ABSTRACT
A randomized controlled pilot study was performed with a sample of extremely preterm infants to evaluate the impact of postnatal estradiol and progesterone replacement on postnatal bone mineral accretion. Twenty-five of 30 infants in the pilot study survived, and of these, 24 infants were available for the follow-up examination at a median chronological age of 18.1 months (minimum-maximum, 17.0--20.6) corresponding to a corrected age of 14.8 months (minimum-maximum, 12.9--17.4). Somatic growth data and bone mineralization showed no differences between the hormone-treated and control group infants. The deviation of the skeletal age from the corrected age was 0.0 months (minimum-maximum, -7.7 to 7.4) for hormone-treated infants compared with -1.7 months (minimum-maximum, -7.5 to 5.9) for the control group. The Bayley scales mental and psychomotor developmental indexes were 89 (minimum-maximum, 71--107) and 101 (minimum-maximum, 49--121) for the hormone-treated infants and 93 (minimum-maximum, 49--111) and 71 (minimum-maximum, 49--121) for the control group infants, respectively (mental developmental index, P = 1.0; psychomotor developmental index, P = 0.14). The normal psychomotor development in the hormone-treated infants compared with the below average development in the control group infants is encouraging and indicates the potentially important integrative role of sex steroids for the developing brain. Larger studies on the effects of the postnatal replacement of estradiol and progesterone in extremely preterm infants are warranted.
Subject(s)
Estradiol/therapeutic use , Hormone Replacement Therapy/methods , Infant, Premature/growth & development , Progesterone/therapeutic use , Body Constitution , Body Height , Body Weight , Calcification, Physiologic , Child Development , Follow-Up Studies , Humans , Infant, Newborn , Pilot Projects , Psychomotor Performance , Time FactorsABSTRACT
Regular blood transfusions in patients with beta-thalassaemia major lead to secondary hemochromatosis in the majority of cases. As a consequence of chronic iron overload, many endocrinopathies may occur. The most frequent endocrine dysfunction is hypogonadotropic hypogonadism, which is mainly responsible for osteopenia in as much as 80% of thalassemic patients. The frequencies of other endocrine disorders (hypothyroidism, diabetes mellitus and hypoparathyroidism) are lower. We investigated 5 female patients aged 22-25 years for endocrine dysfunction and bone density. All presented with hypogonadotropic hypogonadism and amenorrhea (four primary and one secondary). 4 patients showed absent or delayed pubertal development and short stature (below 10th percentile). In all five, hypogonadism is the most relevant cause of osteopenia as demonstrated by osteodensitometry. Endocrine disorders, especially absent pubertal development, should be detected in good time and treated with hormonal replacement. Established osteopenia is treated hormonally and with vitamin D3 and calcium.
Subject(s)
Bone Diseases, Metabolic/etiology , beta-Thalassemia/complications , Adult , Amenorrhea/etiology , Bone Density , Bone Diseases, Metabolic/physiopathology , Female , Hemochromatosis/complications , Hemochromatosis/etiology , Humans , Hypogonadism/complications , Hypogonadism/etiology , Puberty, Delayed/etiology , Transfusion Reaction , beta-Thalassemia/physiopathology , beta-Thalassemia/therapyABSTRACT
In clinical endocrinology an elevated prolactin concentration in serum is often encountered. This may be either physiological during pregnancy and lactation or pathological in all other cases. The most frequent causes are drugs (dopamine antagonists, estrogens) and primary hypothyroidism. These hyperprolactinemic states have to be distinguished from prolactinomas and other tumors of the pituitary gland, which can increase the level of prolactin in the serum through different mechanisms. Drug therapy with dopamine agonists will almost always decrease prolactin levels, but will rarely cure the disease. Long-term success rates after surgery are 50% for microadenomas and 10 to 15% for macroadenomas. Therefore, the decision to operate should be made after careful discussion between the surgeon and the endocrinologist. Pregnancy will rarely cause expansion of the tumors, more often with macro- than with microadenomas. Pregnant women with prolactinomas have to be followed clinically, and drug therapy has to be instituted immediately when clinical signs of tumor progression exist.
Subject(s)
Hyperprolactinemia/physiopathology , Adenoma/physiopathology , Adenoma/surgery , Dopamine Agonists/therapeutic use , Female , Humans , Hyperprolactinemia/etiology , Hyperprolactinemia/therapy , Hypophysectomy/methods , Pituitary Neoplasms/physiopathology , Pituitary Neoplasms/surgery , Pregnancy , Pregnancy Complications/physiopathology , Pregnancy Complications, Neoplastic/physiopathology , Prolactinoma/physiopathology , Prolactinoma/surgeryABSTRACT
Endocrine disorders in the course of HIV infection are often a result of opportunistic infections of endocrine organs. We describe the case of a 30-year-old HIV positive man in whom diabetes insipidus developed initially with no abnormal findings in cranial magnetic resonance imaging. 2 months later the patient presented with symptoms of panhypopituitarism. At this time, neuroradiologic examination was consistent with cerebral toxoplasmosis. Symptoms and neuroradiologic findings improved after treatment for cerebral toxoplasmosis. Toxoplasmosis is the most frequent opportunistic infection of the brain in patients with AIDS. In HIV positive patients with malfunction of the hypothalamic-hypophyseal system cerebral toxoplasmosis must be considered in differential diagnosis. Treatment of this disorder may alleviate symptoms and signs of endocrine malfunction.
