Circulating PACAP levels are associated with altered imaging measures of entorhinal cortex neurite density in posttraumatic stress disorder.

Introduction: Pituitary adenylate cyclase-activating polypeptide (PACAP) regulates plasticity in brain systems underlying arousal and memory and is associated with posttraumatic stress disorder (PTSD). Research in animal models suggests that PACAP modulates entorhinal cortex (EC) input to the hippocampus, contributing to impaired contextual fear conditioning. In PTSD, PACAP is associated with higher activity of the amygdala to threat stimuli and lower functional connectivity of the amygdala and hippocampus. However, PACAP-affiliated structural alterations of these regions have not been investigated in PTSD. Here, we examined whether peripheral PACAP levels were associated with neuronal morphology of the amygdala and hippocampus (primary analyses), and EC (secondary) using Neurite Orientation Dispersion and Density Imaging.Methods: Sixty-four (44 female) adults (19 to 54 years old) with DSM-5 Criterion A trauma exposure completed the Clinician-Administered PTSD Scale (CAPS-5), a blood draw, and magnetic resonance imaging. PACAP38 radioimmunoassay was performed and T1-weighted and multi-shell diffusion-weighted images were acquired. Neurite Density Index (NDI) and Orientation Dispersion Index (ODI) were quantified in the amygdala, hippocampus, and EC. CAPS-5 total score and anxious arousal score were used to test for clinical associations with brain structure.Results: Higher PACAP levels were associated with greater EC NDI (ß = 0.0099, q = 0.032) and lower EC ODI (ß = -0.0073, q = 0.047), and not hippocampal or amygdala measures. Neither EC NDI nor ODI was associated with clinical measures.Conclusions: Circulating PACAP levels were associated with altered neuronal density of the EC but not the hippocampus or amygdala. These findings strengthen evidence that PACAP may impact arousal-associated memory circuits in PTSD.

PACAP was associated with altered entorhinal cortex neurite density in PTSD.PACAP was not associated with altered neurite density in amygdala or hippocampus.PACAP may impact arousal-associated memory circuits.

Preoperative 3D volume reconstruction of the posterior wall of the sphenoid sinus with Horos: A free, simple and reliable tool in endoscopic endonasal trans-sphenoidal surgery / Reconstrucción volumétrica 3D preoperatoria de la pared posterior del seno esfenoidal con Horos: una herramienta gratuita, sencilla y fiable en la cirugía endoscópica endonasal transesfenoidal

BackgroundThe purpose of the study was to create computer-aided design models of the sphenoid sinus with a free-source software in order to perform a preoperative planning during trans-sphenoidal endoscopic surgery (TES) and clarify the three-dimensional anatomical features of the sphenoid sinus and its surrounding structures.MethodsFor each patient a 3D volume rendering of the sphenoid sinus was obtained from a thin slice head and maxilla-facial CT scan using a free-source DICOM viewer. The 3D models obtained preoperatively were examined preoperatively by six neurosurgeons in order to identify the boundaries of the sella.ResultsFor the main anatomical landmark, all of the observers were able to recognize the anatomical structure at a rate ranging from 80 to 98%, 28 to 60% and 25 to 58% for expert (n=3), inexpert (n=3) and the entire group of observers (n=6), respectively. The analysis of the data shows that both observation groups presented a lower recognition rate of the following parameters: right and left medial and lateral optocarotid recesses and tumor prominence, however, the sellar prominence, clival recess, planum sphenoidalis, right and left ICA prominence, right and left optic prominences represent the main anatomical landmarks to be recognized during TES immediately before the opening of the sellar floor.ConclusionsThe use of a preoperative 3D imaging is not in itself a novelty in the literature, however the fact that a simple tool obtained with a free-source software like Horos can represent a considerable help in surgical practice without resorting to the use of more complex software and expensive represents the real utility of this work (AU)

AntecedentesEl objetivo del estudio es crear modelos de diseño asistido por ordenador del seno esfenoidal con software de código abierto para realizar la planificación preoperatoria durante la cirugía transesfenoidal endoscópica (TES) y dilucidar las características anatómicas tridimensionales del seno esfenoidal y las estructuras que lo rodean.MétodosPara cada paciente, se obtuvo una representación volumétrica en 3D del seno esfenoidal, a partir de una tomografía computarizada maxilofacial de corte fino utilizando un visor DICOM de fuente libre. Los modelos 3D obtenidos antes de la cirugía fueron revisados por seis neurocirujanos para identificar los límites de la silla turca.ResultadosPara el principal punto de referencia anatómico, todos los observadores fueron capaces de reconocer la estructura anatómica en un rango de 80 a 98%, 28 a 60% y 25 a 58% para los experimentados (n=3), los inexpertos (n=3) y todo el grupo de observadores (n=6), respectivamente. El análisis de los datos muestra que ambos grupos de observación presentaron una tasa de reconocimiento menor de los siguientes parámetros: recesos optocarotídeos medial y lateral izquierdo y prominencia tumoral, sin embargo, prominencia selar, receso clival, plano esfenoidal, prominencia ICA derecha e izquierda. Las prominencias ópticas derecha e izquierda representan los principales puntos de referencia anatómicos que deben reconocerse durante la TES inmediatamente antes de la apertura del suelo selar.ConclusionesEl uso de una imagen 3D preoperatoria no es en sí mismo una novedad en la literatura, sin embargo, el hecho de que una simple herramienta obtenida con un software de código abierto como Horos pueda representar una importante ayuda en la práctica quirúrgica, sin tener que recurrir al uso de un software más complejo y costoso, representa la verdadera utilidad de este trabajo (AU)

Preoperative 3D volume reconstruction of the posterior wall of the sphenoid sinus with Horos: A free, simple and reliable tool in endoscopic endonasal trans-sphenoidal surgery.

BACKGROUND: The purpose of the study was to create computer-aided design models of the sphenoid sinus with a free-source software in order to perform a preoperative planning during trans-sphenoidal endoscopic surgery (TES) and clarify the three-dimensional anatomical features of the sphenoid sinus and its surrounding structures. METHODS: For each patient a 3D volume rendering of the sphenoid sinus was obtained from a thin slice head and maxilla-facial CT scan using a free-source DICOM viewer. The 3D models obtained preoperatively were examined preoperatively by six neurosurgeons in order to identify the boundaries of the sella. RESULTS: For the main anatomical landmark, all of the observers were able to recognize the anatomical structure at a rate ranging from 80 to 98%, 28 to 60% and 25 to 58% for expert (n=3), inexpert (n=3) and the entire group of observers (n=6), respectively. The analysis of the data shows that both observation groups presented a lower recognition rate of the following parameters: right and left medial and lateral optocarotid recesses and tumor prominence, however, the sellar prominence, clival recess, planum sphenoidalis, right and left ICA prominence, right and left optic prominences represent the main anatomical landmarks to be recognized during TES immediately before the opening of the sellar floor. CONCLUSIONS: The use of a preoperative 3D imaging is not in itself a novelty in the literature, however the fact that a simple tool obtained with a free-source software like Horos can represent a considerable help in surgical practice without resorting to the use of more complex software and expensive represents the real utility of this work.

Idiopathic granulomatous hypophysitis mimicking adenoma.

Hypophysitis is a rare disease of pituitary gland, which, although it is usually a primary lesion, can also occur secondary to systemic conditions. Granulomatous hypophysitis is an inflammatory disease condition which accounts for less than 1% of all cellular lesions and can mimic adenoma. A 32-year-old woman presented with weight gain, galactorrhea and blurred vision. The MRI showed a cystic, nodular lesion in the intermediate lobe of the pituitary gland and the initial diagnosis was adenoma. She underwent surgery and the histopathology revealed granulomas composed of epithelioid histiocytes, multinuclear giant cells and mononuclear inflammatory cells. Inflammatory diseases of the pituitary gland are much less frequent than pituitary adenomas and idiopathic granulomatous hypophysitis is extremely rare. Histopathology and the ruling out of a systemic cause are the gold standards for its diagnosis.

Idiopathic granulomatous hypophysitis mimicking adenoma

Hypophysitis is a rare disease of pituitary gland, which, although it is usually a primary lesion, can also occur secondary to systemic conditions. Granulomatous hypophysitis is an inflammatory disease condition which accounts for less than 1% of all cellular lesions and can mimic adenoma. A 32-year-old woman presented with weight gain, galactorrhea and blurred vision. The MRI showed a cystic, nodular lesion in the intermediate lobe of the pituitary gland and the initial diagnosis was adenoma. She underwent surgery and the histopathology revealed granulomas composed of epithelioid histiocytes, multinuclear giant cells and mononuclear inflammatory cells.Inflammatory diseases of the pituitary gland are much less frequent than pituitary adenomas and idiopathic granulomatous hypophysitis is extremely rare. Histopathology and the ruling out of a systemic cause are the gold standards for its diagnosis.(AU)

La hipofisitis es una enfermedad rara de la glándula pituitaria, y a pesar de ser fundamentalmente una enfermedad primaria, puede ser también secundaria a enfermedades sistémicas. La hipofisitis granulomatosa es una enfermedad inflamatoria que representa menos del 1% de todas las lesiones celulares, y remedar al adenoma. Mujer de 32 años de edad ingresada en el hospital con aumento de peso, galactorrea y visión borrosa. La RM reflejó una lesión quística y nodular en el lóbulo intermedio de la glándula pituitaria, que fue operada con diagnóstico primario de adenoma. El examen microscópico reveló granulomas formados por histiocitos epitelioides, células gigantes multinucleares y células inflamatorias mononucleares. Las enfermedades inflamatorias de la glándula pituitaria son muy raras en comparación con los adenomas pituitarios. La hipofisitis granulomatosa idiopática es una de ellas. El criterio de referencia para este diagnóstico es realizar un examen histopatológico, y descartar una causa sistémica.(AU)

Hipercortisolismo severo e hipocalemia recurrente / Severe hypercortisolism and recurring hypocalemia

RESUMEN El síndrome de Cushing endógeno deriva de un aumento crónico, inapropiado y sostenido de glucocorticoides principalmente como respuesta al exceso en las concentraciones séricas elevadas de la hormona adrenocorticotropa (ACTH) desde un tumor adenohipofisiario, enfermedad de Cushing; o producida de forma ectópica por tumores neuroendocrinos. El Cushing suprarrenal se origina por tumores de la corteza adrenal que producen de forma autónoma cortisol y es independiente de ACTH. El curso clínico, tratamiento, pronóstico y posibles complicaciones dependen de identificar de forma correcta la lesión desencadenante; situación que en múltiples ocasiones resulta en una experiencia retadora para los clínicos. Se presenta el caso de una mujer de 62 años, ingresada por síntomas constitucionales con hipocaliemia severa de difícil corrección e hipercortisolismo severo.

ABSTRACT Endogenous Cushing syndrome derives from a chronic, inappropriate, and sustained increase in glucocorticoids, mainly in response to remarkably high serum concentrations of adrenocorticotropic hormone (ACTH) secreted from an adenohypophyseal tumor, Cushing's disease, or due to ectopic production by neuroendocrine tumors. Adrenal Cushing's disease is caused by tumors of the adrenal cortex that autonomously produce cortisol and this is independent from ACTH action. Clinical course, treatment, prognosis, and possible complications depend on correctly identifying the triggering lesion; this situation frequently becomes a challenging experience for clinicians. We present the case of a 62-year-old woman, admitted for constitutional symptoms with severe hypokalemia that was difficult to correct and severe hypercortisolism.

Apoplejía hipofisaria durante el embarazo: reporte de un caso / Pituitary apoplexy during pregnancy: A case report

Resumen ANTECEDENTES: La apoplejía hipofisaria es un infarto o hemorragia súbita en un tumor o tejido sano de la glándula pituitaria. El 80% de los casos es en pacientes con un adenoma hipofisario. El cuadro clínico se caracteriza por: cefalea, alteraciones visuales, náuseas y vómito; además, insuficiencia hipofisaria, que puede ser potencialmente mortal para la madre y el feto. El tratamiento conservador incluye analgésicos, corticosteroides y agonistas dopaminérgicos en caso de prolactinoma. El tratamiento quirúrgico de elección es la resección transesfenoidal. CASO CLÍNICO: Paciente de 35 años, con antecedentes de tres embarazos, un aborto y prolactinoma diagnosticado a los 22 años, en tratamiento con cabergolina. Acudió a consulta debido a cefalea a las 17 semanas de embarazo que se exacerbó a las 28.4 semanas. En la resonancia magnética se observó que la hipófisis medía 17 x 12 x 7 mm, con datos de hemorragia subaguda; con base en ello se diagnosticó: apoplejía hipofisaria. Se indicó tratamiento conservador con antiinflamatorios no esteroideos, opioides y corticosteroides; sin embargo, ante el deterioro del cuadro clínico se decidió la resección transeptal-transesfenoidal endoscópica del adenoma hipofisiario, a las 30.5 semanas de embarazo. La paciente evidenció una mejoría significativa y permaneció asintomática hasta la finalización del embarazo a las 37.5 semanas. CONCLUSIONES: Si bien la apoplejía hipofisaria es de baja incidencia en el embarazo se torna en un factor de riesgo de muerte; por ello, el ginecoobstetra debe tener conocimiento de las posibles implicaciones en el embarazo, ofrecer atención multidisciplinaria y considerar que el tratamiento quirúrgico es una opción segura en el embarazo.

Abstract BACKGROUND: Pituitary apoplexy is a sudden infarction or hemorrhage in a tumor or healthy tissue of the pituitary gland. Eighty percent of cases are in patients with a pituitary adenoma. The clinical picture is characterized by headache, visual disturbances, nausea and vomiting, and pituitary insufficiency, which can be life-threatening for the mother and fetus. Conservative treatment includes analgesics, corticosteroids and dopaminergic agonists in case of prolactinoma. The surgical treatment of choice is transsphenoidal resection. CLINICAL CASE: 35-year-old female patient with a history of three pregnancies, one miscarriage and prolactinoma diagnosed at 22 years of age, under treatment with cabergoline. She came for consultation due to headache at 17 weeks of pregnancy that was exacerbated at 28.4 weeks. Magnetic resonance imaging showed that the pituitary gland measured 17 x 12 x 7 mm, with evidence of subacute hemorrhage; based on this, a diagnosis of pituitary apoplexy was made. Conservative treatment with non-steroidal anti-inflammatory drugs, opioids and corticosteroids was indicated; however, due to the deterioration of the clinical picture, endoscopic transseptal-transsphenoidal resection of the pituitary adenoma was decided at 30.5 weeks of pregnancy. The patient showed significant improvement and remained asymptomatic until the end of pregnancy at 37.5 weeks. CONCLUSIONS: Although pituitary apoplexy is of low incidence in pregnancy, it becomes a risk factor for death; therefore, the obstetrician/gynecologist should be aware of the possible implications in pregnancy, offer multidisciplinary care and consider that surgical treatment is a safe option in pregnancy.

The role of prostaglandin F2α on ovulation and LH release in cows / A função da prostaglandina F2α na ovulação e na liberação de LH em vacas

This study aimed to evaluate the role of prostaglandin F2α (PGF) on ovulation. In Experiment 1, cows were randomly allocated to two treatments to receive 150 µg of d-Cloprostenol (PGF Group, n = 12) or 2 mL of NaCl 0.9% (Control Group, n = 11) and CIDRs, were removed 4 days later. No cow ovulated in Control and PGF groups. In Experiment 2, cows were randomly separated into two experimental groups to receive 4 injections of 150 µg of d-Cloprostenol (n = 9) or 2 mL of NaCL 0.9% (n = 9). In this experiment, ovulation was not observed in any cows. In Experiment 3, ovariectomized cows receive three injections of 300µg of PGF analog (PGF Group, n = 5), 100µg of Lecirelin (GnRH Group, n = 5) or 2 mL of PBS (Control Group, n = 4). The LH concentration was higher (P <0.0001) in cows from the GnRH group than in the PGF and Control groups. In experiment 4, cows with preovulatory follicles (>11.5 mm) were treated with Saline (Control Group, n = 6); Lecirelin (GnRH Group, n = 7) or Cloprostenol Sodium (PGF Group, n = 6). There was a significant increase in the vascular area of follicles from 0 to 24 h in GnRH and PGF treatments. In conclusion, PGF was not able to induce ovulation in cows with high or low plasma progesterone concentration. Additionally, PGF alone was not able to induce LH release and follicle luteinization, but increased follicular vascularization.(AU)

O objetivo deste estudo foi avaliar o papel da prostaglandina F2α (PGF) na ovulação. No Experimento 1, as vacas foram alocadas aleatoriamente em dois tratamentos para receber 150 µg de d-Cloprostenol (Grupo PGF, n = 12) ou 2 mL de NaCl 0,9% (Grupo Controle, n = 11) e os CIDR, foram removidos 4 dias depois. Nenhuma vaca ovulou nos grupos Controle e PGF. No Experimento 2, as vacas foram separadas aleatoriamente em dois grupos experimentais para receber 4 injeções de 150 µg de d-Cloprostenol (n = 9) ou 2 mL de NaCL 0,9% (n = 9). Não foi observada ovulação em nenhum dos animais deste experimento. No Experimento 3, vacas ovariectomizadas receberam três injeções de 300µg de análogo de PGF (Grupo PGF, n = 5), 100µg de Lecirelina (Grupo GnRH, n = 5) ou 2 mL de PBS (Grupo Controle, n = 4). A concentração de LH foi maior (P <0,0001) nas vacas do grupo GnRH do que nos grupos PGF e Controle. No Experimento 4, vacas com folículos pré-ovulatórios (> 11,5 mm) foram tratadas com solução salina (Grupo Controle, n = 6), Lecirelina (Grupo GnRH, n = 7) ou Cloprostenol Sódico (Grupo PGF, n = 6). Houve um aumento significativo na área vascular dos folículos de 0 a 24h nos tratamentos com GnRH e PGF. Em conclusão, a PGF não foi capaz de induzir ovulação em vacas com alta ou baixa concentração plasmática de progesterona. Além disso, a PGF sozinha não foi capaz de induzir a liberação de LH e a luteinização do folículo, mas aumentou a vascularização folicular.(AU)

Sampling of the petrosal sinuses. Indications, results and usefulness / Muestreo de senos petrosos. Indicaciones, resultados y utilidad

Abstract Objectives: to analyze, evaluate and describe the usefulness of petrosal sinus sampling for diagnosing central Cushing's syndrome. Materials and methods: the technical aspects and results of bilateral venous sampling of the petrosal sinuses at the Hospital Universitario San Vicente de Paul in Medellín, Colombia, from January 1, 2012 to December 31, 2018, were analyzed. Results: the average age was 43.3 years, with a range from 19 to 69 years. Laterality could be shown in 68.2% of cases, with a tendency to be located on the left in 53.3%. The central source of ACTH production could be shown in 95.4% of cases, with a basal average central/peripheral ratio of 21.7, and 70.8 after stimulation. All samples at 3, 5 and 10 minutes were confirmatory following stimulation. Conclusion: in our retrospective study, petrosal sinus catheterization provided laboratory confirmation of the central source of ACTH production in a high percentage of patients, with no immediate complications.

Resumen Objetivos: analizar, evaluar y describir la utilidad del muestreo de senos petrosos para diagnóstico del síndrome de Cushing de origen central. Material y métodos: se analizaron los aspectos técnicos y resultados del muestreo bilateral venoso de senos petrosos, desde el 1° de enero de 2012 a 31 de diciembre de 2018 en el Hospital Universitario San Vicente de Paúl en Medellín, Colombia. Resultados: el promedio de edad fue 43.3 años con un rango de edad desde los 19 hasta los 69 años. La lateralidad pudo ser demostrada en 68.2% de los casos con una tendencia a la localización en el lado izquierdo en 53.3%. El origen central de producción de ACTH logró ser demostrado en 95.4% de los casos, con una relación central/periferia basal promedio de 21.7 y postestimulación de 70.8. Todas las muestras a los 3, 5 y 10 minutos fueron confirmatorias tras la estimulación. Conclusión: en nuestro estudio retrospectivo el cateterismo de senos petrosos confirmó la fuente central de producción de ACTH por laboratorio en un alto porcentaje de pacientes sin ninguna complicación inmediata.

Colapso del inmunoprivilegio y estrés emocional en Alopecia Areata / Collapse of the immunoprivilege and emotional stress in alopecia areata

Resumen El folículo piloso es una estructura compleja que presenta diversas características morfológicas macroscópicas, microscópicas e inmunológicas especiales que permiten el adecuado funcionamiento de la misma, en algunasenfermedades estos mecanismos de regulación inmunológica se ven alteradose incluso exacerbados por factores como el estrés emocional. El objetivo de esta revisión es conocer los mecanismos inmunobiológicos específicos del folículo pilosoanalizando el papel que juegan diversos factores como la pérdida delinmunoprivilegio y el estrés emocional en el desarrollo de la alopecia areata.

Abstract The hair follicle is a complex structure that presents diverse morphologicaland immunological characteristics that allow the proper functioning of the unit.In some diseases as alopecia areata these mechanisms of immune regulation are disrupted by external factorssuch as emotional stress preventing the growth of the hair shaft. The objective of this review is to recognize the specific immunobiological mechanisms of the hair follicle, analyzing the role played by the loss of immunoprivilege and emotional stress in the development of alopecia areata.

Sellar region: magnetic resonance imaging assessment of uncommon tumors and pseudotumors. / Región selar: evaluación mediante resonancia magnética de lesiones tumorales y pseudotumorales de baja frecuencia.

OBJECTIVE: To show the usefulness of magnetic resonance imaging in the anatomic and pathologic characterization of the sellar region, emphasizing the differential diagnosis of uncommon non-adenomatous tumors and pseudotumors studied in our institution. CONCLUSION: The sellar region is a complex anatomic space with diverse types of tissues from which a wide spectrum of diseases can arise. Magnetic resonance imaging's high tissue resolution and ability to characterize the patterns of tumor growth and biological behavior make it the best imaging technique to study this region.

Hormona de crecimiento en sangre de papel filtro para el diagnóstico de deficiencia de hormona de crecimiento / Growth hormone of dried blood spot for the diagnosis of growth hormone deficiency

INTRODUCCIÓN: El diagnóstico de deficiencia de hormona de crecimiento (DHC) es difícil de establecer, y se puede asociar a serias complicaciones, especialmente en el período neonatal. La prueba de estímulo de secreción de hormona de crecimiento (HC) se considera de elección para el diagnóstico, pero presenta complicaciones metodológicas y se asocia a efectos adversos. Los neonatos presentan aumento de la secreción de HC de forma fisiológica, siendo una ventana diagnóstica. OBJETIVO: Evaluar si la muestra de sangre en papel filtro tomada en el período neonatal, en contexto del tamizaje neonatal de hipotiroidismo congénito y fenilcetonuria, permite diferenciar pacientes con DHC, de los que no la presentan. PACIENTES Y MÉTODO: Estudio de casos y controles mediante determinación de concentración de HC en sangre de papel filtro extraída en período neonatal, comparando controles con DHC con casos con deficiencia descartada. Se realizó extracción de la muestra del papel filtro, obteniendo dos discos de 0,125 pulgada por cada uno de los pacientes desde el centro de la mancha de sangre del papel, para un ELISA de HC humana altamente sensible basado en el uso de anticuerpos policlonales dirigidos contra la HC humana recombinante de 22kDa de peso molecular. RESULTADOS: Se obtuvo un total de 7 casos de DHC y 10 controles. La mediana de concentración de HC de papel filtro en los casos es 2,0 ng/ml (Rango intercuartil 3,6 ng/ml) y controles 2,05 ng/mL (RIC 2,0 ng/ml), U de Mann-Withney 30,5 (p = 0,68). Los dos casos con deficiencia de hormonas hipofisarias múltiples (DHHM) presentan concentraciones menores a 1 ng/ml. CONCLUSIÓN: La muestra de papel filtro no permitió diferenciar a los pacientes con DHC de los casos controles, aunque los casos con DHHM presentaron concentraciones mucho menores, en comparación a la deficiencia de hormona de crecimiento aislada (DHCA).

INTRODUCTION: The diagnosis of growth hormone deficiency (GHD) is difficult to determine, and could be associated with severe complications, especially in the neonatal period. The stimulation test of growth hormone (GH) secretion is considered the gold standard for diagnosis, but it has methodological complications and is associated with adverse effects. Neonates present physiological increased secretion of GH, representing a diagnostic window. OBJECTIVE: To evaluate if the dried blood spot on filter paper obtained in the neonatal period, as part of a neonatal screening for con genital hypothyroidism and phenylketonuria, allows differentiating patients with GHD from those who do not have it. PATIENTS AND METHOD: Study of cases and controls by measuring the GH concen tration in dried blood spot on filter paper obtained in the neonatal period, comparing controls with GHD with cases with discarded deficiency. The sample was extracted from the filter paper, obtaining two 0.125 inch discs per each patient from the center of the blood spot on the paper, for a highly sen sitive ELISA assay for human GH based on the use of polyclonal antibodies against 22 kDa recom binant human GH. RESULTS: Seven cases of GHD and ten controls were obtained. The median GH concentration of the dried blood spot in the cases is 2.0 ng/ml (Interquartile range 3.6 ng/ml) and 2.05 ng/ml (Interquartile range 2.0 ng/ml) in the controls, Mann-Whitney U test 30.5 (p = 0.68). The two cases with multiple pituitary-hormone deficiency (MPHD) present concentrations lower than 1 ng/ml. CONCLUSION: The dried blood spot sample did not differentiate GHD patients from control cases, although MPHD cases present much lower concentrations compared to isolated growth hor mone deficiency (IGHD).

Efecto del protocolo de inducción hormonal en la espermiación y las características seminales de yaque ( Leiarius marmoratus ) / Effect of hormone induction protocol in the spermiation and seminal characteristics of yaque (Leiarius marmoratus) / Efeito do protocolo de indução hormonal sobre a spermiação e as características do sêmen do yaque (Leiarius marmoratus)

Resumen El yaque Leiarius marmoratus, es una especie de siluriforme nativo con gran potencial para la diversificación de la acuicultura colombiana; sin embargo, la espermiación en cautiverio aún presenta dificultades debido al bajo volumen seminal liberado con los protocolos de inducción tradicionales. En consecuencia, el objetivo fue evaluar los efectos de cinco protocolos de inducción hormonal, basados en Extracto de Hipófisis de Carpa (EHC), sGnRHa + domperidona (OVAPRIM®) y Gonadotropina Coriónica Humana (GHC) (FERTIVET®), sobre la calidad y volumen seminal de la especie. Fueron seleccionados 18 machos sexualmente maduros de 54,4 ± 2,2 cm de longitud total y 1,6 ± 0,1 kg peso corporal. Se evaluaron 5 tratamientos, así: T1: 0,25 ml/kg (0 h) y 1 ml/kg de OVAPRIM® (12 h); T2: 1 mg/kg de EHC (0 h) y 3 mg/kg de EHC (12 h); T3: dosis única de 200 UI/kg de GCH; T4: 3 mg/kg de EHC (0 h) y 200 UI/Kg de GHC (8h); T5: 1 ml/kg de OVAPRIM® (0h) y 200 UI/kg de GHC (8h); Control: 1 ml de suero fisiológico. El semen se colecto 6 h después de aplicada la última dosis hormonal. El T1 y T5 mostraron un volumen mayor (p<0,05) (5,4 ± 1,1; 4,8 ± 1,2 ml) cuando comparados con T2 (3,1 ± 1ml), T3 (2,3 ml) T4 (2,4 ± 1,1 ml) y el control (0,2 ml). En cuanto a la movilidad y tiempo de activación, T1 y T5 presentaron los mejores resultados (90 ± 0% y 54,2 ± 7 s; 90 ± 0% y 52,9 ± 3,8 s, respectivamente). La concentración espermática fue mayor (p<0,05) en T2 y T5 (1,275 ± 322; y 1,261 ± 225 sptz x 103/µl) comparadas con los otros tratamientos. Se concluye que la inducción hormonal con OVAPRIM® combinada con HCG, son efectivas para la producción seminal en la especie.

Abstract The yaque Leiarius marmoratus is specie of native silurid, with great potential for the diversification of the colombian aquaculture; however, the spermiation in captive yet presents difficulties due to the low seminal volume released with traditional induction protocols. In consequence, the aim of this study was to evaluate the effects of five protocols of hormonal induction based on carp pituitary extract (EHC), sGnRHa + domperidone (OVAPRIM®) and human chorionic gonadotropin (GHC) (FERTIVET®) on seminal quality and volume of the specie. Were selected 18 sexually mature males of 54,4 ± 2,2 cm in total length and 1,6 ± 0,1 kg body weight. 5 treatments were evaluated so: T1 : 0,25 ml/kg (0 h) and 1 ml/kg of OVAPRIM® (12 h ); T2: 1 mg/kg of EHC (0 h) and 3 mg/kg of EHC (12 h) ; T3 : single dose of 200 UI/kg HCG; T4: 3 mg/kg of EHC (0 h) and 200 UI /kg GHC (8h) ; T5: 1 ml/kg of OVAPRIM® (0h) and 200 U.I / kg of GHC (8h) ; Control: 1 ml of saline solution. Semen was obtained 6 hours after the last dose hormone. T1 and T5 showed a larger volume (p<0.05) (5,4 ± 1,1, 4,8 ± 1,2 ml) compared to T2 (3,1 ± 1ml), T3 (2,3 ml) T4 (2,4 ± 1.1 ml) and control (0.2 ml). Regarding motility and activation time, T1 and T5 had the best results (90 ± 0 % and 54,2 ± 7 s; 90 ± 0 % and 52,9 ± 3,8 s, respectively). The sperm concentration was higher in (p<0,05) T2 and T5 (1,275 ± 322, ± 225 and 1,261 sptz x 103/ul) compared with the other treatments. In conclusion, hormonal induction with OVAPRIM® combined with HCG, are effective for the seminal production in the specie.

Resumo O yaque Leiarius marmoratus, é uma espécie siluriforme nativa com grande potencial para a diversificação da aquicultura colombiana; No entanto, a spermiação em cativeiro ainda apresenta dificuldades devido ao baixo volume seminal liberado com protocolos de indução tradicionais. Por conseguinte, o objetivo foi avaliar os efeitos de protocolos de indução de cinco hormonais base de extrato de hipófise de carpa (EHC), sGnRHa + domperidona (Ovaprim®) e Gonadotropina coriónica humana (GHC) (FERTIVET®) sobre a qualidade e volume seminal das espécies. Foram Selecionados 18 machos sexualmente maduros de 54,4 ± 2,2 cm de comprimento total e 1,6 ± 0,1 kg de peso corporal. Foram avaliados cinco tratamentos: T1: 0,25 ml / kg (0 h) e 1 ml / kg de OVAPRIM® (12 h); T2: 1 mg / kg de EHC (0 h) e 3 mg / kg de EHC (12 h); T3: dose única de 200 UI / kg de HCG; T4: 3 mg / kg de EHC (0 h) e 200 UI / kg de GHC (8h); T5: 1 ml / kg de OVAPRIM® (0h) e 200 UI / kg de GHC (8h); Controle: 1 ml de solução salina fisiológica. O sêmen foi coletado 6 h após a última dose hormonal foi aplicada. T1 e T5 mostraram um volume maior (p <0,05) (5,4 ± 1,1, 4,8 ± 1,2 ml) quando comparado com T2 (3,1 ± 1 ml), T3 (2,3 ml) T4 (2,4 ± 1,1 ml) e controle (0,2 ml). Em relação à mobilidade e ao tempo de ativação, T1 e T5 apresentaram os melhores resultados (90 ± 0% e 54,2 ± 7 s, 90 ± 0% e 52,9 ± 3,8 s, respectivamente). A concentração de esperma foi maior (p <0,05) em T2 e T5 (1275 ± 322 e 1261 ± 225 sptz x 103 / µl) em comparação com os outros tratamentos. Conclui-se que a indução hormonal com OVAPRIM® combinada com HCG, é efetiva para a produção seminal nas espécies.

Pituicitoma hipofisario, un hallazgo diagnóstico inusual: reporte de caso / Pituitary pituicytoma, finding of an unusual diagnosis: a case report

Los pituicitomas son tumores infrecuentes de la región selar y supraselar, originados de la neurohipófisis, que suelen ser confundidos con otros tumores al compartir características imaginológicas. Se reporta el caso de una mujer de 36 años de edad, con un pituicitoma en la región selar, que fue diagnosticado como un adenoma hipofisario debido a los hallazgos clínicos e imaginológicos preoperatorios y se realiza una revisión de la literatura.

The Pituicytomas are rare tumors of the sellar and suprasellar region originated of the neurohypophysis and are usually confused with other tumors when sharing imagining features. It is reported a case of a 36 years old woman with pituicytoma in the sellar region that was diagnosed as a pituitary adenoma due to the presurgical clinical and imaging findings and, it is revised the literature.

[Cerebral infarction after pituitary apoplexy: Description of a case and review of the literature]. / Infarto cerebral tras apoplejía pituitaria: descripción de un caso y revisión de la literatura.

Pituitary apoplexy is usually the result of hemorrhagic infarction in a pituitary adenoma. The clinical presentation varies widely and includes asymptomatic cases, classical pituitary apoplexy and even sudden death. Cerebral ischemia due to pituitary apoplexy is very rare. It may be caused by vasospasm or direct compression of cerebral vessels by the tumor. We report a case of pituitary apoplexy associated with cerebral infarction and discuss the relationship between the two events.

Histopathological hoof laminar changes in horses with pituitary pars Intermedia adenoma: cases report / Alterações histopatológicas do tecido laminar do casco em cavalos com adenoma da pars intermedia da hipófise: relato de casos

Laminitis in horses is often associated with endocrine disorders, especially the pituitary pars intermedia dysfunction (PPID) in older animals. Morphologic exams of the laminar tissue of the hoof were performed in two horses with suspected PPID, with no clinical signs of laminitis. Changes compatible with laminitis of endocrine origin were observed, such as rounding of the nuclei of the basal cells, thinning and stretching of the secondary epidermal laminae and tissue proliferation. PPID horses with no clinical signs of laminitis may be affected by lesions of the laminar tissue of the hoof that compromise the integrity of the dermal-epidermal junction and may develop clinical symptoms of the disease. It has been suggested that the development stage of endocrine laminitis is longer, but further studies should be conducted to confirm it.

A laminite em cavalos está frequentemente associada a distúrbios endócrinos, como a disfunção da pars intermedia da pituitária (PPID) em animais mais velhos. Exames morfológicos do tecido laminar do casco foram realizados em dois cavalos com suspeita de PPID após o óbito, os quais não apresentaram sinais clínicos de laminite. Alterações compatíveis com a laminite de origem endócrina foram observadas, como arredondamento da núcleo das células basais, alongamento e afilamento das lâminas epidérmicas secundárias e proliferação tecidual. Cavalos com PPID sem sinais clínicos de laminite podem estar acometidos por lesões do tecido laminar do casco que comprometam a integridade das interdigitações dérmico-epidérmicas e podem desenvolver a sintomatologia clínica da doença. Sugere-se que o período de desenvolvimento da laminite endócrina seja mais longo, porém estudos adicionais devem ser realizados para confirmar essa hipótese.

Apoplejía tumoral pituitaria / Pituitary tumor apoplexy

La apoplejía tumoral pituitaria es un síndrome infrecuente que resulta del infarto y/o hemorragia espontánea de un adenoma pituitario preexistente. Ya que el evento primario involucra el adenoma, este síndrome debe ser nombrado como apoplejía tumoral pituitaria y no como apoplejía pituitaria. El aumento súbito en la presión de los contenidos de la silla turca da como resultado una cefalea de inicio agudo (puede ser incluso una "cefalea en trueno") de intensidad severa, alteraciones visuales y compromiso en la función pituitaria. El diagnóstico se basa en una alta sospecha clínica, imagen por resonancia magnética y medición de hormonas hipofisiarias en sangre. El tratamiento se basa en medidas de soporte (líquidos intravenosos y corticoides) y en casos sin buena respuesta o con deterioro neurológico, descompresión de silla turca. A continuación presentamos el caso de un adenoma previamente no diagnosticado que debutó como apolejía tumoral pituitaria. (Acta Med Colomb 2015; 40: 249-253).

Pituitary tumor apoplexy is an infrequent condition resulting from infarction and/or spontaneous bleeding from a pre-existing pituitary adenoma. This entity requires the prior existence of an adenoma in order to be named as pituitary tumor apoplexy, otherwise, it should be named pituitary apoplexy. The sudden increase in pressure of the sella turcica's contents results in a clinical syndrome characterized by headache (which can be "thunderclap headache"), visual disturbances and hypopituitarism. Diagnosis is not always straight forward and requires high clinical suspicion in addition to magnetic resonance imaging and measurement of serum pituitary hormones. Treatment is mainly based on supportive measures (intravenous fluids and steroids) and surgical decompression in those cases with no response to medical treatment and progressive neurological impairment. We report the case of a patient with a previously unknown pituitary adenoma presenting as a tumor apoplexy. (Acta Med Colomb 2015; 40: 249-253).

Objective short sleep duration is associated with the activity of the hypothalamic-pituitary-adrenal axis in insomnia / Insônia, com tempo de sono curto, medido objetivamente, esta associada a atividade do eixo hipotálamo-hipófise-adrenal

Objective To evaluate the association between objective short sleep duration in patients with insomnia and changes in blood parameters related to hypothalamic-pituitary-adrenal (HPA) axis activity.Method A cross-sectional pilot study was conducted in 30 middle-aged adults with chronic insomnia who were divided into 2 groups according to polysomnography (PSG) total sleep time (TST) (TST > 5h and < 5h). All patients underwent subjective analysis of sleep quality, anthropometric measurements, PSG, and determination off asting blood parameters.Results The results revealed lower sleep efficiency and higher sleep latency for those with a TST < 5h. The subjective sleep quality was worse in the TST < 5h. Significantly, higher glucose and cortisol levels were observed with a TST < 5h. Glucose, cortisol and ACTH levels were inversely correlated with the PSG total sleep time.Conclusion Patients with insomnia with objective short sleep duration had HPA-associated endocrine and metabolic imbalances chronically linked to increases in cardiovascular risk observed with this more severe insomnia phenotype.

Objetivo Avaliar a associação entre insônia com tempo de sono curto e alterações sanguíneas relacionados com a atividade do eixo hipotálamo-hipófise-adrenal (HPA).Método Estudo piloto transversal, com 30 adultos de meia-idade, distribuídos em 2 grupos de acordo com o tempo total de sono (TTS) pela polisonografia (PSG) (TTS > 5h e < 5h). Os pacientes foram submetidos a análise subjetiva da qualidade do sono, medidas antropométricas, PSG e parâmetros sanguíneos em jejum.Resultados Revelaram baixa eficiência do sono e maior latência do sono para aqueles com TTS < 5h. A qualidade subjetiva do sono foi pior no TTS < 5h. Significativamente, os níveis de glicose e cortisol mais elevados foram observados no grupo com TTS < 5h. Os níveis de glicose, cortisol e ACTH foram inversamente correlacionados com o TTS da PSG.Conclusão Pacientes com insônia com tempo de sono curto apresentaram desequilíbrios endócrinos e metabólicos associados a atividade do eixo HPA, correlacionados ao aumento do risco cardiovascular observado neste fenótipo mais grave de insônia.

Fatal complication after transsphenoidal surgery of pituitary adenoma: case report / Complicação fatal após cirurgia transesfenoidal de adenoma em hipófise: relato de caso

ABSTRACT The objective of this study was to report a rare fatal complication in the postoperative period of transsphenoidal surgery of the pituitary gland (adenoma), with a brief review of the subject. The patient was a 54-year-old white man with acromegaly and severe heart failure, who after microsurgery developed blood pressure instability within 32 hours after the procedure and died. The autopsy revealed: hypertrophy and ventricular dilation with myocarditis, pericarditis and myocardial fibrosis; mesenteric ischemia with transmural coagulation necrosis of the intestinal loops; acute tubular necrosis; and hepatic steatosis. The findings are consistent with cardiogenic shock and abdominal sepsis due to necrosis of the intestinal loops.

RESUMO O objetivo deste estudo é relatar uma rara complicação fatal no pós-operatório de cirurgia transesfenoidal de hipófise (adenoma), com breve revisão sobre o tema. Homem branco, 54 anos, com acromegalia e insuficiência cardíaca grave que, após microcirurgia, evoluiu com instabilidade pressórica nas 32 horas seguintes ao procedimento, o que levou ao óbito. Necropsia evidenciou hipertrofia e dilatação ventricular com miocardite, miocardiofibrose e pericardite; isquemia mesentérica com necrose de coagulação transmural em alças intestinais; necrose tubular aguda; e esteatose hepática. Os achados são compatíveis com choque cardiogênico e sepse abdominal pela necrose de alças intestinais.

Resposta ao estresse: I. Homeostase e teoria da alostase / Stress response: I. Homestasis and allostasis theory / Respuesta al estrés: I. Homeostasis y teoría de la alostasis

Os seres vivos desenvolvem ao longo de sua história evolutiva mecanismos de enfrentamento às condições adversas originadas tanto no ambiente geofísico como no ambiente social. Esta resposta adaptativa é coordenada e envolve diferentes sistemas funcionais, particularmente, os sistemas nervoso, endócrino e imune, e é denominada de resposta ao estresse e deve atender a duas demandas principais da vida: sobrevivência e reprodução. Esta revisão tem o objetivo de discutir o emprego do conceito clássico de homeostase e um conceito alternativo, alostase, que inclui os mecanismos preditivos e reativos de regulação, assim como os diferentes níveis de impacto dos estressores crônicos, resultando em sobrecarga alostática que pode ou não se seguir de falha alostática. Os mecanismos neurais, hormonais, imunes, sistêmicos e moleculares, que compreendem os sistemas alóstaticos subjacentes à resposta ao estresse são também apresentados.

Over the course of their evolution organisms developed mechanisms to cope with challenging situations originating from both physical and social environments. These adaptive mechanisms are coordinated and involve the sequential and/or simultaneous recruitment of different functional systems, mainly neural, endocrine and immune, the so-called stress response. They operate to maintain physiological variables at suitable. This review aims to discuss the use of the classical homeostasis concept and allostasis, an alternative model, which includes reactive and predictive mechanisms, as well as the different levels of impact of the chronic stressor, resulting in allostatic overload or allostatic failure. The organizing role of neural, hormonal, immune, systemic and molecular mechanisms, which comprise the allostatic systems underlying the stress response, is also presented.

Los seres vivos desarrollan a lo largo de su historia evolutiva mecanismos de enfrentamiento a las condiciones adversas originadas tanto en el ambiente geofísico como en el ambiente social. Esta respuesta adaptativa es coordinada y envuelve distintos sistemas funcionales, particularmente, el sistema nervioso, endócrino e inmune y es denominada de respuesta al estrés y debe atender a las dos demandas principales de la vida: supervivencia y reproducción. Esta revisión tiene como objetivo de discutir el empleo del concepto clásico de homeostasis y una concepto alternativa, alostasis, que incluye los mecanismos y el impacto de los agentes de estresores crónicos resultando en sobrecarga alostática o falla alostática. Los mecanismos neuronales, hormonales e inmunes, sistémicos y moleculares que comprenden los sistemas alóstaticos subyacentes a la respuesta al estrés son también presentados.