Psychopathological Analysis of Adolescent Girls With Autoimmune Thyroiditis.

AIM: Clinical studies indicate that there is an association between high levels of thyroid autoantibodies and psychiatric disorders, independent of impairment of thyroid function. Therefore, we aimed to investigate the association between thyroid autoimmunity and mood disorders in euthyroid girls with Hashimoto's thyroiditis (HT) in a case-control study. MATERIAL AND METHODS: We recruited 82 participants: 41 pubertal female patients with thyroiditis from endocrine outpatient clinics and a control group of 41 healthy pubertal girls from the University Hospital. Age ranged from 12 to 18 years; the diagnosis of HT was based on high levels of anti-TPO and/or anti-Tg antibodies associated with a hypoechogenic or normal thyroid ultrasound pattern. Other comorbidities known to affect mental and physical health were exclusion factors. All participants underwent a complete thyroid evaluation, assays of serum-free T4, TSH, anti-TPO antibodies, anti-Tg antibodies, and thyroid ultrasonography. They were then referred to a child psychiatrist. A psychiatric diagnosis was made in two steps. First, the Children's Depression Inventory (CDI) and Screen for Child Anxiety-Related Emotional Disorders (SCARED) tests were implemented according to the DSM-IV diagnostic criteria to be calculated. Second, the same psychiatrist conducted a K-SADS-PL semi-structured interview while unaware of the children's data. RESULTS: There was no significant difference in CDI score between patients with and without HT (p = 0.47). Patients with HT had significantly higher SCARED scores than patients without HT (p < 0.05). In the SCARED test, the subcategories of separation anxiety and social anxiety were significantly higher in the HT group (p = 0.04 and p = 0.01, respectively). During the K-SADS interview by the attending child psychiatrist, psychopathology diagnoses were detected in 27 of 41 patients (66%) with HT and in 8 of 41 individuals (19.5%) in the control group. Psychopathology was significantly higher in the HT group (p < 0.01). The incidences of depressive disorder, generalized anxiety disorder, and social phobia were significantly higher in the HT group than in the control group (p < 0.05). Multivariate logistic regression analysis revealed that the anti-TPO value was the most significant independent risk factor for the presence of depressive disorder (p < 0.01). CONCLUSION: This study described severe psychometric impairment in patients with euthyroid HT. We have demonstrated that autoimmune thyroid diseases, even in a euthyroid state, are associated with psychiatric disorders.

Clinical and Laboratory Characteristics of Hyperprolactinemia in Children and Adolescents: National Survey

Objective: We aimed to report the characteristics at admission, diagnosis, treatment, and follow-up of cases of pediatric hyperprolactinemia in a large multicenter study. Methods: We reviewed the records of 233 hyperprolactinemic patients, under 18 years of age, who were followed by different centers. The patients were divided as having microadenomas, macroadenomas, drug-induced hyperprolactinemia and idiopathic hyperprolactinemia. Complaints of the patients, their mode of treatment (medication and/or surgery) and outcomes were evaluated in detail. Results: The mean age of the patients with hyperprolactinemia was 14.5 years, and 88.4% were females. In terms of etiology, microadenomas were observed in 32.6%, macroadenomas in 27%, idiopathic hyperprolactinemia in 22.7% and drug-induced hyperprolactinemia in 6.4%. Other causes of hyperprolactinemia were defined in 11.3%. Common complaints in females (n=206) were sorted into menstrual irregularities, headaches, galactorrhea, primary or secondary amenorrhea and weight gain, whereas headache, gynecomastia, short stature and blurred vision were common in males (n=27). Median prolactin levels were 93.15 ng/mL, 241.8 ng/mL, 74.5 ng/mL, 93.2 ng/mL, and 69 ng/mL for microadenomas, macroadenomas, idiopathic hyperprolactinemia, drug-induced hyperprolactinemia, and other causes of hyperprolactinemia, respectively. Of 172 patients with hyperprolactinemia, 77.3% were treated with cabergoline and 13.4% with bromocriptine. 20.1% of the patients with pituitary adenomas underwent pituitary surgery. Conclusion: We present the largest cohort of children and adolescents with hyperprolactinemia in the literature to date. Hyperprolactinemia is more common in females and cabergoline is highly effective and practical to use in adolescents, due to its biweekly dosing. Indications for surgery in pediatric cases need to be revised.

Dynamic thiol/disulphide homeostasis as a novel indicator of oxidative stress in obese children and its relationship with inflammatory-cardiovascular markers.

OBJECTIVE: Childhood obesity is an important cause of cardiovascular risk with chronic inflammation. Oxidative stress may contribute to the pathogenesis of obesity-related cardiovascular pathologies. We aimed to evaluate thiol/disulphide homeostasis as a novel and sensitive marker of oxidative stress and to evaluate its relationship with some inflammatory and cardiovascular markers in obese children. METHODS: In this case-controlled study, 65 children with exogenous obesity and 64 healthy children, as a control group, were included. In both groups, thiol/disulphide homeostasis parameters and inflammatory (white blood cells, platelets, mean corpuscular volume, neutrophil/lymphocyte ratio, and high-sensitivity C-reactive protein) and cardiovascular (epicardial adipose tissue thickness and left ventricular mass index) markers were studied. Correlation analyses of thiol/disulphide homeostasis parameters with body mass index standard deviation scores (BMI SDS) and inflammatory and cardiovascular markers were performed. Receiver-operating characteristic analysis was performed to determine the sensitivity, specificity, and optimal cut-off values of thiol/disulphide homeostasis parameters. RESULTS: Native thiol, total thiol, and native thiol/total thiol ratios (antioxidant parameters) were lower (p<0.05) and disulphide/native thiol and disulphide/total thiol ratios (oxidant parameters) were higher in the obese group than in the control group (p<0.01). A positive correlation of oxidant parameters with BMI SDS and inflammatory markers was found. However, a negative correlation of antioxidant parameters with BMI SDS and inflammatory markers was found. The specificities of disulphide/native thiol and disulphide/total thiol ratios were higher in the obese group. CONCLUSION: The impairment in thiol/disulphide homeostasis, which is indicative of oxidative stress, is associated with inflammation in obesity. In addition, cardiovascular involvement may also contribute to this impairment.

Tamoxifen-associated hirsutism: an unusual side effect in a 5-year-old girl with McCune-Albright syndrome.

Tamoxifen, a selective estrogen receptor modulator, has been used in the treatment of peripheral precocious puberty. A 5-year and 3-month-old girl, diagnosed with McCune-Albright syndrome, came in with abnormal hair growth approximately 2 months after the initiation of tamoxifen. The pattern of terminal hair on the skin following the administration of the drug and the exclusion of other causes suggested tamoxifen-induced hirsutism.