Pituitary function in subjects with mild traumatic brain injury: a review of literature and proposal of a screening strategy

Traumatic brain injury (TBI) is an important public health problem all over the world. The level of consciousness of the patients and the severity of the brain injury is commonly evaluated by the Glascow Coma Scale as mild, moderate and severe TBI. When we consider the high frequency of mild TBI (MTBI) among the all TBI patients the burden of the pituitary dysfunction problem in this group could not be ignored. However, one of the most important and still unresolved questions is which patients with MTBI should be screened for hypopituitarism? Another type of head trauma which could be considered as the subgroup of MTBI is sports related chronic repetitive head trauma. Therefore, in this review we will discuss the frequency, characteristics and current management of pituitary dysfunction in patients with MTBI including the subjects exposed to sports related chronic mild head trauma

Non polycystic ovary syndrome-related endocrine disorders associated with hirsutism

Background Hyperandrogenism refers to classical androgen-dependent signs such as hirsutism, acne and androgenetic alopecia. Hirsutism is the main hyperandrogenic symptom, defined as an excess of body hair in the androgen-sensitive skin regions of the women. In this review, we attempt to focus on the pathogenesis of hirsutism related to disorders other than polycystic ovary syndrome (PCOS). Also, we will discuss their clinical and biochemical features as well as therapeutic options. Design Several original articles, meta-analysis and reviews have been screened in the field of hirsutism and hyperandrogenic disorders. Results Current English literature including our studies suggests that PCOS is the most common cause of hirsutism. The most important purpose for investigation is to identify those women with androgen-secreting tumours because of their life-threatening potential. In approximately 18% of the women with hirsutism, the underlying cause is nonclassical adrenal hyperplasia because of 21-hydroxylase deficiency. Depending on ethnicity and the geographic area, idiopathic hirsutism constitutes 517% of the patients with hirsutism. Approximately 3% of hyperandrogenic women were observed to suffer from hyperandrogenic-insulin-resistant acanthosis nigricans syndrome. More rare causes are glucocorticoid resistance syndrome, hyperprolactinemia, acromegaly, Cushings syndrome and some drugs. Specific causes of hirsutism such as Cushings syndrome and adrenal/ovarian tumours should be treated specifically. In other patients, pharmacological approach is the mainstay of therapy. Conclusions A number of patients presenting with hirsutism and exhibiting similar features to PCOS may have other underlying diagnoses. Unlike PCOS, some of these disorders can occasionally be life threatening and require prompt diagnosis and treatment

Growth hormone replacement therapy in adults with growth hormone deficiency: Benefits and cost-effectiveness

In recent years, growth hormone deficiency in adults has been accepted as a clinical entity. Although beneficial effects of growth hormone replacement therapy (GHRT) in adults - including improvements in body composition, lipid profile, quality of life and bone mineral density - have been shown in many studies, there are still controversies and ongoing debates regarding GHRT in adults. It seems that this subject will continue to be a hot topic in the near future. Therefore, the aim of this review is to re-evaluate the current understanding on GHRT in adults in the light of recent data. Additionally, the clinical aspects, risks, benefits and cost-effectiveness of GHRT are summarized. © 2006 Future Drugs Ltd

Hirsutism - From Diagnosis to Use of Antiandrogens

Hirsutism affects 5-8% of the whole female population. It results either from an increase in circulating androgen concentrations, an increase in the sensitivity of the pilosebaceous unit to normal androgen concentrations or a combination of these factors. Polycystic ovary syndrome is the underlying cause in the vast majority of patients with hirsutism; however, it should be kept in mind that it can only be diagnosed after exclusion of some other diseases such as non-classical congenital adrenal hyperplasia, Cushing's syndrome, hyperprolactinemia and acromegaly. The most important purpose for investigation is to identify those women with pathologies that can be potentially life threatening either due to their systemic effects or malignant potential. Specific causes of hirsutism such as Cushing's syndrome and adrenal/ovarian tumors should be treated by surgical excision of the tumor. In the other patients, pharmacological approach is the mainstay of the therapy. Antiandrogens can be competitive antagonists of the androgen receptor (spironolactone, cyproterone acetate, flutamide) or inhibitors of 5-alpha reductase, which decrease the conversion of testosterone to the more potent androgen 5-alpha dihydrotestosterone (finasteride). Antiandrogens should be used only after ensuring safe nonhormonal contraception to avoid fetal male pseudohermaphroditism in case of unplanned pregnancy

Role of insulin and insulin resistance in androgen excess disorders

Insulin has complex effects on cell growth, metabolism and differentiation, and these effects are mediated by a cell-surface bound receptor and eventually a cascade of intracellular signaling events. Among the several metabolic and growth-promoting effects of insulin, insulin resistance is defined as an attenuated effect of insulin on glucose metabolism, primarily the limited export of blood glucose into skeletal muscle and adipose tissue. On the other hand, not all the signaling pathways and insulin-responsive tissues are equally affected, and some effects other than the metabolic actions of insulin are overexpressed. Ovaries and the adrenal glands are two examples of tissues remaining sensitive to insulin actions where insulin may contribute to increased androgen secretion. Polycystic ovary syndrome (PCOS) is the most common form of androgen excess disorder (AED), and its pathogenesis is closely associated with insulin resistance. Patients with idiopathic hirsutism also exhibit insulin resistance, albeit lower than patients with PCOS. Although it is not as evident as in PCOS, patients with congenital adrenal hyperplasia may have insulin resistance, which may be further exacerbated with glucocorticoid overtreatment and obesity. Among patients with severe insulin resistance syndromes, irrespective of the type of disease, hyperinsulinemia promotes ovarian androgen synthesis independently of gonadotropins. It is highly debated in whom and how insulin resistance should be diagnosed and treated among patients with AEDs, including PCOS. It is not suitable to administer an insulin sensitizer relying on only some mathematical models used for estimating insulin resistance. Instead, the treatment decision should be based on the constellation of the signs, symptoms and presence of obesity; acanthosis nigricans; and some laboratory abnormalities such as impaired glucose tolerance and impaired fasting glucose