Hair cortisol in polycystic ovary syndrome.

The aim of the study was to evaluate adrenal axis hyperactivation measuring hair cortisol levels, and its influence on the relationship among metabolic parameters, inflammation markers and androgens in adult women with PCOS. 44 women (18-34 years) with PCOS diagnosis and a control group of 49 healthy women (19-35 years) were included. In both gropus body mass index (BMI) was calculated and waist circumference (WC) was measured. Hair cortisol, total serum testosterone (TT), serum cortisol, 25 OH vitamin D (25OHD), insulin, high sensitivity C-reactive protein (hsCRP), triglycerides (TG), HDL cholesterol (HDL), glucose and leptin were measured. Bioavailable testosterone (bioT) was calculated. Hair cortisol concentration was higher and significantly different in PCOS patients compared to the control group (130 vs 63 pg/mg of hair, p < 0.001). Subsequently, patients with PCOS were divided into two groups according to hair cortisol levels: group 1 with normal hair cortisol concentration and group 2 with levels above the upper limit of the reference values (128 pg/mg of hair). In group 2, TT significantly correlated with 25OHD, hsCRP, TG/HDL index, BMI, WC, insulin and HOMA (p < 0.05); bioT correlated with hsCRP and leptin (p < 0.05). Finally, 25OHD was inversely correlated with leptin and with TG/HDL index (p < 0.05). High hair cortisol concentration in patients with PCOS confirmed hyperactivation of the HPA axis. The associations observed were only found in patients with PCOS with high hair cortisol levels (> 128 pg/mg of hair), showing a possible effect of HPA axis in these associations.

Relación entre el valor del ratio elastográfico y la clasificación citológica de Bethesda en la patología tiroidea / Relationship between the value of elastography ratio and the cytological classification of Bethesda in thyroid pathology

Objetivo: Presentar nuestra experiencia en la categorización de la patología tiroidea, a través de la utilización de parámetros ecográficos de malignidad y elastografía con medición del ratio de la deformación tisular, y la correlación de los hallazgos obtenidos con la clasificación citológica de Bethesda. Materiales y métodos: Se llevó a cabo un estudio prospectivo y observacional, entre septiembre de 2012 y abril de 2013, que incluyó 137 nódulos tiroideos. Se excluyeron 10 casos Bethesda III-IV. Se realizó ecografía, power Doppler, visualización de micropartículas (Micropure) y elastografía con medición del ratio elastográfico, así como también punción aspirativa con aguja fina guiada por ecografía (con el citólogo presente), utilizando la clasificación Bethesda. Los estudios fueron hechos por el mismo operador con un ecógrafo Toshiba Aplio 400 y los datos estadísticos se evaluaron con el programa IBM SPSS Statistics 20. Resultados: Se estudiaron 127 nódulos en pacientes con una edad promedio de 59±16 anos. El 82% de los casos ocurrió en mujeres. Ciento veinte nódulos (94%) fueron clasificados como Bethesda II. La media elastográfica para Bethesda I-II fue de 1,94±2,12 vs. 7,07±5,46 para V-VI (p: 0,048). El punto de corte elastográfico ≤ 2 (87 de 127) presentó una sensibilidad del 85,7% y una especificidad del 81,7% para predecir Bethesda asociada a patología benigna, con un valor predictivo negativo (VPN) del 99% y un valor predictivo positivo del 15%. Conclusiones: El ratio elastográfico permitió descartar la patología tiroidea maligna con valores ≤ 2 y un VPN del 99%, mejorando la selección de los pacientes a punzar. El incremento del ratio elastográfico se asoció a una mayor probabilidad de patología maligna, aunque no se pudo establecer un valor de corte debido al bajo número de casos con Bethesda V-VI.

Objectives: We present our experience in the categorization of thyroid pathology using the sonographic parameters of malignancy and elastography with measurement elastography strain ratio, to evaluate the relationship between the results found and the Bethesda classification. Materials and methods: Prospective observational study, included 137 thyroid nodules studied between September 2012- April 2013. We excluded 10 cases with Bethesda categories III-IV. Ultrasonography, Doppler, Micropure, elastogrphy strain ratio between the lesion and the normal tissue, fine needle aspiration cytology (FNAC),were the diagnosis methods used. The pathologist was always present and the cytological classi fication of Bethesda was used. All study was made by the same physician used Toshiba Aplio 400 ultrasound unit. Results were analyzed with IBM SPSS Statistics 20. Results: We studied 127 nodules in patients 59±16 years old, 82% were female; 120 were Bethesda II (94%). The average strain ratio for nodules Bethesda I-II was 1.94±2.12 vs. 7.07±5.46 for those nodules Bethesda V-VI (p:0,048). This means that an elastography strain ratio ≤ 2 (87 of 127 nodules) has a sensibility of 85.7% and a specificity of 81.7% of predicting Bethesda associated with benign pathology with a negative predictive value (NPV) of 99% and a positive predictive value of 15%. Conclusion: The elastography strain ratio allowed to discard malignant nodules with strain ratio ≤ 2 with a NPV of 99% improves the selection of patients for FNAC. The increment in the elastography strain ratio was associated to a higher possibility of malignant thyroid pathology, being unable to determine a limit value due to the low amount of cases with nodules Bethesda V-VI.

Primary empty sella (PES): a review of 175 cases.

The term primary empty sella (PES) makes reference to the herniation of the subarachnoid space within the sella turcica in patients with no history of pituitary tumor, surgery or radiotherapy. To retrospectively assess clinical features, radiological findings and the biochemical endocrine function from the records of 175 patients with a diagnosis of PES. One hundred seventy-five patients (150 females) were studied. The mean age at diagnosis was 48.2 ± 14 year. Most diagnoses were made by magnetic resonance imaging (n = 172). In most patients, the pituitary function was assessed by basal pituitary hormones measurements. Pituitary scans were ordered for different reasons: headache (33.1 %), endocrine disorders (30.6 %), neurological symptoms (12.5 %), visual disturbances (8.75 %), abnormalities on sella turcica radiograph (8.75 %) and others (6.25 %). Multiple pregnancies were observed in 58.3 % of women; headaches, obesity, and hypertension were found in 59.4, 49.5, and 27.3 % of the studied population, respectively. Mild hyperprolactinemia (<50 ng/ml) was present in 11.6 % of women and 17.3 % of men. Twenty-eight percent of our patients had some degree of hypopituitarism. In the male population, hypopituitarism represented 64 % of cases, whereas it accounted for 22 % of all females. PES seems to be more commonly found in middle-aged women, with a history of multiple pregnancies. In most patients, PES was discovered as an incidental finding on imaging studies, while in almost a quarter of patients PES was found during the diagnostic evaluation of anterior pituitary deficiency, which was more common in men.

Silla turca vacía primaria (STVP): estudio de 117 casos / Primary Empty Sella (PES): A review of 117 cases

Introducción: El término Silla Turca Vacía Primaria (STVP) hace referencia a la invaginación del espacio subaracnoideo hacia el interior de la silla turca en pacientes sin antecedentes de tumor, cirugía o radioterapia de la región selar. Aunque usualmente no está asociado con disfunciones endocrinas, diferentes grados de hipopituitarismo e hiperprolactinemia han sido reportados. Objetivo: Analizar retrospectivamente datos clínicos, hallazgos radiológicos y bioquímicos de 117 pacientes con diagnóstico de STVP. Pacientes y Métodos: Se estudiaron 117 pacientes, 98 mujeres (48 ± 14.9 años). Los diagnósticos fueron realizados por Resonancia Magnética Nuclear (n=115) y Tomografía Computada (n=2). La evaluación de la función adenohipofisaria se realizó a través de determinaciones hormonales basales. Resultados: Los motivos que llevaron al pedido de las imágenes fueron: cefaleas (35 %), sospecha clínica y/o bioquímica de deficiencia pituitaria (22 %), trastornos visuales (11 %), anormalidades de la radiografía simple de la silla turca (11 %), hiperprolactinemia (2,6 %), otros (18.4 %). El 48,9 % de las mujeres eran multíparas. Cefaleas, obesidad, hipertensión arterial y autoinmunidad tiroidea fueron halladas en el 60, 67, 24,5 y 22,5 % de la población evaluada respectivamente. Hiperprolactinemia (< 50 ng/ml) estuvo presente en 6,1 % de las mujeres y 15, 8 % de los hombres. El 27 % de los pacientes estudiados presentó algún grado de hipopituitarismo, que fue más frecuente en la población masculina. Conclusiones: STVP fue más frecuente en mujeres multíparas de mediana edad. En la mayoría de los casos fue descubierta incidentalmente por estudios radiológicos, mientras que en un cuarto de los pacientes, fue encontrada durante la evaluación diagnóstica de deficiencia adenohipofisaria, lo cual fue más frecuente en hombres.

Introduction: The term Primary Empty Sella (PES) makes reference to the herniation of the subarachnoid space within the sella turcica in those patients with no history of pituitary tumor, neither surgery, nor radiotherapy. Though it is usually not associated with endocrine abnormalities, different degrees of hypopituitarism and mild hyperprolactinemia have been reported. Objective: To assess clinical features, radiological findings and biochemical endocrine function retrospectively from the records of 117 patients with diagnosis of PES. Patients and Methods: One hundred seventeen patients, 98 females, were studied. The mean age at diagnosis was 48 ± 14.9 yr. Most diagnoses were made with magnetic resonance imaging (n = 115), and only 2 through sellar computed tomography scan. Only pituitary basal hormones determinations were made, except for the TRH and ACTH tests which were performed for the diagnosis of primary hypothyroidism and secondary adrenal failure respectively. Results: Pituitary images were requested because of different reasons: headaches (35 %), clinical and biochemical suspicion of pituitary deficiency (22 %), visual disturbances (11 %), abnormalities on the simple sella turcica radiography (11 %) hyperprolactinemia (2.6 %), others (18.4 %): dizziness, seizures, rhinorrhea, loss of consciousness, skull trauma, galactorrhea. Multiple pregnancies were observed in 48.9 % of women; headaches, obesity, arterial hypertension and thyroid autoimmunity were found in 60 %, 67 %, 24.5 % and 22.5 % of the studied population respectively. Mild hyperprolactinemia (< 50 ng/ml) was present in 6.1 % of women and 15.8 % of men. Twenty seven percent of our patients had some degree of hypopituitarism. For male population hypopituitarism comprised 72 %, whereas it took up 19 % for the whole female group. Conclusions: PES seems to be more commonly found in middle-aged women (sex ratio 5/1) with history of multiple pregnancies. In most patients it was discovered as an incidental finding at image studies, while in almost a quarter of patients PES was found during the diagnosis stage of anterior pituitary deficiency, which was more frequently seen among men.

Experience from the Argentine Pegvisomant Observational Study: preliminary data.

The GH receptor antagonist pegvisomant is an efficient agent to achieve biochemical control of acromegaly in those cases refractory to surgery and medical therapy with somatostatin analogs. We conducted an observational multicenter study consisting of data collection in accordance with the standard management of patients with acromegaly in everyday practice. We reviewed the medical records of 28 patients, 23 females, who were treated with pegvisomant due to the lack of biochemical response or intolerance to the somatostatin analogs. The objective was to monitor long-term safety and efficacy of the antagonist. 82% of the patients had previous pituitary surgery, 53.6% radiotherapy and 96.4% received medical therapy for acromegaly. Only 19.2% of the patients had pituitary residual tumor size larger than 1 cm, the remainder harbored a microadenoma or no visible tumor in the pituitary images. In terms of biochemical efficacy, IGF-I levels decreased to normal ranges in 45% and 58.8% of patients after 3 and 6 months of treatment, respectively, the daily mean dose of pegvisomant being 9.6+/-1.1 mg. Adverse events, potentially related to pegvisomant were reported in 6 patients (21.4%), local injection site reaction and elevated liver enzymes being the most frequent. Tumor size did not show enlargement in the evaluated population (15 patients) during the period of the study. This paper presents preliminary data from a small observational study in Argentina which represents the first database in our country.

Gonadotrofinomas: análisis multicéntrico y retrospectivo de 66 pacientes / Gonadotrophinomas: multicenter and retrospective analysis of 66 patients

Objetivo: Analizar la presentación clínica, radiológica, bioquímica y el comportamiento posquirúrgico de una cohorte de pacientes portadores de gonadotrofinomas. Pacientes y Métodos: Se evaluaron pacientes con gonadotrofinomas estudiados en nueve centros endocrinológicos de la ciudad de Bs.As. durante el período 1983 a 2003. El criterio de inclusión fue la inmunohistoquímica (IH) positiva para hormona luteinizante (LH), folículoestimulante (FSH) y/o alfa subunidad (ASU). Los adenomas plurihormonales fueron excluidos. Resultados: Fueron analizados 66 pacientes de 51,8 ± 12,1 (X +/- DS) años (39 varones). Los síntomas mas frecuentemente observados fueron las alteraciones visuales (72,8%), seguidas por el hipogonadismo y las cefaleas. El 10,6% se diagnosticaron en forma incidental. El 98,5% fueron macroadenomas, 56,9% de los cuales correspondieron a un estadio Hardy (EH) 3 y 29,6% a un EH 4. El tiempo de seguimiento fue de 47,8 meses (r: 5-168). El hipogonadismo definido bioquímicamente se presentó en el 82,4% de los pacientes. En su mayoría presentaban niveles bajos o inapropiadamente normales de gonadotrofinas, pero 4 mujeres y 3 varones presentaron niveles séricos elevados y disociados de FSH y LH. La hiperprolactinemia por desconexión fue observada en 45,2% de la población (X: 65.6 ng/ml r: 30-172). El hipopituitarismo se detectó en 25,7% de los casos. La cirugía fue transeptoesfenoidal (TSE) en 80%; una segunda operación fue realizada en el 28% de la población. La IH fue positiva por orden de frecuencia para LH, FSH y ASU o las 3 combinaciones. La evolución posquirúrgica evidenció mejoría en el campo visual (CV) en el 41%. La presencia de restos tumorales y/o recidiva fue del 84%. Se indicó radioterapia en 37% y la sustitución hormonal fue necesaria en el 65% de los pacientes.

The aim of our study was to describe the clinical-biochemical and radiologic presentation and the post surgery outcome in a cohort of patients with gonadotrophinomas. Patients were selected from nine Endocrinology Units of the city of Buenos Aires from 1983 at 2003. The inclusion criteria was defined by nonfunctinoning pituitary adenomas with positive innmunohistochemical (IH) for luteinizing hormone (LH), follicle-stimulating hormone (FSH) and/or alpha subunit (ASU). Innmunohistochemically plurihormonal adenomas were excluded. Sixty six patients were analyzed, aged 51,8 ± 12,1 (X +/- DS) years; (39 men). More prevalent symptoms were visual alterations (72,8%), hypogonadism and headaches. Eleven percent was diagnosed as incidentalomas. Ninety eight percent were macroadenomas, 56,9% was Hardy stage (HS) 3 and 29,6% was HS 4. The patients were followed up for 47,8 months (r: 5-168). Hypogonadism was biochemically found in 82,4%. The majority showed low or inappropriately normal levels of gonadotrophins except for 4 women and 3 men that had high and dissociated levels. Hyperprolactinemia was observed in 45,2% and was interpreted as an interference with normal dopamine inhibition of prolactin secretion (X+/-DS: 65.6+/- ng/ml, r: 30-172). Hypopituitarism was found in 25,7% of the patients. Transsphenoidal surgery was carried out in 80% and in 28% a second surgery was needed. The IH was positive for LH, FSH and ASU in this order of frequency or its combinations. Tumor persistency and/or recurrency were found in 84% of the patients. Forty one percent showed improvement of visual defects. Radiotherapy was indicated in 37% and hormonal replacement was needed in 65% of the patients.