Psychiatric Symptoms in Cushing's Syndrome: A Systematic Review.

Objective: Psychiatric symptoms are frequently comorbid with Cushing's syndrome (CS), a relatively rare condition that results from chronic hypercortisolism. Psychiatric manifestations might be present in the prodromal phase, during the course of the illness, and even after the resolution of CS. Our goals are to review the prevalence of psychiatric symptoms in CS; to determine the impact of psychiatric symptoms on morbidity, functioning, and quality of life; and to analyze the impact of treatment of CS on psychiatric symptoms. Methods: A systematic search of the literature database was conducted according to predefined criteria. Two authors independently conducted a focused analysis of the full-text articles and reached a consensus on 17 articles to be included in this review. Results: Overall, studies suggested that psychiatric symptoms-including, most prominently, depression-were present in a significant proportion of patients with CS. They reported lower health-related quality of life, which persisted even following the resolution of hypercortisolism. Though treatment and cure of CS significantly improved psychiatric symptoms, some patients did not achieve complete resolution of psychiatric symptoms and required continued psychiatric treatment. Conclusion: The majority of the literature indicates that psychiatric manifestations are an important part of CS and overall lower health-related quality of life and psychiatric symptoms can persist even after the cure of CS. This emphasizes the significance of early diagnosis for psychiatric management and stresses the importance of monitoring the long-term effects of neurocognitive and psychiatric symptoms and its impact on the quality of life, even after hypercortisolism resolution.

Panic Attacks in HYPERALDOSTERONISM.

Panic attacks and panic disorders are common in the general population. However, the presence of panic attacks associated with primary hyperaldosteronism has been rarely documented. We describe a patient with new-onset hyperaldosteronism secondary to adrenal adenoma who presented with recurrent panic attacks. The patient underwent adenoma resection, which was the definitive cure for the patient's hyperaldosteronism and panic attacks. Clinicians should include hyperaldosteronism on the differential for medical etiologies of panic attacks. Further research is needed to elucidate the mechanistic relationship between primary hyperaldosteronism and panic attacks.

Prognostic indicators for the development of strabismus among patients with graves' ophthalmopathy.

OBJECTIVE: Thyroid eye disease (TED), an autoimmune inflammatory process involving the orbital tissues around the eye, is the most common extra-thyroidal manifestation of Graves' disease (GD). Due to changes in the patient's appearance, TED is a socially and visually disabling condition with significant impacts on quality of life. The aim of this study is to assess predictors of strabismus, a severe manifestation of TED. DESIGN: Single-institution retrospective case-control study. Cases of Graves' ophthalmopathy patients with strabismus were matched 1:1 to controls of Graves' ophthalmopathy patients without strabismus by age and sex. PATIENTS: Patients ≥18 years old with severe Graves' ophthalmopathy who received their medical care at UCLA with strabismus between 2012 and 2015. MEASUREMENTS: Eligibility criteria for cases was a diagnosis of Graves' ophthalmopathy with a subsequent diagnosis of strabismus. Using conditional logistic regression, the odds ratios of developing strabismus following the diagnosis of Graves' disease were assessed. The prognostic indicators assessed include race, ethnicity, cigarette smoking (active), serum thyroid peroxidase (TPO) antibody positivity, serum thyroglobulin (Tg) antibody positivity, antithyroidal medication use, and steroid use. RESULTS: The study sample (45 cases 1:1 matched against 45 controls) was comprised primarily of non-Hispanic, non-Latino Caucasian women with TED (mean ± SD age 63.0 ± 13.1 years). There were no significant predictors for the development of strabismus, including cigarette smoking (active), serum thyroid peroxidase (TPO) antibody positivity, serum thyroglobulin (Tg) antibody positivity, antithyroidal medication, and steroid use. CONCLUSIONS: No significant predictors of strabismus, a severe manifestation of Graves' ophthalmopathy, were identified following a diagnosis of TED in this study.

Incidence of abnormal liver biochemical tests in hyperthyroidism.

OBJECTIVE: Abnormal serum liver function tests are common in patients with untreated thyrotoxicosis, even prior to the initiation of antithyroidal medications that may worsen the severity of the abnormal serum liver biochemistries. There is a wide range of the incidence of these abnormalities in the published literature. The aim of this study was to assess the risks factors and threshold of thyrotoxicosis severity for developing an abnormal liver biochemical test upon the diagnosis of new thyrotoxicosis. DESIGN: Single-institution retrospective cohort study. PATIENTS: Patients of ≥18 years old receiving medical care at a large, academic, urban US medical centre between 2002-2016. MEASUREMENTS: Inclusion criteria were a serum thyroid stimulating hormone (TSH) concentration of <0·3 mIU/l or ICD-9 code for thyrotoxicosis, with thyrotoxicosis confirmed by either a concurrent elevated serum triiodothyronine (T3) or thyroxine (T4) concentration ([total or free] within 3 months), and an available liver biochemical test(s) within 6 months of thyrotoxicosis. The biochemical liver tests assessed were serum aspartate transaminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (AP), gamma-glutamyltransferase (GGT), total bilirubin, and conjugated bilirubin concentrations. RESULTS: In this cohort of 1514 subjects, the overall incidence of any biochemical liver test abnormality within 6 months of thyrotoxicosis was 39%. An initial serum TSH concentration <0·02 mIU/l, male gender, and African-American race were significant predictors of an abnormal serum liver biochemical test within 6 months of the diagnosis of new-onset untreated thyrotoxicosis. CONCLUSIONS: This study identifies risk factors for patients who develop an abnormal serum liver biochemical test result within 6 months of a diagnosis of untreated thyrotoxicosis.

Investigation of mercury methylation pathways in biofilm versus planktonic cultures of Desulfovibrio desulfuricans.

Biofilms can methylate mercury (Hg) at higher rates than unattached bacteria and are increasingly recognized as important Hg methylation sites in the environment. Our previous study showed that methylation rates in biofilm cultures were up to 1 order of magnitude greater than those in planktonic cultures of a sulfate-reducing bacterium. To probe whether the differential Hg methylation rates resulted from metabolic differences between these two cultures, Hg methylation assays following molybdate or chloroform inhibition (a specific inhibitor of the acetyl-CoA pathway) were conducted on biofilm and planktonic cultures of Desulfovibrio desulfuricans strains M8 and ND132. Molybdate was as effective in inhibiting Hg methylation as well as growth in both planktonic and biofilm cultures. The addition of chloroform only impacted Hg methylation in biofilm cultures, suggesting that different pathways are used for methylation in biofilm compared to planktonic cultures. To investigate this further, expression of the cooS gene, which encodes for carbon monoxide dehydrogenase, a key enzyme in the acetyl-CoA pathway, was compared in biofilm and planktonic cultures of ND132. Biofilm cultures showed up to 4 times higher expression of cooS than planktonic cultures. On the basis of these results, the acetyl-CoA pathway appears to play an important role in methylation in biofilm cultures of this organism, possibly by supplying the methyl group to Hg methylating enzymes; methylation in planktonic cultures appears to be independent of this pathway. This observation has important implications, particularly in developing reliable models to predict Hg methylation rates in different environments and perhaps eventually in being able to control this undesirable chemical transformation.

Persistence of fecal indicator bacteria in Santa Monica Bay beach sediments.

Monitoring the water quality of recreational beaches is only one step toward understanding microbial contamination -- the primary cause of beach closings. The surf zone sediment reservoir is typically overlooked and may also be important. This study involved monitoring the fecal indicator bacteria (FIB) levels in water and sediment at three ocean beaches (two exposed and one enclosed) during a storm event, conducting laboratory microcosm experiments with sediment from these beaches, and surveying sediment FIB levels at 13 beaches (some exposed and some enclosed). Peaks in Escherichia coli and enterococci concentrations in water and sediment coincided with storm activity at the two exposed beaches, while levels of both FIB were consistently high and irregular at the enclosed beach. Results from microcosm experiments showing similar, dramatic growth of FIB in both overlying water and sediment from all beaches, as well as results from the beach survey, support the hypothesis that the quiescent environment rather than sediment characteristics can explain the elevated sediment FIB levels observed at enclosed beaches. This work has implications for the predictive value of FIB measurements, and points to the importance of the sediment reservoir.