ABSTRACT
We present an unusual case of Turner syndrome (TS) and Cushing disease (CD) in a young woman, admitted to our department seven years after a successful surgical removal of ACTH-secreting pituitary tumor. To our knowledge, this is the first ever report of these two disorders coexisting. Our patient was diagnosed with TS at the age of 16 due to primary amenorrhea and short stature. Hormone replacement therapy with estrogen was initiated, but she did not receive growth hormone therapy. At the age of 28, she developed clinical and biochemical abnormalities consistent with hypercortisolism, but the definitive diagnosis of CD was established nine years later when she was admitted to our department. Appropriate treatment was applied, however, the patient developed serious complications: a myocardial infarction, diabetes and osteoporosis. Surgical treatment appeared to improve some, but not all of the symptoms, indicating a significant contribution of concomitant TS to the severity of adverse cardiovascular and bone turnover outcomes in a subject with a genetic susceptibility to these complications. Thus, multidisciplinary evaluation in such patients is strongly indicated, particularly if more predisposing conditions are present.
Subject(s)
ACTH-Secreting Pituitary Adenoma/surgery , Adenoma/surgery , Pituitary ACTH Hypersecretion/surgery , Turner Syndrome/drug therapy , ACTH-Secreting Pituitary Adenoma/complications , ACTH-Secreting Pituitary Adenoma/physiopathology , Adenoma/complications , Adenoma/metabolism , Adenoma/physiopathology , Adult , Diabetes Mellitus, Type 2/drug therapy , Diabetes Mellitus, Type 2/etiology , Diabetes Mellitus, Type 2/metabolism , Estrogen Replacement Therapy , Female , Humans , Myocardial Infarction/etiology , Osteoporosis/diagnostic imaging , Osteoporosis/drug therapy , Osteoporosis/etiology , Osteoporotic Fractures/etiology , Pituitary ACTH Hypersecretion/complications , Pituitary ACTH Hypersecretion/metabolism , Pituitary ACTH Hypersecretion/physiopathology , Turner Syndrome/complicationsABSTRACT
OBJECTIVE AND AIM: A significant incidence of systemic lupus erythematosus (SLE), the severity of lupus nephritis and varying responses to treatment rationalize the search for novel biomarkers of disease activity. The aim of the study was to assess whether antibodies against monomeric C reactive protein (anti-mCRP) are associated with the presence of lupus nephritis, correlate with disease activity, and whether they can serve to evaluate a response to treatment. METHODS: The study involved 74 patients with lupus nephritis, 29 patients with systemic lupus without renal involvement and 31 patients with primary glomerulonephritis; the control group included 31 healthy volunteers. Interleukin-6 and tumor necrosis factor alpha were measured using commercially available ELISA tests. The presence of anti-mCRP in the serum was tested with the use of in-house ELISA. RESULTS: The highest prevalence and concentrations of antibodies against monomeric C-reactive protein were observed among patients with lupus nephritis, as compared to other groups. The elevated level of anti-mCRP was associated with standard clinical and laboratory indicators of SLE activity. Moreover, the highest concentrations of both Il-6 and TNF-α were observed for patients with the most severe nephropathy. A significant decrease in anti-mCRP and cytokines' levels in the course of treatment was observed. CONCLUSION: The study gives further evidence that antibodies against monomeric C-reactive protein may be considered an indicator of renal involvement in patients with SLE. Assessment of anti-mCRP supports monitoring of disease activity and can be used in evaluating the treatment effectiveness.
