Increased prevalence of obstructive sleep apnea in patients with Cushing's syndrome compared with weight- and age-matched controls.

OBJECTIVE: Diabetes mellitus and obesity are well-known risk factors associated with obstructive sleep apnea (OSA). Cushing's syndrome (CS) is also characterized by obesity and diabetes mellitus. However, the association between CS and OSA remains unclear. Therefore, we investigated the possible associations between CS and OSA in this study. PATIENTS AND METHODS: Thirty female patients with newly diagnosed active CS and 30 age-, gender- and body mass index (BMI)-matched controls were included in this study. All participants were evaluated by overnight polysomnography. OSA was defined as having an apnea-hypopnea index (AHI) score of ≥5 events/h. Insulin resistance was calculated by homeostasis model assessment (HOMA) scores. Fasting serum cortisol was also determined. RESULTS: The prevalence of OSA was higher (50% vs 23%, P = 0.003) in patients with CS compared with the control subjects. The mean HOMA (P = 0.046) and AHI (P = 0.028) scores were higher in patients with CS compared with the control subjects. AHI was positively correlated with the HOMA scores (r = 0.281, P = 0.046) in both groups. Linear regression analysis showed that serum cortisol remained as an independent predictor for AHI after controlling for BMI and HOMA score (P < 0.001). CONCLUSIONS: The prevalence of OSA increased in patients with CS compared with control subjects with similar ages and BMI levels. Hypercortisolemia is an independent risk factor for developing OSA. The presence of OSA needs to be considered in patients with CS.

Sheehan syndrome.

Sheehan syndrome or postpartum hypopituitarism is a condition characterized by hypopituitarism due to necrosis of the pituitary gland. The initial insult is caused by massive postpartum haemorrhage (PPH), leading to impaired blood supply to the pituitary gland, which has become enlarged during pregnancy. Small sella turcica size, vasospasms (caused by PPH) and/or thrombosis (associated with pregnancy or coagulation disorders) are predisposing factors; autoimmunity might be involved in the progressive worsening of pituitary functions. Symptoms are caused by a decrease or absence of one or more of the pituitary hormones, and vary, among others, from failure to lactate and nonspecific symptoms (such as fatigue) to severe adrenal crisis. In accordance with the location of hormone-secreting cells relative to the vasculature, the secretion of growth hormone and prolactin is most commonly affected, followed by follicle-stimulating hormone and luteinizing hormone; severe necrosis of the pituitary gland also affects the secretion of thyroid-stimulating hormone and adrenocorticotropic hormone. Symptoms usually become evident years after delivery, but can, in rare cases, develop acutely. The incidence of Sheehan syndrome depends, to a large extent, on the occurrence and management of PPH. Sheehan syndrome is an important cause of hypopituitarism in developing countries, but has become rare in developed countries. Diagnosis is based on clinical manifestations combined with a history of severe PPH; hormone levels and/or stimulation tests can confirm clinical suspicion. Hormone replacement therapy is the only available management option so far.

Natural History of Congenital Generalized Lipodystrophy: A Nationwide Study From Turkey.

CONTEXT: Congenital generalized lipodystrophy (CGL) is a rare autosomal recessive disorder characterized by near-total lack of body fat. OBJECTIVE: We aimed to study natural history and disease burden of various subtypes of CGL. DESIGN: We attempted to ascertain nearly all patients with CGL in Turkey. SETTING: This was a nationwide study. PATIENTS OR OTHER PARTICIPANTS: Participants included 33 patients (22 families) with CGL and 30 healthy controls. MAIN OUTCOME MEASURE(S): We wanted to ascertain genotypes by sequencing of the known genes. Whole-body magnetic resonance imaging was used to investigate the extent of fat loss. Metabolic abnormalities and end-organ complications were measured on prospective follow-up. RESULTS: Analysis of the AGPAT2 gene revealed four previously reported and four novel mutations (CGL1; c.144C>A, c.667_705delinsCTGCG, c.268delC, and c.316+1G>T). Analysis of the BSCL2 gene revealed four different homozygous and one compound heterozygous possible disease-causing mutations (CGL2), including four novel mutations (c.280C>T, c.631delG, c.62A>T, and c.465-468delGACT). Two homozygous PTRF mutations (c.481-482insGTGA and c.259C>T) were identified (CGL4). Patients with CGL1 had preservation of adipose tissue in the palms, soles, scalp, and orbital region, and had relatively lower serum adiponectin levels as compared to CGL2 patients. CGL4 patients had myopathy and other distinct clinical features. All patients developed various metabolic abnormalities associated with insulin resistance. Hepatic involvement was more severe in CGL2. End-organ complications were observed at young ages. Two patients died at age 62 years from cardiovascular events. CONCLUSIONS: CGL patients from Turkey had both previously reported and novel mutations of the AGPAT2, BSCL2, and PTRF genes. Our study highlights the early onset of severe metabolic abnormalities and increased risk of end-organ complications in patients with CGL.

Evaluation of olfactory function in adults with primary hypothyroidism.

BACKGROUND: Sufficient clinical data are not available on the effect of hypothyroidism on olfactory function in adults. In this study, we aimed to evaluate the olfactory function of adult patients diagnosed with primary hypothyroidism. METHODS: Forty-five patients aged between 18 and 60 years who were diagnosed with clinical primary hypothyroidism and 45 healthy controls who had normal thyroid function tests were included in the study. Sniffin' Sticks olfactory test results of the 2 groups were compared. The relationships between thyroid function tests and olfactory parameters were evaluated. RESULTS: Odor threshold, identification, and discrimination scores of the hypothyroid group were significantly lower than those of the control group (p < 0.001). A significant positive correlation was detected between free triiodothyronine (FT3) levels and odor threshold, identification, and discrimination scores (p < 0.001). There was no significant relationship between thyroid-stimulating hormone (TSH) or free thyroxine (FT4) levels and olfactory parameters. CONCLUSION: Our study revealed diminished olfactory function in adults with hypothyroidism. FT3 levels were found to have a more significant relationship with olfactory parameters than TSH or FT4 levels.

Marine-Lenhart syndrome with papillary thyroid carcinoma.

Graves' disease with accompanying functioning nodules is known as Marine-Lenhart syndrome. Autonomously functioning thyroid nodules (AFTNs) also within Graves' thyroid tissue are almost always bening in nature. A 45-year-old man developed hyperthyroidism due to the coexistence of Graves' disease and AFTN. Total thyroidectomy was performed. The hyperfunctioning nodule with centrally hypoactive foci detected by technetium-99m thyroid scanning was histologically diagnosed as papillary thyroid carcinoma that was 2.5 cm in diameter. We report the presence of papillary thyroid carcinoma within AFTN in patients with Marine-Lenhart syndrome, which has not been reported so far.

Nuclear morphometric and morphological analysis of exfoliated buccal and tongue dorsum cells in type-1 diabetic patients.

BACKGROUND: Diabetes mellitus type 1 that results from immunologically mediated damage to the ß-cells in the pancreas. Diabetes mellitus is characterized by recurrent or persistent hyperglycemia. Hyperglycemia can be associated with salivary gland dysfunction and alterations in the oral epithelial cells. AIM: The aim of this study was to evaluate the qualitative and quantitative changes in buccal and tongue dorsum epithelial cells using an exfoliative cytology method in type 1 diabetic patients. MATERIALS AND METHODS: We performed light microscopic analysis of the buccal and tongue dorsum smears in thirty type 1 diabetic patients and thirty healthy individuals. The oral smears were stained using Papanicolaou method for cytological examination and nuclear morphometric analysis. In each case, the mean nuclear area, perimeter, length, breadth, and roundness factor were evaluated in each smear using the image analysis software (Q Win, Leica™). RESULTS: The nuclear area, length, breadth, and perimeters were significantly higher in the diabetic group from tongue dorsum smear than that of the control group (P < 0.05). In the cytological examination, karyorrhexis-karyolysis-karyopyknosis, binucleation, nuclear membrane irregularity, cytoplasmic polymorphism, perinuclear halo were observed in oral smears with type 1 diabetic patients. Binucleation (P = 0.002) and nuclear membrane irregularity (P = 0.024) were significantly more common in buccal smears of diabetic group. Furthermore, the sensitivity of buccal mucosa was significantly higher in the diabetic group (P = 0.006). CONCLUSION: The light microscopic and nuclear morphometric study indicates that type 1 diabetes can produce morphological and nuclear morphometric changes in the oral mucosa that are noticeable with exfoliative cytology.

Extensive investigation of 114 patients with Sheehan's syndrome: a continuing disorder.

OBJECTIVE: Sheehan's syndrome (SS) is a well-known cause of hypopituitarism resulting from postpartum pituitary necrosis. Because of its rarity in Western society, its diagnosis is often overlooked. We aimed to investigate the clinical, laboratory, and radiological aspects of SS in a large number of patients. STUDY DESIGN: A retrospective assessment of the medical records of 114 patients with SS was conducted. In addition, sella turcica volumes of 29 healthy women were compared with those of patients by magnetic resonance imaging examinations. RESULTS: The mean period of diagnostic delay was 19.7 years in patients with SS. It was found that 52.6% of patients had nonspecific complaints, 30.7% had complaints related to adrenal insufficiency, and 9.6% had complaints related to hypogonadism when diagnosed. At the time of diagnosis, 55.3% of the patients had panhypopituitarism, while 44.7% had partial hypopituitarism. The number of deficient hormones was found to be increased over the years. None of the patients whose basal prolactin was below 4.0 ng/ml had adequate prolactin responses to TRH test, while all patients whose basal prolactin was above 7.8 ng/ml had adequate responses. Mean sella volume was found to be significantly lower in the SS group (340.5±214 mm(3)) than that in the healthy group (602.5±192 mm(3)). CONCLUSIONS: SS is a common cause of hypopituitarism in underdeveloped and developing countries. The main reasons for diagnostic delay seem to be the high frequency of patients with nonspecific complaints and neglect of SS. In addition, the TRH stimulation test was found to have a high sensitivity and specificity to recognize PRL deficiency. Furthermore, small sella size may have an important contributing role in the etiopathogenesis of SS.

Visual field defects in 23 acromegalic patients.

Pituitary tumors are the third most common primary intracranial neoplasm. Pathologic proliferation of the somatotrophs results as overproduction of growth hormone presenting as acromegaly. In pituitary adenomas typical visual field (VF) defect is bitemporal hemianopsia but tumor size and optic chiasmal position may cause variable VF defects and VF examination may remain normal. We retrospectively reviewed the medical records of 23 acromegalic patients with pituitary adenomas who received VF tests in the Department of Ophthalmology and Endocrinology, Ondokuz Mayis University Hospital, between 2000 and 2012. Pituitary tumor volume was calculated after performing measurements of tumor diameter in three orthogonal planes using Cavalieri's principle. VF test was performed with a Humphrey field analyzer 750 using a 4-mm² Goldmann size III stimulus. The mean age of the 23 patients (11 male/12 female) was 50.4 ± 11.9 years. 15 patients (65.2 %) had normal VF, two patients (9 %) had quadrantanopsia, three patients (13 %) had hemianopsia and three patients (13 %) had three quadrantanopsia. Among the patients with normal VF, four patients had a suprasellar mass that was elevating the chiasm and spreading along the optic tracts. We also observed VF defects typical of a chiasmal compression even though no suprasellar extension was detected in a few cases. Tumor volume of the patients with VF defects was significantly larger than tumor volume of patients with normal VF (p = 0.02). Tumor volume is an important parameter in VF defects. Advanced neuroimaging assesments should always be complemented in patients even with normal VF.

Lymphocyte subpopulations in Sheehan's syndrome.

The role of autoimmunity in the development of Sheehan's syndrome is obscure. There are a limited number of studies investigating the immunological alterations accompanying Sheehan's Syndrome. Our objective was to evaluate lymphocyte subsets in these patients. We conducted a cross-sectional clinical study. Cytofluorometry was used for the immunophenotyping of peripheral blood leukocytes from patients with Sheehan's syndrome followed up in the endocrine clinic during 2005-2009. Fifteen consecutive patients (mean age 61.6 ± 11.3, range 34-75 years) and 25 healthy controls (mean age 56.7 ± 10.6, range 34-80 years) were included. There was no statistically significant difference between the groups in terms of mean age. The percentages of CD19(+), CD16(+)/56(+), CD8(+)28(-), γδTCR(+), CD8(+); the total lymphocyte counts; and the ratio of CD8(+)28(-)/CD8(+)28(+) were similar (p > 0.05) between patients and controls. Whereas the leucocyte counts (p = 0.003), the percentage of CD3 (+) DR (+) (p < 0.001), CD8(+)28(+) (p = 0.030), CD4(+)CD25(+) (p = 0.007), the ratio of CD3 (+) DR(+)/CD3 (p < 0.001) were higher; the percentage of CD3 (p = 0.020), CD4 (p < 0.001) and the ratio of CD4/CD8 (p = 0.006) were lower in patients with Sheehan's syndrome compared to healthy controls. There was a positive correlation between the duration of illness and the percentage of CD3(+)DR(+) (r = 0.53, p = 0.03) expression. Some peripheral lymphocyte cell subsets show marked variation in patients with Sheehan's syndrome in comparison to matched healthy subjects, which may have implications for altered immune regulation in these patients. High CD3 (+) DR (+) expression that correlates with the duration of illness in Sheehan's patients is suggestive of an ongoing inflammation accompanying the slow progression of pituitary dysfunction in Sheehan's syndrome. It is not clear if these cellular alterations contribute to the cause or consequence of pituitary deficiency in Sheehan's syndrome.

Gonadal function in male mountain bikers.

Some studies reported testicular disorders associated with biking in mountain cyclists, which include injuries, erectile dysfunction, and higher scrotal temperatures. But none of these studies evaluated gonadal function. Therefore, the aim of this study was to evaluate gonadal function in male mountain bikers. Twenty-two male professional mountain bikers and 30 healthy noncyclist controls were included in the study. The mean age and body mass index were similar in both groups. Fasting blood samples for the measurement of the levels of total testosterone (TT), sex-hormone binding globulin (SHBG), luteinizing hormone (LH), and follicle-stimulating hormone (FSH) were obtained from all study participants before any physical activity. In addition, because insulin sensitivity and leptin modulate gonadal function, the concentrations of insulin, glucose, and leptin were also measured in the same samples. Calculated free testosterone (cFT) and bioavailable testosterone (bioT) were calculated from SHBG and TT. Basal hormonal levels including insulin, leptin, LH, FSH, SHBG, TT, glucose, and homeostasis model assessment scores were similar between the groups. However, bioT and cFT levels were significantly lower (p ≤ 0.05) in the mountain bikers than those in the controls. Despite the lower mean testosterone levels in the study group, the levels of LH and FSH were similar to controls. Insulin and leptin do not contribute to lower testosterone levels. In conclusion, male mountain bikers have lower testosterone concentrations compared to controls. This alteration cannot solely be explained by testicular dysfunction. The etiology of lower testosterone levels in cyclists appears to be complex and requires further research. The influence of such a decline on the athlete's performance, quality of life, and muscle strength is not known as yet.

Clinical characterization of patients with macroprolactinemia and monomeric hyperprolactinemia.

Macroprolactinemia is often a cause of misdiagnosis, unnecessary expensive investigation, and unsuitable treatment. The aim of the present study was to investigate the clinical findings and the concentrations of macroprolactin in patients with hyperprolactinemia in our region. Eighty-four female hyperprolactinemic patients were screened for macroprolactinemia. Prolactin was measured by chemiluminescence method on an Immulite 2000 analyzer (Siemens Health Diagnostics, Deerfield, IL, USA). Recoveries less than or equal to 40% after polyethylene glycol precipitation were indicative of macroprolactinemia. Clinical features and biochemical values were compared in true hyperprolactinemic and macroprolactinemic patients. Macroprolactinemia was detected in 31 patients (36.9%), with 84 hyperprolactinemic female patients. There was no difference in frequency of galactorrhea and oligomenorrhea/amenorrhea between the two groups. When we evaluated the clinical features of patients according to prolactin levels, no significant difference was found between the groups. In conclusion, our initial data show that no clinical features could reliably differentiate macroprolactinemic from true hyperprolactinemic patients, but at least one of these symptoms was present in most macroprolactinemic patients.

The prevalence of non-classic adrenal hyperplasia among Turkish women with hyperandrogenism.

The prevalence of non-classic adrenal hyperplasia (NCAH) among Turkish women with hirsutism has not been established so far. Thus, we aimed to evaluate the prevalence of 21-hydroxylase (21-OH) deficiency by ACTH stimulation test among hirsute women. The study population consisted of 285 premenopousal women, aged 16-46 years (mean: 23.2 ± 0.3). All were hirsute and hyperandrogenic. Androgen secreting tumors of the ovaries and the adrenal glands were excluded as well as thyroid dysfunction and hyperprolactinemia. All the patients were evaluated by 0.25 mg (i.v.) ACTH stimulation test and 17-OHP responses were obtained at 30 and 60 min. The diagnosis of NCAH due to 21-OH deficiency was considered in patients with the poststimulation 17-OHP level exceed 10 ng/ml. Six (2.1%) of the patients had NCAH due to 21-OH deficiency confirmed by genotyping. The rest of the patients were polycystic ovary syndrome (n = 166, 58.2%) and idiopathic hyperandrogenemia (n = 113, 39.7%). There were no patients with idiopathic hirsutism because patients with normal serum androgen levels were excluded. This first and most extensive national study investigating NCAH prevalence among Turkish population showed that NCAH is not prevalent in this population.

Hypothalamic-pituitary-adrenal axis in patients with ankylosing spondylitis.

OBJECTIVE: To investigate the hypothalamic-pituitary-adrenal (HPA) axis via the insulin-tolerance test (ITT), standard-dose (250 microg) ACTH test (SDT) and low-dose (1 microg) ACTH test (LDT) in patients with ankylosing spondylitis (AS). DESIGN: The study group included 13 male patients with AS who were diagnosed according to the Modified New York criteria, and 8 healthy male subjects and was carried out at the Department of Physical Medicine and Rehabilitation, Erciyes University Medical School. ACTH stimulation tests were carried out by using 1 microg and 250 microg i.v. ACTH as a bolus injection, and blood samples were drawn at 0, 30 and 60 min. ITT was performed by using intravenous (i.v.) soluble insulin, and serum glucose and cortisol levels were measured before and after 30, 60, 90 and 120 min. All of the tests were performed consecutively with 3-day intervals, after an overnight fast. RESULTS: There were no significant differences between the patients with AS (mean age 36.9+/-6.7 years) and the healthy subjects (mean age 37.4+/-5.7 years) in terms of age. The basal cortisol levels in the AS group measured during LDT, SDT and ITT (556+/-204 nmol/l; 524+/-169 nmol/l; 418+/-232 nmol/l, respectively) were comparable to the values of the control group (572+/-199 nmol/l; 520+/-182 nmol/l; 424+/-194 nmol/l, respectively). There were also no significant differences in peak cortisol responses between the two groups using LDT (patients 1025+/-339 nmol/l; controls 844+/-236 nmol/l), SDT (patients 1082+/-243 nmol/l; controls 1120+/-131 nmol/l) and ITT (patients 834+/-256 nmol/; controls 820+/-239 nmol/). CONCLUSION: In contrast with findings in other inflammatory diseases such as rheumatoid arthritis and polymyalgia rheumatica, the present data indicate that there is no apparent abnormality of the HPA axis activity in patients with AS.

Oxidative stress markers, C-reactive protein and heat shock protein 70 levels in subjects with metabolic syndrome.

BACKGROUND: The metabolic syndrome is a cluster of cardiovascular risk factors and essential components of metabolic syndrome are hyperglycemia, hypertension, visceral obesity, hypertriglyceridemia and low high-density lipoprotein cholesterol. Oxidative stress plays a critical role in the pathogenesis of metabolic syndrome components and insulin resistance. The aim of this study was to investigate the role of oxidative stress, C-reactive protein and heat shock protein 70 levels in the pathogenesis of this disease. METHODS: A total of 36 patients diagnosed with metabolic syndrome and 33 controls were included in the study. Malondialdehyde, carbonyl protein, C-reactive protein and heat shock protein 70 levels and xanthine oxidase and superoxide dismutase activities were measured in the serum of the subjects. RESULTS: Mean serum malondialdehyde, carbonyl protein, C-reactive protein (p<0.01, p<0.05 and p<0.001, respectively) and xanthine oxidase activity were significantly higher (p<0.01) in serum of the patients than the control group. Superoxide dismutase activity and heat shock protein 70 levels were significantly lower (p<0.01 and p<0.05, respectively) in serum of the patients. CONCLUSIONS: These results suggest that oxidative stress parameters and components of metabolic syndrome are closely related; therefore, significant alterations may occur in the antioxidant and inflammatory status. However, further studies are required to evaluate the possible molecular mechanisms of heat shock protein 70 levels in metabolic syndrome.

The evaluation of serum cystatin C, malondialdehyde, and total antioxidant status in patients with metabolic syndrome.

BACKGROUND: This study was designed to determine if serum cystatin C (Cys C) levels are affected by metabolic syndome and whether they correlate with lipid peroxidation and total antioxidant status (TAS) in this disorder. MATERIAL/METHODS: Cases with metabolic syndrome diagnosed according to the ATP III criteria (18 females, 12 males) were compared with healthy control subjects (20 females, 17 males) matched by age and gender. Plasma Cys C, malondialdehyde (MDA), and TAS levels were studied. RESULTS: Compared with the controls, Cys C and MDA levels were significantly higher (p<0.001 and p<0.001, respectively), whereas TAS was lower (p<0.001) in metabolic syndrome patients. A significant positive correlation between MDA and Cys C (r=0.308, p<0.05) and a significant negative correlation between TAS and Cys C levels (r=-0.358, p<0.01) were found. CONCLUSIONS: As Cys C and MDA levels increased but TAS decreased, Cys C may be an important indicator in the pathogenesis of metabolic syndrome.

Do we still need the TRH stimulation test?

OBJECTIVE: To evaluate the diagnostic value of the thyrotropin-releasing hormone (TRH) stimulation test in the diagnosis of central hypothyroidism in patients with Sheehan's syndrome. DESIGN: TRH stimulation test was performed in 72 patients with Sheehan's syndrome. Basal free triiodothyronine (fT(3)) and free thyroxine (fT(4)) levels were measured. Serum thyrotropin (TSH) concentration was determined before and 30, 60, 90, and 120 minutes after 200 mug TRH IV bolus injection. The peak TSH values <5.5 microIU/ml were defined as inadequate response. A peak TSH at 60 minutes or later was considered as delayed response. If TSH (60 minutes after peak), was more than 40% of the peak value it was considered as prolonged response. The diagnosis of central hypothyroidism (CH) was made if either serum fT(4) concentration was subnormal with an inappropriately low serum TSH concentration or inadequate response to TRH stimulation test and/or a delayed or prolonged response to TRH stimulation test. MAIN OUTCOME: Fifty-six (77.7%) of the patients had low serum fT(4) and fT(3) levels with an inappropriately low serum TSH levels were defined as CH (CH0 group). Ten (13.8%) patients with normal and low-normal fT(4) levels had no response and/or delayed or prolonged response to TRH stimulation test (CH1group). Six (8.3%) patients had fT(3), fT(4), and TSH levels within normal limits and peak TSH responses >/=5.5 microIU/ml consistent with euthyroidism (euthyroid group). Thus, 66 (91.6%) of 72 patients with Sheehan's syndrome had CH. Although fT(4) levels were within normal reference range, TRH stimulation test revealed that 10 (13.8%) of these had CH. CONCLUSION: TRH stimulation test is useful in the diagnosis of central hypothyroidism, especially in whom fT(4) and/or TSH is low-normal and known to have hypothalamo-pituitary pathology.

Impaired longitudinal myocardial velocities in patients with growth hormone deficiency improves after hormone replacement therapy.

Cardiac parameters in growth hormone (GH) deficiency and the effects of GH replacement treatment (GHRT) are still controversial. We investigated 19 adult patients (mean age: 45 +/- 10 years, 7 male), with GH deficiency before and after 12 months of GHRT. Twenty age- and sex-matched healthy individuals (mean age: 44 +/- 12 years, 9 male) were taken as a control group. All participants underwent echocardiography both before and after GHRT. The patients before GHRT and control subjects had similar left ventricular sizes and ejection fraction whereas patients before GHRT had impaired diastolic indices of left ventricle. Peak systolic annular velocity, which identifies myocardial longitudinal systolic function, was lower in patients before GHRT than in the control subjects (0.08 +/- 0.01 vs 0.10 +/- 0.02, P < .05) and improved after GHRT (0.09 +/- 0.03, P < .05). Adult-onset GH deficiency is associated with normal left ventricular sizes and preserved ejection fraction whereas longitudinal systolic function obtained by Doppler tissue imaging is deteriorated, which improves with 12 months of GHRT.

Posterior pituitary function in Sheehan's syndrome.

OBJECTIVE: We studied posterior pituitary function in 27 patients with Sheehan's syndrome and 14 controls. DESIGN: All patients were investigated by water deprivation test and 26 of them by 5% hypertonic saline infusion test. None of the patients had symptoms of diabetes insipidus and all patients were on adequate glucocorticoid and thyroid hormone replacement therapy before testing. RESULTS: According to dehydration test, 8 (29.6%) patients had partial diabetes insipidus (PDI group) and 19 (70.3%) had normal response (non-DI group). During the 5% hypertonic saline infusion test, the maximal plasma osmolality was higher in PDI (305 +/- 4.3) and non-DI (308 +/- 1.7) groups when compared with controls (298 +/- 1.7 mOsm/kg; P < 0.005), but the maximal urine osmolality was lower in PDI group (565 +/- 37) than in non-DI (708 +/- 45) and control (683 +/- 17 mOsm/kg) groups (P < 0.05). The osmotic threshold for thirst perception was higher in PDI (296 +/- 4.3) and non-DI (298 +/- 1.4) groups when compared with control group (287 +/- 1.5 mOsm/kg) (P < 0.005). Basal plasma osmolalities were also higher in PDI (294 +/- 1.0) and non-DI (297 +/- 1.1) groups than in controls (288 +/- 1.2 mOsm/kg; P < 0.001). CONCLUSIONS: Our findings demonstrated that patients with Sheehan's syndrome have an impairment of neurohypophyseal function. The thirst center may be affected by ischemic damage and the osmotic threshold for the onset of thirst in patients with Sheehan's syndrome is increased.

Investigation of hypothalamo-pituitary-gonadal axis and glucose intolerance among the first-degree female relatives of women with polycystic ovary syndrome.

OBJECTIVE: To assess the glucose intolerance and the hypothalamo-pituitary-gonadal (HPG) axis in the first-degree relatives (FDRs) of patients with polycystic ovary syndrome (PCOS). DESIGN: Clinical study of the female FDRs of patients with PCOS. SETTING: Outpatients at endocrinology department of a university hospital. PATIENT(S): Seventy FDRs of PCOS patients and 20 healthy women were evaluated. INTERVENTION(S): Basal hormonal investigations, buserelin test, and 75-g oral glucose tolerance test (OGTT) were performed. MAIN OUTCOME MEASURE(S): Basal hormone levels were measured. Additionally, insulinogenic index, glucose and insulin responses to OGTT, and FSH, LH, E(2), and 17-OHP responses to buserelin test were obtained. RESULT(S): Four (5.7%) of the FDRs showed impaired glucose tolerance, and the FDRs had significantly higher fasting plasma glucose (P<.05) and basal insulin (P<.01) than control subjects. Peak and area-under-the-curve (AUC) insulin (P<.001) and AUC glucose (P<.05) responses to OGTT were also significantly higher in the FDRs than in control subjects. The FDRs showed higher insulinogenic index than the control subjects (P<.001). The FDRs had significantly (P<.05) higher LH and DHEAS levels and lower (P<.005) 17-OHP levels than the control subjects. Peak (P<.05) and AUC (P<.01) LH responses to buserelin testing were lower in the FDRs than in the control subjects while peak (P<.05) and AUC (P<.01) E(2) responses to buserelin were higher in the FDRs than in the control subjects. CONCLUSION(S): These data support the hypothesis that FDRs of PCOS patients may have insulin resistance and the HPG axis is more susceptible than in control subjects. The FDRs also have an increased prevalence of hyperandrogenism and high DHEAS levels compared with the background population.