ABSTRACT
Objective:To investigate the preoperative endocrinological characteristics of pituitary apoplexy of infarcted type.Methods:Twenty-six patients with pituitary apoplexy of infarcted type, confirmed by pathological pathology in our hospital from January 2010 to October 2019, were chosen. All patients were performed pituitary adenoma stroke scale before surgery, and endocrine examinations were performed on three pituitary target gland axes, namely the pituitary-thyroid axis, pituitary-gonadal axis and pituitary-adrenal axis, to evaluate the pituitary function and functions of three target gland axes.Results:Preoperative pituitary adenoma stroke scale scores were (1.92±1.78), ranged from 2 to 8. Twenty-five patients (96%) were with impaired pituitary function, including 13 patients (50%) with panhypopituitarism and 12 patients (46%) with partial hypopituitarism; in these 12 patients with partial hypopituitarism, 9 patients were noted to be involved two target gland axes, and 3 patients were noted to be involved one target gland axis. There were 22 patients (85%) with hypophysia-gonadal axis hypopituitarism, 14 (54%) with hypophysia-thyroid axis hypopituitarism, and 13 (50%) with hypophysia-adrenal axis hypopituitarism. Preoperative levels of prolactin in 26 patients (100%), testosterone in 26 patients (100%), luteinizing hormone in 18 patients (75%), progestational hormone in 18 patients (75%), thyroid stimulating hormone in 18 patients (69%), free triiodothyronine in 17 patients (65%), free thyroxine in 14 patients (54%), estradiol in 13 patients (54%), cortisol in 13 patients (52%), follicle stimulating hormone in 9 patients (38%), adrenocorticotrophic hormone in 9 patients (35%), growth hormone in 3 patients (15%) were lower as compared with baseline levels.Conclusion:Hypophysia-gonadal axis hypopituitarism is most common in pituitary apoplexy of infarcted type, and the endocrinological features are the sharp decrease of prolactin and testosterone levels.
ABSTRACT
Objective@#To test whether the tryptophan metabolism was abnormal in newly diagnosed ITP patients as well as in these patients after treatment with dexamethasone.@*Methods@#Newly diagnosed patients with ITP between Jan 2014 and May 2015 were enrolled, including 14 females and 11 males, with a median age of 57 years and a median PLT count of 16 (0-32) ×109/L. All patients were treated with oral dexamethasone. The expression levels of IDO mRNA and TTS mRNA in peripheral blood mononuclear cells (PBMC) were analyzed by real-time quantitative polymerase chain reaction. ELISA was used to test the concentrations of IDO and TTS in serum. The concentrations of plasma kynurenine and tryptophan were detected by high-pressure liquid chromatography. Samples from healthy individuals were tested as controls.@*Results@#①After dexamethasone treatment, 17 patients resulted in persistent remission, 2 cases were ineffective, and relapse occurred in 6 cases at a median follow-up of 11 (6-18) months. ②Before and after dexamethasone treatment, the relative expression of indoleamine2,3-dioxygenase (IDO) mRNA and tryptophanyl t-RNA synthetase (TTS) mRNA showed that there were significant decline in persistent remission group (2.54±0.86 vs 19.85±5.36, t=3.188, P=0.003; 0.68±0.19 vs 45.39±15.83, t=2.842, P=0.008) , compared with the normal control group, the difference was not statistically significant (t=2.313, P=0.027; t=1.127, P=0.268) . After treatment, the IDO concentration decreased [ (19.34±0.42) U/ml] and the TTS concentration was markedly increased [ (13.37±0.54) μg/L] in sustained remission group compared with that before treatment [ (21.91±0.37) U/ml] as well as that in normal controls. In particularly, abnormal tryptophan catabolism could be recovered in these 17 patients with persistent remission [Try: (19.85±5.36) μmol/L vs (19.65±4.55) μmol/L, t=1.027, P=0.311; Kyn: (0.56±0.26) μmol/L vs (0.58±0.23) μmol/L, t=2.075, P=0.448]. ③There was no obviously difference in the relative expression of IDO mRNA and TTS mRNA, the concentration of IDO and TTS and the abnormal tryptophan catabolism between before and after treatment of dexamethasone in patients without response and relapsed patients (all P>0.01) .@*Conclusion@#The tryptophan catabolism was abnormal in ITP patients, and it could be recovered in patients with persistent remission.