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PubMedDate not supplied

American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules.

Thyroid nodules are common and are frequently benign. Current data suggest that the prevalence of palpable thyroid nodules is 3% to 7% in North America; the prevalence is as high as 50% based on ultrasonography (US) or autopsy data. The introduction of sensitive thyrotropin (thyroid-stimulating hormone or TSH) assays, the widespread application of fine-needle aspiration (FNA) biopsy, and the availability of high-resolution US have substantially improved the management of thyroid nodules. This document was prepared as a collaborative effort between the American Association of Clinical Endocrinologists (AACE) and the Associazione Medici Endocrinologi (AME). Most Task Force members are members of AACE. We have used the AACE protocol for clinical practice guidelines, with rating of available evidence, linking the guidelines to the strength of recommendations. Key observations include the following. Although most patients with thyroid nodules are asymptomatic, occasionally patients complain of dysphagia, dysphonia, pressure, pain, or symptoms of hyperthyroidism or hypothyroidism. Absence of symptoms does not rule out a malignant lesion; thus, it is important to review risk factors for malignant disease. Thyroid US should not be performed as a screening test. All patients with a palpable thyroid nodule, however, should undergo US examination. US-guided FNA (US-FNA) is recommended for nodules > or = 10 mm; US-FNA is suggested for nodules < 10 mm only if clinical information or US features are suspicious. Thyroid FNA is reliable and safe, and smears should be interpreted by an experienced pathologist. Patients with benign thyroid nodules should undergo follow-up, and malignant or suspicious nodules should be treated surgically. A radioisotope scan of the thyroid is useful if the TSH level is low or suppressed. Measurement of serum TSH is the best initial laboratory test of thyroid function and should be followed by measurement of free thyroxine if the TSH value is low and of thyroid peroxidase antibody if the TSH value is high. Percutaneous ethanol injection is useful in the treatment of cystic thyroid lesions; large,symptomatic goiters may be treated surgically or with radioiodine. Routine measurement of serum calcitonin is not recommended. Suggestions for thyroid nodule management during pregnancy are presented. We believe that these guidelines will be useful to clinical endocrinologists, endocrine surgeons, pediatricians, and internists whose practices include management of patients with thyroid disorders. These guidelines are thorough and practical, and they offer reasoned and balanced recommendations based on the best available evidence.

Biopsy, Fine-Needle↗
PubMedDate not supplied

Sertoli-Leydig cell tumor of the ovary: a case report with endocrinologic observations.

OBJECTIVE: To present a case of a Sertoli-Leydig cell ovarian tumor and discuss the endocrinologic findings. METHODS: We describe the clinical manifestations in a female patient with an ovarian tumor and summarize the results of hormonal studies. RESULTS: A 33-year-old woman with abrupt cessation of menses, progressive hirsutism, and weight gain because of a unilateral ovarian mass identified sonographically and an increased serum testosterone level underwent laparotomy, which disclosed a left ovarian Sertoli-Leydig cell tumor. Hysterectomy and bilateral adnexectomy were performed. Tissue extraction studies revealed 17-hydroxyprogesterone as the predominant steroid in tumor tissue in conjunction with substantially increased testosterone, free testosterone, dihydrotestosterone, androstenedione, and dehydroepiandrosterone levels and left ovarian vein effluent. CONCLUSION: A unilateral ovarian mass associated with substantially increased serum testosterone should suggest the presence of a functioning ovarian tumor. Androgenic symptoms are a consequence of disturbed steroidogenesis from multipotential steroidogenic cells of ovarian stromal origin whose clinical effects depend on enzymatic specificity and the relative concentrations of steroids produced.

Journal Article↗
PubMed1999

[Influence of abnormal structure beta chain of luteinizing hormone on endocrinological kinetics of luteinizing hormone and gynecologic diseases].

With recent progress in endocrinology and in procreation physiology, the importance of kinetics of pituitary gonadotropin has been increasing, and the measurement method has been improved. In the present study, however, we found inconsistency in measured LH values between IRMA (SPAC-S LH) as the conventional method and CLEIA (IMMULYZE LH) as the newly developed method. The inconsistency between the SPAC-S LH value and the IMMULYZE LH value was observed in 10.0% of the healthy group and in 12.5% of the patient group. The cause of this discrepancy was due to a reaction of the SPAC-S LH of the intact LH monoclonal antibodies to the LH with the abnormal structure beta chain by two point mutation in the LH beta gene. The response of LH-RH test varied depending on the measurement reagent of LH in patients who had the LH with the abnormal structure beta chain, which made it difficult to determine the lesion and histological grading regarding the ovulation mechanism. Therefore, in patients with abnormal beta chain, an accurate treatment protocol was indeterminate. In this study, although a relationship between various gynecological diseases and the point mutation of LH was not clarified, we suggest that LH of the abnormal structure beta chain may cause excessive secretion in the early stage, and lead to some effect on physical activities.

Biomarkers↗
PubMed1999

Molecular studies of diabetes reported at the Fourth European Congress of endocrinology.

In his lecture at the Fourth European Congress of Endocrinology, C.R. Kahn considered the effects of knock-out of genes encoding the proteins involved into insulin signal transduction on the development of insulin-resistance and non-insulin-dependent diabetes mellitus. The latter were induced in animals by knockout of genes encoding insulin receptors and intracellular substrate proteins of the insulin receptor. Using special technology, the authors achieved selective knock-out of the insulin receptor gene in muscles and pancreatic beta-cells of mice. Non-insulin-dependent diabetes mellitus developed only after the knock-out of the insulin receptor gene in beta-cells and resulted from the inability of glucose to penetrate into beta-cells and stimulate insulin secretion. The insensitivity of muscles to insulin due to the lack of its receptor did not result in diabetes. In these animals insulin and glucose blood level did not differ from the control values, but blood lipid concentration was increased. For the cases of the reduction in the insulin-dependent penetration of glucose into muscles, these data may indirectly indicate a transition of energy metabolism in muscles from carbohydrate utilization to increased fat consumption as an energy source.

Animals↗
PubMed1976

[Endocrinological evaluation of sellar and suprasellar tumor cases (the seventh report)--endcrinological study on four cases of pituitary adenoma with intratumoral hemorrhage (author's transl)].

Four cases of pituitary adenoma with intratumoral hemorrhage were studied endocrinologically. 1) It would be suggested that ACTH and TSH secretion of these cases was strongly impaired but LH, FSH and PRL secretion was fairly preserved immediately after hemorrhagic episode. 2) Two of these four cases revealed normal TSH secretion and normal thyroid function following the period of excessive TSH secretion and impaired thyroid function.

Acromegaly↗
PubMed1999

Prevention of the initial testosterone surge induced by a luteinizing hormone-releasing hormone analogue in prostate cancer patients: the endocrinological effects of pretreatment with chlormadinone acetate.

We investigated the endocrinological effects of pretreatment with chlormadinone acetate (CMA) in preventing the initial testosterone surge induced by a luteinizing hormone-releasing hormone (LH-RH) analogue. A total of 25 patients with previously untreated prostate cancer were included in this study. The patients were randomly assigned to 2 treatment groups: Group 1; CMA therapy was begun 4 weeks before the initial LH-RH analogue injection. Group 2; CMA therapy was begun 2 weeks before the initial LH-RH analogue injection. After the initial LH-RH analogue injection, CMA was administered during this study. After LH-RH analogue application, the mean values of serum luteinizing hormone (LH) and testosterone increased in both groups on day 3. However, LH and testosterone levels remained beneath pretreatment values in both groups. The mean relative PSA levels did not significantly increased on day 3 and day 7 in both groups. Our results indicate that pretreatment with CMA for 2 weeks was sufficient to prevent the initial testosterone surge in the maximal androgen blockade which was associated with CMA.

Administration, Oral↗
PubMed1999

[Leptin in the endocrinology of obesity].

The article summarizes the endocrinology axis in relation to leptin in the obesity. There is a glucocorticoid hypothesis in the obesity origin. Human plasma leptin levels are elevated in Cushing's syndrome and there is a robust leptin secretory responses to dexamethasone. Obesity impacts on reproductive function in man and women. Leptin levels are higher in women than in men and a critical blood leptin level is necessary to trigger reproductive ability in women. The relationship between body mass index and circulating leptin varies during the course of spontaneous cycles in women, the best correlation occurring during the luteal phase when progesterone and leptin concentrations are highest. Obesity is associated with a decrease in growth hormone (GH) and reversible with weight loss. The influence of body composition on GH secretion in the obesity may be mediated through leptin, acting as a peripheral signal from adipose tissue. Thyroid dysfunction appear not associated with alterations in serum leptin levels. There is a significant relationship between insulin and leptin, but it is not immediate, since type 2 diabetics show similar leptin levels to those of nondiabetic humans of the same body mass index.

Adult↗
PubMed2000

[Endocrinology 1998-1999].

In the cascade hormone--second messenger--cellular G-proteins (GTP binding proteins), impairment can occur also at the last step: Mutant G-proteins may amplify the response (e.g. hypophyseal and thyroid adenomas) or reduce it (pseudohypoparathyreosis, testitoxicosis). Other new group of diseases appears to be anexinopathy: Among anexins belong also lippocortins and impairments occur in the hemocoagulation. "Reverse endocrinology" is a process description when the recognition of receptor (called an "orphan receptor") comes earlier than that of the hormone: Such receptors are known for several steroid hormones, retinoids and eicosanoids and it appears they are important also in the metabolism of cholesterol. A single antigen--glutamic acid decarboxylase (GAD), can cause autoimmune disease as the immuno-dependent diabetes (IDDM). Treatment of the skin T-cell lymphoma by some retinoids can result in hypothyroidism. Retrotransposones are example of the human genome modification with yet unknown clinical manifestations. Hepatocytal growth factor reveals to be the hope for treatment of cirrhosis. Search for effective peroral insulin substitutes is at present based on testing of various metabolites of fungi. Antibodies against TNF (tumor necrosis factor) become tested as "anti-cytokine therapy" in patients with rheumatoid arthritis. Some other suggestions for new ways of treatment is also listed, including the intranasal administration of estradiol.

Endocrine System Diseases↗
PubMed1976

The practice of endocrinology in a rural setting: suggested guidelines.

For the purposes of medical practice, a ;rural setting' implies an environment with little or no facilities for the sophisticated laboratory investigations that may be needed for the diagnosis of certain endocrine disorders. Fortunately, however, most of the commoner endocrine disorders may be diagnosed from the patient's history and a physical examination, together if necessary with the observed response to therapy. A lack of facilities, therefore, need not hinder the effective practice of endocrinology in rural areas.

Endocrine System Diseases↗
PubMedDate not supplied

[Thyroid gland nodules registered at the Endocrinology Department of the Medical Center in Prokuplje].

INTRODUCTION: Thyroid nodules are often found in clinical practice. General population prevalence is about 4%, whereas in women it is over 6%. The basic disorder of cell kinetics of thyroid tumors is inappropriate growth response to corresponding thyroid-stimulating hormone (TSH) concentration. MATERIAL AND METHODS: At the Endocrinology Department of Medical Centre in Prokuplje, during the first year of practice (1997), 430 patients with thyroid gland disease were registered, both male and female belonging to different age groups. Patients were examined in regard to: sex, age, heredity, symptoms. Basic laboratory analyses were done with the aim to establish inflammatory syndromes: sedimentation, leukocytes, differential blood picture, cholesterolemia and fibrinogenemia; hormones of thyroid glands (T3, T4, TSH) with corresponding radioimmunoassay (RIA) technique. In the aim of identifying the nodules in the thyroid gland and perceiving nodular features, an ultrasound examining was done and scintigraphy of thyroid gland if necessary. Scintigraphy was done with radioactive technicium-99 mTc. RESULTS: From the total number of registered patients (430) with thyroid gland disease, nodules were found in 172 glands (40%). The presence of thyroid nodules is more frequent in women (91.3%). The average age of thyroid gland patients is 50.33 years, of which men aged 52 and women aged 50.17. The following risk factors are stated as the most frequent: chronic stress 58.13%, consuming goiter substances 46.51% (cabbage, kale, sulphonamide). Swollen thyroid gland--goiter occurred in 105 cases (61.07%), whereas in 120 patients (69.32%) normal function was registered. In most cases the nodules are solitary 90 (52.32%). In 71.01% of patients cold nodules were found. In 36.04% of patients nodules were 1 to 1.9 cm in size. The greatest number of patients--83 (36.61%) complained of heart disorder as a symptom. 2.9% out of 172 patients with thyroid nodules underwent operation. DISCUSSION: The obtained data mostly coincide with the findings of other authors. Trbojević found thyroid nodules 3 to 4 times more often with women. In this research it is ten times more frequent. Bozović especially pointed out the existence of inflammatory factors, mentioned in this group in 12.97% cases. We can not neglect the hereditary factor either--11.62% which is not clearly defined by other authors [1,2,3]. According to Trbojević, solitary nodules are present in 60% of cases. In this research the number is 52.32%. Cold nodules are found in 71.07% (according to Trbojević 90%). Only 2.9% of patients were operated, which is not enough if we follow all the medical indications. CONCLUSION: Out of the total number of patients (430) with thyroid gland disease, 172 patients (40%) with nodular changes in thyroid glands have been found. Far more frequent (90%) are women aged 51 to 60 years (after menopause). The number of operated patients with thyroid nodules is insufficient.

Adult↗
PubMed2000

[Altitude hypoxia: effects on selected endocrinological parameters].

During the past few years, the investigation of altitude hypoxia and its effect on metabolic functions in humans has increasingly attracted the attention of endocrinologists. Most of the studies have been performed as field studies at moderate or high altitude, but with conflicting results. One of the possible reasons certainly is the fact that standardisation of field studies is almost impossible. Furthermore, many factors such as wind, temperature, radiation and others, may affect certain endocrine parameters, but they cannot be individually quantified. Hence, their inclusion into statistical analyses of the obtained data is not useful. Nevertheless, several endocrine parameters were shown to be affected by altitude hypoxia. Among them, there is erythropoietin, a hormone which is well known to stimulate erythropoiesis. This hormone shows a rapid increase after ascent to moderate or high altitude. There is also evidence that urinary and serum noradrenalin levels increase significantly, whereas adrenalin seems to be less affected. Another "stress-hormone", cortisol, also shows a significant increase. Furthermore, the biologically active fraction of the thyroidal hormones thyroxine and triiodothyronine increases significantly. And last but not least, one of the most important proinflammatory cytokines, interleukin-6, shows a manyfold increase compared to the basal level. However, the clinical significance of most of these studies is not yet clear. Hence, from an endocrinological point of view, no specific recommendations may be given to people staying at moderate or high altitude.

Adaptation, Physiological↗
PubMed2000

[Nuclear medicine for general radiologists: endocrinological examinations].

We reviewed nuclear endocrinological examinations of the thyroid, parathyroid, and adrenal glands that are clinically performed in Japan as well as somatostatin receptor imaging, which is widely used in Europe, the United States, and other countries. 123I thyroid scintigraphy is especially useful in detecting ectopic goiters and differentiating between Basedow's disease and subacute thyroiditis or Plummer's disease, all of which exhibit thyrotoxicosis. 201Tl is useful to detect foci metastasized from well differentiated thyroid cancer and to differentiate malignant from benign tumors. 67Ga-citrate is an agent used for patients suspected of having malignant lymphoma or undifferentiated carcinoma of the thyroid. Radioiodinated MIBG is a specific agent for medullary thyroid carcinoma. 99mTc-MIBI is a good agent for locating hyperfunctioning parathyroid tissues. 131I-adosterol is useful to locate the lesions of primary aldosteronism, Cushing's syndrome, adrenogenital syndrome, and select adenomas among incidental tumors. Radioiodinated MIBG scintigraphy has high diagnostic accuracy in locating pheochromocytomas and neuroblastomas. 111In-labeled octreotide is useful in locating, hormone-producing gastrointestinal and pancreatic tumors including carcinoids, gastrinomas, and insulinomas. Radiolabeled somatostatin receptor analogs are used not only to locate but also to treat malignant somatostatin receptor-positive tumors. We hope that Octreoscan will be available in Japan in the near future.

Endocrine Glands↗
PubMed2000

[Endocrinological parameters of patients with acute progressive pulmonary tuberculosis].

Examining the levels of the hormones insulin and cortisole that play a significant role in nonspecific protection in tuberculosis indicates the heterodirectional pattern of changes in endocrinological parameters in relation to the clinical form of acute progressive tuberculosis. In drug-treated patients with caseous pneumonia, the high level of cortisole decreased and the content of insulin reached the lower normal range with 18.2% of cases having hypoinsulinemia. Patients with disseminated pulmonary tuberculosis had an inversely proportion ratio of the hormones, which reflected the specific features of acute progression of this clinical form. In acute progressive infiltrative tuberculosis, the levels of cortisole and insulin significantly increased during chemotherapy. Nevertheless, whatever changes were observed in hormonal levels, variations in the parameters indicate the long-term activity of specific inflammation in acute progressive pulmonary tuberculosis.

Acute Disease↗
PubMed2000

Differences in reproductive endocrinology between Asian men and Caucasian men--a literature review.

This review provides an overview of the literature on aspects of reproductive endocrinology wherein Asian men may differ from Caucasian, notably, prostatic neoplasm and the sensivity to pharmacological regimens of male contraception. Both genetic and environmental factors, such as nutrition, might be relevant. Asian men residing in Asia seem to be relatively protected from clinical prostatic neoplasm while the prevalence of preclinical prostatic neoplasm is not different. Migration to an area with a higher prevalence reduces this difference but does not undo it. With regard to prostatic neoplasm the following factors have been considered as relevant in Asian men: 1) a reduction in 5 alpha-reductase level, 2) decreased levels of androgenic ketosteroid precursors of 5 alpha-reduced androgen metabolites, 3) the decreased presence of a P53 mutation, 4) a higher CAG-repeat length of the androgen receptor, 5) a possible higher level of physical activity, 6) differences in sexual activity. Furthermore, Asian men respond to a higher degree with azoospermia in response to contraceptive steroids. Possible explanations offered for the more pronounced response to contraceptive steroids are: 1) differences in testicular structure and decreased spermatogenic potential, 2) an earlier and more marked suppression in LH secretion by exogenous androgens. The differences may be due to genetical and/or environmental factors influencing the peripheral testosterone metabolism. Dietary factors such as the higher intake of phytoestrogens in Asians might exert effects on 5 alpha-reductase activity and/or on sex hormone binding globulin (SHBG) levels, thus having an impact on the biological efficacy of circulating androgens.

Asian People↗
PubMed2001

Endometrial patterns and endocrinologic characteristics of asymptomatic menopausal women.

The endometrial histology and endocrinologic and demographic characteristics of 556 asymptomatic postmenopausal women, who attended the menopause outpatient clinic at Ankara Numune Education and Research Hospital were studied before initiating estrogen replacement therapy. Of these women, 486 (87.4%) had atrophic endometrium, 37 (6.65%) had proliferative endometrium, 27 (4.86%) had endometrial hyperplasia without atypia, three (0.54%) had endometrial hyperplasia with atypia and three (0.54%) had endometrial adenocarcinoma on their biopsy specimens. When demographic characteristics of the patients were considered, we found that the patients with endometrial adenocarcinoma and endometrial hyperplasia with atypia had potential risk factors for endometrial pathology such as chronic anovulation, diabetes or hypertension. This study confirms that routine endometrial sampling in asymptomatic postmenopausal women is not warranted, but patients with associated risk factors should be screened for endometrial pathology before starting estrogen replacement therapy.

Adenocarcinoma↗
PubMed2001

The gonadotropin-releasing hormone antagonist abarelix depot versus luteinizing hormone releasing hormone agonists leuprolide or goserelin: initial results of endocrinological and biochemical efficacies in patients with prostate cancer.

PURPOSE: We contrasted the endocrinological and biochemical efficacies of abarelix depot, a pure gonadotropin-releasing hormone antagonist, with a prospective concurrent control cohort receiving luteinizing hormone releasing hormone (LH-RH) agonists with or without antiandrogen for treatment of patients with prostate cancer receiving initial hormonal therapy. MATERIALS AND METHODS: In this phase 2 open label study 242 patients with prostate cancer requiring initial hormonal treatment received abarelix depot (209) or LH-RH agonists (33) with or without antiandrogen. A total of 100 mg. abarelix depot was delivered intramuscularly every 28 days with an additional injection on day 15. LH-RH agonists with or without antiandrogen were administered according to the depot formulation used. Endocrine efficacy was measured by the absence of testosterone surge and rapidity of castration onset. The rate of prostate specific antigen decrease was assessed. RESULTS: No patient treated with abarelix depot had testosterone surge during week 1 compared with 82% of those treated with LH-RH agonists. The concomitant administration of antiandrogen had no effect. During the first week of drug administration, in 75% of patients treated with abarelix depot and in 0% of those treated with LH-RH agonist medical castration was achieved. Prostate specific antigen decrease was faster, with no flare or surge in patients treated with abarelix depot. Abarelix depot was well tolerated. CONCLUSIONS: Abarelix depot represents a new class of hormonal therapy, gonadotropin releasing hormone antagonists, that has rapid medical castration and avoids the testosterone surge characteristic of LH-RH agonists.

Aged↗
PubMedDate not supplied

Female reproductive endocrinology at the turn of the millennium.

The mainstays of female reproductive endocrinology, even as the millennium occurs and we cite highly technological advances in assisted reproduction, continue to be-as for the past decade-and-a-half-the use of GnRH analogs, both agonists and antagonists; the use of other gonadotropins, both alone and in combination, as well as with other types of drugs; testing for "ovarian reserve," as we attempt infertility treatment for populations that now include more nulliparous women of older reproductive age; and diagnosing and treating polycystic ovarian syndrome (PCOS), for both its reproductive and general health effects, especially as concerns insulin resistance. These topics are covered in detail, with reviews of well-controlled, and sometimes contrasting, studies.

Adult↗
PubMed2001

[Interaction of ambulatory service, endocrinologic inpatient care and specialized departments in the treatment of patients with diabetes mellitus and foot lesions].

Three-year experience of management and treatment of 3553 patients with diabetes mellitus (DM), including 500--insulindependent and 3053--insulinindependent cases, was summarized. Divisional endocrinologist is choosing patients with DM and high risk of the diabetic foot syndrome (DFS) or its signs. In presence of risk factors for DFS occurrence the patient is trained to care of foot and petty surgical manipulations are performed: to cut off toenails, treatment of superficial affection of skin and fungous affection of skin, determination of the foot setting, correcting insole to fit footwear if necessary. If all kinds of sensitivity are reduced on the foot in the absence of its deformity and ulcer the patient is recommended once a year to treat in endocrinological stationary and to consult surgeon in Centre of treatment of DM complications. If the foot blood supply is disordered, ulcer occurrs the patient is referred to surgeon. In 2132 (60%) patients risk factors or DFS signs were revealed. Surgical treatment for purulent-necrotic affection was conducted in 61 patients (2.9% of the patients number with risk factors of the foot affection), including intervention on the foot--in 50 (2.3%), high amputation of lower extremity--in 11 (0.6%).

Amputation, Surgical↗