Diagnosis and Treatment of Acromegaly: An Update.

Acromegaly is typically caused by a growth hormone-secreting pituitary adenoma, driving excess secretion of insulin-like growth factor 1. Acromegaly may result in a variety of cardiovascular, respiratory, endocrine, metabolic, musculoskeletal, and neoplastic comorbidities. Early diagnosis and adequate treatment are essential to mitigate excess mortality associated with acromegaly. PubMed searches were conducted using the keywords growth hormone, acromegaly, pituitary adenoma, diagnosis, treatment, pituitary surgery, medical therapy, and radiation therapy (between 1981 and 2021). The diagnosis of acromegaly is confirmed on biochemical grounds, including elevated serum insulin-like growth factor 1 and lack of growth hormone suppression after glucose administration. Pituitary magnetic resonance imaging is advised in patients with acromegaly to identify an underlying pituitary adenoma. Transsphenoidal pituitary surgery is generally first-line therapy for patients with acromegaly. However, patients with larger and invasive tumors (macroadenomas) are often not in remission postoperatively. Medical therapies, including somatostatin receptor ligands, cabergoline, and pegvisomant, can be recommended to patients with persistent disease after surgery. Select patients may also be candidates for preoperative medical therapy. In addition, primary medical therapy has a role for patients without mass effect on the optic chiasm who are unlikely to be cured by surgery. Clinical, endocrine, imaging, histologic, and molecular markers may help predict the response to medical therapy; however, confirmation in prospective studies is needed. Radiation therapy is usually a third-line option and is increasingly administered by a variety of stereotactic techniques. An improved understanding of the pathogenesis of acromegaly may ultimately lead to the design of novel, efficacious therapies for this serious condition.

A Rare Case of Simultaneous Intrahepatic and Porcelain Gallbladder: Case Report.

Intrahepatic gallbladder is a rare anomaly that is due to the failure of gallbladder migration from liver to its proper position. This condition increases the risk of cholelithiasis, hepatic abscess and cholangiocarcinoma. Calcification in the wall of the gallbladder, which is known as porcelain gallbladder, also increases the risk of malignancy. In this report a 47-year-old man presented at the emergency department with continuous right upper quadrant abdominal pain who was misdiagnosed with acute cholecystitis. During abdominal surgery, gallbladder was not detectable in its proper location. Therefore, the patient underwent enhanced abdominal computed tomography scan and magnetic resonance cholangiopancreatography and the results showed an intrahepatic porcelain gallbladder. In order to avoid future complications, intrahepatic gallbladder should always be considered in patients whose physical examination and radiologic findings do not match.

The prevalence of autoimmune diseases in patients with multiple sclerosis: A cross-sectional study in Qom, Iran, in 2018.

Background: Multiple sclerosis (MS) is one of the most common autoimmune diseases worldwide and various autoimmune comorbidities are reported with MS. The objective of this study is to estimate the prevalence of the autoimmune diseases' comorbidity in patients with MS. Methods: In this cross-sectional study, we investigated a group of patients with MS in terms of age, gender, duration of MS, presence of simultaneous autoimmune diseases, such as Graves' disease, Hashimoto's thyroiditis, type 1 diabetes mellitus (DM), and systemic lupus erythematous (SLE). Results: This study included 1215 patients with MS, of which 70.8% were women. The mean age of participants was 33.70 ± 27.63 years. 55 patients (4.5%) had at least one autoimmune disease. The most common comorbidity was for Hashimoto's thyroiditis (30 patients). The frequency of simultaneous autoimmune disease was higher in women. Mean age (P = 0.01), mean duration of MS (P = 0.03), and mean age on MS diagnosis (P = 0.02) were significantly higher in simultaneous MS and other autoimmune diseases. Conclusion: Our study revealed that the probability of autoimmune diseases co-occurrence in patients with MS could be higher in older patients, in longer duration of disease, and also in patients with higher age at time of MS diagnosis.