THE ROLE OF ENDOGENOUS DOPAMINE IN TSH SECRETION IN PATIENTS WITH NON THYROIDALDISEASE

PATIENTS WITH CHRONIC NON THYROIDAL DISEASES EXHIBIT A DECREASE IN SERUM T3, AN INCREASE IN SERUM REVERSE T3 AND NORMAL OR REDUCED BASAL OR STIMULATED TSH SECRETION BY TRH. IT IS POSSIBLE THAT THE DECREASED TSH RESPONSE TO TRH IS DUE TO AN INCREASED DOPAMINERGIC TONE TO THE PITUATARY. TO EXAMINE THIS POSSIBILITY WE STUDIED 14 PATIENTS WITH VARIOUS CHRONIC NON THYROIDAL DISEASES AND 8 HEALTHY AGE AND SEX MATCHED CONTROLS. WE MEASURED TSH AND T3 AND T4 BEFORE AND AFTER ADMINISTRATION OF TRH. THE SAME MEASUREMENTS WERE DONE SEVEN DAYS LATER AFTER ADMINISTRATION OF TRH AND METOCLOPRAMIDE. THE MAXIMUM RESPONSE TO TRH WASSIMILAR IN BOTH GROUPS. METOCLOPRAMIDE ADMINISTRATION HAD NO EFFECT ON TSH SECRETION OF THE PATIENTS BUT INCREASED CONTROLS' TSH. PATIENTS WITH LOW BASAL SERUM T3 DISPLAYED A VERY SMALL INCREASE IN STIMULATED SERUM T3. WE THEREFORE CONCLUDE THAT ENDOGENOUS DOPAMINERGIC TONE HAS NO EFFECT ON TSH SECRETION IN PATIENTS WITH CHRONIC NON THYROIDAL ILLNESS. THE DECREASED THYROIDAL RESPONSE OF T3 TO ENDOGENOUS TSH IN PATIENTS WITH SEVERE NON THYROIDAL ILLNESS SUGGESTS THAT THE INTRATHYROIDAL T3 POOL IS DECREASED IN THESE PATIENTS OR THE CONVERSION OF T4 TO T3 INTO THE THYROID IS IMPAIRED AS WELL.ΟΙ ΑΣΘΕΝΕΙΣ ΜΕ ΧΡΟΝΙΑ ΣΥΣΤΗΜΑΤΙΚΑ ΜΗ ΘΥΡΕΟΕΙΔΙΚΑ ΝΟΣΗΜΑΤΑ ΠΑΡΟΥΣΙΑΖΟΥΝ ΕΛΑΤΤΩΣΗ ΤΗΣ ΤΙΜΗΣ Τ3, ΑΥΞΗΣΗ ΑΝΑΣΤΡΟΦΗΣ Τ3 ΚΑΙ ΦΥΣΙΟΛΟΓΙΚΗ 'Η ΕΛΑΤΤΩΜΕΝΗ ΒΑΣΙΚΗ 'Η ΜΕΤΑ ΔΙΕΓΕΡΣΗ ΜΕ TRH ΤΙΜΗ TSH. ΥΠΟΘΕΣΑΜΕ ΟΤΙ Η ΕΛΑΤΤΩΣΗ ΤΗΣ TSH ΟΦΕΙΛΕΤΑΙ ΣΕ ΑΝΑΣΤΑΛΤΙΚΗ ΔΡΑΣΗ ΤΗΣ ΝΤΟΠΑΜΙΝΗΣ ΣΤΗΝ ΑΠΟΦΥΣΗ. ΜΕΛΕΤΗΣΑΜΕ 14 ΑΣΘΕΝΕΙΣ ΜΕ ΧΡΟΝΙΑ ΣΥΣΤΗΜΑΤΙΚΑ ΝΟΣΗΜΑΤΑ ΚΑΙ 8 ΥΓΙΗ ΑΤΟΜΑ ΣΑΝ ΜΑΡΤΥΡΕΣ. ΠΡΟΣΔΙΟΡΙΣΑΜΕ ΤΗΝ ΤΙΜΗ ΤΗΣTSH ΚΑΙ ΤΩΝ Τ3 ΚΑΙ Τ4 ΠΡΙΝ ΚΑΙ ΜΕΤΑ ΤΗΝ ΔΙΕΓΕΡΣΗ ΜΕ TRH. ΣΕ ΔΕΥΤΕΡΗ ΦΑΣΗ ΚΑΝΑΜΕ ΤΙΣ ΙΔΙΕΣ ΜΕΤΡΗΣΕΙΣ ΑΦΟΥ ΠΡΩΤΑ ΧΟΡΗΓΗΣΑΜΕ METOCLOPRAMIDE (ΑΝΤΑΓΩΝΙΣΤΗ ΤΗΣ ΝΤΟΠΑΜΙΝΗΣ) ΚΑΙ TRH. Η ΜΕΓΙΣΤΗ ΑΝΤΑΠΟΚΡΙΣΗ ΣΤΗΝ TRH ΗΤΑΝ ΙΔΙΑ ΣΤΙΣ ΔΥΟ ΟΜΑΔΕΣ.Η METOCLOPRAMIDE ΔΕΝ ΕΠΗΡΕΑΣΕ ΤΗΝ ΑΝΤΑΠΟΚΡΙΣΗ ΤΗΣ TSH ΣΤΟΥΣ ΑΡΡΩΣΤΟΥΣ ΕΝΩ ΑΥΞΗΣΕ ΑΥΤΗ ΣΤΟΥΣ ΜΑΡΤΥΡΕΣ. ΟΙ ΑΣΘΕΝΕΙΣ ΠΟΥ ΕΙΧΑΝ ΠΟΛΥ ΧΑΜΗΛΗ ΤΙΜΗ Τ3 ΠΑΡΟΥΣΙΑΣΑΝΚΑΙ ΜΙΚΡΗ ΑΥΞΗΣΗ ΤΗΣ ΤΙΜΗΣ Τ3 ΜΕΤΑ ΔΙΕΓΕΡΣΗ ΜΕ TRH. ΣΥΜΠΕΡΑΙΝΟΥΜΕ ΛΟΙΠΟΝ ΟΤΙ Ο ΕΝΔΟΓΕΝΗΣ ΝΤΟΠΑΜΙΝΕΡΓΙΚΟΣ ΤΟΝΟΣ ΔΕΝ ΠΑΙΖΕΙ ΡΟΛΟ ΣΤΗΝ ΕΚΚΡΙΣΗ TSH ΣΕ ΑΣΘΕΝΕΙΣΜΕ ΧΡΟΝΙΑ ΜΗ ΘΥΡΕΟΕΙΔΙΚΑ ΝΟΣΗΜΑΤΑ. Η ΜΕΙΩΜΕΝΗ ΘΥΡΕΟΕΙΔΙΚΗ ΑΝΤΑΠΟΚΡΙΣΗ ΤΗΣ Τ3 ΣΤΗΝ ΕΝΔΟΓΕΝΗ TSH ΣΕ ΑΡΡΩΣΤΟΥΣ ΜΕ ΧΡΟΝΙΑ ΜΗ ΘΥΡΕΟΕΙΔΙΚΑ ΝΟΣΗΜΑΤΑ ΔΕΙΧΝΕΙ ΜΕΙΩΣΗ ΤΗΣ ΕΝΔΟΘΥΡΕΟΕΙΔΙΚΗΣ Τ3 ΚΑΙ ΤΗΣ ΜΕΤΑΤΡΟΠΗΣ ΤΗΣ Τ4 ΣΕ Τ3 ΜΕΣΑ ΣΤΟΝ ΘΥΡΕΟΕΙΔΗ

Abnormal liver function tests in a patient with myotonic dystrophy type 1

Myotonic dystrophy type 1, also known as Steinert's disease, is a multisystemic disorder with significant genetic and clinical heterogeneity. Apart from skeletal muscles' myotonia and wasting, a variety of system organs can be affected. We report on a 49 years old female patient with unremarkable medical and family history, who presented with elevated liver enzymes without signs or symptoms of chronic liver disease neither neurological features. Initial assessment, including liver biopsy, did not reveal the cause of these abnormalities. Eight months later, she complained for disequilibrium and eventually electromyography confirmed the diagnosis of Steinert's disease. Steinert's disease should be considered in the differential diagnosis of patients with elevated liver enzymes, as long as abnormal liver tests may be the initial presentation. The pathophysiological mechanism of this abnormality remains unclear

Lapatinib-induced hepatitis: A case report

Lapatinib is an inhibitor of the tyrosine kinases of human epidermal growth factor receptor type 2 (HER2) and epidermal growth factor receptor type 1, with clinical activity in HER2-positive metastatic breast cancer. We present here a 60 year-old patient with metastatic breast cancer who presented with jaundice and increased serum aminotransferase levels and who had been treated with lapatinib for the previous 14 days. Laboratory tests excluded other causes of acute liver injury. Liver biopsy revealed lesions compatible with drug-induced hepatotoxicity. Bilirubin and liver enzymes returned to normal within three months of lapatinib discontinuation. Lapatinib should be included among the causes of drug-induced hepatitis

Fatigue and depressive symptoms associated with chronic viral hepatitis patients’ health-related quality of life (HRQOL)

Background and rationale. It is well established that chronic viral hepatitis (CVH) negatively affects patients’ health-related quality of life (HRQOL). The aim of the present study was to assess the extent to which fatigue and depressive symptoms are associated with CVH patients’ HRQOL.Methods. Eighty-four adult CVH outpatients [45 with hepatitis B virus (HBV) and 39 with hepatitis C virus (HCV) infection] participated in the study. The Short Form-36 Health Survey (SF-36), the Beck Depression Inventory-II (BDI-II) and the Fatigue subscale of the Functional Assessment of Cancer Therapy-Anemia Scale (FACT-F) were used to assess HRQOL, depression and fatigue, respectively.Results. All aspects of HRQOL perceived by CVH patients were significantly impaired compared to the general population, as a comparison with Greek population-based normative data revealed. HBV patients presented similar HRQOL with HCV patients. Clinical parameters including infection activity, fibrosis stage or inflammation grade, as well as depressive symptoms and fatigue were found to be significantly associated with HRQOL. Multivariate analyses showed that older age (p <0.001) and higher fatigue scores (p <0.001) were the variables most closely associated with the physical HRQOL, whereas higher rates on depressive symptoms (p <0.0005) and fatigue (p <0.020) scales were the variables most closely associated with the mental HRQOL.Conclusions. In conclusion, CVH is associated with impaired HRQOL. Fatigue and impaired psychological functioning is associated with diminished HRQOL in CHV, independent of the disease etiology. Consequently, management of fatigue and depressive symptoms should be considered a priority, in order to improve HRQOL in CVH patients

Prevalence of anti-HAV antibodies in multitransfused patients with beta-thalassemia

AIM: To detect the prevalence of anti-HAV IgG antibodies in adult multitransfused beta-thalassemic patients