Circulating thyrotropin is upregulated by estradiol

After encountering two women with serum thyrotropin (TSH) levels greater in periovulatory phase than in other days of the menstrual cycle, we hypothesized that TSH levels could be sensitive to changes in circulating estrogens in women. The objective of this study was to evaluate whether serum TSH increases after an induced acute increase of serum estradiol, and compare serum TSH increase with that of prolactin (PRL) which is a classic estradiol-upregulated pituitary hormone. In this retrospective study, we resorted to stored frozen sera from 55 women who had undergone the GnRH agonist (buserelin)-acute stimulation test of ovarian steroidogenesis. This test, that is preceded by dexamethasone administration to suppress adrenal steroidogenesis, had been performed to show an increased buserelin-stimulated response of 17-hydroxyprogesterone, a response that is frequent in polycystic ovary syndrome. Fifty-five women had enough serum volume at pertinent times (first observation early in the follicular phase and all times of the test) to permit assay of serum estradiol, TSH and PRL. Before dexamethasone administration, estradiol averaged 26.4 ± 15.5 pg/ml (reference range 23–139, follicular phase), TSH 1.78 ± 0.86 mU/L (reference range 0.3–4.2) and PRL 409.4 ± 356 mU/L (reference range 70.8–556) (mean ± SD). Serum estradiol, TSH and PRL averaged 47.2 ± 27 pg/ml, 0.77 ± 0.48 mU/L and 246.4 ± 206.8 mU/L just prior to the buserelin injection, but they peaked at 253.4 ± 113.5 pg/ml (nv 83–495, midcycle), 3.30 ± 1.65 mU/L and 540.3 ± 695.2 mU/L after injection. The responses to buserelin of estradiol, TSH and PRL were of wide magnitude. There was a significant correlation between TSH peak and serum estradiol peak, betweeen AUC0-24 h-TSH and AUC0-24 h-estradiol, or between PRL peak and estradiol peak and AUC0-24 h -PRL and AUC0-24 h-estradiol in only a subgroup of women. Therefore, women with estradiol-dependent increase in serum TSH do exist. Reference bands of serum TSH dependent on the phases of the menstrual cycle should be available

La gravidanza dell’adolescente del 2000: cosa è cambiato in 10 anni?

Gli Autori riferiscono i dati relativi alla gravidanza e al parto di due gruppi di adolescenti, dal 1993 e del 2003. Scopo del lavoro è stato quello di valutare i risultati ottenuti negli ultimi dieci anni nella popolazione adolescenziale attraverso gli ambulatori e i servizi territoriali al fine di migliorare l’evoluzione della gravidanza. In realtà è stato dimostrato un notevole decremento di alcune patologie evidenti negli anni ’90, ma purtroppo sono aumentate notevolmente le richieste di interruzione di gravidanza. Gli Autori auspicano che siano incrementate le iniziative di educazione sessuale rivolte agli adolescenti. Ribadiscono, infine, il concetto che nella scelta della modalità del parto, il ricorso al taglio cesareo nelle giovanissime dovrebbe essere quanto più possibile evitato

Complete Androgen Insensitivity Syndrome: A Rare Case of Disorder of Sex Development

Androgen Insensitivity Syndrome (AIS) could be considered as a disease that causes resistance to androgens actions, influencing both the morphogenesis and differentiation of the body structures, and systems in which this hormone exerts its effects. It depends on an X-linked mutations in the Androgen Receptor (AR) gene that express a variety of phenotypes ranging from male infertility to completely normal female external genitalia. The clinical phenotypes of AIS could vary and be classified into three categories, as complete (CAIS), partial (PAIS), and mild (MAIS) forms, according to the severity of androgen resistance. We will describe a case of CAIS in a 16-year-old patient

La nostra esperienza nel trattamento della pubertà precoce

Gli Autori riferiscono i risultati ottenuti in 54 bambine affette da pubertà precoce idiopatica ed in 10 bambine con pubertà anticipata utilizzando gli analoghi del GnRh. I loro risultati sono simili a quanto riportato in letteratura e dimostrano che la terapia è più efficace sulla pubertà precoce rispetto a quella anticipata ed è in genere ben tollerata. Gli Autori insistono sulla necessità di selezionare accuratamente le piccole pazienti prima di cominciare qualsiasi trattamento e ritengono che l'efficacia della terapia possa essere valutata sfruttando parametri clinici

Interferenza della flutamide sulla differenziazione sessuale di un feto maschio. Descrizione di un caso

Gli Autori descrivono un caso, da loro osservato, in cui l’assunzione dell’antiandrogeno flutamide da parte di una donna nelle prime settimane di gravidanza ha interferito sulla differenziazione sessuale di un feto geneticamente maschio abortito alla 15ª settimana di gestazione

Informazione contraccettiva e adolescenza: risultati di una indagine condotta nelle scuole superiori della città di Messina

Gli Autori riportano i risultati di un’indagine conoscitiva sui metodi contraccettivi effettuata in alcune scuole superiori della città di Messina. Gli adolescenti intervistati hanno dimostrato una scarsa conoscenza dei metodi contraccettivi e, nonostante una discreta percentuale di essi dichiari di aver avuto rapporti sessuali, solo pochi praticano la contraccezione. Gli Autori ritengono che gli interventi di educazione sessuale vadano implementati nelle scuole e debbano coinvolgere anche le scuole medie inferiori

Effects of the insulin sensitizer pioglitazone on menstrual irregularity, insulin resistance and hyperandrogenism in young women with polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is the most common endocrine cause of menstrual irregularities, hirsutism and acne. Women with PCOS present elevated plasma insulin levels, both fasting and after a glucose load, as an indirect evidence of insulin resistance. PCOS women may also present hypertension, low levels of HDL cholesterol, hypertriglyceridemia, visceral obesity and a higher level of CRP and fibrinogen that can predict an atherosclerotic risk

Relatively high rate of postpartum thyroiditis in the Straits of Messina area. Predictivity of both postpartum thyroiditis and permanent hypothyroidism by performing, in the first trimester of gestation, thyroid ultrasonography and measurement of serum thyroperoxidase and thyroglobulin autoantibodies

The prevalence of postpartum thyroiditis (PPT) averages 5%, with a range from 1% (Thailand) to 22% (Wales, UK, and Liguria, Italy), but 3.6% in another Italian region (Puglia). Evolution of PPT into permanent hypothyroidism (PH) occurs in approximately 50% of cases. Positive thyroperoxidase autoantibodies (TPOAb) in a pregnant woman is a strong predictor of PPT. Because in previous gestational cohorts we found an approximate 12% rate of TPOAb positivity, which compares with 15% in the Liguria cohort and 6% in the Puglia cohort, we hypothesized that the currently unknown prevalence of PPT in Sicily would approximate the said Liguria prevalence. We also explored the predictive value of serum thyroglobulin Ab (TgAb) positivity and ultrasonographic signs suggestive of thyroiditis (UST) at first trimester of gestation for PPT.Of 412 pregnant women who were followed-up for 1 year after delivery, 63 (15.3%) developed PPT, and 54% of them had PH. Gestational rates of TPOAb positivity alone, TgAb positivity alone or UST were 11.4%, 7.8% or 35.0%, with associated PPT rates of 66%, 45% or 36%. TgAb assay allowed detection of 9/63 PPT women (14.3%) who were TPOAb-negative. However, TPOAb remained a better predictor compared to TgAb or UST (odds ratio = 32 vs 10 or 13). Lowering the positivity threshold for either Ab to ≥61 U/ml, Ab-positive were 23.8% of PPT women and 17.7% of pH women. UST was detected in 82.5% of women who developed PPT, precisely 88% of those who evolved into PH and 75.9% of those who did not.Ours is the second study of the new millennium showing a PPT frequency >10%. The dual Ab and lowered threshold strategy correctly predicts more cases of PPT and PH compared to the sole TPOAb strategy. We confirm that half of the PPT women will have PH. Keywords: Geoepidemiology, Postpartum thyroiditis, Thyroid autoimmunit