ABSTRACT
Hypothalamic amenorrhea is secondary to the dysfunction of the hypothalamic pacemaker that regulates the pulsatile secretion of gonadotropin releasing hormone (GnRH). We report a 21 years old female with an isolated and persistent hypogonadotropic hypogonadism probably of congenital origin. The patient had a good olfactory function, did not have anatomical alterations and two GnRH stimulation tests showed a pre puberal pattern. Hormone replacement therapy allowed her to complete her puberal development.
Subject(s)
Humans , Female , Adult , Amenorrhea/etiology , Hypothalamic Diseases/complications , Amenorrhea/diagnosis , Amenorrhea/drug therapy , Estrogen Replacement Therapy , Hypothalamic Diseases/diagnosis , Hypogonadism/etiology , Gonadotropin-Releasing Hormone , PubertyABSTRACT
We report a 45 years old female that consulted for amenorrhea and galactorrhea after discontinuing oral contraceptives, that she used for several years. The patient had hyperprolactinemia, a hypogonadotrophic hypogonadism and a primary hypothyroidism. Sella turcica magnetic resonance showed a pituitary macroadenoma with a diameter of 23 mm and supraselar extension. The patient was subjected to a transsphenoidal excision of the tumor with good clinical and surgical results. Therefore radiotherapy was not used for the treatment of the tumor.
Subject(s)
Humans , Female , Middle Aged , Adenoma/surgery , Adenoma/radiotherapy , Pituitary Neoplasms/surgery , Pituitary Neoplasms/radiotherapy , Radiotherapy, Adjuvant , Decision Making , Patient Selection , Postoperative Care , Neurosurgical Procedures/methods , Neoplasm Recurrence, Local/prevention & controlABSTRACT
Background: Untreated functional thyroid diseases are a risk factor for maternal and fetal complications during pregnancy. Aim: To determine the frequency of functional or autoimmune thyroid disease in healthy women during the first trimester of pregnancy. Subjets and Methods: healthy pregnant women attending a routine consult during their first trimester of pregnancy were studied. Thyroid stimulating hormone (TSH), total and free thyroxin (T4) anti-thyroid peroxidase (TPO) antibodies and spot urine iodine levels were measured. The reference ranges provided by the Atlanta Georgia Consensus in 2004 were used as normal values. A urine iodine concentration < 150 ug/L was considered low. Results: One hundred women age 30 +/- 5 years with a mean gestational age of 8,8 +/- 1,9 weeks, were studied. The frequencies of subclinical hypothyroidism, clinical hypothyroidism, isolated low thyroxin lecels, high antiTPO antibodies and low urine iodine levels were 19, 2, 3, 13 and 15 percent, respectively. Women with high TSH levels had lower total and free T4 levels. Conclusions: Twenty one percent of this sample of apparently healthy pregnant women had a clinical or subclinical hypothyroidism.
Subject(s)
Humans , Female , Pregnancy , Adolescent , Adult , Middle Aged , Thyroid Diseases/epidemiology , Thyroid Diseases/blood , Pregnancy Complications , Autoantibodies/analysis , Autoimmune Diseases/epidemiology , Thyroid Diseases/immunology , Thyroid Diseases/urine , Hypothyroidism/epidemiology , Pregnancy Trimester, First , Thyrotropin/blood , Iodine/urineABSTRACT
Dysthyroid optic neuropathy is an uncommon and severe form of presentation of Graves ophtalmopathy, caused by compression and elongation of the optic nerve. Use of high dose steroids is the treatment of choice. Decompressive surgery is reserved for refractory cases. We report a 41 years old female with a dysthyroid optic neuropathy that appeared 18 years after the diagnosis of Graves disease, manifested by a marked reduction in visual acuity. Orbit CAT scan did not show compression or elongation of optic nerve. She was treated with prednisone 60 mg per day, obtaining a complete remission after 19 days of treatment. After 90 days of follow up with low doses of steroids, the patient remains asymptomatic.
Subject(s)
Humans , Female , Adult , Optic Nerve Diseases/etiology , Graves Ophthalmopathy/complications , Graves Disease/drug therapy , Optic Nerve Diseases/drug therapy , Prednisone/therapeutic use , Treatment Outcome , Vision Disorders/etiologyABSTRACT
We report a 77 years old woman with osteoporosis in whom a hyperparathyroidism secondary vitaminD deficiency and renal hypercalciuria was diagnosed. Serum calcium was normal. During the diagnostic work up, a parathyroid nodule was discovered and subjected to a fine needle aspiration biopsy, that showed normal parathyroid cells. The patient was treated with calcitriol, cholecalciferol, hydrochlorothiazide and intravenous zolendronic acid. There was a reduction in urinary calcium and serum PTH levels and improvement of serum 25 hydroxy vitamin D levels.
Subject(s)
Humans , Female , Aged , Vitamin D Deficiency/complications , Kidney Diseases/complications , Hypercalciuria/complications , Hyperparathyroidism/etiology , Bone Density , Calcitriol/therapeutic use , Cholecalciferol/therapeutic use , Vitamin D Deficiency/drug therapy , Kidney Diseases/drug therapy , Hypercalciuria/drug therapy , Thyroid Nodule/diagnosis , Osteoporosis/etiologyABSTRACT
Hyperparathyroidim secondary to chronic renal failure is a common form of presentation of renal osteodystrophy in patients on chronic hemodialysis. Treatment is based on the maintenance of adequate serum calcium and phosphate levels. However, when hyperparathyroid hyperplasia acquires a nodular form, it becomes refractory to medical treatment and total parathyroidectomy is indicated. We report a 37 years old male on hemodialysis, with a progressive secondary hyperparathyroidism that required the excision of the two superior parathyroid glands at the age of 29.Hyperparathyroidsm was not modified, serum PTH remained excessively high and the patient had a non traumatic femoral fracture. Therefore he was subjected to the excision of the two remaining parathyroid glands. During the postoperative period he had a severe hungry bone syndrome, but was discharged in good conditions, 15 days after the operation.
Subject(s)
Humans , Male , Adult , Hyperparathyroidism, Secondary/surgery , Hyperparathyroidism, Secondary/etiology , Renal Insufficiency, Chronic/complications , Chronic Kidney Disease-Mineral and Bone Disorder/etiology , Parathyroidectomy , Renal DialysisABSTRACT
The study of hypothalamic, pituitary adrenal axis function requires complex tests. However, themeasurement of basal morning serum cortisol levels may be a simple measure to evaluate this axis. AIM: To determine if an isolated morning measurement of basal serum cortisol levels in the absence of stress, may predict the indemnity of the hypothalamic, pituitary adrenal axis. MATERIAL AND METHODS: Morning cortisol levels in the basal period and 30 minutes after the injection of 50 ug ACTH were measured in 76 patients with a mean age of 52 years (48 females), operated of a pituitary tumor, without cushing syndrome and not using steroids or oral estrogens. Twenty healthy volunteers with a mean age of 30 years (11 males) were studied as controls. In this last group, the lower limit of normal stimulated cortisol levels was defined as the mean value less two standard deviations and corresponded to 17 ug/dL. RESULTS: Based on stimulated cortisol levels, 15 percent of operated patients had a hypothalamic, pituitary adrenal axis dysfunction. Using cut-off levels of less than 5, 7.5 and 10 ug/dL, basal cortisol levels had a sensitivity for the diagnosis of hypothalamic, pituitaryadrenal axis dysfunction of 64, 81 and 100 percent, respectively. The figures were 100, 95 and 66 percent for specificity respectively, 100, 75 and 34 percent for positive predictive value and 94, 97 and 100 percent for negative predictive value. CONCLUSIONS: A basal morning cortisol value over 10 ug/dL discards the presence of hypothalamic, pituitary adrenal axis dysfunction and a value lower than 5 ug/dL confirmed alteration in all of the cases.