Bone density and turnover in Addison's disease: effect of glucocorticoid treatment.

Osteoporosis is a well-known side-effect of chronic treatment with glucocorticoids. We have studied vertebral bone mineral density (BMD) and biochemical markers of bone metabolism in 30 patients diagnosed of Addison's disease (AD) to determine the effect of long-term replacement treatment with hydrocortisone (30 mg/day) or prednisone (7.5 mg/day). Lumbar bone mineral density was measured with dual energy X-ray absorptiometry in L-1-4 in two occasions, separated by 12 months. BMD in premenopausal women and men with AD was similar to healthy controls and postmenopausal women had slightly lower results. Rate of change of bone density followed up over a period of 12 months was -0.82%. Bone loss was not influenced by duration or type of steroid treatment. Biochemical parameters, serum calcium, alkaline phosphatase, osteocalcin, procollagen type I, PTH and 25(OH)vitamin D were within normal limits. Our results show that in patients with AD, after replacement with low doses of glucocorticoids there is no significative trabecular bone loss neither modifications in bone formation markers.

Fine needle aspiration biopsy in the diagnosis of thyroid cancer and thyroid disease.

Fine needle aspiration biopsy (FNAB) performed for diffuse and nodular goiter in the past 5 years, was evaluated in 1399 cases. Surgery was performed on the basis of FNAB cytologic diagnosis that was positive or suggestive of malignancy and/or a suggestive clinical history. Surgery also was performed in cases of cold nodules with negative FNAB results that did not respond to 6 months of suppressive thyroxine therapy. A correlation of cytologic findings with histologic findings was possible in 415 patients who underwent surgery: the evaluation of FNAB results yielded better results when suspicious cytologic findings were considered to be positive (2.4% false-negative, 86.3% sensitivity) rather than negative (6.5% and 65.7%, respectively). FNAB has become a useful procedure in the study and diagnosis of thyroid diseases. It is a simple, rapid diagnostic procedure that may be used to expedite the management of malignant lesions.

[Association of acromegaly and a cerebral arterial aneurysm disclosed by a subarachnoid hemorrhage]. / Association d'une acromégalie et d'un anévrysme artériel cérébral révélé par une hémorragie sous-arachnoïdienne.

The association of acromegaly and cerebral aneurysm is an infrequent clinical finding, being few the cases reported in literature. A major incidence of cerebral aneurysm in patients with other pituitary adenoma and cerebral tumour has been described, in relation to the general population. We have studied a male patient, aged 37 years old, with an acromegaly disease initiated 5 years before, that came to our hospital because of subarachnoid hemorrhage symptomatology. A right middle cerebral aneurysm was found in surgery. Hormonal studies confirmed a high basal Growth Hormone (64 ng/ml) that was not suppressed during an Oral Glucose Tolerance Test (75 g). A triple stimulus test (Insulin, TRH, LHRH) demonstrated non-response of GH to TRH and hypoglycemia others hormones were normal. Radiological studies were suggestive of Acromegaly disease. Computed axial tomography showed an intra-sellar tumour. The patient was operated (Transsphenoidal surgery) and a GH pituitary secreting tumour found, without suprasellar extension. The clinical significance and importance of the coexistence of the Acromegaly and Cerebral Aneurysm is discussed, with a review of hypothesis implicated.