DOCSLIB.ORG

An Update on the Pathophysiology and Diagnosis of Inappropriate Secretion of Thyroid-Stimulating Hormone

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text

Load more

International Journal of Molecular Sciences Review An Update on the Pathophysiology and Diagnosis of Inappropriate Secretion of Thyroid-Stimulating Hormone Kenji Ohba 1,2 1 Medical Education Center, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka 431-3192, Japan; [email protected]; Tel./Fax: +81-53-435-2843 2 Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka 431-3192, Japan Abstract: Inappropriate secretion of thyroid-stimulating hormone (IST), also known as central hy- perthyroidism, is a clinical condition characterized by elevated free thyroxine and triiodothyronine concentrations concurrent with detectable thyroid-stimulating hormone (TSH) concentrations. Simi- larly, the term syndrome of IST (SITSH) is widely used in Japan to refer to a closely related condition; however, unlike that for IST, an elevated serum free triiodothyronine concentration is not a requisite criterion for SITSH diagnosis. IST or SITSH is an important indicator of resistance to thyroid hormone β (RTHβ) caused by germline mutations in genes encoding thyroid hormone receptor β (TRβ) and TSH-secreting pituitary adenoma. Recent evidence has accumulated for several conditions associated with IST, including RTH without mutations in the TRβ gene (non-TR-RTH), the phenomenon of hysteresis involving the hypothalamus-pituitary-thyroid axis (HPT-axis), methodological interfer- ence, and Cushing’s syndrome after surgical resection. However, little information is available on the systematic pathophysiological aspects of IST in previous review articles. This report presents an overview of the recent advances in our understanding of the etiological aspects of IST that are relevant for diagnosis and treatment. Moreover, the report focuses on the potential mechanism of IST caused by hysteresis in the HPT-axis (lagging TSH recovery) in terms of epigenetic regulation. Citation: Ohba, K. An Update on the Pathophysiology and Diagnosis of Inappropriate Secretion of Keywords: thyroid function; inappropriate secretion of thyroid-stimulating hormone (IST); Thyroid-Stimulating Hormone. Int. J. syndrome of inappropriate secretion of thyroid-stimulating hormone (SITSH); genuine IST Mol. Sci. 2021, 22, 6611. https:// doi.org/10.3390/ijms22126611 Academic Editor: Noriyuki Koibuchi 1. Introduction Circulating concentrations of thyroid-stimulating hormone (TSH) and other thyroid Received: 7 June 2021 hormones are tightly regulated in healthy individuals [1]. The liganded thyroid hormone Accepted: 17 June 2021 receptor (TR) negatively regulates the synthesis and secretion of TSH in pituitary thy- Published: 21 June 2021 rotrophs, resulting in drastic decreases in serum TSH concentrations [2]. For example, the most common forms of hyperthyroidism, including Graves’ disease and toxic multinodular Publisher’s Note: MDPI stays neutral goiter, demonstrate elevated thyroid hormone levels with suppressed TSH concentrations. with regard to jurisdictional claims in Inappropriate secretion of TSH (IST) is characterized by the laboratory findings of published maps and institutional affil- elevated free thyroxine (T ) and triiodothyronine (T ) concentrations in the presence of iations. 4 3 detectable TSH concentrations [3,4], contrary to what happens in the most common forms of hyperthyroidism (Figure1A). This abnormal pattern in the thyroid function test is an im- portant hallmark of genetic and acquired disorders of the hypothalamus-pituitary-thyroid axis (HPT-axis), including resistance to thyroid hormone β (RTHβ) caused by germline Copyright: © 2021 by the author. mutations in genes encoding the β isoform of the TR (TRβ) and TSH-secreting pituitary Licensee MDPI, Basel, Switzerland. adenoma (TSHoma). Although previous review articles have sufficiently investigated This article is an open access article several conditions associated with IST, little information is available on systematic patho- distributed under the terms and physiological aspects of IST in previous review articles. In addition, a recent study has conditions of the Creative Commons revealed that diagnostic delay and inappropriate treatments (e.g., pituitary surgeries in Attribution (CC BY) license (https:// β creativecommons.org/licenses/by/ patients with RTH or thyroid ablation in patients with TSHoma) are still provided in 4.0/). several cases with thyroid hormone profiles suggestive of IST [5]. Int. J. Mol. Sci. 2021, 22, 6611. https://doi.org/10.3390/ijms22126611 https://www.mdpi.com/journal/ijms Int. J. Mol. Sci. 2021, 22, x FOR PEER REVIEW 2 of 11 addition, a recent study has revealed that diagnostic delay and inappropriate treatments (e.g., pituitary surgeries in patients with RTHβ or thyroid ablation in patients with Int. J. Mol. Sci. 2021, 22, 6611 2 of 11 TSHoma) are still provided in several cases with thyroid hormone profiles suggestive of IST [5]. ABSubclinical hypothyroidism TSH IST or range Within reference FT4 and FT3 FT4 Low High Within Low reference High Serum TSH concentration range IST SITSH Serum FT4 and FT3 concentrations Figure 1.1. TheThe differentdifferent hormonehormone profilesprofiles of of inappropriate inappropriate secretion secretion of of thyroid-stimulating thyroid-stimulating hormone hormone (IST) (IST) and and syndrome syndrome of ISTof IST (SITSH). (SITSH). (A) ( AA) schematic A schematic explanation explanation of the of difference the difference between between IST and IST SITSH. and SITSH. Note thatNote an that elevated an elevated free triiodothyro- free triio- ninedothyronine (FT3) concentration (FT3) concentration is a requisite is a requisite diagnostic diagnostic criterion criterion for IST. (forB) AIST. schematic (B) A schematic explanation explanation of the difference of the difference between ISTbetween and subclinicalIST and subclinical hypothyroidism. hypothyroidi Thesm. shaded The shaded region andregion striped and striped region representregion represent the areas the of areas IST andof IST subclinical and sub- clinical hypothyroidism, respectively. FT4, free thyroxine. hypothyroidism, respectively. FT4, free thyroxine. In this article, the author has performed a review of literature and has presented a balanced overview ofof thethe recentrecent advances advances in in our our understanding understanding of of the the clinical, clinical, biochemical, biochem- ical,and etiologicaland etiological aspects aspects of IST ofrelevant IST relevant for its for diagnosis. its diagnosis. 2. Definition Definition of IST The term “IST” waswas proposedproposed byby GershengornGershengorn and and Weintraub Weintraub in in 1975 1975 [6 [6].]. In In a a subse- sub- sequentquent report, report, IST IST was was described described as as a conditiona condition characterized characterized by by elevated elevated serum serum levels levels of ofimmunoreactive immunoreactive TSH TSH in thein the presence presence of elevatedof elevated free free thyroid thyroid hormone hormone concentrations concentrations [3]. [3].However, However, it has it has been been suggested suggested that that TSH TS secretionH secretion is compensatory is compensatory and and appropriate appropriate in inRTH RTHβ,β because, because the the response response to to thyroid thyroid hormones hormones in peripheralin peripheral tissues tissues is reducedis reduced due due to toimpairment impairment of theof the TR TR [7]. [7]. Beck-Peccoz Beck-Peccoz et al.et al. also also suggested suggested that that the the definition definition of “IST” of “IST” ap- appearspears inadequate, inadequate, as itas does it does not reflect not reflect the pathophysiological the pathophysiological events underlying events underlying TSHoma TSHomaand RTH βand[4]. RTH Therefore,β [4]. theTherefore, authors proposedthe authors the proposed term “central the hyperthyroidism”term “central hyperthy- instead roidism”of IST, because instead TSH of IST, itself because is responsible TSH itself for theis responsible hyperstimulation for the ofhyperstimulation the thyroid gland ofand the thyroidthe consequent gland and thyrotoxicosis. the consequent thyrotoxicosis. The term “syndrome of inappropriateinappropriate secretionsecretion ofof thyroid-stimulatingthyroid-stimulating hormonehormone (SITSH)” has has been been widely widely used used in in journal journal ar articlesticles and and textbooks textbooks written written by byJapanese Japanese re- searchersresearchers since since the the late late 1980s. 1980s. Based Based on on th thee 2016 2016 Japan Japan Thyroid Thyroid Association Association (JTA) (JTA) guide- guide- β lines for the diagnosis of RTHβ, SITSH is defineddefined as being characterized by elevatedelevated freefree T and normal-to-elevated TSH concentrations [8] (Figure1A). An elevated serum free T4 and normal-to-elevated TSH concentrations [8] (Figure 1A). An elevated serum free T3 Tconcentration3 concentration is not is not a requisite a requisite criterion criterion for for SITSH SITSH diagnosis. diagnosis. In In this this study, study, the author conducted a MEDLINE search using the keyword “SITSH” to retrieve relevant articles pub- conducted a MEDLINE search using the keyword “SITSH” to retrieve relevant articles lished between 1975 and 2020. The literature search yielded 30 articles, of which 28 were published between 1975 and 2020. The literature search yielded 30 articles, of which 28 published in Japanese institutions. were published in Japanese institutions. Physicians must keep in mind
Recommended publications

  • Hyperthyroidism with an FSH- and TSH-Secreting Pituitary Adenoma

    • Hyperthyroidism with an FSH- and TSH-secreting pituitary adenoma JOHN BERMINGHAM, DO LOUIS C. HAENEL, DO A 34-year-old man was found noma is rare. The combined secretion of follicle- to have elevated thyroxine (T 4 ), triiodothy- stimulating hormone (FSH) and TSH by a pi- ronine (T3 ), calculated free T4 , thyroid- tuitary adenoma is rarer. But with current stimulating hormone (TSH), follicle-stimu- widespread use of TSH assays, plus the future lating hormone (FSH), and alpha subunits clinical availability of more sensitive TSH as- of TSH and FSH. A computed tomography says as well as TSH bioactivity testing, more scan of the head showed a 16-mm mac- patients will have pituitary-induced hyperthy- roadenoma of the pituitary gland. There roidism correctly diagnosed, and the disorder was no evidence of loss or excess secre- will be better understood. tion of other pituitary hormones. The large As illustrated in the following case study, chromophobe adenoma was removed via making the correct diagnosis of primary ver- a transphenoidal approach. The patient sus secondary hyperthyroidism is imperative has been taken off all medication. Thyroid because the treatment and potential conse- function has returned to normal and there quences of each of these diseases are totally has been no loss of pituitary secretory ca- different. pacity of other pituitary hormones. The oc- currence of a combined TSH- and FSH- Report of case secreting pituitary adenoma is rare; to the In August 1985, a 34-year-old man was seen with authors knowledge, only one case has complaints that were initially vague and nonspe- been documented in the literature.
  • A Case of Malignant Insulinoma Responsive to Somatostatin Analogs

    A Case of Malignant Insulinoma Responsive to Somatostatin Analogs

    Caliri et al. BMC Endocrine Disorders (2018) 18:98 https://doi.org/10.1186/s12902-018-0325-4 CASE REPORT Open Access A case of malignant insulinoma responsive to somatostatin analogs treatment Mariasmeralda Caliri1†, Valentina Verdiani1†, Edoardo Mannucci2, Vittorio Briganti3, Luca Landoni4, Alessandro Esposito4, Giulia Burato5, Carlo Maria Rotella2, Massimo Mannelli1 and Alessandro Peri1* Abstract Background: Insulinoma is a rare tumour representing 1–2% of all pancreatic neoplasms and it is malignant in only 10% of cases. Locoregional invasion or metastases define malignancy, whereas the dimension (> 2 cm), CK19 status, the tumor staging and grading (Ki67 > 2%), and the age of onset (> 50 years) can be considered elements of suspect. Case presentation: We describe the case of a 68-year-old man presenting symptoms compatible with hypoglycemia. The symptoms regressed with food intake. These episodes initially occurred during physical activity, later also during fasting. The fasting test was performed and the laboratory results showed endogenous hyperinsulinemia compatible with insulinoma. The patient appeared responsive to somatostatin analogs and so he was treated with short acting octreotide, obtaining a good control of glycemia. Imaging investigations showed the presence of a lesion of the uncinate pancreatic process of about 4 cm with a high sst2 receptor density. The patient underwent exploratory laparotomy and duodenocephalopancreasectomy after one month. The definitive histological examination revealed an insulinoma (T3N1MO, AGCC VII G1) with a low replicative index (Ki67: 2%). Conclusions: This report describes a case of malignant insulinoma responsive to octreotide analogs administered pre- operatively in order to try to prevent hypoglycemia. The response to octreotide analogs is not predictable and should be initially assessed under strict clinical surveillance.
  • A Case of Cushing Syndrome with Both Secondary Hypothyroidism and Hypercalcemia Due to Postoperative Adrenal Insufficiency

    A Case of Cushing Syndrome with Both Secondary Hypothyroidism and Hypercalcemia Due to Postoperative Adrenal Insufficiency

    Endocrine Journal 2004, 51 (1), 105–113 NOTE A Case of Cushing Syndrome with Both Secondary Hypothyroidism and Hypercalcemia Due to Postoperative Adrenal Insufficiency MASAHITO KATAHIRA, TSUTOMU YAMADA* AND MASAHIKO KAWAI* Department of Internal Medicine, Kyoritsu General Hospital, Nagoya 456-8611, Japan *Division of Endocrinology, Department of Internal Medicine, Okazaki City Hospital, Okazaki 444-8553, Japan Abstract. A 48-year-old woman was referred to our hospital because of secondary hypothyroidism. Upon admission a left adrenal tumor was also detected using computed tomography. Laboratory data and adrenal scintigraphy were compatible with Cushing syndrome due to the left adrenocortical adenoma, although she showed no response to the TRH stimulation test. Hypercortisolism resulting in secondary hypothyroidism was diagnosed. After a left adrenalectomy, hydrocortisone administration was begun and the dose was reduced gradually. After discharge on the 23rd postoperative day, she began to suffer from anorexia. ACTH level remained low, and serum cortisol, free thyroxine and TSH levels were within the normal range. Since her condition became worse, she was re-admitted on the 107th postoperative day at which time serum calcium level was high (15.6 mg/dl). Both ACTH response to the CRH stimulation test and TSH response to the TRH stimulation test were restored to almost normal levels, but there was no response of cortisol to CRH stimulation test. We diagnosed that the hypercalcemia was due to adrenal insufficiency. Although the serum calcium level decreased to normal after hydrocortisone was increased (35 mg/day), secondary hypothyroidism recurred. It was suggested that sufficient glucocorticoids suppressed TSH secretion mainly at the pituitary level, which resulted in secondary (corticogenic) hypothyroidism.
  • Current Medicine: Current Aspects of Thyroid Disease

    Current Medicine: Current Aspects of Thyroid Disease

    CURRENT MEDICINE CM CURRENT ASPECTS OF THYROID DISEASE J.H. Lazarus, Department of Medicine, University of Wales College of Medicine, Cardiff INTRODUCTION solved) the details of the immune dysfunction in these During the past two decades or so, advances in immunology conditions. Since the description of the HLA system and and molecular biology have contributed to a substantial the association of certain haplotypes with autoimmune increase in our understanding of many aspects of the endocrine disease, including Graves’ disease and Hashimoto’s pathophysiology of thyroid disease.1 This review will thyroiditis, it was anticipated that the immunogenetics of indicate some of these advances prior to illustrating their these diseases would shed definitive light on their significance in clinical practice. Emphasis is placed on pathogenesis. This hope has only been partially achieved, recent developments and it is not intended to provide full and the relative risk of the HLA haplotype has been low; clinical descriptions. other factors must be sought. Developments in the understanding of the interaction between the T lymphocyte THYROID HORMONE ACTION and the presentation of antigen (e.g. co-stimulatory signals) Since the discovery that the thyroid hormone receptor is have enabled further immunological insight.5 However, derived from the erb c oncogene, it has been realised that the role of environmental factors should not be overlooked. there are two receptor types, alpha and beta, whose genes The ambient iodine concentration may affect the incidence are located on chromosomes 3 and 17 respectively.2 There of autoimmune thyroid disease, and iodine has documented is now known to be differential tissue distribution of the immune effects in the thyroid gland both in vitro and in active TRs alpha 1 and beta 1 and 2.
  • Clinical Research Protocol

    Clinical Research Protocol

    CLINICAL RESEARCH PROTOCOL NCT02399475 The Thyroid Axis in Older Individuals with Persistent Subclinical Hypothyroidism: a Mechanistic, Randomized, Double-Blind, Cross-Over Study of Levothyroxine and Liothyronine Administration Regulatory Sponsor: Anne R. Cappola, MD, ScM Division of Endocrinology, Diabetes, and Metabolism 12-136 Translational Research Center 3400 Civic Center Blvd, Bldg 421 Philadelphia, PA 19104-5160 (215) 573 5359 Funding Sponsor: National Institute on Aging, NIH Medications Used: Thyrotropin Releasing Hormone (TRH) Levothyroxine (LT4) Liothyronine (LT3) Protocol Number: 821564 IND Number: 125167 Initial version:[11/26/2014] Amended [7/22/2015] Amended: [12/18/2014] Amended [9/9/2015] Amended: [1/2/2015] Amended [8/25/2016] Amended: [3/26/2015] Amended [12/23/2016] Amended: [5/13/2015] Amended [3/24/2017] Amended: [06/04/2015] Amended [9/26/2017] Amended: [6/10/2015] Amended [12/18/2017] (additional next page) Amended [12/18/18] CONFIDENTIAL This material is the property of the University of Pennsylvania. Do not disclose or use except as authorized in writing by the study sponsor LT4 and LT3 in Subclinical Hypothyroidism Page ii Version 12/18/2018 Table of Contents STUDY SUMMARY ......................................................................................................... 1 1 INTRODUCTION ...................................................................................................... 3 1.1 BACKGROUND ....................................................................................................
  • Thyroiditis: an Integrated Approach LORI B

    Thyroiditis: an Integrated Approach LORI B

    Thyroiditis: An Integrated Approach LORI B. SWEENEY, MD, Virginia Commonwealth University Health System, Richmond, Virginia CHRISTOPHER STEWART, MD, Bayne-Jones Army Community Hospital, Fort Polk, Louisiana DAVID Y. GAITONDE, MD, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia Thyroiditis is a general term that encompasses several clinical disorders characterized by inflammation of the thyroid gland. The most common is Hashimoto thyroiditis; patients typically present with a nontender goiter, hypothyroid- ism, and an elevated thyroid peroxidase antibody level. Treatment with levothyroxine ameliorates the hypothyroid- ism and may reduce goiter size. Postpartum thyroiditis is transient or persistent thyroid dysfunction that occurs within one year of childbirth, miscarriage, or medical abortion. Release of preformed thyroid hormone into the bloodstream may result in hyperthyroidism. This may be followed by transient or permanent hypothyroidism as a result of depletion of thyroid hormone stores and destruction of thyroid hormone–producing cells. Patients should be monitored for changes in thyroid function. Beta blockers can treat symptoms in the initial hyperthyroid phase; in the subsequent hypothyroid phase, levothyroxine should be considered in women with a serum thyroid-stimulating hormone level greater than 10 mIU per L, or in women with a thyroid-stimulating hormone level of 4 to 10 mIU per L who are symptomatic or desire fertility. Subacute thyroiditis is a transient thyrotoxic state characterized by anterior neck pain, suppressed thyroid-stimulating hormone, and low radioactive iodine uptake on thyroid scanning. Many cases of subacute thyroiditis follow an upper respiratory viral illness, which is thought to trigger an inflammatory destruction of thyroid follicles. In most cases, the thyroid gland spontaneously resumes normal thyroid hormone production after several months.
  • Kaplan & Sadock's Study Guide and Self Examination Review In

    Kaplan & Sadock's Study Guide and Self Examination Review In

    Kaplan & Sadock’s Study Guide and Self Examination Review in Psychiatry 8th Edition ← ↑ → © 2007 Lippincott Williams & Wilkins Philadelphia 530 Walnut Street, Philadelphia, PA 19106 USA, LWW.com 978-0-7817-8043-8 © 2007 by LIPPINCOTT WILLIAMS & WILKINS, a WOLTERS KLUWER BUSINESS 530 Walnut Street, Philadelphia, PA 19106 USA, LWW.com “Kaplan Sadock Psychiatry” with the pyramid logo is a trademark of Lippincott Williams & Wilkins. All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form or by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. Printed in the USA Library of Congress Cataloging-in-Publication Data Sadock, Benjamin J., 1933– Kaplan & Sadock’s study guide and self-examination review in psychiatry / Benjamin James Sadock, Virginia Alcott Sadock. —8th ed. p. cm. Includes bibliographical references and index. ISBN 978-0-7817-8043-8 (alk. paper) 1. Psychiatry—Examinations—Study guides. 2. Psychiatry—Examinations, questions, etc. I. Sadock, Virginia A. II. Title. III. Title: Kaplan and Sadock’s study guide and self-examination review in psychiatry. IV. Title: Study guide and self-examination review in psychiatry. RC454.K36 2007 616.890076—dc22 2007010764 Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication.
  • Hashimoto Thyroiditis

    Hashimoto Thyroiditis

    Hashimoto thyroiditis Description Hashimoto thyroiditis is a condition that affects the function of the thyroid, which is a butterfly-shaped gland in the lower neck. The thyroid makes hormones that help regulate a wide variety of critical body functions. For example, thyroid hormones influence growth and development, body temperature, heart rate, menstrual cycles, and weight. Hashimoto thyroiditis is a form of chronic inflammation that can damage the thyroid, reducing its ability to produce hormones. One of the first signs of Hashimoto thyroiditis is an enlargement of the thyroid called a goiter. Depending on its size, the enlarged thyroid can cause the neck to look swollen and may interfere with breathing and swallowing. As damage to the thyroid continues, the gland can shrink over a period of years and the goiter may eventually disappear. Other signs and symptoms resulting from an underactive thyroid can include excessive tiredness (fatigue), weight gain or difficulty losing weight, hair that is thin and dry, a slow heart rate, joint or muscle pain, and constipation. People with this condition may also have a pale, puffy face and feel cold even when others around them are warm. Affected women can have heavy or irregular menstrual periods and difficulty conceiving a child ( impaired fertility). Difficulty concentrating and depression can also be signs of a shortage of thyroid hormones. Hashimoto thyroiditis usually appears in mid-adulthood, although it can occur earlier or later in life. Its signs and symptoms tend to develop gradually over months or years. Frequency Hashimoto thyroiditis affects 1 to 2 percent of people in the United States.
  • Management of Women with Premature Ovarian Insufficiency

    Management of Women with Premature Ovarian Insufficiency

    Management of women with premature ovarian insufficiency Guideline of the European Society of Human Reproduction and Embryology POI Guideline Development Group December 2015 1 Disclaimer The European Society of Human Reproduction and Embryology (hereinafter referred to as 'ESHRE') developed the current clinical practice guideline, to provide clinical recommendations to improve the quality of healthcare delivery within the European field of human reproduction and embryology. This guideline represents the views of ESHRE, which were achieved after careful consideration of the scientific evidence available at the time of preparation. In the absence of scientific evidence on certain aspects, a consensus between the relevant ESHRE stakeholders has been obtained. The aim of clinical practice guidelines is to aid healthcare professionals in everyday clinical decisions about appropriate and effective care of their patients. However, adherence to these clinical practice guidelines does not guarantee a successful or specific outcome, nor does it establish a standard of care. Clinical practice guidelines do not override the healthcare professional's clinical judgment in diagnosis and treatment of particular patients. Ultimately, healthcare professionals must make their own clinical decisions on a case-by-case basis, using their clinical judgment, knowledge, and expertise, and taking into account the condition, circumstances, and wishes of the individual patient, in consultation with that patient and/or the guardian or carer. ESHRE makes no warranty, express or implied, regarding the clinical practice guidelines and specifically excludes any warranties of merchantability and fitness for a particular use or purpose. ESHRE shall not be liable for direct, indirect, special, incidental, or consequential damages related to the use of the information contained herein.
  • Hematological Diseases and Osteoporosis

    Hematological Diseases and Osteoporosis

    International Journal of Molecular Sciences Review Hematological Diseases and Osteoporosis , Agostino Gaudio * y , Anastasia Xourafa, Rosario Rapisarda, Luca Zanoli , Salvatore Santo Signorelli and Pietro Castellino Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; [email protected] (A.X.); [email protected] (R.R.); [email protected] (L.Z.); [email protected] (S.S.S.); [email protected] (P.C.) * Correspondence: [email protected]; Tel.: +39-095-3781842; Fax: +39-095-378-2376 Current address: UO di Medicina Interna, Policlinico “G. Rodolico”, Via S. Sofia 78, 95123 Catania, Italy. y Received: 29 April 2020; Accepted: 14 May 2020; Published: 16 May 2020 Abstract: Secondary osteoporosis is a common clinical problem faced by bone specialists, with a higher frequency in men than in women. One of several causes of secondary osteoporosis is hematological disease. There are numerous hematological diseases that can have a deleterious impact on bone health. In the literature, there is an abundance of evidence of bone involvement in patients affected by multiple myeloma, systemic mastocytosis, thalassemia, and hemophilia; some skeletal disorders are also reported in sickle cell disease. Recently, monoclonal gammopathy of undetermined significance appears to increase fracture risk, predominantly in male subjects. The pathogenetic mechanisms responsible for these bone loss effects have not yet been completely clarified. Many soluble factors, in particular cytokines that regulate bone metabolism, appear to play an important role. An integrated approach to these hematological diseases, with the help of a bone specialist, could reduce the bone fracture rate and improve the quality of life of these patients.
  • Endocrine Causes of Secondary Osteoporosis in Adults

    Endocrine Causes of Secondary Osteoporosis in Adults

    DOI: 10.7860/JCDR/2021/45677.14471 Review Article Endocrine Causes of Secondary Osteoporosis Section in Adults: Mechanisms and Evaluation Internal Medicine HIMANSHU SHARMA1, ANSHUL KUMAR2, BALRAM SHARMA3, NAINCY PURWAR4, SANDEEP K MATHUR5, SANJAY SARAN6 ABSTRACT Osteoporosis and fragility fractures are a major public health issue. Secondary osteoporosis is characterised by the presence of an underlying disease, deficiency, or use of a drug. Conditions that increase speculation for secondary osteoporosis include fragility fractures amongst the younger men or premenopausal women, markedly decreased Bone Mineral Density (BMD) values, and fractures despite conforming to anti-osteoporotic therapy. Since the emphasis is on the treatment of the primary disorder, a diagnosis of osteoporosis and thus the opportunity of preventive intervention can be missed. With this review, the authors objective is to emphasise the importance of secondary osteoporosis, discuss the causes and their mechanism and summarise treatment options. Keywords: Fragility fractures, Hyperparathyroidism, Hyperthyroidism, Hypogonadism induced osteoporosis, Steroid-induced osteoporosis INTRODUCTION Autoimmune Rheumatoid Arthritis (RA), Lupus erythematosus, Multiple Osteoporosis is a affliction characterised by decreased bone mass disorders sclerosis, Ankylosing spondylitis and mineral density with poor bone quality predisposing to fracture Leukaemia; haemophilia, sickle cell anaemia, thalassaemia, Neoplastic and metastatic disease; myelofibrosis, lymphoma; multiple in both men and women and is the most common bone disease [1]. Hematologic myeloma; systemic mastocytosis; monoclonal The presence of fragility fractures predominates the clinical features disorders Gammopathy of unknown significance. Breast and of severe osteoporosis. Osteoporosis and the resulting fragility prostate cancer fractures are major public health burdens both humanly and Coeliac disease, Weight loss surgery, Gastrectomy and other Gastrointestinal causes of malabsorption including chronic pancreatitis; liver economically.
  • Multiple Endocrine Neoplasia Type 2: an Overview Jessica Moline, MS1, and Charis Eng, MD, Phd1,2,3,4

    Multiple Endocrine Neoplasia Type 2: an Overview Jessica Moline, MS1, and Charis Eng, MD, Phd1,2,3,4

    GENETEST REVIEW Genetics in Medicine Multiple endocrine neoplasia type 2: An overview Jessica Moline, MS1, and Charis Eng, MD, PhD1,2,3,4 TABLE OF CONTENTS Clinical Description of MEN 2 .......................................................................755 Surveillance...................................................................................................760 Multiple endocrine neoplasia type 2A (OMIM# 171400) ....................756 Medullary thyroid carcinoma ................................................................760 Familial medullary thyroid carcinoma (OMIM# 155240).....................756 Pheochromocytoma ................................................................................760 Multiple endocrine neoplasia type 2B (OMIM# 162300) ....................756 Parathyroid adenoma or hyperplasia ...................................................761 Diagnosis and testing......................................................................................756 Hypoparathyroidism................................................................................761 Clinical diagnosis: MEN 2A........................................................................756 Agents/circumstances to avoid .................................................................761 Clinical diagnosis: FMTC ............................................................................756 Testing of relatives at risk...........................................................................761 Clinical diagnosis: MEN 2B ........................................................................756