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Objective:To explore the clinical characteristics of patients with pituitary thyrotropin-secreting adenoma and evaluate the effect of preoperative short-acting octreotide treatment on hyperthyroidism.Methods:A retrospective analysis was performed in 40 patients with pituitary thyrotropin adenoma diagnosed in Beijing Tiantan Hospital from January 2008 to January 2018. The general data, laboratory examinations and imaging findings were reviewed and analyzed. The clinical effect of preoperative octreotide on hyperthyroidism was evaluated.Results:The age of onset year of the 40 patients (male: female = 24∶16) was (30.5±5.1) years. Among them, 35 patients (87.5%) were with macroadenoma. The most common symptoms were thyroid hypermetabolism syndrome, followed by headache, dizziness, visual field damage and hypogonadism. The thyroid function of 30 patients (75%) recovered to normal within 3-5 days after the octreotide treatment. The total effective rate of the octreotide was 90.0%. The level of free thyroxine (FT 4) before treatment in patients with more than 10 times of effective cumulative dose was significantly higher than that in patients with less than 10 doses. Conclusions:Thyroid hypermetabolism syndrome and pituitary occupying effect are the most common clinical manifestations of thyrotropin-secreting adenoma. Preoperative octreotide treatment can effectively control hyperthyroidism. The level of FT 4 is a crucial factor affecting the efficacy of octreotide.
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Objective:To analyze the effect of long-acting somatostatin treatment on blood glucose, blood lipid, insulin resistance and islet function in patients with acromegaly after surgical treatment.Methods:Self-control study before and after treatment was used. A total of 30 subjects who were diagnosed as acromegalyand received surgical treatment in Beijing Tiantan Hospital from January 2016 to January 2018 were enrolled in this study. Because patients′ growth hormone (GH) level was notc ompletely controlled after surgery, all the patients were treated with long-acting octreotide for more than 1 year. Before and 1 year after treatment, oral glucose tolerance testing (OGTT) was performed at pretreatment and 1 year after initiation of treatment with long-acting octreotide. Homeostatic model assessment (HOMA) was used to estimate insulin resistance (HOMA-IR) and β-cell function (HOMA-β). The HOMA-IR and HOMA-β were detected by 75 g glucose, insulin, C peptide release test and growth hormone suppression test to evaluate the therapy effects on insulin resistance and islet function.Results:The levels of GH, insulin-like growth factor 1(IGF-1), HOMA-IR, HOMA-β, and triacylglycerol(TG) were all decreased after 1 year of octreotide treatment compared with that before treatment: (2.8 ± 2.5) μg/L vs. (12.1 ± 10.5) μg/L, (356.8 ± 209.2) μg/L vs. (698.1 ± 207.3) μg/L, 1.56 ± 1.08 vs. 2.71 ± 1.52, 1.01 ± 0.97 vs. 4.87 ± 3.57, (1.12 ± 0.49) mmol/L vs. (1.76 ± 0.92) mmol/L, and the differences were statistically significant ( P<0.05). After treatment, the level of fasting blood glucose was increased compared with that before treatment: (5.83 ± 1.19) mmol/L vs.(5.11 ± 1.73) mmol/L, and the difference was statistically significant ( P<0.05). While there were no significant changes in postprandial 2 h blood glucose and glycosylated hemoglobin (GHb), total cholesterol (TC), low-density lipoprotein cholesterol(LDL-C) and high-density lipoprotein cholesterol (HDL-C) levels before and after treatment ( P>0.05). Conclusions:Long-acting somatostatin therapy can effectively improve the insulin sensitivity of acromegaly patients, reduce β cell function, and slightly increase fasting blood glucose. It has no adverse effect on GHb, and can reduce the level of TG of the patients.
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Objective:To summarize the clinical characteristics and treatment of pituitary thyrotropin mixed secreting adenoma.Methods:The clinical data of 9 patients with pituitary thyrotropin mixed secreting adenoma from January 2008 to December 2019 in Beijing Tiantan Hospital, Capital Medical University, were retrospectively analyzed.Results:Among 9 patients, male was in 7 cases, and female in 2 cases; age was (35.7 ± 13.5) years; course of disease was (3.8 ± 3.1) years; mixed thyrotropin and growth hormone secreting adenoma was in 6 cases; most of them were accompanied with different degrees of thyrotoxicosis, 6 with acromegaly and 2 with amenorrhea and lactation. All the tumors were pituitary macroadenoma, with aggressive growth. Only 1 patient was completely relieved after operation, and most patients needed combined treatment to control the disease.Conclusions:Mixed thyrotropin and growth hormone secreting adenoma is the most common type of the disease, the clinical manifestations are complex, and the tumor is aggressive growth, surgical treatment can not be completely relieved and radiotherapy and/or combination of medicine treatment can help to improve the condition.
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Objective@#To explore the correlation between serum uric acid level and disease activity in patients with growth hormone-secreting pituitary adenoma.@*Methods@#The clinical data of 76 patients with growth hormone-secreting pituitary adenoma in the Department of Endocrinology of Beijing Tiantan Hospital, Capital Medical University from 2012 to 2018 were retrospectively analyzed. The patients were divided into 4 groups according to serum uric acid quartiles with 19 cases each, uric acid <233.9 μmol/L in Q1 group, uric acid 233.9 to 275.9 μmol/L in Q2 group, uric acid 276.0 to 366.7 μmol/L in Q3 group, uric acid >366.7 μmol/L in Q4 group. The sex, age, duration of disease, height, weight and blood pressure were collected, and the body mass index (BMI) was calculated. The fasting blood glucose (FBG), glycated hemoglobin, fasting insulin (FINS), triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), uric acid, basal growth hormone, insulin-like growth factor-1 (IGF-1) were examined, and the IGF-1 index and homeostasis model assessment of insulin resistance (HMOA-IR) were calculated. Pearson correlation analysis was performed to explore the correlation between serum uric acid levels and disease activity.@*Results@#In 76 patients, 8 cases were diagnosed with hyperuricemia, accounting for 10.5%. There were no statistical differences in sex constituent, duration of disease, systolic blood pressure, diastolic blood pressure, FBG, glycated hemoglobin, TG, TC, LDL-C, growth hormone and IGF-1 index among 4 groups (P>0.05). As uric acid level increased, age and HDL-C decreased gradually from Q1 group to Q4 group: (43.58 ± 8.95), (42.58 ± 10.89), (36.58 ± 9.79), (35.37 ± 11.51) years, (1.28 ± 0.22), (1.29 ± 0.23), (1.17 ± 0.28), (1.04 ± 0.22) mmol/L; while BMI, uric acid, IGF-1 and HOMA-IR increased gradually: (25.75 ± 2.86), (27.33 ± 3.94), (26.16 ± 2.94), (28.76 ± 3.69) kg/m2, (190.73 ± 28.80), (249.57 ± 12.00), (325.75 ± 25.61), (430.39 ± 58.41) mmol/L, (594.50 ± 222.45), (733.06 ± 212.42), (774.90 ± 287.87), (962.00 ± 323.36) μg/L, 2.09 (1.64, 2.09), 3.02 (0.94, 3.55), 3.53 (2.31, 6.48), 4.09 (2.52, 5.41), there were statistical differences (P<0.05 or <0.01). Pearson correlation analysis result showed that uric acid was positive correlation with IGF-1, IGF-1 index, HOMA-IR, TG and systolic blood pressure (r = 0.491, 0.341, 0.372, 0.240 and 0.266; P<0.01 or <0.05), and uric acid was negative correlation with HDL-C (r = -0.367, P<0.01). After adjustment for sex, age, duration of disease and BMI, uric acid was still positive correlation with IGF-1 and IGF-1 index (r = 0.352 and 0.318, P<0.01).@*Conclusions@#Serum uric acid level is associated with disease activity in patients with growth-hormone secreting pituitary adenoma.
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Objective To explore the correlation between serum uric acid level and disease activity in patients with growth hormone-secreting pituitary adenoma. Methods The clinical data of 76 patients with growth hormone-secreting pituitary adenoma in the Department of Endocrinology of Beijing Tiantan Hospital, Capital Medical University from 2012 to 2018 were retrospectively analyzed. The patients were divided into 4 groups according to serum uric acid quartiles with 19 cases each, uric acid﹤233.9 μmol/L in Q1 group, uric acid 233.9 to 275.9 μmol/L in Q2 group, uric acid 276.0 to 366.7 μmol/L in Q3 group, uric acid＞366.7 μmol/L in Q4 group. The sex, age, duration of disease, height, weight and blood pressure were collected, and the body mass index (BMI) was calculated. The fasting blood glucose (FBG), glycated hemoglobin, fasting insulin (FINS), triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), uric acid, basal growth hormone, insulin-like growth factor-1 (IGF-1) were examined, and the IGF-1 index and homeostasis model assessment of insulin resistance (HMOA-IR) were calculated. Pearson correlation analysis was performed to explore the correlation between serum uric acid levels and disease activity. Results In 76 patients, 8 cases were diagnosed with hyperuricemia, accounting for 10.5% . There were no statistical differences in sex constituent, duration of disease, systolic blood pressure, diastolic blood pressure, FBG, glycated hemoglobin, TG, TC, LDL-C, growth hormone and IGF-1 index among 4 groups (P＞0.05). As uric acid level increased, age and HDL-C decreased gradually from Q1 group to Q4 group: (43.58 ± 8.95), (42.58 ± 10.89), (36.58 ± 9.79), (35.37 ± 11.51) years, (1.28 ± 0.22), (1.29 ± 0.23), (1.17 ± 0.28), (1.04 ± 0.22) mmol/L; while BMI, uric acid, IGF-1 and HOMA-IR increased gradually: (25.75 ± 2.86), (27.33 ± 3.94), (26.16 ± 2.94), (28.76 ± 3.69) kg/m2, (190.73 ± 28.80), (249.57 ± 12.00), (325.75 ± 25.61), (430.39 ± 58.41) mmol/L, (594.50 ± 222.45), (733.06 ± 212.42), (774.90 ± 287.87), (962.00 ± 323.36) μg/L, 2.09 (1.64, 2.09), 3.02 (0.94, 3.55), 3.53 (2.31, 6.48), 4.09 (2.52, 5.41), there were statistical differences (P﹤0.05 or﹤0.01). Pearson correlation analysis result showed that uric acid was positive correlation with IGF-1, IGF-1 index, HOMA-IR, TG and systolic blood pressure (r=0.491, 0.341, 0.372, 0.240 and 0.266; P﹤0.01 or﹤0.05), and uric acid was negative correlation with HDL-C (r =-0.367, P﹤0.01). After adjustment for sex, age, duration of disease and BMI, uric acid was still positive correlation with IGF-1 and IGF-1 index (r=0.352 and 0.318, P﹤0.01). Conclusions Serum uric acid level is associated with disease activity in patients with growth-hormone secreting pituitary adenoma.
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Objective To explore the strategy for grading evaluation of neuroendocrine deficiencies in patients with craniopharyngioma. Methods According to published research literature of Beijing Tiantan Hospital and related guidelines and book, the neuroendocrine deficiencies in patients with craniopharyngioma and variables for evaluation were defined. The evaluation criteria according to weighted scores was established. The neuroendocrine deficiencies were graded into 4 levels. Grad 0 standed for normal neuroendocrine function. Grade 3 standeds for the most severe neuroendocrine impairement. Thirty-seven patients who were diagnosed with craniopharyngioma pathologically after neurosurgery were consecutively recruited. The neuroendocrine function was graded according to the variables and grading strategy during hospitalization. Results In this study, the patients with neuroendocrine deficiencies were graded into 0, 1, 2 and 3 accounting for 0, 18.9%(7/37), 67.6% (25/37) and 13.5%(5/37) respectively. Impairment of hypothalamic function was present in each grade. The patients with more hypothalamic function impairment had more severe manifestations. Diabetes insipidus was the most frequent hypothalamic impairment. Pituitary-target glands function impairment had even distribution in patients with each grade, while the proportion of patients with hyperprolatinemia (stalk effect) gradually increased with the grade level. Conclusions The evaluation criteria and function grading system can be used to evaluate the degree of neuroendocrine deficiencies effectively in patients with craniopharyngioma, and also to evaluate the impairment of hypothalamic function and impairment of pituitary-target glands function.
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Objective To observe the efficacy and safety of recombinant human growth hormone ( rhGH) replacement therapy in GHD childhood with craniopharyngioma after surgery. Methods This study retrospectively reviewed the records of 18 inpatients with secondary GHD diagnosed by insulin tolerance test ( ITT ) after craniopharyngioma surgery at the Department of Endocrinology, Beijing Tiantan Hospital, from January 2012 to December 2015. The clinical benefits and risks of 18 patients were evaluated systematically, and then were divided into rhGH treatment group(n=9) and control group(n=9). The parameters of height, growth velocity(GV), height standard deviation score (HtSDS), insulin-like growth factors-1 (IGF-Ⅰ), insulin-like growth factor binding protein 3 (IGFBP3) and adverse events rate were recorded after treatment for six months. MRI was followed up every 3 to 6 months to observe the difference of the tumor recurrence and second malignant neoplasm between two groups. Results All 18 patients with craniopharyngioma presented with multiple pituitary-target glands hormone deficiency after surgery. Among these patients, 17 cases (95% ) presented with hypothyroidism or adrenal insufficiency, 7 cases (39% ) with delayed puberty, and 12 cases(67% ) with central diabetes insipidus. Based on pituitary-target gland axis function deficiency, these patients were given appropriate L-thyroxine, prednisone, and desmopressin(DDAVP) replacement therapy, respectively. The median time of 9 patients starting rhGH replacement was 48(36,72)months after surgery. The levels of height, GV, IGF-Ⅰ, HtSDS, and IGFBP3 were significant increased after rhGH treatment for 6 months as compared with pre-treatment and control group (all P 0. 05 ). The tumor recurrence and second malignant neoplasm were not detected by MRI scanning in rhGH treatment group,but there were 3 cases in the control group. Conclusion Multiple pituitary-target glands axis deficiencies were observed in childhood patients with craniopharyngioma after neurosurgery, and the evident deficiency of GH-IGF-Ⅰ axis was observed. rhGH replacement therapy in short-term would significantly improve the parameters of growth and development of patients with GHD after craniopharyngioma neurosurgery. No recurrence tumor in situ and second malignant neoplasms were detected during the period of rhGH replacement therapy.
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Objective To investigate the efficacy and safety of domestic exenatide injection versus imported exenatide injection in type 2 diabetic patients with inadequate glycemic control on monotherapy or combination therapy of metformin and insulin secretagogues. Methods A multicenter, randomized, parallel-controlled, and non-inferiority trial was carried out. A total of 240 subjects were randomized at a 1:1 ratio to add domestic exenatide injection (trial group) or imported exenatide injection (control group) on the background therapies. The primary endpoint of efficacy was HbA1C change from baseline to week 16. The secondary endpoints of efficacy were the proportion of HbA1C0.05). The changes in FPG, 2hPG, 7P-SMBG and body weight from baseline to week 16 were comparable between the two groups (all P>0.05). Moreover, the incidences of hypoglycemia and adverse events were similar between the two groups (both P>0.05). Conclusion In type 2 diabetic patients inadequately controlled by monotherapy or combination therapy of metformin and insulin secretagogues, the efficacy of cotreatment with domestic exenatide injection is not inferior to that of imported product ones, with a similar safety profile.
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Objective To investigate the clinical characteristics and the risk factors for chronic complications in hospitalized early-onset type 2 diabetic mellitus patients. Methods The clinical data of 462 hospitalized type 2 diabetic mellitus patients were retrospectively analyzed. The patients were divided into early-onset group (age of diagnosis ≤40 years, 120 cases) and late-onset group (age of diagnosis>40 years, 342 cases) according to the age of diagnosis of diabetes. The clinical characteristics were compared and risk factors for chronic complications of early-onset type 2 diabetes were explored. Results The percentage of family history of diabetes, fasting plasma glucose, triglyceride and diastolic blood pressure in early-onset group were significantly higher than those in late-onset group:70.0％(84/120) vs. 52.3％(179/342), (8.68 ± 3.08) mmol/L vs. (8.07 ± 2.74) mmol/L, 1.69 (1.06, 2.92) mmol/L vs. 1.48 (1.07, 2.24) mmol/L and (84 ± 10) mmHg (1 mmHg = 0.133 kPa) vs. (81 ± 10) mmHg, and there were statistical differences (P0.05). The incidences of peripheral vasculopathy and cerebrovascular disease in early-onset group were significantly lower than those in late-onset group:13.3％(16/120) vs. 24.3％(83/342) and 11.7％(14/120) vs. 22.8％(78/342), but the incidence of diabetic nephropathy was significantly higher than that in late-onset group: 37.5％ (45/120) vs. 27.8％ (95/342), and there were statistical differences (P0.05). Multivariate Logistic stepwise regression analysis result showed that age, duration of diabetes, hypertension, smoking, levels of glycated hemoglobin and triglyceride were the risk factors for chronic complications in early-onset type 2 diabetic mellitus patients. Conclusions The clinical characteristics are different between early-onset and late-onset type 2 diabetic mellitus patients. Early-onset patients are more prone to diabetic nephropathy, while late-onset patients are prone to macrovascular diseases such as peripheral vascular disease and cerebrovascular disease. Comprehensive management should be administered for early-onset type 2 diabetic mellitus patients to prevent chronic complications especially microvascular complications.
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Objective To observe the effectiveness of long-acting octreotide in the treatment of acromegaly patients who did not achieve biochemical control after neurosurgery or gamma knife therapy of growth hormone-secreting pituitary adenoma. Methods Six acromegaly patients who received long-acting octreotide treatment regularly were included. Five patients had received prior trans-sphenoidal surgery and 1 patient had received prior gamma knife therapy before admission. All patients were admitted monthly for evaluation of pituitary-target gland function and octreotide therapy. Data of treatment with octreotide for 6 months were retrospectively summarized. Results Symptoms were reported to be alleviated. Two patients achieved biochemical control of the disease. Two patients had fasting growth hormone level less than 2.5 μg/L,but insulin-like growth factor-1(IGF-1)level was still higher than the age-adjusted normal range.Another 2 patients had decreased growth hormone and IGF-1 level, but both still higher than the normal range. Compared with baseline, IGF-1 level was decreased after treatment:(371.83 ± 217.46)μg/L vs.(713.33 ± 198.29)μg/L,and there was statistical difference (P = 0.017). There were no statistical differences in glycated hemoglobin and fasting plasma glucose before and after octreotide treatment (P > 0.05). Conclusions For acromegaly patients who do not achieve biochemical control after neurosurgery or gamma knife therapy, long-acting octreotide can effectively control IGF-1 level and increase the biochemical control rate of the disease.
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Objective To compare the impact of the mass effects in situ ( MEIS ) of the sella tumor on neuroendocrine function in children and adolescents with craniopharyngioma before surgery. Methods A total of 227 inpatients with craniopharyngioma in Beijing Tiantan Hospital, Capital Medical University, from October 2009 to October 2014, were retrospectively analyzed. These patients were divided into children group ( n = 167 ) and adolescent group(n=60) according to the age at the time of the first diagnosis. The clinical characteristics and damage degrees of neuroendocrine function by MEIS of sella tumor were analyzed and compared between these two groups before surgery. Result (1) Clinical characteristics of neuroendocrine function:Among hypothalamic dysfunctional manifestations, central diabetes insipidus showed the highest percentage(children group 35. 93%vs adolescent group 31. 67%), followed by the abnormal appetite and obesity ( children group 19. 76% vs adolescent group 28. 33%). The incidences of abnormal body temperature regulation, sleeping disorder, personality abnormality, and cognitive abnormality all were less than 5%. There were no statistical significant differences in the aforementioned hypothalamic dysfunction parameters between two groups (P=0. 524). Among pituitary-target glands dysfunction parameters, growth hormonce ( GH )-insulin-insulin like growth factor Ⅰ( IGF-Ⅰ) axis dysfunction showed the highest percentage ( children group 64. 07% vs adolescent group 50. 0%), followed by pituitary-gonad axis dysfunction in adolescent group (53. 33%), hyperprolactinemia ( children group 31. 14% vs adolescent group 43. 33%), pituitary-thyroid dysfunction(children group 22. 16%vs adolescent group 28. 33%), pituitary-adrenal gland dysfunction(children group 20. 36%vs adolescent group 25%). There were no statistical significant differences intheseabnormalpituitary-targetglandaxes(exceptpituitary-gonadaxis)betweentwogroups(P=0.475). (2) Comparison of damage degrees of neuroendocrine dysfunction: The patients with normal neuroendocrine function accounted for 10. 2%in children group and 8. 3%in adolescent group. The patients with 1 to 4 items of neuroendocrine dysfunction accounted for 75. 6%in children group and 73. 3%in adolescent group. The patients with more than 5 items of neuroendocrine dysfunction accounted for 14. 4%in children group and 18. 4%in adolescent group. There were no significant differences between two groups(Z=-1. 63,P=0. 103). Conclusions There were no significant differences in characteristics and damage degrees of MEIS of the sella tumor on neuroendocrine dysfunction between children and adolescents with craniopharyngioma. It suggests that systematical evaluation on hypothalamus-pituitary-targets axis function is very important for reducing the risks of further neuroendocrine dysfunction in young patients with craniopharyngioma after surgery.
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Objective To compare the effect of occupy effects of tumor in situ before surgery(OETS) and after neurosurgery (ANS) on neuroendocrine dysfunction and grading of neuroendocrine function in children with craniopharyngioma. Methods The grading evaluation criteria of neuroendocrine dysfunction in children with craniopharyngioma were drew up according to references and the endocrine feedback principle. Based on these grading evaluation criteria, the clinical date of 227 cases of children with craniopharyngioma who underwent neurosurgical treatment were retrospectively studied. These children were divided into pre-pubertal group (167 cases) and pubertal group (60 cases). The neuroendocrine impairment status before and after the surgery were evaluated separately. Results Among 227 children with craniopharyngioma, after the surgery, the incidence of the hypothalamus-pituitary-thyroid dysfunction increased from 16.74%(38/227) to 67.40%(153/227), the incidence of the hypothalamus-pituitary-adrenal gland dysfunction increased from 14.54%(33/227) to 44.49%(101/227), and the the incidence of pituitary function impairment increased from 17.62%(40/227) to 21.15%(48/227). Meanwhile, the incidence of body temperature dysregulation, sleeping disorder, personality abnormality and cognitive abnormality all increased after the surgery. The scoring and grading on neuroendocrine dysfunction in pre-pubertal group were increased after the surgery (Z=-5.20, P<0.01; Z=-4.94, P<0.01,). The scoring and grading on neuroendocrine dysfunction in pubertal group were increased after the surgery( Z=-4.10, P<0.01;Z=-4.25, P<0.01). Conclusions Both the mass effect of tumor in situ of craniopharyngioma and the neurosurgical treatment can be harmful to the neuroendocrine function. Even though the surgery can remove the mass effect of tumor in situ in the saddle area, it can increase the level of grading of neuroendocrine dysfunction. The status of neuroendocrine dysfunction can be evaluated by the grading evaluation criteria of neuroendocrine dysfunction in children with craniopharyngioma, which then provides an effective evaluation tool for the reconstruction and rehabilitation of neuroendocrine function.
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Objective To observe the efficacy and safety of arginine vasopressin receptor antagonist tolvaptan for treating hyponatremia caused by syndrome of inappropriate secretion of antidiuretic hormone (SIADH).Methods Six patients diagnosed with SIADH were enrolled in this study.Four cases were allocated to tolvaptan group (oral tolvaptan 15-60 mg/d,the dosage was adjusted based on the level of serum sodium).Two cases were allocated to regular treatment group (liquid was limited 1 000 ml/d,intravenous drip was less than 3％ sodium chloride and/or oral salt capsule 10-15 g/d several times was adjusted based on the level of serum sodium).Data of the level of serum sodium at 4,7 d,baseline value of serum sodium,serum sodium at the first normal time,24 h urine and weight change were collected.Safety assessment was given before and after treatment,including medical history,physical examination,electrocardiogram,laboratory tests,and incidence of adverse events.Results The level of serum sodium in tolvaptan group increased from the first day of the treatment.During the period of treatment,serum sodium at 4 d increased 22,16,14,11 mmol/L compared with the baseline value respectively.No obvious change of sodium was observed in regular treatment group compared with the baseline value.For 7 d treatment,serum sodium level increased 14,13,14,13 mmol/L in tolvaptan group compared with the baseline level respectively.Only 2 cases in regular treatment group increased 4 mmol/L,and sodium level in regular treatment group did not reach the lower limit of normal level of serum sodium.In tolvaptan group,all patients urine output increased after 1 d treatment and began to stabilize in 3 d.24 h urine putouts were much more than 1 500 ml during treatment.Urine putouts 780-1 400 ml were observed in regular treatment group.There was no difference before and after treatment.Although weight dropped after treatment in the two groups,weight in tolvaptan group fell obviously.In the two groups,there was no difference in blood pressure and heart rate before and after treatment.There were no serious complications and adverse events.Conclusions Compare with regular treatment,arginine vasopressin receptor antagonist is more effective therapy because it can correct the SIADH in patients with hyponatremia and reduce water retention.It also has a good security.
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Objective To investigate the effects of gastric bypass on glycometabolism and improvement of islet β cell function and insulin resistance in patients with type 2 diabetes. Methods Eight patients with type 2 diabetes combined with gastric carcinoma who treated with gastric bypass were studied prospectively. Fasting and postprandial plasma glucose levels, fasting and postprandial insulin C-peptide levels, and body mass index (BMI) were measured right before the surgery and at intervals of 1 week, 2 weeks, 1 month and 3 months after the surgery. Glycosylated hemoglobin (HbA1c) levels were measured before and 3 months after the surgery. The outcome of the diabetes after 3 months of the surgery was also monitored. Results Fasting and postprandial plasma glucose levels decreased (P ＜ 0.05) and fasting and postprandial insulin C-peptide levels increased (P ＜ 0.05) after the surgery. HbA1c levels also decreased (P ＜ 0.05) after 3 months of the surgery. There was no significant change of BMI at all intervals after the surgery(P＞ 0.05). All of the 8 patients reached the total effective standard and 6 patients reached the clinical remission standard after 3 months of the surgery. Conclusions It suggests that gastric bypass can significantly lower plasma glucose levels in type 2 diabetes, which does not depend on the loss of weight. The control of plasma glucose by gastric bypass may be due to the improvement of islet β cell function and increasing secretion of endogenous insulin.
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Objective To evaluate the clinical significance of quantitative sensory testing (QST) in screening diabetic peripheral neuropathy of the early stage. Methods One hundred patients with type 2 diabetes mellitus were examined by nerve conduction velocity (NCV) and QST examination. With the NCV positive as the gold criterion for screening diabetic peripheral neuropathy of the early stage, the sensitivity and specificity of QST was further analyzed for diagnosis of the early stage diabetic peripheral neuropathy. Results Among the 100 patients with type 2 diabetes mellitus,there were 41 cases positive and 59 cases negative in NCV examination. On the other hand,there were 74 cases positive,and 26 cases negative in QST. The sensitivity and specificity of QST for the diagnosis of early stage diabetic peripheral neuropathy was 97.56% (40/41) and 42.37% (25/59). Conclusions In the screening of early stage diabetic peripheral neuropathy,QST shows higher detection sensitivity,but lower specificity than NCV examination. Therefore, QST may be an examination for the supplement of the routine electromyography.
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Objective To explore the clinical characteristics,changes of neuroendocrine hormone before and aftter operation in patients with craniopharyngioma,so as to provide the basis for the replacement therapy after operation and educational practice.Methods The clinical data of 183 patients with craniopharyngioma were retrospectively analyzed. Results (1)Symptoms mainly were headache with nausea,disevesight,the second symptom was polydipsia and polyuria,in child,growth and development retardation was more,and another was hypothalamus syndrome.(2)Functions in endocrine:functions in thyreoid,adrenal and gonad(except PRL),the dysfunctions in neurohypophysis was displayed with completed insipidus and immaturity insipidus,contrasted it anteoperation to that postoperation,it was obvious in statishcs meanings (P＜0.05). Conclusions In patients with craniopharyngioma,children and adolescent is more than the other people,clinical situation is complicated,neuroendocrine hormone is derangement before and after operation,tumor itself to oppress and operation trauma are the basic reasons for the hypofunction of neuroendocrine hormpne,hormones replacement therapy and monitoring should be catch earlier.
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Objective To investigate the effects of melatonin on oxidative stress and metabolisms of glucose and lipid of diabetic patients.Methods By means of random,single-blind,placebo-parallel control clinical trial,91 of diabetic patients were randomly divided into melatonin group and placebo group.The parameters of Glutathione Peroxidase (GSH-Px),Superoxide Dismutase(SOD)and Malondialdehyde(MDA),as well as the profiles of glycemia and lipidemia were observed before and after 8 weeks treatments,respectively.Results Before treatment,both the serum levels of GSH-Px and SOD of diabetic patients were decreased significantly,whereas the serum level of MDA increased significantly.After 8 weeks consecutive melatonin treatment,the serum levels of GSH-Px and SOD increased significantly,whereas the serum level of MDA decreased significantly compared with pre-treatment in the melatonin group.There were no significant variations of serum levels of GSH,SOD and MDA observed before and after treatment in the placebo group.There were significan benefit on FBG and HbA1c after 8 weeks treatment compared with pre-treatment.The other profile of glycemia and lipidemia such as PBG,TG,TC,LDL-C and HDL-C hed no significant variations compared with pre-treatment.There were no significant variations of the profiles of glycemia and lipidemia compared with pre-treatment in the placebo group.Conclusion Melatonin significantly inhibits oxidative stress provoked by hyperglycemia and has beneficial effects on the glucose homeostasis of diabetic patients.
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Objective:To investigate the effects of exogenous melatonin on Hypothalamus-Pituitary-Adrenal(HPA) axis and immune function which inhibited by exogenous corticosterone.Methods:By means of radioimmunoassay and cytoimmunology techniques respectively, we observed the effects of two doses exogenous melatonin on the plasma concentrations of ACTH ,corticosteron0e as well as the variations of lymphocytes proliferating response, natural killer cytotoxicity(NKCC) and the level of IL-2 induced by ConA of rat model which Hypothalamus-Pituitary-Adrenal axis and immune function were inhibited by exogenous corticosterone.Results:After 14 consecutive days melatonin injection(i.p.),there were an increasing trends of plasma concentration of ACTH, corticosterone which inhibited by exogenous corticosterone were observed in the melatonin 100 ?g/kg treated group, but no significance in statistics, otherwise, there were significant increasing of plasma concentration of ACTH, corticosterone were observed in the melatonin 200 ?g/kg treated group( P