An unusual case of hypopituitarism and transient thyrotoxicosis following asymptomatic pituitary apoplexy.

Although pituitary function is often impaired in pituitary apoplexy, the development of thyrotoxicosis is rare. We describe an unusual case of hypopituitarism due to pituitary apoplexy coexisting with transient hyperthyroidism. A 74-year-old woman presented with severe fatigue, palpitation, appetite loss, hypotension, and hyponatremia. Endocrine studies showed hyperthyroidism and anterior pituitary hormone deficiencies. A magnetic resonance imaging suggested recent-onset pituitary apoplexy in a pituitary tumor, although the patient had no apoplectic symptoms such as headache and visual disturbance. Thyrotoxicosis and adrenal insufficiency worsened her general condition. Glucocorticoid supplementation improved her clinical symptoms and hyponatremia. Serum anti-thyrotropin receptor and thyroid-stimulating antibody titers were negative, and her thyroid function was spontaneously normalized without antithyroid medication, suggesting painless thyroiditis. Thereafter, her thyroid function decreased because of central hypothyroidism and 75 µg of levothyroxine was needed to maintain thyroid function at the euthyroid stage. The pituitary mass was surgically removed and an old hematoma was detected in the specimen. Considering that painless thyroiditis develops as a result of an autoimmune process, an immune rebound mechanism due to adrenal insufficiency probably caused painless thyroiditis. Although the most common type of thyroid disorder in pituitary apoplexy is central hypothyroidism, thyrotoxicosis caused by painless thyroiditis should be considered even if the patient has pituitary deficiencies. Because thyrotoxicosis with adrenal insufficiency poses a high risk for a life-threatening adrenal crisis, prompt diagnosis and treatment are critical.

Rheinanthrone, a metabolite of sennoside A, triggers macrophage activation to decrease aquaporin-3 expression in the colon, causing the laxative effect of rhubarb extract.

ETHNOPHARMACOLOGICAL RELEVANCE: Aquaporin-3 (AQP3) is expressed in mucosal epithelial cells in the colon and is important for regulating fecal water content. We examined the role of AQP3 in the laxative effect of rhubarb extract. METHODS: After orally administering rhubarb extract or its major component (sennoside A) to rats, the fecal water content, AQP3 expression and prostaglandin E2 (PGE2) concentrations in the colon were examined. The mechanism by which sennoside A decreases the expression of AQP3 was examined using the human colon cancer HT-29 cells and macrophage-derived Raw264.7 cells. RESULTS: During diarrhea by rhubarb extract administration, the PGE2 levels in the colon increased while the AQP3 expression significantly decreased. Similar changes were also observed when sennoside A was administered. When sennoside A or its metabolites, rheinanthrone and rhein were added to Raw264.7 cells, a significant increase in the PGE2 concentration was observed only in cells treated with rheinanthrone. Fifteen minutes after adding PGE2 to the HT-29 cells, the AQP3 expression decreased to approximately 40% of the control. When pretreated with indomethacin, sennoside A neither decreased the AQP3 expression nor induced diarrhea. CONCLUSIONS: Sennoside A may decrease AQP3 expression in the colon to inhibit water transport from the luminal to the vascular side, leading to a laxative effect. The decreases in the levels of AQP3 are caused by rheinanthrone, which is a metabolite of sennoside A, this metabolite activates the macrophages in the colon and increases the secretion of PGE2; PGE2 acts as a paracrine factor and decreases AQP3 expression in colon mucosal epithelial cells.

Byakkokaninjinto prevents body water loss by increasing the expression of kidney aquaporin-2 and skin aquaporin-3 in KKAy mice.

Byakkokaninjinto (BKN) is an herbal medicine used for the relief of diuresis, thirst and dermal pruritus that are associated with diabetes. The effects of BKN on the expression of aquaporins (AQPs) in the kidney, salivary gland and skin were investigated in order to clarify the mechanism of drug action. Seven-week-old KKAy mice were given feed containing 4.5% BKN for 4 weeks. Compared with the control group, BKN administration did not affect the blood glucose and insulin concentration. However, water intake and urine volume were significantly reduced. AQP2 protein expression in the kidney inner medullary was significantly increased after BKN administration. AQP3 mRNA and protein expression in skin tissue was significantly increased after BKN administration. However, BKN administration did not affect AQP5 mRNA expression in the salivary gland. These results suggest that BKN treatment relieves diuresis, thirst, and dermal pruritis by increasing kidney AQP2 expression and skin AQP3 expression.

Relationship among workload, health complaints, and depressive state of workers as revealed using a questionnaire survey.

OBJECTIVE: Identifying the relationship between workload content and health complaints would likely aid the establishment of preventative health care strategies. PARTICIPANTS: The study population consisted of 137 male workers from a pharmaceutical company. METHODS: The workloads of the target subjects were divided into three groups (A, B, and C+D) according to the scores of a self-administered questionnaire. The results of General Health Questionnaire (GHQ, 12 items version) for assessing health complaints were also analyzed. RESULTS: The percentages of workers who reported feelings of stress in response to overtime work, irregular work, business trips, nighttime work, no rest and/or no nap, mental workload, and physical workload were 22.6%, 15.3%, 2.9%, 8.0%, 13.9%, 58.3%, and 18.2%, respectively. The significant odds ratio of workload predicting health complaints was 6.9 for subjects in group B and 13.9 for subjects in group C+D. Among them, the significant odds ratios of mental workload predicting health complaints and a positive GHQ were 5.7 and 4.0, respectively. Having no regular exercise also resulted in ORs of greater than 3 for health complaints and a positive GHQ. CONCLUSIONS: To cope with the health complaints of workers, mental health support by reducing individual workloads is recommended.

Body mass index of 23 or more is a risk factor for hypertension and hyperlipidemia in Japanese workers.

In comparison with western populations, body mass index (BMI) of the Japanese population is typically lower. In this study, the relationship between BMI and other metabolic risk factors was examined in 1,130 male manufacturing workers surveyed from 2000 to 2003. The association between the BMI and the relative risk of hypertension was evaluated in a cross-sectional design using logistic regression analysis. The mean BMI in the subjects was 23.6 (SD=3.2). Of the total number of subjects, 26.6% and 3.3% were classified as pre-obese and obese, respectively. Multivariate analysis indicated that BMI of 23 or greater was significantly associated with an increased risk of hypertension and/or hyperlipidemia. Health education of weight control of borderline obesity of workers is important for the primary prevention of hypertension and hyperlipidemia in Japan.