Demonstration of reserved anterior pituitary function among patients with amenorrhea after postpartum hemorrhage.

To demonstrate the residual pituitary function of patients with Sheehan's syndrome years after the obstetric complication, 14 patients with postpartum hemorrhage followed by secondary amenorrhea and agalactia were included in this review. Due to their unfamiliarity with the clinical symptoms, these patients did not receive pretreatment hormonal therapy. The mean age at their last delivery was 29 years (range 21-38 years). The mean duration between postpartum hemorrhage and the subsequent clinical manifestations leading to the endocrine investigation was 18 years (range 1-33 years). Eight patients presented with symptoms of severe hyponatremia (serum sodium less than 125 mmol/l) more than 16 years (mean 23 +/- 10) after the occurrence of postpartum hemorrhage. The electrolyte abnormality was primarily due to adrenal dysfunction. Seven out of 14 patients had normal basal luteinizing hormone (LH) levels and adequate LH responses to gonadotropin releasing hormone stimulation. Administration of thyrotropin releasing hormone provoked thyrotropin release and/or prolactin secretion in four cases. The manifestation of clinical hypopituitarism and the degree of empty sella on computed tomography scanning did not accurately indicate the secreting ability of the pituitary in patients with Sheehan's syndrome. Although all the patients had amenorrhea, the gonadotropic functions of the pituitary still remain in some patients. Various degrees of other pituitary functions can also been demonstrated even several decades after the occurrence of obstetric complications. Our data suggest that the amenorrhea of Sheehan's patients is not simply due to a dysfunction of the pituitary gonadotrophs.

Recurrent fetal thyrotoxicosis in a woman with Graves' disease: case report.

The thyroid stimulating immunoglobulins are generally believed to be the cause of hyperthyroidism in Graves' disease. Placental transfer of these antibodies from a mother with autoimmune thyroid disease can result in fetal thyroid disorders. We report the case of a 31-year-old woman who had a history of Graves' disease. She received thyroxine therapy for post thyroidectomy hypothyroidism. Two years after the thyroidectomy, she became pregnant. Unfortunately, intrauterine fetal death occurred in midgestation. One year later, she became pregnant again. In the 26th week of gestation, fetal thyrotoxicosis was diagnosed using clinical pictures, including fetal tachycardia and cardiomegaly, and a hormonal evaluation of a periumbilical blood sampling (T4: 18 micrograms/dl, T3: 65.3 ng/dl, TSH: < 0.03 microU/ml) was performed. Antimicrosomal antibodies were not detectable in either the maternal or fetal blood. In this case, high levels of TBII were detected during pregnancy and crossed the placenta to result in a thyrotoxic fetus in the second pregnancy. We recommend that both the regular monitoring of the thyrotropin receptor antibodies of pregnant women with a history of autoimmune thyroid disease, and routine measurements of the fetal heart rate and intrauterine growth during gestation be mandatory for the early detection of fetal thyroid disorders. Cordocentesis for measuring fetal thyroid function is helpful in reaching a definite diagnosis and for guiding therapy.

Video microscopy to quantitate the inhomogeneous equilibrium strain within articular cartilage during confined compression.

The objectives of this study were to develop a method to quantitate the displacement and strain fields within articular cartilage during equilibrium confined compression, and to use the method to determine the variation of the equilibrium confined compression modulus with depth from the articular surface in bovine cartilage. The method made use of fluorescently labeled chondrocyte nuclei as intrinsic fiducial markers. Articular cartilage was harvested from the patellofemoral groove of adult bovines and trimmed to rectangular blocks 5 mm long, 0.76 mm wide, and 500 microns deep with the articular surface intact. Test specimens were stained with the DNA binding dye Hoechst 33258, placed in a custom confined compression chamber, and viewed with an epifluorescence microscope equipped for video image acquisition. Image processing was used to localize fluorescing chondrocyte nuclei in uncompressed and compressed (approximately 17%) specimens, allowing determination of the intra-tissue displacement profile. Strain was determined as the slope of linear regression fits of the displacement data in four sequential 125-microns-thick layers. Equilibrium strains varied 6.1-fold from the articular surface through 500 microns of cartilage depth, with the greatest compressive strain in the superficial 125-microns layer and the least compressive strain in the two deepest 125-microns layers. Thus, the four successive 125-microns layers have moduli that are 0.44 (superficial), 1.07, 2.39, and 2.67 (deep) times the apparent modulus for a 500-microns thick cartilage sample assumed to be homogeneous.