[Endocrine problems during pregnancy]. / Wichtige endokrine Funktionsstörungen bei Schwangeren.

Endocrine disorders may have an important influence on fertility, the course of a pregnancy and fetal development. For example, fertility is decreased and the risk of miscarriage is increased in women with autoimmune disorders, such as Addison's disease or autoimmune thyroiditis. Treatment of endocrine diseases in many cases has to be adapted during the course of a pregnancy. In patients with Addison's disease the dosage of hydrocortisone necessarily has to be increased. This is also valid for the time of delivery. Disorders of the thyroid gland are of great importance during pregnancy. If hypothyroidism is diagnosed in early pregnancy, immediate treatment with levothyroxine should be initiated. Iodine supplementation is strongly recommended in all pregnant and breast-feeding women. Treatment of Graves's disease will be performed during the first trimenon with propylthiouracile, afterwards with methimazole (thiamazole). In contrast, thyrotoxicosis due to hCG should not be treated with methimazole. In this paper, we present an overview on the most important endocrine disorders during pregnancy.

[Osteoporosis]. / Osteoporose.

Osteoporosis is among the main causes for bone fractures. In this overview we report on the prevalence of the disease, the diagnostic procedures, and the therapeutic options. The prevalence increases with age and women are more often affected than men. The diagnosis usually is made on the basis of dual X-ray absorptiometry. Prophylactic measures include a sufficient intake of calcium and vitamin D. Bisphosphonates play a central role in the pharmacotherapy of this disease.

[Autoimmune thyroiditis (Hashimoto's thyroiditis): current diagnostics and therapy]. / Die Autoimmunthyreoiditis (Hashimoto-Thyreoiditis): aktuelle diagnostik und therapie.

Hashimoto's thyroiditis is a common autoimmune thyroid disease with preference of female gender. The chronic thyroiditis is characterized by autoantibodies against thyroid peroxidase and thyroglobulin. With manifestation, there is often a subclinical hypothyroidism that finally progresses to a persistent hypothyroidism with typical clinical symptoms and the need of hormonal substitution in succession of the lymphocytic infiltration of the thyroid. The ultrasound of the thyroid shows a hypoechogenic and inhomogeneous parenchyma. Autoimmune thyroiditis is frequently associated with autoimmune disease of other organs, such as vitiligo, Addison's disease, diabetes mellitus type 1, often in the sense of polyglandular syndrome 2.

[Aleukemic mast cell leukemia (formerly: "malignant mastocytosis"): an extremely rare form of leukemia. A case report and simultaneously a contribution to revised classification of mastocytosis]. / Aleukämische Mastzellenleukämie (vormals: "maligne Mastozytose"): Eine extrem seltene Leukämieform. Ein Fallbericht und gleichzeitig ein Beitrag zu einer revidierten Klassifikation der Mastozytosen.

The term mastocytosis denotes a heterogeneous group of rare hematological disorders characterized by abnormal accumulation of mast cells. While cutaneous mastocytosis is relatively frequent mast cell leukemia belongs to the rarest forms of human leukemia. In the following we present the case of an aleukemic mast cell leukemia and shall discuss the revised classification of mastocytosis based on the "Year 2000 Working Conference on Mastocytosis" held in Vienna, Austria. A 48 year-old caucasian man presented with a four-week history of diarrhea, obstipation, vomiting, rash, and mild fever. Clinical inspection revealed a disseminated itching rash and a mild hepatomegaly. Red and white blood cell counts were within the normal range. Levels of the alkaline phosphatase and serum histamine were significantly increased. There was no splenomegaly or lymphadenopathy. Cytologic and histologic investigation of the bone marrow revealed a marked increase in atypical mast cells. Since only a few circulating mast cells could be detected in a cytospin preparation of the blood, the diagnosis of an aleukemic mast cell leukemia was established. About four weeks after the diagnosis had been established, the patient died with signs of a hemorrhagic shock due to a massive gastrointestinal bleeding. Autopsy revealed widespread mast cell infiltration of bone marrow, spleen, liver and lungs, but also a small, deeply penetrating, non-specific duodenal ulcer. In conclusion, despite of presentation with signs of a primary gastrointestinal disorder, the patient was found to suffer from an exceedingly rare aleukemic mast cell leukemia ("malignant mastocytosis") and died after a total duration of the disease of only about three months.