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Journal Article 2016; 37(4): 282-288 PubMed PMID: 27857044 Citation  Keywords:  Case-Control Studies, Child, Exons, Female, Genotype, Growth Disorders:drug therapy, Growth Hormone:therapeutic use, Hormone Replacement Therapy:methods, Human Growth Hormone:deficiency, Humans, Infant, Newborn, Male, Poland, Polymorphism, Genetic, Recept.   

OBJECTIVES: The human growth hormone receptor (GHR) exon 3 deletion (d3) polymorphism has been reported to be associated with the responsiveness to growth hormone (GH) therapy. This study aimed to: (a) assess the frequency of this polymorphism in a group of Polish children with idiopathic growth hormone deficiency (IGHD) and (b) analyze their response to GH therapy.

METHODS: The study group consisted of 67 prepubertal children with IGHD. The control group was composed of 150 Caucasian newborns from whom umbilical cord blood samples were drawn. A genotype analysis was performed using the PCR multiplex technique in search for the existence or deletion of exon 3 of the GHR gene.

RESULTS: In the study group the following genotype distribution was observed: fl/fl-GHR 64.2%; fl/d3-GHR 29.9%; d3/d3-GHR 5.9%. The total percentage of patients with d3-GHR polymorphism was 35.8% and 64.2% patients had a fl/fl-GHR. No significant differences were noted in growth rate SD before introducing therapy and growth rate after one year of recombinant human GH therapy in patients with individual genotypes. In the control group the genotype distribution was: fl/fl-GHR 63.3%; fl/d3-GHR 29.9%; d3/d3-GHR 6.8%.

CONCLUSION: No differences were observed in genotype distribution between the study and the control group. Patients with IGHD did not differ among each other depending on their genotype (fl/fl-GHR or fl/d3-GHR) in terms of growth velocity before introducing therapy or growth rate after one year of recombinant human GH therapy....

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Case Reports 2015; 36(8): 734-736 PubMed PMID: 26921572 Citation  Keywords:  Antidiuretic Agents:therapeutic use, Deamino Arginine Vasopressin:therapeutic use, Female, Hormone Replacement Therapy:methods, Human Growth Hormone:therapeutic use, Humans, Hydrocortisone:therapeutic use, Hypopituitarism:diagnosis, Infant, Newborn, Magne.   

: Turner syndrome (TS) is a congenital disease caused by absence or structural abnormalities of sex chromosomes resulting in gonadal dysgenesis. Spontaneous pregnancies occur in 2-8% of patients, especially with mosaic kariotypes, however they are associated with increased risk of poor outcome both for mother and fetus. We report a 4-day-old male infant delivered by women with mosaic TS who was admitted to the pediatric intensive care unit and presented with severe panhypopituitarism as the early manifestation of pituitary stalk interruption syndrome (PSIS). To the best of our knowledge this is the first report of severe panhypopituitarism in a newborn borne by women with TS....

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Journal Article 2015; 36(5): 511-514 PubMed PMID: 26707053 Citation  Keywords:  ACTH-Secreting Pituitary Adenoma:genetics, Adenoma:genetics, Adult, Aged, Aged, 80 and over, Biomarkers, Tumor:genetics, Cohort Studies, Electrophoresis, Capillary, Female, Growth Hormone-Secreting Pituitary Adenoma:genetics, Humans, Male, Microsatellite .   

OBJECTIVE: Mutator phenotypes with microsatellite instability (MSI) are observed in a subset of solid tumors including those localized in the brain. MSI arises from impaired DNA mismatch repair. It can be a potential marker of resistance to radiation and chemotherapy, as demonstrated for several cancer types. Our study aims are to investigate MSI incidence in pituitary adenomas (PA) with a currently recommended methodology.

METHODS: DNA was obtained from 107 patients with PA of which 83 adenomas were nonfunctioning, 13 somatotrophic, 9 lactotrophic and 2 corticotrophic. These were examined for MSI status by PCR and capillary electrophoresis using five quasimonomorphic microsatellite markers: BAT25, BAT26, NR21, NR24 and NR27; in accordance to current Bethesda guidelines.

RESULTS AND CONCLUSION: No microsatellite instability was detected in the tumor samples thus implying the lack of any clinical usefulness of MSI testing in PA cases....

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Journal Article 2015; 36(5): 498-503 PubMed PMID: 26707051 Citation  Keywords:  APACHE, Adult, Calcitonin:metabolism, Calcitonin Gene-Related Peptide, Cohort Studies, Critical Illness, Euthyroid Sick Syndromes:etiology, Female, Human Growth Hormone:metabolism, Humans, Intensive Care Units, Male, Middle Aged, Multiple Trauma:complicat.   

OBJECTIVE: Acute multiple-trauma induces activation of neuroendocrine system. Nonthyroidal illness syndrome (NTIS) is considered to be associated with adverse outcome in intensive care unit (ICU) patients. This study was aimed to assess dynamic changes of neuroendocrine hormones in patients with polytrauma and their association with the polytrauma score (PTS).

METHODS: Blood samples from 24 critically ill patients with polytrauma were obtained on 1st, 2nd, 3rd and 7th day after admission to ICU for analysis of thyroid-stimulating hormone (TSH), total triiodothyronine (T3); free triiodothyronine (fT3), total thyroxine (T4), free thyroxine (fT4), growth hormone (GH), prolactin (PRL) and procalcitonin levels.

RESULTS: Acute Physiology and Chronic Health Evaluation (APACHE) II score was 16±5 points on average at the admission to ICU. All patients had normal baseline TSH, T4, fT4, but low T3, and fT3 levels were found in 20% and 33% ICU patients, respectively. On the 7th day after admission to ICU TSH had tendency to increase (p=0.07) and fT4 significantly decreased (p=0.03). The PRL level significantly increased on the 3rd day after admission as compared to 1st day (p=0.04). PTS positively correlated with fT3 (r=0.582, p=0.004) and negatively with fT4 (r=-0.422, p=0.04) at the 1st day in ICU.

CONCLUSION: Critical illness in patients with polytrauma leaded to trauma severity-dependent alterations of the thyroid axis response early after injury. Our findings suggest that detection of dynamic hormonal response is more appropriate than single measurement. However supplemental therapy for NTIS should be used after more detailed studies are completed....

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Journal Article 2015; 36(4): 348-353 PubMed PMID: 26454490 Citation  Keywords:  Adolescent, Body Height:drug effects, Child, Dwarfism:drug therapy, Female, Growth Hormone:administration & dosage, Human Growth Hormone:deficiency, Humans, Male, Neural Networks (Computer), Outcome Assessment (Health Care):methods, Recombinant Proteins,.   

INTRODUCTION: The leading method for prediction of growth hormone (GH) therapy effectiveness are multiple linear regression (MLR) models. Best of our knowledge, we are the first to apply artificial neural networks (ANN) to solve this problem. For ANN there is no necessity to assume the functions linking independent and dependent variables. The aim of study is to compare ANN and MLR models of GH therapy effectiveness.

MATERIAL AND METHODS: Analysis comprised the data of 245 GH-deficient children (170 boys) treated with GH up to final height (FH). Independent variables included: patients' height, pre-treatment height velocity, chronological age, bone age, gender, pubertal status, parental heights, GH peak in 2 stimulation tests, IGF-I concentration. The output variable was FH.

RESULTS: For testing dataset, MLR model predicted FH SDS with average error (RMSE) 0.64 SD, explaining 34.3% of its variability; ANN model derived on the same pre-processed data predicted FH SDS with RMSE 0.60 SD, explaining 42.0% of its variability; ANN model derived on raw data predicted FH with RMSE 3.9 cm (0.63 SD), explaining 78.7% of its variability.

CONCLUSION: ANN seem to be valuable tool in prediction of GH treatment effectiveness, especially since they can be applied to raw clinical data....

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Journal Article 2015; 36(2): 165-170 PubMed PMID: 26071586 Citation  Keywords:  Adult, Aged, Ether-A-Go-Go Potassium Channels:metabolism, Growth Hormone-Secreting Pituitary Adenoma:metabolism, Humans, Ki-67 Antigen:metabolism, Male, Middle Aged, Pilot Projects, Young Adult,.   

OBJECTIVE: To determine immunohistochemical expression of Eag1 in pituitary adenomas of patients with acromegaly and to assess the correlation between Eag1 expression with cavernous sinus invasion, tumoral Ki-67 labeling index (LI), age and gender of the patients.

METHODS: The paraffin embedded pituitary adenoma tissue sections of 28 patients with acromegaly who were diagnosed as monohormonal growth hormone (GH) secreting adenomas were immunostained for Eag1 using the avidin-biotin-peroxidase complex method. Eag1 immunoreactivity was scored according to the extensity of the cytoplasm and cell membrane immunoreactivity for Eag1 (score 1 = <10%, score 2 = 10-25%, score 3 = 25-50% and score 4 = >50% of the adenoma cells showed immunoreactivity for Eag1, respectively).

RESULTS: Overall, GH secreting pituitary adenomas displayed diverse levels of Eag1 immunoreactivity, however, 64% of the adenomas displayed a strong Eag1 immunoreactivity (score 3 and 4). Five of the tumors displayed Eag1 immunoreactivity score 1, 5 displayed score 2, 10 displayed score 3 and 8 displayed score 4, respectively. No correlation was found between Eag1 immunoreactivity with cavernous sinus invasion, Ki-67 LI, age and gender of the patients.

CONCLUSIONS: Our results suggest Eag1 is strongly expressed in the majority of GH secreting pituitary adenomas. However, we could not find any correlation between immunoreactivity of Eag1 with cavernous sinus invasion, Ki-67 LI, age and gender of the patients. Further studies with larger sample sizes are required to demonstrate the role of Eag1 on tumorigenesis, angiogenesis, invasion and response to the treatment in GH secreting pituitary adenomas....

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Journal Article 2015; 36(2): 136-142 PubMed PMID: 26071582 Citation  Keywords:  Adult, Alternative Splicing:genetics, Female, Growth Hormone-Secreting Pituitary Adenoma:genetics, Humans, Male, Middle Aged, Pituitary Neoplasms:genetics, Placental Lactogen:genetics,.   

OBJECTIVES: Somatotroph adenomas secrete supraphysiological amounts of GH, causing acromegaly. We have previously shown epithelial splicing regulator 1 (ESRP1) to play a role in epithelial mesenchymal transition (EMT) progression in these adenomas and account for poor treatment response. We evaluated if the mRNA levels of the GH/CSH gene cluster in somatotroph adenomas are associated with an epithelial phenotype and response to SA treatment.

METHODS: We investigated the associations between ESRP1 and the growth hormone/chorionic somatomammotropin (GH/CSH) gene cluster by RNA sequencing (RNAseq). CSH2 isoform 3 mRNA was further evaluated in 65 somatotroph adenomas and associations with disease severity and treatment response.

RESULTS: mRNA for all genes in the GH/CSH cluster were expressed, however, only chorionic somatomammotropin 2/placental lactogen 2 (CSH2) displayed an alternative splicing pattern. CSH2 isoform 3 was associated with a dense granulation pattern and an epithelial phenotype with high levels of ESRP1 and E-cadherin expression. Further, CSH2 isoform 3 was associated with reduced serum GH and IGF-I levels after somatostatin analog treatment.

CONCLUSIONS: Attenuated CSH2 isoform 3 was associated with mesenchymal phenotype and a blunted clinical response to somatostatin analog treatment in patients with acromegaly....

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Case Reports 2015; 36(2): 119-123 PubMed PMID: 26071578 Citation  Keywords:  Adrenal Insufficiency:chemically induced, Adult, Female, Hashimoto Disease:chemically induced, Human Growth Hormone:adverse effects, Humans, Polyendocrinopathies, Autoimmune:chemically induced, Turner Syndrome:drug therapy, Young Adult,.   

: Autoimmune polyglandular syndrome is a constellation of signs and symptoms of simultaneous insufficiencies of several endocrine glands. Autoimmune polyglandular syndrome type 2 (APS 2) may be diagnosed when the adrenocortical insufficiency is associated with an autoimmune thyroid disease (Hashimoto's thyroiditis or Graves' disease), and/or insulin-dependent diabetes mellitus. Turner syndrome is the most common chromosomal disorder in females, caused by complete or partial X chromosome monosomy. We present the case of a 20-year-old woman with Turner syndrome, in whom APS 2 (Hashimoto's thyroiditis and adrenocortical insufficiency) has been diagnosed after introduction of recombinant human growth hormone (rhGH) therapy. In Turner syndrome, examination of the patient must regularly be conducted in order to diagnose a possible onset of autoimmune diseases; respective treatment must be applied as soon as the diagnosis is established. In particular, therapy of rhGH, used for short stature treatment, may be a trigger factor of adrenal insufficiency. The cortisol level in blood should be assessed before rhGH administration and carefully monitored during the therapy, especially in case of autoimmune thyroid disease coexistence....

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