The Effect of Teriparatide Treatment on Spinal Deformity Index in Severe Osteoporosis

Objective:This study’s purpose was to evaluate the efficacy of teriparatide (TPTD) therapy on back pain, quality of life, and spinal deformity index (SDI) in the presence of established postmenopausal osteoporosis.Materials and Methods:The mean ages of 21 patients with established osteoporosis were 72.43±4.06 years. The patients with L1-L4 mean vertebral and/or hip total T score -4 and less, and at least two vertebral and/or non-vertebral fractures, were included in the study. The patients received 20 microgram (μg)/day TPTD treatment and 800 IU/day vitamin D3 + 1200 mg/day calcium (Ca) treatment during six months. Biochemical parameters were examined before the treatment and sixth month controls. Visual analog scale (VAS) was used for back pain, short form 36 (SF-36) for quality of life, in addition, grading of vertebral fracture severity according to Genant method and SDI evaluation were performed.Results:The mean total alkaline phosphatase, uric acid, and 24-hour urinary Ca values of the patients demonstrated a statistically significant increase after TPTD treatment compared to the pre-treatment level (p<0.01, p<0.05, p<0.05; respectively). There was no statistically significant difference in other biochemical markers according to the pre-treatment. A statistically significant increase was observed in the L1-L4 bone mineral density of the patients (p<0.01). After the treatment, there was a statistically significant improvement in SF-36 and VAS values of the patients according to pre-treatment (p<0.01). A statistically significant increase was detected in SDI after TPTD treatment (p<0.01).Conclusion:It has been determined that the treatment of TPTD treatment improves back pain and quality of life by decreasing the risk of new fracture developments in advanced age group and in patients with multiple fractures, however, the expected increase in SDI is still continuing in the present fractures

Sheehan’s syndrome

Sheehan’s syndrome is postpartum hypopituitarism resulting from pituitary necrosis due to severe hypotension or shock secondary to massive bleeding during or following delivery. Sheehan’s syndrome is one of the neglected endocrine disorders. Although the definite mechanisms have not been clearly defined; disturbed blood supply of the pituitary gland due to hypotension in addition to increased demand of the gland due to physiological enlargement during gestation, relatively small sella size and autoimmunity in the longterm are suggested factors that are involved in the pathogenesis. Sheehan’s syndrome is characterized by variable degrees of hypopituitarism. Patients may have isolated, partial or complete hypopituitarism and they present with symptoms or signs due to the deficient hormone(s). The main difference from hypopituitarism due to other causes, such as pituitary adenoma or pituitary surgery, is the severity of the hormonal insufficiency. The symptoms and signs depend on the type and the severity of the underlying hormonal insufficiency. A history of failure of postpartum lactation and resumption of normal menses are the most common diagnostic features suggesting Sheehan’s syndrome. Partial or complete empty sella on MRI or CT is almost always seen in the patients. Treatment includes appropriate replacement of deficient hormones

Octreotide Uptake in Parathyroid Adenoma

The patient with a history of bone pain and muscle weakness, was thought to have oncogenic osteomalacia as a result of biochemical investigations and directed to Nuclear Medicine Department for a whole-body bone scintigraphy and 111In-octreotide scintigraphy. There was no focal pathologic tracer uptake, but generalized marked increase in skeletal uptake on bone scintigraphy. Octreotide scintigraphy showed accumulation of octreotide in the region of the left lobe of the thyroid gland in the neck. Thereafter, parathyroid scintigraphy was performed with technetium-99m labeled metroxy-isobutyl-isonitryl (99mTc-MIB) and MIBI scan demonstrated radiotracer uptake at the same location with octreotide scintigraphy. The patient underwent left inferior parathyroidectomy and histopathology confirmed a parathyroid adenoma. Somatostatin receptor positive parathyroid adenoma may show octreotide uptake. Octreotide scintigraphy may be promising and indicate a possibility of using somatostatin analogues for the medical treatment of somatostatin receptor positive parathyroid tumors. (MIRT 2012;21:77-79

A Case with Pituitary Abscess Presented with Acute Purulent Meningitis

Pituitary abscess is a rare and potentially life-threatening disease. Misdiagnosis is extremely frequent, until the drainage of purulent material during surgery because of the non-spesific clinical signs and laboratory findings. The diagnosis can be made preoperatively with awareness of the disease and careful assessment of radiological investigations, especially magnetic resonance imaging (MRI). We report a 43-year-old man who presented with acute purulent meningitis. Control MRI scans, performed because of the deterioration in patient’s general status during follow-up, revealed a pituitary abscess. We preferred a conservative approach initially, but abscess drainage later became essential, since there was no response to antibiotic therapy. The lesion disappeared after transsphenoidal drainage. The general health status of the patient, receiving a replacement therapy for anterior pituitary deficiency, was good 2 months after discharge. Pituitary abscess should be kept in mind in patients with acute meningitis whose clinical picture deteriorates despite the appropriate treatment. This case illustrates that the preoperative diagnosis is possible with careful evaluation, and with the treatment of this life-threatening condition, satisfactory results might be achieved. Turk Jem 2009; 13: 63-

How does pregnancy affect the patients with pituitary adenomas: A study on 113 pregnancies from Turkey

WOS: 000419489200014PubMed ID: 28634705Objective Data regarding pregnancies in relation to pituitary tumors are limited. The effects of pregnancy on pituitary adenomas and the effects of adenoma itself (hormonal activity, mass effects and pituitary insufficiency) and/or treatment on the ongoing gestation and developing fetus were evaluated. Methods The study was a retrospective study. A questionnaire involving questions regarding medical history before index gestation, history of related pregnancy, result of index gestation and postpartum follow-up of the patients was filled by the investigator in one of the eight Referral Endocrinology Centers from Turkey. Results One hundred and thirteen (83 prolactinoma, 21 acromegaly, 8 NFPA and 1 plurihormonal pituitary adenoma) pregnancies of 87 (60 prolactinoma, 19 acromegaly, 7 NFPA and 1 plurihormonal pituitary adenoma) patients were reviewed. The clinically important pregnancy-related tumor growth of pituitary adenomas was found to be low in previously treated adenomas. Prolactinomas were more likely to increase in size during pregnancy especially if effective prior treatment was lacking. The risk of hypopituitarism is also minimal due to pituitary adenomas during pregnancy. The results of pregnancies did not differ in patients who were on medical treatment or not for prolactinomas and acromegaly during gestation. Neural tube defect and microcephaly associated with maternal cabergoline use; Down syndrome and corpus callosum agenesis associated with maternal bromocriptine use; unilateral congenital cataract, craniosynostosis and microcephaly associated with maternal acromegaly were detected for the first time. Conclusion Medical treatment can be safely done stopped in patients with prolactinoma and acromegaly when pregnancy is confirmed and reinstituted when necessary. Prospective studies may help to determine the effects of medical treatment during gestation on the mother and fetus