A thyrotropin-secreting macroadenoma with positive growth hormone and prolactin immunostaining: A case report and literature review.

Thyrotropin (thyroid stimulating hormone [TSH]) secreting pituitary adenomas (TSHoma) are rare adenomas presenting with hyperthyroidism due to impaired negative feedback of thyroid hormone on the pituitary and inappropriate TSH secretion. This article presents a case of TSH-secreting macroadenoma without any clinical hyperthyroidism symptoms accompanying immunoreaction with growth hormone (GH) and prolactin. A 36-year-old female patient was admitted with complaints of irregular menses and blurred vision. On physical exam, she had bitemporal hemianopsia defect. Magnetic resonance imaging (MRI) evaluation showed suprasellar macroadenoma measuring 33 mm × 26 mm × 28 mm was detected on pituitary MRI. She had no hyperthyroidism symptoms clinically. Although free T4 and free T3 levels were elevated, TSH level was inappropriately within the upper limit of normal. Response to T3 suppression and thyrotropin releasing hormone-stimulation test was inadequate. Other pituitary hormones were normal. Transsphenoidal adenomectomy was performed due to parasellar compression findings. Immunohistochemically widespread reaction was observed with TSH, GH and prolactin in the adenoma. The patient underwent a second surgical procedure 2 months later due to macroscopic residual tumor, bitemporal hemianopsia and a suprasellar homogenous uptake with regular borders on indium-111 octreotide scintigraphy. After second surgery; due to ongoing symptoms and residual tumor, she was managed with octreotide and cabergoline treatment. On her follow-up with medical treatment, TSH and free T4 values were within normal limits. Although silent TSHomas are rare, they may arise with compression symptoms as in our case. The differential diagnosis of secondary hyperthyroidism should include TSHomas and thyroid hormone receptor resistance syndrome.

Tirofiban in Takotsubo cardiomyopathy. Atypical broken heart syndrome with extremely fast recovery: a case report.

Takotsubo cardiomyopathy, also known as broken heart syndrome, is similar to acute coronary syndrome. The absence of significant stenosis on coronary angiography and spontaneous improvement of ventricular akinesia are very important features that distinguish this syndrome from acute coronary syndromes. Despite the fact that ST segment elevations are typically encountered, atypical presentation without ECG changes should be kept in mind. We herein report the case of a 61-year-old woman who presented with mid-apical left ventricular akinesia resolving within 24 h.

Hepatobiliary scintigraphy for evaluating the hepatotoxic effect of halothane and the protective effect of catechin in comparison with histo-chemical analysis of liver tissue.

Halothane and its metabolites cause liver damage by decreasing liver blood flow and generating free-radical species. Catechin suppresses lipid peroxidation and increases enzyme activity, therefore it seems to be capable of protecting liver parenchyma against the direct toxic effect of halothane. The aim of this study was to investigate the role of hepatobiliary scintigraphy in detecting liver damage after halothane anaesthesia and the protective effect of catechin in comparison with histo-chemical analysis. Thirty rabbits, divided into three groups (A, controls; B, halothane; and C, catechin+halothane), were investigated. In group A no anaesthesia was administered. Group B only received halothane, while group C was pretreated with catechin and halothane anaesthesia was administered for 2 h. Dynamic scintigrams were taken for 60 min after injecting 99mTc-mebrofenin, and the time of peak uptake (TPU) and the time for half of the activity to clear from the liver (T(1/2)) were calculated. Rabbits were killed, and malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and catalase (CAT) levels were measured in hepatic tissue. The TPU and T(1/2) values of group A is significantly lower than in groups B and C (P<0.0002 and P<0.0002, respectively, for TPU; and P<0.0002 and P<0.0003, respectively, for T(1/2)). The TPU and T(1/2) values of group B were significantly higher than in group C (P<0.0003 and P<0.0003, respectively). The hepatic MDA level of group A was significantly lower than in groups B and C (P<0.0002 and P<0.0002, respectively). SOD, GSH-Px and CAT levels of group A were significantly higher than in groups B and C (P<0.0002, P<0.0001 and P<0.003, respectively, for group A vs group B; and P<0.0005, P<0.0002 and P<0.03, respectively, for group A vs group C). The MDA level of group B was significantly higher than that in group C (P<0.0002). SOD, GSH-Px and CAT levels of group B were significantly lower than in group C (P<0.0002, P<0.0002 and P<0.003, respectively). According to these results, we suggest that catechin protects liver parenchyma against the toxic effect of halothane and its metabolites, and that, compared to invasive histo-chemical analysis, hepatobiliary scintigraphy is a useful and alternative non-invasive method for detecting the protective effect of catechin on liver parenchyma after halothane anaesthesia.

The role of hepatobiliary scintigraphy in the evaluation of the protective effects of dimethylsulphoxide in ischaemic/reperfusion injury of liver.

Liver ischaemia may lead to parenchymal damage depending on the duration of the ischaemia. Dimethylsulphoxide (DMSO), a well-known radical oxygen scavenger, is a protective agent against ischaemia/reperfusion injury. In this study we aimed to investigate the role of hepatobiliary scintigraphy (HBSc) in detecting the protective effect of DMSO. Eighteen rabbits, in three groups of six, were injected with 37 MBq technetium-99m-mebrofenin via the ear veins. Dynamic scintigrams were taken for 60 min (1 frame/min). In group A, HBSc was performed without any surgery. In groups B and C the Pringle manoeuvre (PM) was applied for 30 min, and tissue specimens for electron microscopy were taken from the liver parenchyma 5 min after the end of the PM. In addition, in group C 1 g/kg DMSO was injected into each rabbit 5 min before application of the PM. HBSc was then performed in groups B and C. From the dynamic images time-activity curves (TACs) were obtained for each group, and the time of peak uptake (TPU) and time for half of the activity to clear from the liver (T1/2) were calculated. The TPU and T1/2 of group B were significantly longer than those of groups A and C (P<0.0005 and P<0.005 for TPU, and P<0.0005 and P<0.02 for T1/2, respectively). The TPU and T1/2 of group C were significantly longer than those of group A (P < 0.005 and P < 0.02, respectively). While the electron microscopic images in group C showed reversible changes, those in group B showed both irreversible and reversible changes. The electron microscopic findings of groups B and C confirmed the scintigraphic findings. In conclusion, HBSc might be used as a practical quantitative method for detecting the protective effects of DMSO. However, its clinical value should be evaluated by further studies with human subjects.