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OBJECTIVE: We studied the prevalence of endocrine dysfunction in subjects with idiopathic Parkinson's disease (IPD) on newer dopaminergic agents (DA). DA are also used in endocrine hypersecretory states in small doses and we hypothesized that endocrine dysfunction was likely in IPD where DA were used in comparatively much higher dosage. PATIENTS AND METHODS: Twenty-five subjects with IPD, established on DA, were recruited to this cross-sectional study. We measured insulin-like growth factor-1, prolactin, luteinizing hormone, follicle stimulating hormone, thyroid function, oestradiol or testosterone and cortisol levels following a short synacthen test. RESULTS: We studied 18 males and 7 females, whose median age was 72 years, and whose median time from diagnosis, and duration of treatment was 27 months (interquartile range 17-45 and 13-39 months, respectively). (1) Endocrine tests were normal in 19 of 25 subjects at recruitment. Minor abnormalities reverted to normal on repeat testing in three of six with initial abnormalities; two had persistent abnormalities and the third subject could not be further investigated. Therefore, 22 of 24 (92%) with IPD on DA therapy had normal endocrine profiles. (2) The cortisol response to ACTH was normal in 24 of 25 subjects (96%). (3) Eleven subjects (44%) had isolated PRL suppression. There were no differences between the suppressed PRL and "normal" PRL groups. However, a higher number of them were on non-ergoline-derived DA (83% vs 31%; P < 0.05). CONCLUSIONS: We have demonstrated that newer non-ergoline DA therapy caused only minimal endocrine perturbations in subjects with IPD. Their clinical significance can only be speculative currently. The cortisol response to ACTH was normal in almost all but a significant minority had suppressed prolactin levels.
RESUMO
BACKGROUND: In recent years there has been increasing recognition that the pattern of presentation of coeliac disease may be changing. The classic sprue syndrome with diarrhoea and weight loss may be less common than the more subtle presentations of coeliac disease such as an isolated iron deficiency anaemia. As a result, the diagnosis of this treatable condition is often delayed or missed. Recent serologic screening tests allow non-invasive screening to identify most patients with the disease and can be applied in patients with even subtle symptoms indicative of coeliac disease. Both benign and malignant complications of coeliac disease can be avoided by early diagnosis and a strict compliance with a gluten free diet. AIM: The aim of this study is to evaluate the trends in clinical presentation of patients diagnosed with adult coeliac disease. In addition, we studied the biochemical and serological features and the prevalence of associated conditions in patients with adult coeliac disease. METHODS: This is an observational, retrospective, cross-sectional review of the medical notes of 32 adult patients attending the specialist coeliac clinic in a district general hospital. RESULTS: Anaemia was the most common mode of presentation accounting for 66% of patients. Less than half of the patients had any of the classical symptoms of coeliac disease and 25% had none of the classical symptoms at presentation. Anti-gliadin antibodies, anti-endomysial antibody and anti-tissue transglutaminase showed 75%, 68% and 90% sensitivity respectively. In combination, serology results were 100% sensitive as screening tests for adult coeliac disease. Fifty nine percent patients had either osteoporosis or osteopenia. There were no malignant complications observed during the follow up of our patients. CONCLUSION: Most adults with coeliac disease have a sub clinical form of the disease and iron deficiency anaemia may be its sole presenting symptom. Only a minority of adult coeliac disease patients present with classical mal-absorption symptoms of diarrhoea and weight loss. Patients with atypical form of disease often present initially to hospital specialists other than a gastro-enterologist. An awareness of the broad spectrum of presentations of adult coeliac disease, among doctors both in primary care and by the various hospital specialists in secondary care, is necessary to avoid delays in diagnosis. It is important to include serological screening tests for coeliac disease systematically in the evaluation of adult patients with unexplained iron deficiency anaemia or unexplained gastro-intestinal symptoms and in those who are considered to be at increased risk for coeliac disease.
