Chronic sacroiliac joint dysfunction and CT-guided percutaneous fixation: a 6-year experience.

PURPOSE: Reporting the clinical outcomes, patient satisfaction, and complications following an imaging-guided percutaneous screw fixation in the treatment of sacroiliac joint dysfunction and evaluating the safety and effectiveness of this method. METHODS: We performed a retrospective study on a prospectively gathered cohort of patients with physiotherapy-resistant pain due to sacroiliac joint incompetence that underwent percutaneous screw fixation, between 2016 and 2022 in our center. A minimum of two screws were used in all patients to obtain fixation of the sacroiliac joint, using percutaneous screw insertion under CT guidance, coupled with a C-arm fluoroscopy unit. RESULTS: The mean visual analog scale significantly improved at 6 months of follow-up (p < 0.05). One hundred percent of the patients reported significant improvement in pain scores at the final follow-up. None of our patients experienced intraoperative or postoperative complications. CONCLUSION: The use of percutaneous sacroiliac screws provides a safe and effective technique for the treatment of sacroiliac joint dysfunction in patients with chronic resistant pain.

A Neutral Effect of Metformin Treatment on Macroprolactin Content in Women with Macroprolactinemia.

Background: Metformin decreases serum levels of monomeric prolactin. No previous study has investigated the effect of metformin on macroprolactin content in patients with macroprolactinemia. Methods: We studied three age-, sex- and weight-matched groups of patients: 15 women with monomeric prolactin, 12 women with macroprolactin, as well as 15 women with normal prolactin levels. Because of coexisting 2 diabetes or prediabetes all patients were treated with metformin (1.7-3 g daily). Plasma lipids, glucose homeostasis markers, as well as serum levels of prolactin and macroprolactin were assessed at baseline and after 4 months of metformin treatment. Results: As expected, metformin reduced plasma glucose and triglycerides, as well as improved insulin sensitivity in all treatment groups. Moreover, the drug reduced post-polyethylene glycol prolactin levels and tended to reduce pre-polyethylene glycol prolactin levels in women with monomeric prolactin but not in women with macroprolactinemia and women with normal prolactin levels. Conclusion: The obtained results indicate that metformin has a negligible effect on macroprolactin levels.

The Effect of Ezetimibe/Statin Combination and High-Dose Statin Therapy on Thyroid Autoimmunity in Women with Hashimoto's Thyroiditis and Cardiovascular Disease: A Pilot Study.

Background: Intensive statin therapy was found to reduce thyroid autoimmunity in women with Hashimoto's thyroiditis. No similar data are available for other hypolipidemic agents. Methods: The participants of the study were 16 women with Hashimoto's thyroiditis and coronary artery disease. On the basis of statin tolerance, they were divided into 2 groups. 8 patients who did not tolerate high-dose statin therapy were treated with a statin, the dose of which was reduced by half, together with ezetimibe. The remaining 8 patients tolerating the treatment continued high-dose statin therapy. Plasma lipids, serum levels of thyrotropin, free thyroxine and free triiodothyronine, as well as titers of thyroid peroxidase and thyroglobulin antibodies were measured at the beginning of the study and 6 months later. Results: Replacing high-dose statin therapy with ezetimibe/statin combination therapy increased serum titers of thyroid peroxidase as well as led to an insignificant increase in serum titers of thyroglobulin antibodies. At the end of the study, thyroid peroxidase and thyroglobulin antibody titers were higher in patients receiving the combination therapy than in those treated only with high-dose statin. Conclusions: Our study shows that high-dose statin therapy produces a stronger effect on thyroid autoimmunity than ezetimibe/statin combination therapy.

The Effect of Metformin on Hypothalamic-Pituitary-Thyroid Axis Activity in Women with Interferon-Induced Hypothyroidism: A Pilot Study.

BACKGROUND: One of the most frequent adverse effects of interferon-α therapy is thyroiditis. Metformin was found to improve insulin sensitivity in hepatitis C patients, as well as to reduce elevated thyrotropin levels in patients with hypothyroidism. The aim of this study was to investigate the effect of metformin on hypothalamic-pituitary-thyroid axis activity in patients with interferon-induced thyroiditis. METHODS: The study included 2 matched groups of women with type 2 diabetes and untreated subclinical hypothyroidism: patients with interferon-induced thyroiditis (n=8) and patients with Hashimoto's thyroiditis (n=12). Fasting plasma glucose, the homeostatic model assessment 1 of insulin resistance ratio (HOMA1-IR), glycated hemoglobin, the estimated glomerular filtration rate, as well as serum levels of thyrotropin, thyroid hormones, prolactin and insulin-like growth factor-1 (IGF-1) were assessed at baseline and after 4 months of metformin treatment. RESULTS: Apart from reducing plasma glucose, HOMA1-IR and glycated hemoglobin, metformin decreased serum levels of thyrotropin. Circulating levels of thyroid hormones, prolactin and IGF-1 remained at a similar level throughout the study. The effect of metformin on serum thyrotropin was stronger in patients with interferon-induced thyroiditis than in patients with Hashimoto's thyroiditis, as well as correlated with its impact on insulin sensitivity. CONCLUSIONS: Our results indicate that metformin may be an effective agent in patients with interferon-induced hypothyroidism.

The Effect of Simvastatin on Plasma Steroid Hormone Levels in Metformin-Treated Women with Non-Classic Congenital Adrenal Hyperplasia.

Non-classic congenital adrenal hyperplasia (NC-CAH), one of the most common genetic disorders, is often associated with the presence of hyperandrogenism. Recently both simvastatin and metformin were found to reduce plasma steroid hormone levels in this disorder. This study included 8 women with NC-CAH and diabetes or impaired glucose tolerance, as well as 12 matched women with similar glucose metabolism abnormalities but normal adrenal function. Both groups of women, receiving metformin for at least 6 months, were then treated with simvastatin (20 mg daily) for the following 12 weeks. Compared to patients with normal adrenal function, metformin-treated women with NC-CAH showed increased plasma levels of 17-hydroxyprogesterone, total testosterone, free testosterone, androstenedione and DHEA-S. Simvastatin reduced total and LDL cholesterol levels in both patients with NC-CAH and normal adrenal function. Moreover, in the former group of women, statin therapy decreased plasma levels of testosterone, free testosterone, androstenedione, dehydroepiandrosterone sulphate and tended to reduce 17-hydroxyprogesterone. Our results suggest that metformin-statin combination therapy may be useful in the management of symptomatic women with NC-CAH.

The effect of vitamin D on thyroid autoimmunity in non-lactating women with postpartum thyroiditis.

The study included 38 non-lactating l-thyroxine-treated women with postpartum thyroiditis (PPT) and 21 matched healthy postpartum women. Women with vitamin D deficiency were treated with oral vitamin D (4000 IU daily), whereas women with vitamin D insufficiency and women with normal 25-hydroxy vitamin levels were either treated with vitamin D (2000 IU daily) or left untreated. Serum hormone levels and thyroid antibody titers were measured at the beginning of the study and 3 months later. 25-hydroxy vitamin D levels were lower in women with PPT than in healthy women. Thyroid peroxidase and thyroglobulin antibody titers inversely correlated with vitamin D status. Apart from increasing serum levels of 25-hydroxy vitamin D and decreasing serum levels of parathyroid hormone, vitamin D reduced titers of thyroid peroxidase antibodies and this effect was stronger in women with vitamin D deficiency. The study's results suggest that vitamin D supplementation may bring benefits to l-thyroxine-treated women with PPT.

The Effect of Metformin and Metformin-Testosterone Combination on Cardiometabolic Risk Factors in Men with Late-onset Hypogonadism and Impaired Glucose Tolerance.

No previous study has investigated the effect of metformin, administered alone or together with testosterone, on cardiometabolic risk factors in men with hypogonadism. The study included 30 men with late-onset hypogonadism (LOH) and impaired glucose tolerance (IGT) who had been complying with lifestyle intervention. After 12 weeks of metformin treatment (1.7 g daily), the participants were allocated to one of 2 groups treated for the following 12 weeks with oral testosterone undecanoate (120 mg daily, n=15) or not receiving androgen therapy (n=15). Plasma lipids, glucose homeostasis markers, as well as plasma levels of androgens, uric acid, high-sensitivity C-reactive protein (hsCRP), homocysteine and fibrinogen were determined before and after 12 and 24 weeks of therapy with the final dose of metformin. Patients with LOH and IGT had higher levels of hsCRP, homocysteine and fibrinogen than subjects with only LOH (n=12) or only IGT (n=15). Metformin administered alone improved insulin sensitivity, as well as reduced 2-h postchallenge plasma glucose and triglycerides. Testosterone-metformin combination therapy decreased also total and LDL cholesterol, uric acid, hsCRP, homocysteine and fibrinogen, as well as increased plasma testosterone. The effect of this combination therapy on testosterone, insulin sensitivity, hsCRP, homocysteine and fibrinogen was stronger than that of metformin alone. The obtained results indicate that IGT men with LOH receiving metformin may gain extra benefits if they are concomitantly treated with oral testosterone.

Different Effects of Metformin on the Hypothalamic-Pituitary-Thyroid Axis in Bromocriptine- and Cabergoline-treated Patients with Hashimoto's Thyroiditis and Glucose Metabolism Abnormalities.

Metformin was found to reduce serum thyrotropin levels in patients with hypothyroidism. This effect was less pronounced if patients were additionally treated with bromocriptine. The study included 39 premenopausal women with autoimmune thyroiditis and thyrotropin levels exceeding 3.0 mU/L. All patients had been treated for at least 6 months with bromocriptine (5.0-7.5 mg daily) or cabergoline (0.5-1.0 mg weekly). Because of coexisting type 2 diabetes or impaired glucose tolerance, they were then given metformin (1.7-2.55 g daily). Glucose homeostasis markers, thyroid antibody titers, as well as serum levels of thyrotropin, total and free thyroid hormones and prolactin were determined before and after 6 months of metformin treatment. At baseline, cabergoline-treated patients were less insulin resistant as well as tended to have lower levels of prolactin than bromocriptine-treated patients. Although in both treatment groups, metformin decreased plasma levels of fasting and post-challenge plasma glucose and improved insulin receptor sensitivity, this effect was more prominent in patients receiving cabergoline. However, only in bromocriptine-treated patients, metformin decreased serum thyrotropin and this effect reached the level of significance in a subgroup of patients with subclinical hypothyroidism. Neither in cabergoline- nor in bromocriptine-treated patients, metformin affected thyroid hormone levels and thyroid antibody titers. Our results indicate that the effect of metformin on hypothalamic-pituitary-adrenal axis activity is partially determined by endogenous dopaminergic tone, thyrotrope activity and insulin sensitivity.

The association between macroprolactin levels and vitamin D status in premenopausal women with macroprolactinemia: a pilot study.

BACKGROUND: Macroprolactinemia is a frequent cause of misdiagnosis and mismanagement of patients with elevated prolactin levels. Its pathogenesis and clinical significance are still controversial. METHODS: The aim of this study was to investigate the relationship between elevated macroprolactin content and vitamin D status. The study population included 20 premenopausal women with isolated macroprolactinemia, 10 of whom were later treated with vitamin D (2 000 IU daily). Serum prolactin, macroprolactin, 25-hydroxyvitamin D and PTH levels were assessed at baseline and after 4 months of treatment. RESULTS: Compared with the control age- and weight-women with normal prolactin levels (n=11), patients with macroprolactinemia were characterized by lower levels of 25-hydroxyvitamin D and slightly higher levels of PTH. Vitamin D administered to patients with macroprolactinemia increased 25-hydroxyvitamin, reduced total prolactin and macroprolactin, as well tended to reduce PTH. The effect of vitamin D on total prolactin and macroprolactin correlated with their baseline values and baseline 25-hydroxyvitamin D levels. CONCLUSIONS: The results of our study suggest the association between vitamin D status and elevated macroprolactin levels in premenopausal women.

Pathologically confirmed breast cancer in Malawi: a descriptive study: Clinical profile of breast cancer.

BACKGROUND: Breast cancer is the most common female cancer in Africa, yet no published studies have investigated breast cancer in Malawi. Understanding the clinical profile of breast cancer is important to develop early diagnosis efforts. AIM: To describe clinical and pathological characteristics of breast specimens from a pathology laboratory at a national teaching hospital. METHODS: Secondary analysis of pathology reports from July 2011 to September 2013. RESULTS: Among 85 breast cancer cases, 55% were < 50 years. Median tumor size was 4 cm and 49% were grade 3. Median symptom duration was eight months. CONCLUSIONS: Malawian women with breast cancer commonly have long symptom durations prior to diagnosis, young age, and poorly differentiated tumors. Improved clinical and pathological characterization, including hormone receptor status, are urgently needed to better understand this disease in Malawi.

Different effects of atorvastatin on metabolic and cardiovascular risk factors in hypercholesterolemic women with normal thyroid function and subclinical hypothyroidism.

BACKGROUND: The presence of hypothyroidism seems to be associated with increased cardiovascular risk. No previous study compared circulating levels of plasma lipids and other cardiovascular risk factors in statin-treated patients with different thyroid function states. METHODS: We studied 15 women with untreated subclinical hypothyroidism (group A), 16 women with treated hypothyroidism (group B) and 17 women with normal thyroid function (group C) who, because of coexistent hypercholesterolemia, were treated with atorvastatin. Plasma lipids, glucose homeostasis markers and plasma levels of cardiovascular risk factors were assessed before and after 12 weeks of therapy. 46 patients completed the study. RESULTS: Baseline lipid levels were similar in all groups of patients. Plasma levels of high-sensitivity C-reactive protein (hsCRP), homocysteine and fibrinogen were higher in group A than in groups B and C. Although the effect on total and LDL cholesterol was observed in all treatment groups, it was less pronounced in patients with untreated hypothyroidism. Similarly, the effect of atorvastatin on hsCRP, homocysteine, fibrinogen and uric acid was stronger in groups B and C than in group A. CONCLUSIONS: Our results suggest that the effect of atorvastatin on plasma lipids and circulating levels of other cardiovascular risk factors partially depends on thyroid function.

The effect of metformin on the hypothalamic-pituitary-thyroid axis in patients with type 2 diabetes and subclinical hyperthyroidism.

In hypothyroid patients, metformin was found to reduce serum levels of TSH. No previous study investigated metformin action on hypothalamic-pituitary-thyroid axis in patients with hyperthyroidism. The aim of our study was to assess the effect of metformin treatment on thyroid function tests in patients with untreated subclinical hyperthyroidism. We studied 15 patients with low but detectable TSH levels (0.1-0.4 mIU/L) (group 1), 12 patients with suppressed TSH levels (less than 0.1 mIU/L) (group 2) and 15 euthyroid patients with a history of hyperthyroidism, who because of coexisting 2 diabetes were treated with metformin (2.55-3 g daily). Glucose homeostasis markers, as well as serum levels of TSH and total and free thyroxine and triiodothyronine levels were assessed at baseline and after 3 and 6 months of therapy. As expected, metformin reduced plasma glucose, insulin resistance and glycated hemoglobin. However, with the exception of an insignificant decrease in TSH levels after 3-month therapy in group 2, metformin therapy did not affect thyroid function tests. Our results indicate that metformin has a negligible effect on hypothalamic-pituitary-thyroid axis activity in type 2 diabetic patients with subclinical hyperthyroidism.

The effect of atorvastatin and atorvastatin-ezetimibe combination therapy on androgen production in hyperandrogenic women with elevated cholesterol levels.

Statins decreased serum androgen levels in hyperandrogenemic women with polycystic ovary syndrome. No previous study has investigated whether this effect is dose-dependent and observed in patients simultaneously treated with other hypolipidemic agents. The study included 23 premenopausal women with elevated total testosterone levels coexisting with hypercholesterolemia, unsuccessfully treated for at least 6 months with atorvastatin (20 mg daily). These patients were then treated with either an increased dose of atorvastatin (40 mg daily, n=11) or atorvastatin (20 mg daily) plus ezetimibe (10 mg daily) (n=12). Plasma lipids, glucose homeostasis markers and serum levels of androgens, sex hormone-binding globulin and gonadotropins were assessed at baseline and after 3 months of treatment. Although both treatments decreased plasma levels of total and LDL-cholesterol levels, only high-dose atorvastatin reduced serum levels of total testosterone, free testosterone and androstendione. The effect of high-dose atorvastatin on serum androgen levels did not differ between insulin-resistant and insulin-sensitive subjects. The obtained results suggest that atorvastatin reduces serum androgen levels in a dose-dependent manner and that its administration in a higher dose is associated with a more pronounced effect on serum androgens than combination therapy with low-dose atorvastatin and ezetimibe.

The effect of metformin on androgen production in diabetic women with non-classic congenital adrenal hyperplasia.

Non-classic congenital adrenal hyperplasia (NC-CAH), one of the most common genetic disorders, is often associated with the clinical features of hyperandrogenism. This study included 19 women with recently diagnosed and previously untreated type 2 diabetes, 8 of whom suffered from NC-CAH, treated with metformin (2.55-3.0 g daily). Glucose homeostasis markers, plasma lipids, as well as plasma levels of 17-hydroxyprogesterone, androgens and gonadotropins were assessed at baseline and after 6 months of therapy. In both groups of patients, metformin reduced fasting plasma glucose, insulin resistance, triglycerides and glycated hemoglobin. Moreover, in patients with NC-CAH, but not in women with normal adrenal function, metformin decreased plasma levels of 17-hydroxyprogesterone, total and free testosterone, androstenedione and dehydroepiandrosterone sulphate. The obtained results suggest that metformin partially normalizes androgen production in symptomatic patients with NC-CAH.

Causes of cervical lymphadenopathy at Kamuzu Central Hospital.

AIM: Description of pathologic causes of cervical lymphadenopathy at Kamuzu Central Hospital. INTRODUCTION: The evaluation of cervical lymphadenopathy is a common diagnostic challenge facing clinicians. Previously at Kamuzu Central Hospital (KCH) tuberculosis (TB) was reported to be the most common cause of cervical lymphadenopathy However, no recent study has assessed this common diagnostic challenge in Malawi, particularly since the beginning of the HIV epidemic and the subsequent scale-up of antiretroviral therapy. METHODS: We conducted a cross-sectional study of all cervical lymph node specimens from the KCH pathology laboratory between 1 July 2011 and 28 February 2013 and describe patient age, gender, and pathologic diagnoses. RESULTS: Our search of the KCH pathology database yielded 179 cases. Of these, 143 (77%) were histologic specimens (open biopsy or core needle samples) while 34 (23%) were cytology specimens. The age range was from 0 to 76 years with a mean of 30 (SD: 19). In adults, the most common diagnosis was malignancy (n=41, 35%), while in children 15 cases each of malignancy and benign masses were diagnosed. Only 6 cases (5%) of TB were diagnosed in adults, and 4 cases (6%) of TB were diagnosed in children. CONCLUSION: Our study shows more malignancy and much less TB than a prior study of cervical lymphadenopathy at KCH. With the successful initiaion of the KCH Pathology Laboratory in 2011, we recommend biopsy or FNA early in the workup of cervical lymphadenopathy to prevent long delays in diagnosis and treatment of curable cancers.

Potentiation of Endocrine Adverse Effects of Lithium by Enalapril and Verapamil.

Lithium, which is widely used in the management of patients with bipolar disorder, may alter the function of some endocrine organs, particularly the thyroid and parathyroid glands, as well as it may reduce the sensitivity of the kidneys to vasopressin. In most lithium-treated patients, endocrine abnormalities are limited to one endocrine organ and are observed only after long-term lithium therapy. The patient reported in this study developed hypothyroidism, hyperparathyroidism and nephrogenic diabetes insipidus. However, the last two disorders were induced by a small increase in plasma lithium levels as a result of the treatment with enalapril and verapamil. This case shows that patients at high risk of thyroid, parathyroid or renal disorders receiving lithium should not be treated with drugs known to interfere with plasma lithium levels.

Relapse of asthma after surgical treatment of Cushing's syndrome.

Endogenous overproduction of glucocorticoids may mask the clinical course of some inflammatory/ autoimmune disorders. In the present paper, we report a man with a history of asthma, which spontaneously remitted after 20 years of duration. Several years later, he was diagnosed with Cushing's syndrome of pituitary origin and underwent transsphenoidal microsurgery of an ACTH-producing pituitary adenoma. Shortly after tumour removal, he developed a severe asthmatic attack requiring hospitalisation and intensive treatment. We conclude that patients with Cushing's syndrome and coexisting inflammatory/autoimmune disorders should be closely supervised after normalisation of cortisol production for exacerbation of the associated disease and would eventually benefit from glucocorticoid treatment.

The effect of simvastatin treatment on plasma steroid levels in females with non-classic congenital adrenal hyperplasia.

Non-classic congenital adrenal hyperplasia (NC-CAH) is one of the most frequent genetic disorders and its presence often results in androgen excess. 4 females with coexisting symptomatic NC-CAH and isolated hypercholesterolemia and 11 sex- and weight-matched control subjects with elevated cholesterol but normal steroid levels, participating in our study, were treated with simvastatin (20 mg daily). Throughout the whole period of simvastatin treatment, plasma levels of 17-hydroxyprogesterone, testosterone, androstendione and dehydroepiandrosterone sulfate in patients with NC-CAH remained lower compared with baseline, but increased in 2 patients after withdrawal of this drug. No changes in plasma steroids were observed in simvastatin-treated control subjects. Our findings suggest that simvastatin treatment may bring some benefits to symptomatic female patients with NC-CAH.

Methyltestosterone-induced transient hyperthyroidism in a hypothyroid patient.

In this paper we report different effects of methyltestosterone administration on thyroid function in two twin brothers, one of whom suffered from hypothyroidism, while the other was apparently healthy. Methyltestosterone, which is a non-aromatisable androgen, resulted in a marked reduction of thyroxine-binding globulin (TBG), irrespectively of the patient's hormonal status, while the impact on free thyroid hormones depended on baseline thyroid function. Our research shows that a possibility of the use of non-aromatisable androgens or other drugs affecting TBG levels should be taken into consideration in all hypothyroid patients receiving levothyroxine, in whom thyroid hormone status suddenly changes without any apparent reason.

Coexistence of glucocorticoid resistance and pseudohypoparathyroidism / Coexistencia de la resistencia a glucocorticoides y el pseudohipoparatiroidismo

We report for the first time the case of a young man who developed both glucocorticoid resistance and resistance to parathyroid hormone. Treatment with high doses of dexamethasone together with administration of calcium and calcitriol resulted in a significant improvement in the patient's condition. In this paper, we discuss in detail diagnostic and treatment strategies used on the patient and the impact on the course and outcome of both disorders. We associate the development of both these disorders with a possible inherited defect in the signal pathways common to glucocorticoid and parathyroid hormone receptors.

Por primera vez se reporta el caso de un joven que desarrolló resistencia a glucocorticoides y resistencia a la hormona paratiroidea. El tratamiento con altas dosis de dexametasona, junto con la administración de calcio y calcitriol, trajo como resultado una mejoría significativa de la condición del paciente. En este papel, se analiza en detalle el diagnóstico así como las estrategias de tratamiento del paciente, y su impacto en el curso y resultado de ambos trastornos. Se concluye que el desarrollo de ambos trastornos se halla asociado a un posible defecto hereditario en las vías de transducción de señales comunes a los receptores de las hormonas glucocorticoides y las hormonas paratiroideas.