng L. Endoscopic vs. microscopic transsphenoidal surgery outcomes in 514 nonfunctioning pituitary adenoma cases. Neurosurg Rev 2022; 45:2375-2383. [PMID: 35230574 DOI: 10.1007/s10143-022-01732-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/19/2021] [Accepted: 01/05/2022] [Indexed: 12/22/2022]
Abstract
Transsphenoidal surgery remains the preference choice for patients with nonfunctioning pituitary tumors at present, but the superiority of surgical modalities is still debated. Moreover, the efficacy of microscopic and endoscopic transsphenoidal surgery has not been fully studied. Therefore, the present study was designed to compare the postoperative outcomes of the two widely used approaches worldwide. This retrospective study included 514 patients with the first transsphenoidal pituitary adenoma resection in Shandong Provincial Hospital from January 2015 to July 2020 and compared the outcomes of microscope transsphenoidal surgery (MTSS) and endoscopy transsphenoidal surgery (ETSS). A total of 514 patients were included in this study, of whom 210 received the ETSS and 304 received the MTSS. The patients in two groups were similar in terms of postoperative hyponatremia (pâ=â0.229), diabetes insipidus (pâ=â0.264), the recovery of hormonal axis (pâ<â0.05), and extent of resection (EOR) (pâ=â0.067). ETSS was more likely to cause cerebrospinal fluid leakage than MTSS (pâ=â0.017, 3.6% vs. 8.6%). CSF leakage might be related to tumor size (95% CIâ=â1.305-2.766, pâ=â0.001), and the surgeon's transsphenoidal surgery volumeâ<â300 was also a risk factor (95% CIâ=â1.396-9.067, pâ=â0.008). The effect of different surgeries on postoperative vision improvement was statistically difference in univariate analysis (pâ=â0.048) but not after adjustment for confounders (pâ=â0.112). Furthermore, there were statistical difference in EOR between MTSS and ETSS when adenomas were performed suprasellar extension (pâ=â0.037) or optic chiasm compression (pâ=â0.045). Both techniques are valid for the treatment of nonfunctional adenomas. But CSF leakage is more likely after ETSS. In addition, ETSS is more conducive to resection of nonfunctional adenomas with suprasellar extension or optic chiasm compression.
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Affiliation(s)
- Shuaihua Song
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Linping Wang
- The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China
| | - Qianjin Qi
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Haoran Wang
- Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250021, China
| | - Li Feng
- Department of Clinical Nutrition, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China.
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16
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MoszczyĆska E, Kunecka K, BaszyĆska-Wilk M, Perek-Polnik M, Majak D, Grajkowska `W. Pituitary Stalk Thickening: Causes and Consequences. The Children's Memorial Health Institute Experience and Literature Review. Front Endocrinol (Lausanne) 2022; 13:868558. [PMID: 35669693 PMCID: PMC9163297 DOI: 10.3389/fendo.2022.868558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/23/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Pituitary stalk thickening (PST) is a rare abnormality in the pediatric population. Its etiology is heterogeneous. The aim of the study was to identify important clinical, radiological and endocrinological manifestations of patients with PST and follow the course of the disease. MATERIALS AND METHODS It is a study conducted in 23 patients (13 boys) with PST with/without central diabetes insipidus (CDI) diagnosed between 1990 and 2020 at Children's Memorial Health Institute (CMHI) in Warsaw, Poland. We analyzed demographic data, clinical signs and symptoms, radiological findings, tumor markers, hormonal results, treatment protocols and outcomes. RESULTS The median age at the diagnosis of PST was 9.68 years (IQR: 7.21-12.33). The median time from the onset of the symptoms to the diagnosis was 2.17 years (IQR: 1.12-3.54). The most common initially reported manifestations were polydipsia, polyuria and nocturia (82.6%); most of the patients (56.5%) also presented decreased growth velocity. Hormonal evaluation at the onset of PST revealed: CDI (91.3%), growth hormone deficiency (GHD) (56.5%), hyperprolactinemia (39%), central hypothyroidism (34.8%), adrenal insufficiency (9%), precocious puberty (8.7%). The majority of the patients were diagnosed with germinoma (seventeen patients - 73.9%, one of them with teratoma and germinoma). Langerhans cell histiocytosis (LCH) was identified in three patients (multisystem LCH in two patients, and unifocal LCH in one patient). A single case of atypical teratoid rhabdoid tumor, suspected low-grade glioma (LGG) and lymphocytic infundibuloneurohypophysitis (LINH). The overall survival rate during the observational period was 87.0%. CONCLUSIONS The pituitary infundibulum presents a diagnostic imaging challenge because of its small size and protean spectrum of disease processes. Germinoma should be suspected in all children with PST, especially with CDI, even when neurological and ophthalmological symptoms are absent.
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Affiliation(s)
- ElĆŒbieta MoszczyĆska
- Department of Endocrinology and Diabetology, The Childrenâs Memorial Health Institute, Warsaw, Poland
| | - Karolina Kunecka
- Department of Endocrinology and Diabetology, The Childrenâs Memorial Health Institute, Warsaw, Poland
| | - Marta BaszyĆska-Wilk
- Department of Endocrinology and Diabetology, The Childrenâs Memorial Health Institute, Warsaw, Poland
- *Correspondence: Marta BaszyĆska-Wilk,
| | - Marta Perek-Polnik
- Department of Oncology, The Childrenâs Memorial Health Institute, Warsaw, Poland
| | - Dorota Majak
- Department of Diagnostic Imaging, The Childrenâs Memorial Health Institute, Warsaw, Poland
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17
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Rachfalska N, Putowski Z, Krzych ĆJ. Distant Organ Damage in Acute Brain Injury. Brain Sci 2020; 10:E1019. [PMID: 33371363 PMCID: PMC7767338 DOI: 10.3390/brainsci10121019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/15/2020] [Accepted: 12/18/2020] [Indexed: 02/07/2023] Open
Abstract
Acute brain injuries pose a great threat to global health, having significant impact on mortality and disability. Patients with acute brain injury may develop distant organ failure, even if no systemic diseases or infection is present. The severity of non-neurologic organs' dysfunction depends on the extremity of the insult to the brain. In this comprehensive review we sought to describe the organ-related consequences of acute brain injuries. The clinician should always be aware of the interplay between central nervous system and non-neurological organs, that is constantly present. Cerebral injury is not only a brain disease, but also affects the body as whole, and thus requires holistic therapeutical approach.
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Affiliation(s)
| | | | - Ćukasz J. Krzych
- Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland; (N.R.); (Z.P.)
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18
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Mittnacht J, Choukair D, Breil T, Klose D, Inta I, Bettendorf M. Relation of health-related quality of life to near final height and body composition in adolescents with chronic endocrinopathies during transition period. Clin Endocrinol (Oxf) 2020; 93:696-704. [PMID: 32682344 DOI: 10.1111/cen.14287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 07/02/2020] [Accepted: 07/12/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION We evaluated sequelae of disease and therapy in adolescents with chronic endocrinopathies using a medical and psychological workup to record health-related quality of life (HRQoL), near final height (NFH) and body compositions during the transition period from paediatric to adult care. METHODS Near final height, weight, body mass index (BMI), grip strength (GS), hip and waist circumference (HC; WC), skin folds (SF) and HRQoL T-scores by KIDSCREEN and DISABKIDS were assessed in 134 patients (70 females and 64 males) from May 2010 to March 2016 diagnosed with congenital adrenal hyperplasia (CAH; n = 22), multiple pituitary hormone deficiency (MPHD; n = 17), growth hormone deficiency (GHD; n = 37), Turner syndrome (TS; n = 27), SGA-short stature (SGA; n = 20) and Klinefelter syndrome (KS; n = 11). RESULTS Median HRQoL T-scores for KIDSCREEN (50.6-56.5) and DISABKIDS (52.7-58.9) ranged within references with considerable variations but without significant deficit in any diagnosis. Median-corrected height SDS (CoH-SDS: NFH-SDS-TH [target height]-SDS) was >-1, except in KS (SDS + 1.3) and in TS (SDS - 1.9; P < .0001) without correlations with HRQoL. Median BMI was below 25 kg/m2 in all patients except MPHD (26.5 kg/m2 ; SDS 1.5; P = .006). BMI correlated negatively in CAH females with self-perception (rs  = -.64, P = .0338), physical well-being (rs  = -.8; P = .0086), social exclusion rs  = -.65; P = .031) and emotions (rs  = -.7; P = .0169). CONCLUSION Health-related quality of life and body compositions were similar to those of healthy adolescents. Lower scores in HRQoL dimensions as self-perception, physical well-being, social exclusion and emotions were detected and correlated negatively with BMI. Treatment strategies and psychological support should consider HRQoL and adapted in specific treatment guidelines.
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Affiliation(s)
- Janna Mittnacht
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics, University Hospital Heidelberg, Heidelberg, Germany
| | - Daniela Choukair
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Breil
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics, University Hospital Heidelberg, Heidelberg, Germany
| | - Daniela Klose
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics, University Hospital Heidelberg, Heidelberg, Germany
| | - Ioana Inta
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics, University Hospital Heidelberg, Heidelberg, Germany
| | - Markus Bettendorf
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics, University Hospital Heidelberg, Heidelberg, Germany
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