Etiology of hypopituitarism in tertiary care institutions in Turkish population: analysis of 773 patients from Pituitary Study Group database.

Hypopituitarism in adult life is commonly acquired and the main causes are known as pituitary tumors and/or their treatments. Since there are new insights into the etiology of hypopituitarism and presence of differences in various populations, more studies regarding causes of hypopituitarism are needed to be done in different ethnic groups with sufficient number of patients. Therefore, we performed a multi-center database study in Turkish population investigating the etiology of hypopituitarism in 773 patients in tertiary care institutions. The study was designed and coordinated by the Pituitary Study Group of SEMT (The Society of Endocrinology and Metabolism of Turkey). Nineteen tertiary reference centers (14 university hospitals and 5 training hospitals) from the different regions of Turkey participated in the study. It is a cross-sectional database study, and the data were recorded for 18 months. We mainly classified the causes of hypopituitarism as pituitary tumors (due to direct effects of the pituitary tumors and/or their treatments), extra-pituitary tumors and non-tumoral causes. Mean age of 773 patients (49.8 % male, 50.2 % female) was 43.9 ± 16.1 years (range 16-84 years). The most common etiology of pituitary dysfunction was due to non-tumoral causes (49.2 %) among all patients. However, when we analyze the causes according to gender, the most common etiology in males was pituitary tumors, but the most common etiology in females was non-tumoral causes. According to the subgroup analysis of the causes of hypopituitarism in all patients, the most common four causes of hypopituitarism which have frequencies over 10 % were as follows: non-secretory pituitary adenomas, Sheehan's syndrome, lactotroph adenomas and idiopathic. With regard to the type of hormonal deficiencies; FSH/LH deficiency was the most common hormonal deficit (84.9 % of the patients). In 33.8 % of the patients, 4 anterior pituitary hormone deficiencies (FSH/LH, ACTH, TSH, and GH) were present. Among all patients, the most frequent cause of hypopituitarism was non-secretory pituitary adenomas. However, in female patients, present study clearly demonstrates that Sheehan's syndrome is still one of the most important causes of hypopituitarism in Turkish population. Further, population-based prospective studies need to be done to understand the prevalence and incidence of the causes of hypopituitarism in different countries.

Relative associations of polycystic ovarian syndrome vs metabolic syndrome with thyroid function, volume, nodularity and autoimmunity.

BACKGROUND: The relative associations of polycystic ovarian syndrome (PCOS) and metabolic syndrome (MS) with the risk for thyroid disease (thyroid function, volume, nodularity and autoimmunity) are unknown.We compared thyroid features and function in patients with PCOS and control subjects by the presence of MS. METHODS: We recruited 84 women with PCOS and 81 age-matched healthy controls. PCOS was defined according to the Rotterdam criteria. Thyroid ultrasound and function tests were performed in all. RESULTS: Although thyroid disease was more prevalent in women with PCOS, ovarian disease was not significantly associated with the risk for thyroid disease. Thyroid volume did not differ between women with PCOS and control subjects (13.7±8.6 vs 12.4±4.4 ml, respectively; p=0.2); however, it differed significantly between subjects with and without MS (regardless of PCOS status): 19.1±14.8 vs 12.4±4.9 ml, respectively; p=0.001). Antithyroglobulin and antithyroid peroxidase antibody levels also were significantly higher in subjects with MS, but not in participants with PCOS vs control subjects. Overall, TSH level correlated significantly with body mass index (BMI), weight, waist circumference, diastolic blood pressure, and levels of LDL cholesterol, triglycerides, and HDL cholesterol. Thyroid volume correlated significantly with age, weight, BMI, waist circumference, systolic blood pressure, 120-min postprandial glucose and HDL level. CONCLUSIONS: PCOS alone was not associated with thyroid disease in our population. However, MS and some of its components appear to be related to thyroid volume, function, and antithyroid antibody levels.

Predictors of serum albumin level in patients receiving continuous ambulatory peritoneal dialysis.

Hypoalbuminemia is the strongest predictor of death in patients with renal failure. We planned to investigate the factors influencing serum albumin levels in continuous ambulatory peritoneal dialysis (CAPD) patients. We prospectively followed 100 CAPD patients for 18.6 +/- 12.8 months. The parameters searched for a correlation with serum albumin levels were: peritoneal transport kinetics; presence of nephrotic syndrome; biochemical parameters; anthropometric measurements; and subjective global assessment (SGA). Older patients (age > or = 60 years), patients with diabetes mellitus or amyloidosis, high and high-average transporters, and those with nephrotic syndrome had significantly lower albumin levels throughout the follow-up. In addition, significantly lower albumin levels were found in patients who were in the SGA "malnourished" categories and those who had iPTH levels < or = 65 pg/mL. Albumin level was negatively correlated with age, C-reactive protein (CRP), and fibrinogen level; it was positively correlated with total cholesterol, intact parathyroid hormone (iPTH) level, and triceps skin-fold thickness. By regression analysis, age [risk ratio (RR): 0.2437], presence of diabetes mellitus (RR: 0.1421) and high or high-average transport status (RR: 0.1156) were independent predictors of hypoalbuminemia (< or = 3.5 g/dL). In conclusion, development of hypoalbuminemia is multifactorial in CAPD patients. Older age, cause of renal failure, transport status, chronic inflammation, presence of nephrotic syndrome, and nutrition status are important determinants of hypoalbuminemia.