Pub Date : 2010-07-01DOI: 10.1097/TEN.0B013E3181E94B87
W. Chapin, C. Yedinak, J. Delashaw, M. Fleseriu
Abstract: Cerebral spinal fluid (CSF) rhinorrhea immediately after the initiation of cabergoline in prolactinoma patients is an uncommon complication that could lead to serious comorbidities and management difficulties. We present a case of a woman with multiple endocrine neoplasia type 1 syndrome and a recurrent macroprolactinoma, who developed CSF rhinorrhea and pneumocephalus after 3 doses of 0.5 mg cabergoline. The patient was treated for sinusitis after complaining of increasing headache. Imaging revealed a large pituitary tumor, skull base erosion, and pneumocephalus. Skull-base defect repair and subsequent transsphenoidal tumor debulking was performed. Prolactin continued to increase postoperatively, and the dopamine agonist (DA) was changed to bromocriptine, with no further CSF leak during 18 months of follow-up. We recommend urgent surgical repair as the treatment of choice for CSF leak following DA treatment. Concurrent surgical tumor debulking should be preformed if possible. Retreatment with DA is a safe option in most cases. To our knowledge, CSF rhinorrhea following cabergoline therapy has not been described in the multiple endocrine neoplasia type 1 syndrome.
{"title":"Cabergoline-induced cerebral spinal fluid leak in a patient with a large prolactinoma and MEN1","authors":"W. Chapin, C. Yedinak, J. Delashaw, M. Fleseriu","doi":"10.1097/TEN.0B013E3181E94B87","DOIUrl":"https://doi.org/10.1097/TEN.0B013E3181E94B87","url":null,"abstract":"Abstract: Cerebral spinal fluid (CSF) rhinorrhea immediately after the initiation of cabergoline in prolactinoma patients is an uncommon complication that could lead to serious comorbidities and management difficulties. We present a case of a woman with multiple endocrine neoplasia type 1 syndrome and a recurrent macroprolactinoma, who developed CSF rhinorrhea and pneumocephalus after 3 doses of 0.5 mg cabergoline. The patient was treated for sinusitis after complaining of increasing headache. Imaging revealed a large pituitary tumor, skull base erosion, and pneumocephalus. Skull-base defect repair and subsequent transsphenoidal tumor debulking was performed. Prolactin continued to increase postoperatively, and the dopamine agonist (DA) was changed to bromocriptine, with no further CSF leak during 18 months of follow-up. We recommend urgent surgical repair as the treatment of choice for CSF leak following DA treatment. Concurrent surgical tumor debulking should be preformed if possible. Retreatment with DA is a safe option in most cases. To our knowledge, CSF rhinorrhea following cabergoline therapy has not been described in the multiple endocrine neoplasia type 1 syndrome.","PeriodicalId":50531,"journal":{"name":"Endocrinologist","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84013396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-07-01DOI: 10.1097/TEN.0B013E3181E947AB
O. Ozkan, Z. Yonden, C. Gokce, R. Davran, H. Yalçin, N. Savaş, H. Kaya
A 21-year-old man was referred to our hospital for the evaluation and treatment of simple goiter. The patient's physical examination was normal except for a palpable left thyroid lobe (grade 1b). All the laboratory investigations and thyroid function tests were normal, except for a subnormal serum thyroid stimulating hormone level. The patient had no complaint of hyperthyroidism. Both the serum antibodies (antithyroglobulin and antithyroid peroxidase) were negative. Thyroid ultrasonography revealed the agenesis of the left lobe and isthmus of the thyroid. Thyroid scan with Tc-99 m pertechnate showed the absence of the left lobe and isthmus and diffusely enlarged right lobe hyperplasia. A follow-up of 6 months was carried out without any medication. Post follow-up, the thyroid function tests were still consistent with subclinical hyperthyroidism. In this report, we have described the case of a patient with thyroid hemiagenesis associated with subclinical hyperthyroidism and goiter.
{"title":"Thyroid Hemiagenesis With Subclinical Hyperthyroidism: An Unusual Association","authors":"O. Ozkan, Z. Yonden, C. Gokce, R. Davran, H. Yalçin, N. Savaş, H. Kaya","doi":"10.1097/TEN.0B013E3181E947AB","DOIUrl":"https://doi.org/10.1097/TEN.0B013E3181E947AB","url":null,"abstract":"A 21-year-old man was referred to our hospital for the evaluation and treatment of simple goiter. The patient's physical examination was normal except for a palpable left thyroid lobe (grade 1b). All the laboratory investigations and thyroid function tests were normal, except for a subnormal serum thyroid stimulating hormone level. The patient had no complaint of hyperthyroidism. Both the serum antibodies (antithyroglobulin and antithyroid peroxidase) were negative. Thyroid ultrasonography revealed the agenesis of the left lobe and isthmus of the thyroid. Thyroid scan with Tc-99 m pertechnate showed the absence of the left lobe and isthmus and diffusely enlarged right lobe hyperplasia. A follow-up of 6 months was carried out without any medication. Post follow-up, the thyroid function tests were still consistent with subclinical hyperthyroidism. In this report, we have described the case of a patient with thyroid hemiagenesis associated with subclinical hyperthyroidism and goiter.","PeriodicalId":50531,"journal":{"name":"Endocrinologist","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82498150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-07-01DOI: 10.1097/TEN.0B013E3181E94A1F
A. Unal, D. Unal, F. Kavuncuoğlu, M. Sipahioğlu, H. Akgün, A. Akcan, B. Tokgoz, F. Öztürk, O. Oymak, C. Utaş
{"title":"Prolonged Control of Hypercalcemia Due to Inoperable Parathyroid Carcinoma by Cinacalcet in a Dialysis Patient","authors":"A. Unal, D. Unal, F. Kavuncuoğlu, M. Sipahioğlu, H. Akgün, A. Akcan, B. Tokgoz, F. Öztürk, O. Oymak, C. Utaş","doi":"10.1097/TEN.0B013E3181E94A1F","DOIUrl":"https://doi.org/10.1097/TEN.0B013E3181E94A1F","url":null,"abstract":"","PeriodicalId":50531,"journal":{"name":"Endocrinologist","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85253241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-07-01DOI: 10.1097/TEN.0B013E3181E94A0E
J. Goh, C. Eagleton
Abstract: Insulinomas are rare neuroendocrine tumors that usually present with fasting hypoglycemia and require demonstration of Whipple triad and laboratory evidence of hyperinsulinemic hypoglycemia for the diagnosis. The neuroglycopenic symptoms that comprise part of Whipple triad can be very nonspecific. Commonly, there is significant delay in insulinomas being diagnosed, with the symptoms frequently attributed to psychiatric or neurologic disorders. There is considerable variability in the modalities used for preoperative tumor localization, there is no consensus regarding the treatment option of choice, although most authors favor a pancreatic-sparing approach. Our patient did not exhibit the classic neuroglycopenic symptoms at the time of low serum glucose, therefore not fulfilling the criteria of Whipple triad, despite his laboratory and radiologic findings being consistent with an insulinoma. Although vascular invasion and tumor size have been quoted as features denoting more aggressive tumor behavior, our patient's tumor (despite being 60 mm in diameter with vascular space invasion) was classified as a low grade tumor with a low Ki-67 proliferative index of
{"title":"A Case of Sporadic Insulinoma With Unusual Features: Case Report","authors":"J. Goh, C. Eagleton","doi":"10.1097/TEN.0B013E3181E94A0E","DOIUrl":"https://doi.org/10.1097/TEN.0B013E3181E94A0E","url":null,"abstract":"Abstract: Insulinomas are rare neuroendocrine tumors that usually present with fasting hypoglycemia and require demonstration of Whipple triad and laboratory evidence of hyperinsulinemic hypoglycemia for the diagnosis. The neuroglycopenic symptoms that comprise part of Whipple triad can be very nonspecific. Commonly, there is significant delay in insulinomas being diagnosed, with the symptoms frequently attributed to psychiatric or neurologic disorders. There is considerable variability in the modalities used for preoperative tumor localization, there is no consensus regarding the treatment option of choice, although most authors favor a pancreatic-sparing approach. Our patient did not exhibit the classic neuroglycopenic symptoms at the time of low serum glucose, therefore not fulfilling the criteria of Whipple triad, despite his laboratory and radiologic findings being consistent with an insulinoma. Although vascular invasion and tumor size have been quoted as features denoting more aggressive tumor behavior, our patient's tumor (despite being 60 mm in diameter with vascular space invasion) was classified as a low grade tumor with a low Ki-67 proliferative index of","PeriodicalId":50531,"journal":{"name":"Endocrinologist","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77070720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-07-01DOI: 10.1097/TEN.0B013E3181E94852
Xinwen Huang, L. Tang, C. Zou, Zhengyan Zhao
{"title":"Chromosome Analysis in 8158 Pediatric Patients: An Experiment of 29 Years From Hangzhou, China","authors":"Xinwen Huang, L. Tang, C. Zou, Zhengyan Zhao","doi":"10.1097/TEN.0B013E3181E94852","DOIUrl":"https://doi.org/10.1097/TEN.0B013E3181E94852","url":null,"abstract":"","PeriodicalId":50531,"journal":{"name":"Endocrinologist","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90970327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-07-01DOI: 10.1097/TEN.0B013E3181E9494C
M. Keskin, O. Keskin, D. Kor, Hatice Uyanik, M. Aksoy, Fatih Palali
{"title":"Jansen Syndrome With Unaccountable Severe Hypercalcemia Treated by Biphosphanate","authors":"M. Keskin, O. Keskin, D. Kor, Hatice Uyanik, M. Aksoy, Fatih Palali","doi":"10.1097/TEN.0B013E3181E9494C","DOIUrl":"https://doi.org/10.1097/TEN.0B013E3181E9494C","url":null,"abstract":"","PeriodicalId":50531,"journal":{"name":"Endocrinologist","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74312818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-07-01DOI: 10.1097/TEN.0B013E3181ECB09B
E. Cappellin, P. Spinella, G. Antonelli, R. Gatti, G. Soldà, E. Palo
A relationship between natriuretic peptides, reproduction, and the elderly has been known for some time. To investigate the relation between Nt-pro C-type natriuretic peptide (CNP) and reproduction, a group of 71 elderly men and women were studied. In particular, the relation between prolactin (PRL) and Nt-proCNP was examined. Nt-proBNP (N-terminal Brain NP), pro Atrial (ANP)(1-98) (Atrial NP), Nt-proCNP, luteinizing and follicle-stimulating hormones, PRL, progesterone, and 17-estradiol were measured in 51 (23 males/28 females) hypertensive patients. A total of 20 normotensive elderly subjects formed the control group. The hypertensive patients (TH) were divided into subgroups, accordingly to their main other clinical diagnosis, namely Diabetes, Hypertension, Peripheral Arterial Oc- clusive Disease. A direct correlation was observed between Nt-proCNP and PRL in all subjects, patients, and healthy volunteers (r 0.56; P 0.001). An inverse correlation between Nt-proCNP and follicle-stimulating hor- mones was observed in TH patients (r 0.55; P 0.05). proANP(1- 98) and Nt-proBNP correlated with PRL respectively in peripheral arterial occlusive disease (r 0.57; P 0.05) and in TH (r 0.52; P 0.05). A direct correlation was found between the latter and luteinizing hormone in Diabetes (r 0.64; P 0.05). We demonstrate, for the first time, a correlation between Nt-proCNP and PRL in sick and healthy elderly subjects. Also proANP(1-98) and Nt-proBNP appeared to coregu- lated with PRL.
{"title":"N-Terminal Pro C-Type Natriuretic Peptide Relation With Prolactin in the Elderly","authors":"E. Cappellin, P. Spinella, G. Antonelli, R. Gatti, G. Soldà, E. Palo","doi":"10.1097/TEN.0B013E3181ECB09B","DOIUrl":"https://doi.org/10.1097/TEN.0B013E3181ECB09B","url":null,"abstract":"A relationship between natriuretic peptides, reproduction, and the elderly has been known for some time. To investigate the relation between Nt-pro C-type natriuretic peptide (CNP) and reproduction, a group of 71 elderly men and women were studied. In particular, the relation between prolactin (PRL) and Nt-proCNP was examined. Nt-proBNP (N-terminal Brain NP), pro Atrial (ANP)(1-98) (Atrial NP), Nt-proCNP, luteinizing and follicle-stimulating hormones, PRL, progesterone, and 17-estradiol were measured in 51 (23 males/28 females) hypertensive patients. A total of 20 normotensive elderly subjects formed the control group. The hypertensive patients (TH) were divided into subgroups, accordingly to their main other clinical diagnosis, namely Diabetes, Hypertension, Peripheral Arterial Oc- clusive Disease. A direct correlation was observed between Nt-proCNP and PRL in all subjects, patients, and healthy volunteers (r 0.56; P 0.001). An inverse correlation between Nt-proCNP and follicle-stimulating hor- mones was observed in TH patients (r 0.55; P 0.05). proANP(1- 98) and Nt-proBNP correlated with PRL respectively in peripheral arterial occlusive disease (r 0.57; P 0.05) and in TH (r 0.52; P 0.05). A direct correlation was found between the latter and luteinizing hormone in Diabetes (r 0.64; P 0.05). We demonstrate, for the first time, a correlation between Nt-proCNP and PRL in sick and healthy elderly subjects. Also proANP(1-98) and Nt-proBNP appeared to coregu- lated with PRL.","PeriodicalId":50531,"journal":{"name":"Endocrinologist","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80177470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-07-01DOI: 10.1097/TEN.0B013E3181E94B3C
C. Agarwal, A. Hassoun, G. Aranoff, C. Pomeranz, S. Oberfield
{"title":"Nonclassic 21-Hydroxylase Deficiency and Short Stature in an Ethnically at-Risk Population","authors":"C. Agarwal, A. Hassoun, G. Aranoff, C. Pomeranz, S. Oberfield","doi":"10.1097/TEN.0B013E3181E94B3C","DOIUrl":"https://doi.org/10.1097/TEN.0B013E3181E94B3C","url":null,"abstract":"","PeriodicalId":50531,"journal":{"name":"Endocrinologist","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77157647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-07-01DOI: 10.1097/TEN.0B013E3181ECB07D
C. Erem
Abstract: Pituitary thyrotroph hyperplasia secondary to primary hypothyroidism is a rare cause of pituitary enlargement. We report a case of pituitary hyperplasia in a young woman thought to have a pituitary macroadenoma with suprasellar extension. A 21-year-old woman was admitted to our hospital, complaining of menstrual irregularity and galactorrhea. Serum thyrotropin and prolactin were high, and serum-free thyroxine was low. Magnetic resonance imaging revealed symmetrical pituitary enlargement associated with contrast enhancement simulating macroadenoma. After adequate hormone replacement therapy with levothyroxine, both symptoms and pituitary hyperplasia regressed within 4 months. It is concluded that pituitary tumor associated with elevated thyroid stimulating hormone and low levels of free T4 should always be treated with replacement thyroxine before other diagnostic tests are ordered.
{"title":"A Case of Pituitary Hyperplasia Secondary to Primary Hypothyroidism Presenting With Irregular Menses, Galactorrhea, and Hyperprolactinemia","authors":"C. Erem","doi":"10.1097/TEN.0B013E3181ECB07D","DOIUrl":"https://doi.org/10.1097/TEN.0B013E3181ECB07D","url":null,"abstract":"Abstract: Pituitary thyrotroph hyperplasia secondary to primary hypothyroidism is a rare cause of pituitary enlargement. We report a case of pituitary hyperplasia in a young woman thought to have a pituitary macroadenoma with suprasellar extension. A 21-year-old woman was admitted to our hospital, complaining of menstrual irregularity and galactorrhea. Serum thyrotropin and prolactin were high, and serum-free thyroxine was low. Magnetic resonance imaging revealed symmetrical pituitary enlargement associated with contrast enhancement simulating macroadenoma. After adequate hormone replacement therapy with levothyroxine, both symptoms and pituitary hyperplasia regressed within 4 months. It is concluded that pituitary tumor associated with elevated thyroid stimulating hormone and low levels of free T4 should always be treated with replacement thyroxine before other diagnostic tests are ordered.","PeriodicalId":50531,"journal":{"name":"Endocrinologist","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84354358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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