Evaluation of anterior pituitary function following traumatic brain injury

Neuroendocrine dysfunction following traumatic brain injury [TBI] is frequently missed due to the absence of major symptoms and very often, no appropriate management is prescribed, thus delaying the patient recovery. This study is aimed to determine the frequency and pattern of anterior pituitary dysfunction following TBI. From June to December 2009, over a period of seven months, a total of 156 cases were admitted to a trauma center following TBI. Of the seventy patients, [61 males and 9 females mean age 30 years] included in the study, 39 patients had moderate [GCS; 9 - 12] and 31 cases had severe [GCS < 8] TBI. Patients were tested 6 months after injury for possible secretory abnormalities of anterior pituitary hormones. Anterior pituitary secretary function was assessed by measurement of serum levels of FT4, TSH, basal GH, IGF-1, 8 am Cortisol, FSH, LH, total testosterone and prolactin. Dynamic tests of ACTH and glucagon stimulation were used to evaluate the pituitary-adrenal axis and GH secretory status. Forty-one patients [58.6%] were found to be suffering from at least one hormonal secretory abnormality, with patterns and frequencies of: Gonadotropins [LH, FSH], 12.9%, corticotrophin [ACTH], 12.9%, somatotropin [GH], 4.3%, and prolactin [PRL], 1.4%. There was no case with thyrotropin deficiency. Hyperprolactinemia was found to be present in 23 cases [31.5%]. The results of this study showed that anterior pituitary hormone deficiencies occur frequently, 6 months following traumatic brain injury. The two most commonly involved axes were the pituitary-gonadal and the pituitary-adrenal. Hypocortisolism may be particularly harmful for the patients' health

[Evaluation of endocrine disorders in patients with thalassemia major]

Thalassemia major is a genetic disorder, in which blood transfusion is critical for the survival of patients. Over the course of the past two and three decades, hypertransfusion therapy in these patients has significantly increased life expectancy and quality of life. Unfortunately however this type of therapy has also increased the frequency of complications due to iron overload. Today endocrine abnormalities are far more common than before in beta-thalassemia patients. The aim of this study was to evaluate the prevalence of endocrine disturbances in patients with thalassemia major, aged over 10 years. Fifty-six patients, aged over 10 years, with thalassemia major were enrolled. Physicians collected demographic data and history of therapies as well as menstrual history in females. Patients were examined to determine their pubertal status and SDS of height for evaluation of short stature. For evaluation of glucose tolerance, fasting blood glucose and oral glucose tolerance tests were performed. Serum levels of calcium, phosphorous, thyroid stimulating hormone, free thyroxin, luteinizing hormone, and follicular stimulating hormone, estradiol in girls and testosterone in boys were measured. Fifty-six patients 10 to 27 years with thalassemia major old were evaluated. In this study, the prevalences of diabetes mellitus, impaired fasting glucose and impaired glucose tolerance test were 8.9%, 28.6% and 7.1% respectively. Short stature [SDS

[Evaluation of thyroid dysfunction in patients with hyperemesis gravidarum]

Recent studies indicate a relationship between beta - hCG and thyroid dysfunction. The aim of this study were evaluation of thyroid dysfunction in patients with hyperemesis gravidarum, evaluation of severity of hyperthyroidism, relation between beta - hCG and hyperemesis gravidarum and outcomes of patients. Material and 135 patients with hyperemesis gravidarum admitted to Ob- Gyn hospital were selected and based on exclusion criteria, 103 pregnant women with hyperemesis gravidarum without any history of anti thyroid drugs consumption or other diseases were chosen. Each woman was examined for clinical signs of thyroid disease and underwent investigations for urine keton Na, k, liver function test, thyroid function test and diluted beta -hCG. 35 women had abnormal thyroid function tests with FT[4]I 4.74 +/- 0.54 and this in another group of 68 women was 2.9 +/- 0.39 [P<0.0001]. beta -hCG in the first group was 59406 +/- 14800 mU/mL and in the second was 6750 +/- 3476 mU/mL [P<0.0001]. In 5 patients PTU was started due to the severe signs and symptoms of hyperthyroidism. Thyroid function tests [TFTS] were rechecked for other patients after 4 weeks routine therapy for hyperemesis gravidarum TFTS normalized in 11 patients with hyperemesis gravidarum, but were abnormal in 22 patients, and PTU was started and anti-TPO anti-body was measured, which was positive in 3. Monthly TFT's were done and PTU was adjusted. Mean therapy was 2.76 months and 60.63 mg/d for Anti-TPO negative and 5.33 months and 170 mg/d for Anti-TPO positive patients. One month after delivery, thyroid function test was performed. PTU was continued in Anti-TPO positive patients but was discontinued in Anti-TPO negative during pregnancy with normal [TFTS] in all of the subjects following delivery. The prevalence of thyroid dysfunction in women with hyperemesis gravidarum was 35% of whom 20% needed low dose anti-thyroid theraphy of short duration, which resulted in significant improvement. A female predominance among offspring of mothers with hyperemesis gravidarum was seen, smilar to findings of other studies