Male-female differences in 6-sulfatoxymelatonin excretion in hypopituitary patients

ABSTRACT Objective To evaluate melatonin secretion in adult hypopituitary patients with Growth Hormone deficiency (AGHD) on and off replacement therapy. Subjects and methods We studied 48 subjects: 12 (6 males) untreated AGHD (AGHDnt), 20 (10 males) treated AGHD (AGHDt) and 16 healthy subjects (8 males) as control group (CG). We measured urinary 6-sulfatoxymelatonin (6-SM) in total (24 h samples), nocturnal (6-SMn): 1800-0800 and diurnal samples (6-SMd): 0800-1800. Results Significant differences were observed among the 3 groups of male subjects, in total 6-SM (p < 0.05), nocturnal 6-SM (p < 0.02) and nighttime-daytime delta values (p < 0.003). CG had significantly higher values than the AGHDnt in total 6-SM (p < 0.01), nocturnal 6-SM (p < 0.05) and nighttime-daytime delta values (p < 0.01). AGHDt patients showed significantly higher levels in nighttime-daytime delta values than AGHDnt patients (p < 0.05). In females, no significant differences were found among the 3 groups studied in total, nocturnal, diurnal or nighttime-daytime delta values. In males, significant correlations were found among total 6-SM (r = 0.58; p = 0.029), nocturnal 6-SM (r = 0.70; p = 0.006) and nighttime-daytime delta values (r = 0.71; p = 0.004) vs. serum IGF-1 levels in subjects evaluated. In females, significant correlations were found among total 6-SM (r = 0.57; p = 0.02) vs. serum IGF-1 levels in subjects evaluated. A tendency towards a significant correlation was found in diurnal 6-SM (r = 0.48; p = 0.07). Conclusions Our findings show a sexual dimorphism in 6-SM excretion in AGHD patients and provide an interesting approach to a further understanding of some chronobiological disorders involved in GH deficiency.

Pituitary deficiency after aneurysmal subarachnoid hemorrhage

OBJECTIVE: Aneurysmal subarachnoid hemorrhage puts patients at high risk for the development of pituitary insufficiency. We evaluated the incidence of pituitary dysfunction in these patients and its correlation with clinical outcome. METHODS: Pituitary function was tested in 66 consecutive patients in the first 15 days after aneurysmal subarachnoid hemorrhage. The following were measured in all patients: thyroid-stimulating hormone, free thyroxine, triiodothyronine, luteinizing hormone, follicle-stimulating hormone, total testosterone (in males), estradiol (in females), prolactin, serum cortisol, plasma adrenocorticotropic hormone, growth hormone and insulin growth factor. RESULTS: The endocrine assessment was made at a mean of 7.4 days (standard deviation ±6.6) after subarachnoid hemorrhage. Forty-four (66.7%) female and 22 (33.3%) male patients were evaluated. Thirty-nine patients (59.1%) had some type of pituitary dysfunction. Follicle-stimulating hormone/luteinizing hormone deficiency was the most frequent disorder (34.8%), followed by growth hormone/insulin growth factor (28.7%), adrenocorticotropic hormone (18.1%) and thyroid-stimulating hormone (9%). Seventeen (25.7%) patients showed deficiencies in more than one axis. A greater incidence of hormone deficiency was observed in patients with a Glasgow Coma Scale score ≤13 (t test, p = 0.008), Hunt-Hess grade ≥4 (t test, p<0.001), or Fisher grade 4 (t test, p = 0.039). Hormone deficiency was not significantly associated (p>0.05) with increased hospitalization or clinical outcome. CONCLUSION: Pituitary dysfunction was identified in a substantial portion of patients with previous aneurysmal subarachnoid hemorrhage, but no association was found between this dysfunction and poor clinical outcome. .

Síndrome de sheeran / Sheehan's syndrome

Os autores descrevem uma paciente com hipopituitarismo e história há 15 anos de quadro hemorrágico severo no período periparto. Na primeira avaliação a paciente apresentava queixas de hipotireoidismo e somente após anamnese completa e exame físico minucioso, associado à avaliação laboratorial, foi possível identificar deficiência de todas as funções endócrinas da hipófise anterior. A síndrome de Sheehan pode causar hipopituitarismo logo após quadro "ictal" do sangramento (uma hora) ou após vários anos (47 anos), dependendo do volume de destruição tecidual. Insuficiência adrenal, hipopituitarismo e amenorréia são apresentações clássicas da síndrome e deve sempre fazer parte do diagnóstico diferencial em mulheres com falência endócrina e história de parto complicado

Body composition and bone mass of children with hypopituitarism following six months of human growth hormone therapy

Total body composition and the bone mineral content (BMC) and density (BMD) of 8 perpubertal (4 boys and 4 girls) GH-deficient children aged 6-14 years were investigated before and during a 3-6 month period on human growth hormone (hGH) therapy (0.075 IU/Kg/day, sc.); measurements were made by dual energy x-ray absorptiometry (DEXA). Before hGH therapy, total body fat mass was 4 + 3 kg and the total body percentage of fat was 22 + 12 per cent; the total lean mass was 14 + 3 kg. Total BMC was 625 + 163 g, and total BMD was 0.777 + 0.025 g/cm2. When compared with a matched population of normal children, GH-deficient children presented decreased lean mass (-0.9 to -5.9 SD), BMC (-0.9 to - 5.6 SD) and BMD (-0.1 to -4 SD). Fat mass, as a percentage, was not significantly different between populations (22 + 12 per cent in GH-deficient children vs. 17 + 5 per cent in normal children, p>0.05). Therapy with hGH was associated with: (I) a major decrease of total body percentage of fat mass: -31 + 15 per cent after 6 months (p<0.05); and with (II) an increase in the total lean mass and total BMC, 14 + 8 per cent and 7 + 5 per cent, respectively (both p<0.05). Total BMD was not significantly changed after 6 months of hGH therapy. We conclude that hGH replacement therapy results in a major and rapid decrease of total fat mass and in a less pronoucend increase of total lean mass.

Pregnancy in Sheehan's syndrome.

This is the first report of pregnancy in a patient with Sheehan's syndrome in Thailand. Resumption of menstruation and pregnancy following massive postpartum hemorrhage although rare, can occur if there is selective hypopituitarism with normal gonadotropin level and are not against the diagnosis. Since the maternal and fetal mortality is far more common in unrecognized cases, therefore, early diagnosis is crucial. Physicians should consider this syndrome every patient who has a history of postpartum hemorrhage and symptoms and signs of hypopituitarism.

Funçäo hipofisária na Síndrome de Sheehan / Pituitary function in Sheekans' syndrome

Quatro (4) pacientes com Síndrome de Sheehan foram estudadas do ponto de vista da funçäo hipofisária. Todas as pacientes apresentaram hipotiroidismo e insuficiência suprarenal secundários. Três (3) pacientes apresentaram déficit da secreçäo de HGH e as 2 pacientes testadas com o TRH näo exibiram resposta do TSH e prolactina após estímulo. Duas (2) apresentaram níveis basais normais de gonadotropinas, uma níveis bordeline e outra níveis baixos. As 2 pacientes testadas apresentaram resposta satisfatória do FSH e LH ao GnRH. Na casuística estudada os testes de estimulaçäo hipofisária mostraram-se úteis em pacientes com parto hemorrágico e falência da lactaçäo pós-partum com objetivo de diagnosticar a Síndrome de Sheehan, avaliar a extensäo do hipopituitarismo e orientar a terapêutica adequada

Funçäo pituitária e gravidez a termo na síndrome de Sheehan / Pituitary function and term pregnancy in Sheehan's syndrome

Uma paciente com síndrome de Sheehan (necrose pituitária pós-parto) desenvolveu gravidez a termo, quatro anos após a instalaçäo do hipopituitarismo, na vigência de reposiçäp hormonal tiroidiana e corticosteróide. Testes de estímulo da pituitária demonstraram claramente que o setor gonadotrófico era responsivo, sugerindo que possivelmente as células gonadotróficas teriam sido poupadas, pelo menos parcialmente, o suficiente para que houvesse ovulaçäo espontânea.