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Case Reports 2016; 37(7): 469-472 PubMed PMID: 28326739 Citation  Keywords:  Adolescent, Adrenal Insufficiency:diagnosis, Female, Hormone Replacement Therapy, Humans, Hyponatremia:diagnosis, Hypopituitarism:blood, Pituitary Diseases:complications, Pituitary Gland:metabolism, Seizures:complications, Sodium:blood, Treatment Outcome,.   

: Pituitary stalk interruption syndrome (PSIS) is a congenital disease with isolated growth hormone deficiency (GHD) or multiple anterior pituitary hormone deficiencies (MPHD). The typical clinical manifestations of PSIS are growth retardation, hypoglycemia or delayed pubertal development. However, few reports showed cases of PSIS were diagnosed with acute epileptic seizures accompanied by hyponatremia. Here, we report an 18-year-old female presenting with episodes of intermittent seizures for 13 years. The electrolyte examination on many occasions has shown hyponatremia, even as low as 99.9 mmol/L. However, the cause of hyponatremia has not been further discussed. The patient had short stature and no pubertal development. The laboratory tests revealed growth hormone deficiency, secondary adrenal insufficiency, hypothyroidism and hypogonadotropic hypogonadism. MRI showed an ectopic hyperintense signal of the posterior pituitary and no visible anterior pituitary gland or stalk. The hormone replacement therapy helped to raise the sodium concentration to a normal level and in the termination of seizures....

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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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Clinical Study 2015; 36(5): 421-429 PubMed PMID: 26707041 Citation  Keywords:  Adolescent, Adult, Aged, Androgens:therapeutic use, Dehydroepiandrosterone:therapeutic use, Estradiol:therapeutic use, Estriol:therapeutic use, Estrogens:therapeutic use, Estrone:therapeutic use, Female, Hormone Replacement Therapy:methods, Humans, Male, .   

OBJECTIVE: In 2002 we suggested a new hypothesis of migraine. This hypothesis implies that migraine is a consequence of a loss of neurohormonal and metabolic integrity. The goal of this clinical analysis is to present the evaluation of the effect of a multimodal treatment program in migraine management.

MATERIAL AND METHODS: We evaluated 30 patients ages 16-66 with migraine who were treated with a multimodal treatment program. All patients received a complex program which included: hormonorestorative therapy (HT) with bio-identical hormones; correction of balance between sympathetic and parasympathetic systems and simultaneously calcium/magnesium balance; "resetting" the pineal gland; improvement of intestinal absorption through restoration of normal intestinal flora, and a cleanse from parasitic infestation (if necessary). Serum levels of total cholesterol (TC), pregnenolone, dehydroepiandrosterone sulfate (DHEAS), progesterone, total estrogen, and total testosterone were determined,

RESULTS: All patients responded to this regimen. We do not have patients who still have migraine after they started to use this program. Laboratory finding prior to HT showed the significant deficiency in production of all basic steroid hormones (progesterone and pregnenolone production declined the most). Concurrent symptoms such as fibromyalgia, insomnia, depression, gastrointestinal disorders, and fatigue had disappeared. Total cholesterol completely normalized in 22 (91.7%) patients. No adverse effects or complications related to this program were registered.

CONCLUSIONS: Our findings support the hypothesis that migraine is a consequence of a loss of neurohormonal and metabolic integrity, and that migraine can be managed by a multimodal approach....

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Case Reports 2015; 36(4): 303-305 PubMed PMID: 26454483 Citation  Keywords:  Adolescent, Female, Hashimoto Disease:complications, Hormone Replacement Therapy:methods, Humans, Magnetic Resonance Imaging, Oculomotor Nerve Diseases:drug therapy, Recurrence, Steroids:therapeutic use, Thyroiditis, Autoimmune:complications,.   

: Ophthalmopathy related to thyroid disease is due mainly to diffuse periorbital or eye muscle inflammation. It is more common in Grave's hyperthyroidism and rare in Hashimoto's hypothyroidism. Here we report a case of recurrent oculomotor nerve palsy associated with autoimmune hypothyroidism. Brain MRI revealed enhancement of the oculomotor nerves. Despite thyroid hormone replacement therapy, oculomotor nerve palsy recurred at the side contralateral to the initially involved nerve and the autoimmune antibody titer remained high. The symptom was responsive to high-dose steroid therapy....

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Case Reports 2015; 36(1): 41-47 PubMed PMID: 25789598 Citation  Keywords:  Adult, Aged, Female, Hormone Replacement Therapy, Humans, Hypothyroidism:metabolism, Male, Middle Aged, Thyroid Hormones:metabolism, Thyrotropin:metabolism, Thyrotropin-Releasing Hormone:metabolism, Thyroxine:administration & dosage,.   

OBJECTIVES: Non-thyroidal illness syndrome (NTIS) is a form of hypothyroidism that occurs during illness. NTIS is characterized by low thyroid hormones (TH) level in the serum and tissues, with normal serum TSH levels that are considered "inappropriately" normal. The mechanisms responsible for a lack of increase in serum TSH during NTIS are unknown. However, a decreased expression of hypothalamic TRH has been documented in deceased humans with NTIS. It has been suggested that pro-inflammatory cytokines are responsible for the inhibition of TRH release. If a similar TSH response occurs in severely ill patients with primary hypothyroidism has not been reported.

DESIGN: Seven severely ill patients with unknown or poorly treated primary hypothyroidism are presented. Serum TSH and TH were measured at admission and during TH replacement.

SETTING: Tertiary university hospital.

RESULTS: Besides suffering severe illness, patient's serum TSH was high and decreased once TH replacement was given. Levothyroxine administration was enough to down regulate TSH secretion. Serum reverse T3 (rT3) was normal or high and showed further elevation with stepwise increase in levothyroxine doses.

CONCLUSIONS: The thyroid axis inhibitory feedback system is fully preserved in primary hypothyroidism during severe illness. In NTIS, serum TSH levels remain within normal limits because the supply of TH to TRH neurons is sustained normally. Pro-inflammatory cytokines does not play a major role inhibiting TRH release during NTIS associated to primary hypothyroidism. D3 activity increases in humans with severe illness, a mechanism behind the increased requirements in TH replacement to achieve normal serum TH....

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Journal Article 2014; 35(8): 684-690 PubMed PMID: 25702296 Citation  Keywords:  Animals, Apoptosis:drug effects, Dietary Supplements, Disease Models, Animal, Drug Therapy, Combination, Hippocampus:drug effects, Hormone Replacement Therapy, Hypothyroidism:drug therapy, Male, Oxidative Stress:drug effects, Random Allocation, Rats.Rats.   

OBJECTIVE: To examine the effect of levothyroxine (L-T4), vitamin E or both on oxidative stress status and hippocampal apoptosis in a propylthiouracil (PTU)-induced hypothyroid rat model.

METHODS: Sprague-Dawley rats were randomly divided into five groups: Control, PTU+PTU+L-T4+PTU+Vit E, PTU+Vit E+L-T4. In each group we assessed levels of serum triiodothyronine (T3), tetraiodothyronine (T4), thyroid stimulating hormone (TSH), hippocampus cellular apoptosis index (AI), hippocampus nicotinamide adenine denucleotide hydrogen (NADPH)oxidase and superoxide dismutase (SOD).

RESULTS: 1) Compared with the control group, NADPH oxidase levels were significantly increased, and SOD levels were significantly reduced in the PTU groups (p<0.05). 2) Compared to the PTU group, SOD levels were significantly increased in the PTU+Vit E and PTU+L-T4+Vit E group (p<0.05). NADPH oxidase levels were significantly decreased in the PTU+L-T4, PTU+Vit E and PTU+ L-T4+Vit E group (p<0.05). 3) Compared with the control group, hippocampus AI increased significantly in the PTU group (p<0.05). Compared with the PTU group, hippocampus AI was significantly reduced in the PTU+L-T4 group and PTU+L-T4+Vit E group (p<0.05). 4) Hippocampus AI was positively correlated with NADPH oxidase expression levels in hippocampus tissue (r=0.644, p<0.01).

CONCLUSION: Levothyroxine replacement therapy combined with vitamin E reduces hippocampus AI by improving oxidative stress. This study suggested that the mechanisms of hippocampus tissue injury in a hypothyroid rat model is related to hippocampus apoptosis from increased oxidative stress....

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Comparative Study 2014; 35(3): 242-247 PubMed PMID: 24977976 Citation  Keywords:  Adolescent, Body Height, Child, Dwarfism, Pituitary:drug therapy, Female, Hormone Replacement Therapy, Human Growth Hormone:therapeutic use, Humans, Male, Poland, Prognosis, Recombinant Proteins:therapeutic use, Severity of Illness Index,.   

OBJECTIVES: The main goal of growth hormone therapy is to reach the height in the population ranges. The aim of the study was the comparison of selected methods for predicting final height in Polish patients with severe (sGHD) and partial (pGHD) growth hormone deficiency.

METHODS: 149 children with growth hormone deficiency treated with rhGH in the Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology Developmental Age, PUM, in Szczecin, in 2000-2010 have been evaluated. Patient were divided into two groups: sGHD and pGHD. Two methods of final height prediction have been used: Roche-Weiner-Thissen (RWT) and target height (TH), results were compared to the final height (FH). 117 children finished therapy in the analysed period and reached final height.

RESULTS: The mean FH was similar in both groups. There was no significant difference between the accuracy of prediction methods of TH and RWT between groups of pGHD v. sGHD. Further analysis revealed, that in the group of boys with sGHD the prediction error of RWT was significantly lower than of the TH method (p < 0.05).

CONCLUSIONS: It seems that in the group of boys with sGHD RWT is a more accurate method than TH....

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