Case Report Bilateral Adrenal Incidentalomas: A Rare Presentation of Lung Cancer

Adrenal incidentalomas are found incidentally during a radiologic examination performed for indications other than an adrenal disease, and 15% of them are bilateral adrenal masses. This study describes a 51-year-old male smoker patient admitted with diabetes mellitus. An abdominal ultrasonography performed due to his anemia revealed bilateral adrenal masses. His chest X-ray showed abnormal 10 cm opacity at the right upper lung, and brain, thorax, and abdomen CT scans showed multiple lesions compatible with lung cancer metastases. The pathological examination of the transthoracic lung biopsy specimen was consistent with lung adenocarcinoma. Findings in this patient indicate that, in middle aged patients with bilateral adrenal mass and a history or finding of any malignancy, the first diagnosis which should be considered is adrenal metastasis, and confirming the diagnosis by adrenal biopsy may be useless. Furthermore, screening all smoking patients by chest X-ray or thoracic CT for lung cancer may not be accepted as a routine procedure, but in smokers admitted to a hospital due to signs and symptoms attributed to a pulmonary disease, at least a chest X-ray should be requested

Neuroendocrine Disturbances after Brain Damage: An Important and Often Undiagnosed Disorder

Traumatic brain injury (TBI) is a common and significant public health problem all over the world. Until recently, TBI has been recognized as an uncommon cause of hypopituitarism. The studies conducted during the last 15 years revealed that TBI is a serious cause of hypopituitarism. Although the underlying pathophysiology has not yet been fully clarified, new data indicate that genetic predisposition, autoimmunity and neuroinflammatory changes may play a role in the development of hypopituitarism. Combative sports, including boxing and kickboxing, both of which are characterized by chronic repetitive head trauma, have been shown as new causes of neuroendocrine abnormalities, mainly hypopituitarism, for the first time during the last 10 years. Most patients with TBI-induced pituitary dysfunction remain undiagnosed and untreated because of the non-specific and subtle clinical manifestations of hypopituitarism. Replacement of the deficient hormones, of which GH is the commonest hormone lost, may not only reverse the clinical manifestations and neurocognitive dysfunction, but may also help posttraumatic disabled patients resistant to classical treatment who have undiagnosed hypopituitarism and GH deficiency in particular. Therefore, early diagnosis, which depends on the awareness of TBI as a cause of neuroendocrine abnormalities among the medical community, is crucially important

Traumatic Brain-Injury-Induced Hypopituitarism: Clinical Management and New Perspectives

Once being a neglected etiologic factor, traumatic brain injury is now acknowledged as an important risk factor for pituitary dysfunction. The gland might be damaged as a result of primary or secondary injury. The prevalence of pituitary dysfunction is highly variable across studies. The occurrence rate during acute and/or chronic phases was reported up to 69% in some series, while the rate of persistent hypopituitarism decreased to 12% when confirmatory testing was conducted. Growth hormone deficiency emerges as the most prevalent hormone deficiency subsequent to traumatic brain injury, followed by adrenocorticotropic hormone, gonadotropins (follicle-stimulating hormone and luteinizing hormone), and thyroid-stimulating hormone deficiencies. Pituitary function tends to be dynamic following traumatic brain injury; hormone insufficiencies may improve, and new deficiencies may occur during follow-up. The clinical findings of pituitary hormone deficiencies may vary widely from non-specific and subtle symptoms to urgent life-threatening conditions such as hypotension and hyponatremia. Timely diagnosis is of utmost importance, and it requires awareness and a high level of suspicion. Screening algorithms have been developed to guide clinicians on who should be tested for pituitary dysfunction, how, and for how long following traumatic brain injury. However, the rate of routine screening is still low among clinicians. We aimed to review the current literature focusing on the diagnosis and clinical management of pituitary dysfunction following traumatic brain injury

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

Long-term neuroendocrine consequences of traumatic brain injury and strategies for management

Introduction: Traumatic brain injuries (TBI) are reported to cause neuroendocrine impairment with a prevalence of 15% with confirmatory testing. Pituitary dysfunction (PD) may have detrimental effects on vital parameters as well as on body composition, cardiovascular functions, cognition, and quality of life. Therefore, much effort has been made to identify predictive factors for post-TBI PD and various screening strategies have been offered. Areas covered: We searched PubMed and reviewed the recent data on clinical perspectives and long-term outcomes as well as predictive factors and screening modalities of post-TBI PD. Inconsistencies in the literature are overviewed and new areas of research are discussed. Expert opinion: Studies investigating biomarkers that will accurately predict TBI patients with a high risk of PD are generally pilot studies with a small number of participants. Anti-pituitary and anti-hypothalamic antibodies, neural proteins, micro-RNAs are promising in this field. As severity of TBI has been the most commonly associated risk factor for post-TBI PD, we suggest prospective screening based on severity of head trauma until new evidence emerges. There is also a need for more studies investigating the clinical effects of hormone replacement in TBI patients with PD