Hipofiz sapı yokluğuna bağlı hipofizer yetmezliği ve ektopik nörohipofizi olan İki erişkin

We report two cases of 27-year-old and 19-year-old female patients with ectopic neurohypophysis and panhypopituitarism due to absent pituitary stalk. They were admitted to the endocrinology clinic with short stature, growth retardation and primary amenorrhea. Basal hormones revealed secondary hypothyroidism, adrenal insufficiency, hypogonadism and growth hormone insufficiency. Peak cortisol response to the short synacthen test (SST) was normal but was inadequate to insulin tolerance test. The other dynamic pituitary function tests showed panhypopituitarism. Magnetic resonance imaging of the pituitary gland revealed an ectopic posterior pituitary tissue and absent pituitary stalk. We administered hormone replacement therapy. As this disorder is usually encountered in the pediatric age group, we report here two adult patients with ectopic posterior pituitary tissue, absent pituitary stalk and panhypopituitarism.Hipofiz sapı yokluğuna bağlı total hipofizer yetmezliği ve ektopik nörohipofizi olan 27 ve 19 yaşlarında iki olguyu sunuyoruz. Bu hastalar endokrinoloji kliniğine boy kısalığı, gelişme geriliği ve primer amenore şikayetleri ile başvurdular. Bazal hormonların değerlendirilmesi ile sekonder hipotiroidi, adrenal yetersizlik, hipogonadizm ve büyüme hormonu eksikliği tespit edildi. Kısa synacten testinde pik kortizol cevabı normalken insülin tolerans testinde yetersizdi. Diğer dinamik hipofiz fonksiyon testlerinde total anterior hipofiz hormon yetersizliği vardı. Hipofiz bezinin manyetik rezonans görüntülemesinde hipofiz sapının olmadığı ve posterior hipofiz dokusunun ektopik yerleştiği görüldü. Hormon replasman tedavisine başlandı. Bu rahatsızlık genellikle çocuk yaş grubunda tespit edilmesine rağmen biz ektopik posterior hipofiz dokusu, hipofiz sap yokluğu ve total anterior hipofiz hormon yetersizliği olan iki erişkin hastayı sunuyoruz

Assessment of bone mineral density in patients with Sheehan's syndrome

WOS: 000337910800015PubMed ID: 24693853Introduction: The number of studies concerning bone mineral density (BMD) in patients with Sheehan's syndrome (SS) are scarce. We aimed to investigate the relationship between BMD and deficient hormones in patients with newly diagnosed SS. Material and methods: Thirty-four patients with SS and age-gender-weight matched 22 controls were included in the study. Results: We found osteoporosis in 61.8%, osteopenia in 32.3%, and normal dual energy X-ray absorptiometry (DEXA) findings in 5.9% patients. In the control group, 68.2% of individuals were osteopenic and 31.8% of them were normal. The number of osteoporotic patients was found to be higher and BMD values were lower in the patient group compared with the control group. There was no relation of DEXA measurements with the period between the last delivery and the initial diagnosis and the estradiol levels. While there was no relation between insulin-like growth factor 1 (IGF-1) and T and Z scores of femur head, the relation between the IGF-1 and L1-L4 T scores was statistically significant. There was a significant relation between the IGF-1 and L1-L4 Z scores. Conclusions: SS patients should also be assessed in terms of osteoporosis at the time of diagnosis and then proper treatment should be initiated afterwards

Two Adult Patients with Ectopic Neurohypophysis and Panhypopituitarism Due to Absent Pituitary Stalk

We report two cases of 27-year-old and 19-year-old female patients with ectopic neurohypophysis and panhypopituitarism due to absent pituitary stalk. They were admitted to the endocrinology clinic with short stature, growth retardation and primary amenorrhea. Basal hormones revealed secondary hypothyroidism, adrenal insufficiency, hypogonadism and growth hormone insufficiency. Peak cortisol response to the short synacthen test (SST) was normal but was inadequate to insulin tolerance test. The other dynamic pituitary function tests showed panhypopituitarism. Magnetic resonance imaging of the pituitary gland revealed an ectopic posterior pituitary tissue and absent pituitary stalk. We administered hormone replacement therapy. As this disorder is usually encountered in the pediatric age group, we report here two adult patients with ectopic posterior pituitary tissue, absent pituitary stalk and panhypopituitarism

Evaluation of ovarian reserve with amh level in patients with well-differentiated thyroid cancer receiving radioactive iodine ablation treatment

WOS: 000390416900003PubMed ID: 27711957Introduction: Radioactive iodine (RAI) ablation treatment is used for patients diagnosed with well-differentiated thyroid cancer in order to reduce the risk of recurrence. RAI ablation treatment can adversely affect gonads in males and females. In this study, we aimed to determine ovary damage and infertility risk due to RAI, using serum anti-Mullerian hormone (AMH) level, in females who received RAI ablation treatment. Materials and Methods: 45 female patients who have not gone through the menopause and had received RAI ablation treatment for well-differentiated thyroid cancer in premenopausal period, and 40 healthy females as control groups were included in this study. The serum AMH, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), thyroid stimulating hormone (TSH) and creatinine levels of the patients included in the study were analyzed and compared to those of the control group with similar demographical characteristics. Results: No differences were found between the patient group and control group in terms of age, height, weight, body mass index, LH, E2 and creatinine. The difference in AMH, FSH and TSH between both groups were found to be significant. There was no statistically significant relation between the age and AMH levels. Similarly, no statistically significant relation between RAI exposure duration and AMH levels was determined. When the patients below and above the age of 35 were compared with regard to AMH (2.95 +/- 1.79 and 2.75 +/- 1.94, respectively) and FSH (5.45 +/- 1.63 and 5.99 +/- 3.06, respectively), the difference between them was found to be statistically insignificant. Oligo/anovulation was detected in 7 patients (15.6 % of the patient group) after RAI treatment, 8 (17.8 %) patients became pregnant after RAI treatment, and none of the patients, who were actively trying to get pregnant, were unable to achieve it. Conclusion: According to these results, it may be concluded that low AMH levels due to RAI treatment can cause damage to the ovaries of patients; nevertheless, considering the AMH levels and the absence of infertility in the patients, the infertility risk was found to be low

Pituitary apoplexy probably due to TRH and GnRH stimulation tests in a patient with acromegaly

Pituitary apoplexy is the most serious and life-threatening complication of pituitary adenomas. Most of the cases occur spontaneously but it may occur also after a number of events such as the pituitary stimulation tests. We report a case of acromegaly due to a giant pituitary adenoma in which pituitary apoplexy developed 88 hours after TRH/GnRH stimulation test. The patient had severe headaches, nausea, vomiting, visual disturbance and mental alteration and the computed tomography (CT) scans revealed intratumoral and intraventricular bleeding. The pituitary mass was removed by transsphenoidal approach. The patient developed pneumonia and died on the 9(th) postoperative day. Pituitary apoplexy was confirmed at surgery and on histological examination. Immunohistochemical staining was positive for GH and PRL. This case indicates that pituitary apoplexy may develop several days after TRH/GnRH stimulation test

Effect of vitamin D treatment on serum sclerostin level

WOS: 000413852500008PubMed ID: 26824280Objective Sclerostin is an osteocyte-secreted endogenous inhibitor of Wnt signaling. Several systemic and local factors have been suggested as possible regulators of sclerostin expression by osteocytes. In this study, we examined the effect of vitamin D treatment on sclerostin levels. Subject and Methods 44 patients with diagnosis of vitamin D deficiency (25(OH)D20ng/ml) were involved in the study. Patients had monthly intramuscular injection of 300.000IU cholecalciferol for 3 consecutive months. Sclerostin, 25(OH)D, parathyroid hormone (PTH), calcium, phosphorus and alkaline phosphatase (ALP) levels were measured during the diagnosis and after the replacement of vitamin D. Results 8 male and 36 female patients were enrolled in the study. Minimum age, maximum age and average age were 21, 55 and 32.02 +/- 9.26 years, respectively. A statistically significant difference was observed between the pre-treatment and post-treatment values in 25(OH)D levels (p:0.001, 10.27 +/- 4.62ng/ml and 51.40 +/- 14.62ng/ml, respectively), PTH levels (p:0.001, 50.32 +/- 19.05pg/ml and 33.97 +/- 13.12pg/ml, respectively) and sclerostin levels (p:0.002, 858.98 +/- 351.63pg/ml and 689.52 +/- 197.92pg/ml, respectively). No statistically significant difference, however, was found between the pre-treatment and post-treatment calcium, phosphorus and ALP levels. Correlation analysis made on pre-treatment and post-treatment sclerostin levels and 25(OH)D, PTH, calcium, phosphorus and ALP levels revealed no statistically significant correlation. Conclusion Our findings show that the sclerostin level of patients with vitamin D deficiency decreases considerably through treatment