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Aljenaee K, Hakami O, Davenport C, Farrell G, Tun TK, Pazderska A, Phelan N, Healy ML, Sreenan S, McDermott JH. Spurious HbA1c results in patients with diabetes treated with dapsone. Endocrinol Diabetes Metab Case Rep 2019; 2019:EDM190027. [PMID: 31566188 PMCID: PMC6765317 DOI: 10.1530/edm-19-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 08/30/2019] [Indexed: 11/08/2022] Open
Abstract
SUMMARY Measurement of glycated haemoglobin (HbA1c) has been utilised in assessing long-term control of blood glucose in patients with diabetes, as well as diagnosing diabetes and identifying patients at increased risk of developing diabetes in the future. HbA1c reflects the level of blood glucose to which the erythrocyte has been exposed during its lifespan, and there are a number of clinical situations affecting the erythrocyte life span in which HbA1c values may be spuriously high or low and therefore not reflective of the true level of glucose control. In the present case series, we describe the particulars of three patients with diabetes who had spuriously low HbA1c levels as a result of dapsone usage. Furthermore, we discuss the limitations of HbA1c testing and the mechanisms by which it may be affected by dapsone in particular. LEARNING POINTS Various conditions and medications can result in falsely low HbA1c. Dapsone can lead to falsely low HbA1c by inducing haemolysis and by forming methaemoglobin. Capillary glucose measurement, urine glucose measurements and fructosamine levels should be used as alternatives to HbA1c for monitoring glycaemic control if it was falsely low or high.
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Affiliation(s)
- Khaled Aljenaee
- Department of Endocrinology, St James Hospital, Dublin, Ireland
| | - Osamah Hakami
- Department of Endocrinology, Royal College of Surgeons in Ireland, Connolly Hospital Blanchardstown, Dublin, Ireland
| | - Colin Davenport
- Department of Endocrinology, St Columcille’s Hospital, Dublin, Ireland
| | - Gemma Farrell
- Department of Clinical Biochemistry, Connolly Hospital, Blanchardstown, Dublin, Ireland
| | - Tommy Kyaw Tun
- Department of Endocrinology, Royal College of Surgeons in Ireland, Connolly Hospital Blanchardstown, Dublin, Ireland
| | | | - Niamh Phelan
- Department of Endocrinology, St James Hospital, Dublin, Ireland
| | | | - Seamus Sreenan
- Department of Endocrinology, Royal College of Surgeons in Ireland, Connolly Hospital Blanchardstown, Dublin, Ireland
| | - John H McDermott
- Department of Endocrinology, Royal College of Surgeons in Ireland, Connolly Hospital Blanchardstown, Dublin, Ireland
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Tanaka Y, Uchida T, Yamaguchi H, Kudo Y, Yonekawa T, Nakazato M. Fulminant hepatitis and elevated levels of sIL-2R in thyroid storm. Endocrinol Diabetes Metab Case Rep 2019; 2019:EDM190078. [PMID: 31600730 PMCID: PMC6765318 DOI: 10.1530/edm-19-0078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 09/06/2019] [Indexed: 11/25/2022] Open
Abstract
SUMMARY We report the case of a 48-year-old man with thyroid storm associated with fulminant hepatitis and elevated levels of soluble interleukin-2 receptor (sIL-2R). Fatigue, low-grade fever, shortness of breath, and weight loss developed over several months. The patient was admitted to the hospital because of tachycardia-induced heart failure and liver dysfunction. Graves' disease with heart failure was diagnosed. He was treated with methimazole, inorganic iodide, and a β-blocker. On the day after admission, he became unconscious with a high fever and was transferred to the intensive care unit. Cardiogenic shock with atrial flutter was treated with intra-aortic balloon pumping and cardioversion. Hyperthyroidism decreased over 10 days, but hepatic failure developed. He was diagnosed with thyroid storm accompanied by fulminant hepatitis. Laboratory investigations revealed elevated levels of sIL-2R (9770 U/mL). The fulminant hepatitis was refractory to plasma exchange and plasma filtration with dialysis, and no donors for liver transplantation were available. He died of hemoperitoneum and gastrointestinal hemorrhage due to fulminant hepatitis 62 days after admission. Elevated circulating levels of sIL-2R might be a marker of poor prognosis in thyroid storm with fulminant hepatitis. LEARNING POINTS The prognosis of thyroid storm when fulminant hepatitis occurs is poor. Liver transplantation is the preferred treatment for fulminant hepatitis induced by thyroid storm refractory to plasma exchange. Elevated levels of soluble interleukin-2 receptor might be a marker of poor prognosis in patients with thyroid storm.
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Affiliation(s)
- Yuri Tanaka
- Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Taisuke Uchida
- Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Hideki Yamaguchi
- Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yohei Kudo
- Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Tadato Yonekawa
- Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Masamitsu Nakazato
- Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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Rafey MF, Butt A, Coffey B, Reddington L, Devitt A, Lappin D, Finucane FM. Prolonged acidosis is a feature of SGLT2i-induced euglycaemic diabetic ketoacidosis. Endocrinol Diabetes Metab Case Rep 2019; 2019:EDM190087. [PMID: 31600728 PMCID: PMC6765316 DOI: 10.1530/edm-19-0087] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 09/06/2019] [Indexed: 12/12/2022] Open
Abstract
SUMMARY We describe two cases of SGLT2i-induced euglycaemic diabetic ketoacidosis, which took longer than we anticipated to treat despite initiation of our DKA protocol. Both patients had an unequivocal diagnosis of type 2 diabetes, had poor glycaemic control with a history of metformin intolerance and presented with relatively vague symptoms post-operatively. Neither patient had stopped their SGLT2i pre-operatively, but ought to have by current treatment guidelines. LEARNING POINTS SGLT2i-induced EDKA is a more protracted and prolonged metabolic derangement and takes approximately twice as long to treat as hyperglycaemic ketoacidosis. Surgical patients ought to stop SGLT2i medications routinely pre-operatively and only resume them after they have made a full recovery from the operation. While the mechanistic basis for EDKA remains unclear, our observation of marked ketonuria in both patients suggests that impaired ketone excretion may not be the predominant metabolic lesion in every case. Measurement of insulin, C-Peptide, blood and urine ketones as well as glucagon and renal function at the time of initial presentation with EDKA may help to establish why this problem occurs in specific patients.
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Affiliation(s)
- Mohammed Faraz Rafey
- Galway University Hospitals, Galway, Ireland
- HRB Clinical Research Facility, National University of Ireland Galway, Galway, Ireland
| | - Arslan Butt
- Galway University Hospitals, Galway, Ireland
| | | | | | | | | | - Francis M Finucane
- Galway University Hospitals, Galway, Ireland
- HRB Clinical Research Facility, National University of Ireland Galway, Galway, Ireland
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Delcourt C, Yildiz H, Camboni A, Van den Neste E, Roelants V, Kozyreff A, Thissen JP, Maiter D, Furnica RM. A sarcoidosis-lymphoma syndrome revealed by hypopituitarism. Endocrinol Diabetes Metab Case Rep 2019; 2019:EDM190091. [PMID: 31600729 PMCID: PMC6765315 DOI: 10.1530/edm-19-0091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 09/03/2019] [Indexed: 12/02/2022] Open
Abstract
SUMMARY A 26-year-old woman presented with persistent headache and tiredness. Biological investigations disclosed a moderate inflammatory syndrome, low PTH-hypercalcemia and complete anterior hypopituitarism. A magnetic resonance imaging (MRI) of the pituitary gland was performed and revealed a symmetric enlargement with a heterogeneous signal. Ophthalmological examination showed an asymptomatic bilateral anterior and posterior uveitis, and a diagnosis of pituitary sarcoidosis was suspected. As the localization of lymphadenopathies on the fused whole-body FDG-PET/computerized tomography (CT) was not evoking a sarcoidosis in first instance, an excisional biopsy of a left supraclavicular adenopathy was performed showing classic nodular sclerosis Hodgkin's lymphoma (HL). A diagnostic transsphenoidal biopsy of the pituitary gland was proposed for accurate staging of the HL and surprisingly revealed typical granulomatous inflammation secondary to sarcoidosis, leading to the diagnosis of a sarcoidosis-lymphoma syndrome. The co-existence of these diseases constitutes a diagnostic challenge and we emphasize the necessity of exact staging of disease in order to prescribe adequate treatment. LEARNING POINTS The possibility of a sarcoidosis-lymphoma syndrome, although rare, should be kept in mind during evaluation for lymphadenopathies. In the case of such association, lymphoma usually occurs after sarcoidosis. However, sarcoidosis and lymphoma can be detected simultaneously and development of sarcoidosis in a patient with previous lymphoma has also been reported. An accurate diagnosis of the disease and the respective organ involvements, including biopsy, is necessary in order to prescribe adequate treatment.
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Affiliation(s)
- Charlotte Delcourt
- Departments of Endocrinology and Nutrition, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Halil Yildiz
- Internal Medicine, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Alessandra Camboni
- Pathology, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Eric Van den Neste
- Hematology, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Véronique Roelants
- Nuclear Medicine, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Alexandra Kozyreff
- Ophthalmology, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Jean Paul Thissen
- Departments of Endocrinology and Nutrition, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Dominique Maiter
- Departments of Endocrinology and Nutrition, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Raluca Maria Furnica
- Departments of Endocrinology and Nutrition, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Prokop J, Estorninho J, Marote S, Sabino T, Botelho de Sousa A, Silva E, Agapito A. POEMS syndrome: a rare cause of adrenal insufficiency in a young male. Endocrinol Diabetes Metab Case Rep 2019; 2019:EDM190010. [PMID: 31967972 DOI: 10.1530/edm-19-0010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 07/16/2019] [Indexed: 11/08/2022] Open
Abstract
SUMMARY POEMS syndrome (Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal protein and Skin changes) is a rare multisystemic disease. Clinical presentation is variable, the only mandatory criteria being polyneuropathy and monoclonal gammapathy in association with one major and one minor criterion. Primary adrenal insufficiency is rarely reported. We describe a case of a 33-year-old patient, in whom the presenting symptoms were mandibular mass, chronic sensory-motor peripheral polyneuropathy and adrenal insufficiency. The laboratory evaluation revealed thrombocytosis, severe hyperkalemia with normal renal function, normal protein electrophoresis and negative serum immunofixation for monoclonal protein. Endocrinologic laboratory work-up confirmed Addison's disease and revealed subclinical primary hypothyroidism. Thoracic abdominal CT showed hepatosplenomegaly, multiple sclerotic lesions in thoracic vertebra and ribs. The histopathologic examination of the mandibular mass was nondiagnostic. Bone marrow biopsy revealed plasma cell dyscrasia and confirmed POEMS syndrome. Axillary lymphadenopathy biopsy: Castleman's disease. Gluco-mineralocorticoid substitution and levothyroxine therapy were started with clinical improvement. Autologous hematopoietic cell transplantation (HCT) was planned, cyclophosphamide induction was started. Meanwhile the patient suffered two ischemic strokes which resulted in aphasia and hemiparesis. Cerebral angiography revealed vascular lesions compatible with vasculitis and stenosis of two cerebral arteries. The patient deceased 14 months after the diagnosis. The young age at presentation, multiplicity of manifestations and difficulties in investigation along with the absence of serum monoclonal protein made the diagnosis challenging. We report this case to highlight the need to consider POEMS syndrome in differential diagnosis of peripheral neuropathy in association with endocrine abnormalities even in young patients. LEARNING POINTS POEMS syndrome is considered a 'low tumor burden disease' and the monoclonal protein in 15% of cases is not found by immunofixation. Neuropathy is the dominant characteristic of POEMS syndrome and it is peripheral, ascending, symmetric and affecting both sensation and motor function. Endocrinopathies are a frequent feature of POEMS syndrome, but the cause is unknown. The most common endocrinopathies are hypogonadism, primary hypothyroidism and abnormalities in glucose metabolism. There is no standard therapy; however, patients with disseminated bone marrow involvement are treated with chemotherapy with or without HCT.
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Affiliation(s)
- Joanna Prokop
- Departments of Endocrinology, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - João Estorninho
- Departments of Endocrinology, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Sara Marote
- Departments of Internal Medicine, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Teresa Sabino
- Departments of Endocrinology, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Aida Botelho de Sousa
- Departments of Hemato-Oncology, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Eduardo Silva
- Departments of Internal Medicine, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Ana Agapito
- Departments of Endocrinology, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
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Ng HY, Namboodiri D, Learoyd D, Davidson A, Champion B, Preda V. Clinical challenges of a co-secreting TSH/GH pituitary adenoma. Endocrinol Diabetes Metab Case Rep 2019; 2019:EDM190068. [PMID: 31967973 DOI: 10.1530/edm-19-0068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 07/16/2019] [Indexed: 11/08/2022] Open
Abstract
SUMMARY Co-secreting thyrotropin/growth hormone (GH) pituitary adenomas are rare; their clinical presentation and long-term management are challenging. There is also a paucity of long-term data. Due to the cell of origin, these can behave as aggressive tumours. We report a case of a pituitary plurihormonal pit-1-derived macroadenoma, with overt clinical hyperthyroidism and minimal GH excess symptoms. The diagnosis was confirmed by pathology showing elevated thyroid and GH axes with failure of physiological GH suppression, elevated pituitary glycoprotein hormone alpha subunit (αGSU) and macroadenoma on imaging. Pre-operatively the patient was rendered euthyroid with carbimazole and underwent successful transphenoidal adenomectomy (TSA) with surgical cure. Histopathology displayed an elevated Ki-67 of 5.2%, necessitating long-term follow-up. LEARNING POINTS Thyrotropinomas are rare and likely under-diagnosed due to under-recognition of secondary hyperthyroidism. Thyrotropinomas and other plurihormonal pit-1-derived adenomas are more aggressive adenomas according to WHO guidelines. Co-secretion occurs in 30% of thyrotropinomas, requiring diligent investigation and long-term follow-up of complications.
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Affiliation(s)
- Hui Yi Ng
- Department of Clinical Medicine, Level 4, Macquarie University, 2 Technology Place, Macquarie University, New South Wales, Australia
| | - Divya Namboodiri
- Department of Clinical Medicine, Level 4, Macquarie University, 2 Technology Place, Macquarie University, New South Wales, Australia
| | - Diana Learoyd
- University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Reserve Road St Leonards, New South Wales, Australia
| | - Andrew Davidson
- Department of Neurosurgery, Level 2, Macquarie University, 2 Technology Place Macquarie University, New South Wales, Australia
| | - Bernard Champion
- Department of Clinical Medicine, Level 4, Macquarie University, 2 Technology Place, Macquarie University, New South Wales, Australia
| | - Veronica Preda
- Department of Clinical Medicine, Level 4, Macquarie University, 2 Technology Place, Macquarie University, New South Wales, Australia
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Wong SWP, Yap YW, Narayanan RP, Al-Jubouri M, Grossman A, Daousi C, Mahgoub Y. Etomidate in the management of severe Cushing's disease and MRSA bacteraemia in a district general hospital in the United Kingdom. Endocrinol Diabetes Metab Case Rep 2019; 2019:EDM190044. [PMID: 31967974 DOI: 10.1530/edm-19-0044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 08/20/2019] [Indexed: 11/08/2022] Open
Abstract
SUMMARY We report our experience on managing a case of florid Cushing's disease with Methicillin-resistant Staphylococcus aureus (MRSA) sepsis using intravenous etomidate in the intensive care unit of a UK district general hospital. LEARNING POINTS Severe Cushing's syndrome is associated with high morbidity and mortality. Etomidate is a safe and effective medical therapy to rapidly lower cortisol levels even in the context of severe sepsis and immunosuppression. Etomidate should ideally be administered in an intensive care unit but is still feasible in a district general hospital. During treatment with etomidate, accumulation of serum 11β-deoxycortisol (11DOC) levels can cross-react with laboratory cortisol measurement leading to falsely elevated serum cortisol levels. For this reason, serum cortisol measurement using a mass spectrometry assay should ideally be used to guide etomidate prescription.
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Affiliation(s)
- Stephanie Wei Ping Wong
- Department of Diabetes and EndocrinologySt Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, UK
| | - Yew Wen Yap
- Department of Diabetes and EndocrinologySt Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, UK
| | - Ram Prakash Narayanan
- Department of Diabetes and EndocrinologySt Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, UK
| | - Mohammad Al-Jubouri
- Department of BiochemistrySt Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, UK
| | - Ashley Grossman
- Centre for EndocrinologyWilliam Harvey Research Institute, Barts and London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Christina Daousi
- Department of Diabetes and EndocrinologyAintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - Yahya Mahgoub
- Department of Diabetes and EndocrinologySt Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, UK
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Astaf'eva LI, Sidneva YG, Kadashev BA, Kalinin PL, Melnichenko GA, Agadzhanian SA. Restoration of fertility in a woman with giant prolactinoma in response to cabergoline treatment. Endocrinol Diabetes Metab Case Rep 2019; 2019:EDM190023. [PMID: 31967975 DOI: 10.1530/edm-19-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 08/16/2019] [Indexed: 11/08/2022] Open
Abstract
SUMMARY A 32-year-old woman presented with primary amenorrhoea, prolactin (PRL) level of 154 150 mIU/L and was diagnosed with a giant pituitary adenoma measuring maximum 6.2 cm. Cabergoline (CAB) treatment at a dose of 0.5 mg/week was prescribed to the patient. The treatment decreased the tumour size after 3 months (MRI scans of the brain) and brought back to normal the level of the PRL (345 mIU/L) after 6 months of CAB treatment. After 7 months of CAB treatment, menarche was achieved, and after 12 months, the patient became pregnant. She discontinued taking CAB at 4-week gestation. The pregnancy resulted in a missed miscarriage at 6-7 weeks; an abortion was conducted by the vacuum aspiration method. The MRI scans of the brain did not show any tumour enlargement. After 18 months from the start of the treatment the patient got pregnant for the second time. At 25-week gestation an MRI scan of the brain was conducted which did not show any increase in the tumour size. At 38 weeks the patient delivered a healthy full-term girl via C-section. The patient chose not to breastfeed and resumed CAB therapy after the delivery. During the treatment, the PRL level returned to the normal range and the menstrual cycle was restored. After 3 years the patient got pregnant for the third time. The patient did not receive CAB during the pregnancies; the examination did not show any tumour enlargement. Further MRI scans did not show any tumour growth. CAB therapy was effective in normalization of the PRL level, tumour shrinkage, menarche and pregnancy-induction which led to the birth of healthy children in a woman with primary amenorrhoea and a giant prolactinoma invading the skull base bones. LEARNING POINTS Giant prolactinomas are very rarely found in women. Cabergoline therapy can be effective in the normalization of the PRL level, tumour shrinkage, menarche induction in a woman with primary amenorrhoea, and giant prolactinoma. Cabergoline therapy can be effective in pregnancy induction which leads to the birth of children in a woman with giant prolactinoma. Cabergoline discontinuation did not trigger tumour enlargement during pregnancy.
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Affiliation(s)
- L I Astaf'eva
- N.N. Burdenko National Medical Research Centre of NeurosurgeryMoscow, Russian Federation
| | - Y G Sidneva
- N.N. Burdenko National Medical Research Centre of NeurosurgeryMoscow, Russian Federation
| | - B A Kadashev
- N.N. Burdenko National Medical Research Centre of NeurosurgeryMoscow, Russian Federation
| | - P L Kalinin
- N.N. Burdenko National Medical Research Centre of NeurosurgeryMoscow, Russian Federation
| | - G A Melnichenko
- National Medical Research Centre of EndocrinologyMoscow, Russian Federation
| | - S A Agadzhanian
- Department of English Language for Natural FacultiesLomonosov Moscow State University, Moscow, Russian Federation
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Berges-Raso I, Giménez-Palop O, Gabau E, Capel I, Caixàs A, Rigla M. Kallmann syndrome and ichthyosis: a case of contiguous gene deletion syndrome. Endocrinol Diabetes Metab Case Rep 2017; 2017:EDM170083. [PMID: 30352392 DOI: 10.1530/edm-17-0083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 09/07/2017] [Indexed: 02/28/2024] Open
Abstract
Kallmann syndrome is a genetically heterogeneous form of hypogonadotropic hypogonadism caused by gonadotropin-releasing hormone deficiency and characterized by anosmia or hyposmia due to hypoplasia of the olfactory bulbs; osteoporosis and metabolic syndrome can develop due to longstanding untreated hypogonadism. Kallmann syndrome affects 1 in 10 000 men and 1 in 50 000 women. Defects in 17 genes, including KAL1, have been implicated. Kallmann syndrome can be associated with X-linked ichthyosis, a skin disorder characterized by early onset dark, dry, irregular scales affecting the limb and trunk, caused by a defect of the steroid sulfatase gene (STS). Both KAL1 and STS are located in the Xp22.3 region; therefore, deletions in this region cause a contiguous gene syndrome. We report the case of a 32-year-old man with ichthyosis referred for evaluation of excessive height (2.07 m) and weight (BMI: 29.6 kg/m2), microgenitalia and absence of secondary sex characteristics. We diagnosed Kallmann syndrome with ichthyosis due to a deletion in Xp22.3, a rare phenomenon. Learning points: Kallmann syndrome is a genetically heterogeneous disease characterized by hypogonadotropic hypogonadism with anosmia or hyposmia associated with defects in the production or action of gonadotropin-releasing hormone (GnRH) and hypoplasia of the olfactory bulbs. Several genes have been implicated in Kallmann syndrome, including KAL1, located in the Xp22.3 region, which is responsible for X-linked Kallmann syndrome. KAL1 encodes the protein anosmin-1. X-linked ichthyosis is caused by deficiency of the steroid sulfatase enzyme, encoded by STS, which is also located in the Xp22.3 region. Deletions involving this region can affect both genes and result in contiguous gene syndromes. Phenotype can guide clinicians toward suspicion of a specific genetic mutation. KAL1 mutations are mostly related to microgenitalia, unilateral renal agenesis and synkinesia, although patients need not present all these abnormalities. Longstanding untreated hypogonadism is associated with poor sexual health, osteoporosis and metabolic syndrome with the concomitant risk of developing type 2 diabetes mellitus and obesity. Treatment aims to promote the development of secondary sex characteristics, build and sustain normal bone and muscle mass and restore fertility. Treatment can also help minimize some psychological consequences. Treatments available for patients with congenital GnRH deficiency such as Kallmann syndrome include gonadal steroid hormones, human gonadotropins and GnRH. The choice of therapy depends on the goal or goals.
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Affiliation(s)
- Irene Berges-Raso
- Endocrinology Department, Parc Taulí University Hospital, Sabadell, Barcelona, Spain
| | - Olga Giménez-Palop
- Endocrinology Department, Parc Taulí University Hospital, Sabadell, Barcelona, Spain
| | - Elisabeth Gabau
- Endocrinology Department, Parc Taulí University Hospital, Sabadell, Barcelona, Spain
| | - Ismael Capel
- Endocrinology Department, Parc Taulí University Hospital, Sabadell, Barcelona, Spain
| | - Assumpta Caixàs
- Endocrinology Department, Parc Taulí University Hospital, Sabadell, Barcelona, Spain
| | - Mercedes Rigla
- Endocrinology Department, Parc Taulí University Hospital, Sabadell, Barcelona, Spain
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