Sarcoidosis of the thyroid: report of a case and a review of the literature.

A case of sarcoidosis involving the thyroid gland in a 75 year-old woman and a review of the literature are described. Fine-needle aspiration of the thyroid and a cervical lymph node was performed. Histological examination confirmed the cytological diagnosis.

Hashimoto's thyroiditis in association with Tolosa Hunt syndrome: a case report.

Tolosa Hunt syndrome (THS) is a painful ophthalmoplegia due to a nonspecific inflammatory process in the cavernous sinus or to parasellar neoplasms. Although the cause of the disease is unknown, previous observations support the hypothesis that THS may be only one manifestation of a generalized vasculitis. The diagnosis is based on findings of painful ophthalmoplegia, excellent response to corticosteroids, and exclusion of other causes including aneurysm, diabetes mellitus, paranasal mucocele, and carotid cavernous fistula. We report the case of a 24-year-old woman with THS who had undergone thyroidectomy 4 years before admission for goiter with histologic diagnosis of Hashimoto's thyroiditis. This case shows the unusual association between Hashimoto's thyroiditis and THS and supports the autoimmune origin of both diseases.

Melatonin and pituitary-gonadal function in disorders of eating behavior.

In order to study the possible relationships between melatonin secretion and pituitary-gonadal function, the circadian rhythm of plasma melatonin, the basal levels of estradiol-17beta and testosterone and the luteinizing hormone (LH) and follicle-stimulating hormone (FSH) response to luteinizing hormone-releasing hormone (LH-RH) stimulation were evaluated in normally cycling healthy women and in two groups of women with menstrual dysfunctions related to eating disorders (19 patients with anorexia nervosa and 16 with primary obesity). The circadian rhythm of plasma melatonin reached statistical significance in anorectic patients but not in obese patients. The mean 24 h melatonin level was significantly higher in anorectic than in obese patients and in control subjects. However, both groups of patients shared some abnormalities of melatonin circadian pattern, such as increased ratio between day and night melatonin levels, abnormal secretory peaks during the light hours and great interindividual variability for timing, amplitude, and duration of melatonin nocturnal peak. A selective impairment of LH secretion was observed in both anorectic and obese patients. By considering together the two groups of patients and controls, a linear inverse correlation between the circadian mesor of plasma melatonin and the basal and LH-RH stimulated LH levels was found. The persistence of a certain melatonin secretion during the light hours in both anorectic and obese patients could play an inhibitory role on the pituitary gonadal function in these subjects.

Prolactin secretion in polycystic ovary syndrome: circadian rhythmicity and dynamic aspects.

The circadian rhythms of plasma prolactin (PRL) and cortisol and of oral temperature were simultaneously studied in 24 women with polycystic ovary syndrome (PCOS). The PRL response to thyrotropin-releasing hormone (TRH) and domperidone was also evaluated in some of these patients. The physiological circadian chrono-organization of prolactin and cortisol secretion and of oral temperature was maintained in PCOS. The PRL responsiveness to the specific stimulations fell within normal limits. These results do not support the hypothesis of an impaired central dopaminergic regulation of prolactin secretion in PCOS.

Melatonin circadian rhythm in anorexia nervosa and obesity.

The mean 24-hour secretion and circadian rhythm of melatonin were studied in 12 female subjects with anorexia nervosa (AN), 13 massively obese (OB) women, and 9 normal weight healthy volunteers to investigate the relationship between type of feeding behavior and hormonal secretory pattern. Blood samples for melatonin were drawn every 4 hours from 0400 h to 2400 h and every 2 hours from 2400 h to 0400 h. Mean 24-hour melatonin secretion was significantly higher in AN than in OB patients and controls. Melatonin circadian rhythms were disrupted in 8 of the 12 AN patients and in 9 of the 13 OB subjects, with phase-advanced nocturnal rises, abnormal diurnal peaks, or no nocturnal rises. The population mean cosinor analysis validated the existence of a significant circadian rhythm of the hormone in AN but not in OB subjects. No significant correlation between mean 24-hour secretion or type of circadian alterations and degree of weight deficit or excess was observed. The circadian alterations of melatonin in AN and OB may be linked to impaired secretory tonus of noradrenalin in the central nervous system, possibly unrelated to feeding patterns.

Changes of biological rhythms in primary headache syndromes.

The circadian periodicity of some endocrine (PRL, cortisol, GH) and vegetative (oral temperature, blood pressure) functions has been studied in cluster headache, common migraine, atypical facial pain, and "mixed" headache. Changes in several biological rhythms have been found not only in cluster headache (CH) but also in other kinds of headache. Although a great individual variability of rhythometric changes has been observed, particularly in CH, the dysrhythmic condition seems to be more evident in chronic than in episodic CH. The clinical and chronobiological effects of lithium administration and of a short-term sleep deprivation have been studied in CH.

Chronobiological study of pituitary adenomas and of the empty sella syndrome.

A chronobiological study was carried out in pituitary GH- and PRL-secreting adenomas and in the empty sella syndrome. The circadian rhythms of plasma GH and plasma PRL were abolished respectively in GH- and PRL-secreting pituitary tumors, and they were again detectable after selective transsphenoidal adenomectomy. In the empty sella syndrome only the chrono-organization of GH secretion was disturbed, whereas plasma PRL exhibited the usual circadian pattern. A normal circadian rhythmicity of plasma cortisol was demonstrable in the 3 groups of patients. The diagnostic significance of the chronobiological findings obtained is discussed.

Adrenocortical responsiveness to the synthetic ACTH 1-17 analogue given at different circadian stages.

The study concerns the adrenocortical glucocorticoid responsiveness to the ACTH 1-17 analogue given at different times of the day, namely near to the zenith and the nadir of the circadian curve of plasma cortisol. Two schedules of administration of the heptadecapeptide have been performed: a pulse i.v. injection of 4 microgram; b. i.m. injection of 100 microgram. Both the doses were given to the same subject in the morning and in the evening of different days. The chrono-sensitivity of the adrenal cortex to ACTH 1.17 analogue is well evident after pulse stimulation by a micro-dose of the heptadecapeptide; in fact the plasma cortisol increase from basal values is significantly higher in evening than in the morning (p less than 0.001). The cortico-stimulatory effect of the higher dose of ACTH 1.17 analogue lasts about 12 h. and then plasma and urinary glucocorticoids take the usual circadian pattern again.

Circadian periodicity of plasma prolactin in some neurological diseases.

The circadian rhythmicity of plasma PRL has been studied in some neurological diseases in which hypothalamic involvement or abnormalities of brain neurotransmitters has been postulated. 11 patients with Steinert's myotonic dystrophy, 7 with cluster headache and 10 with Huntington's chorea have been studied. By the mean cosinor procedure, a significant circadian rhythm of plasma PRL has been observed both in Steinert's disease and in cluster headache, whereas a circadian periodicity is not detectable in Huntington's chorea, a degenerative disorder affecting the basal ganglia, the hypothalamus and many other areas of the CNS.

[Effects of a vagolytic substance on the circadian rhythm of the ACTH-secreting system in man]. / Variations circadiennes des effets d'une substance vagolytique sur le système ACTH-secrétant chez l'homme.

The circadian rhythm of plasma cortisol and urinary 17-hydroxy-corticosteroids has been studied in 6 normal volunteers both in basal conditions and after the administration of a single dose of 30 mg of a banthine derivative (the beta methyl-beta-isopropylaminoethyl ester bromide of xantene-9-carbonic acid, "Pervagal") given orally once a day at different hours (midnight, 4 AM, 8 AM, noon, 4 PM, 8 PM). The vagolytic drug inhibits the cortisol secretion only when administered at 4 PM, 8 PM or midnight, whereas it is ineffective when given at different hours. If don't exist circadian variations of the bio-availability of the drug employed, our results suggest that also in human beings as well as in experimental animals, the cholinergic mechanisms are effective, over all if not exclusively, in starting the circadian activation of the hypothalamo-pituitary-adrenal system.

Sheehan's syndrome with complete bone marrow aplasia: long-term results of substitution therapy with hormones.

A case of Sheehan's syndrome with pancytopenia and bone marrow aplasia is presented. The diagnosis was made 6 years after an ante-partum haemorrhage. The presenting feature was an anaemia unresponsive to usual therapy. Hormonal therapy alone (cortisone and thyroid extract with triiodothyronin, oestrogen and progestogen given sequentially) produced full haematological recovery, which has continued for 2 years since the treatment was begun.