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Hemorrhagic or ischemic pituitary apoplexy is a rare neuro-endocrine emergency, potentially leading to coma. Neuro-ophthalmic symptoms or complications are amongst the most prevalent clinical features at onset, especially in previously asymptomatic patients. Usually, permanent pituitary insufficiency of various degrees follows, implying long-term hormone substitutive therapy. Rarely, the association of pituitary apoplexy with diabetes insipidus has been noticed. We report the case of a young, apparently healthy 32-yearold man presenting with thunderclap headache, fever, optic chiasm compression, central diabetes insipidus and central thyro-gonadic insufficiency. Magnetic resonance imaging and neurosurgery revealed a clinically non-functioning macro-adenoma developing pituitary hemorrhage. One year after the apoplectic episode, complete recovery of diabetes insipidus and pituitary function was confirmed.

Thyroid hormones are involved in the regulation of basal metabolic state and in oxidative metabolism [1]. They can cause many changes in the number and activity of mitochondrial respiratory chain components. This may result in the increased generation of reactive oxygen species (ROS) [2,3]. Oxidative stress is a general term used to describe a state of damage caused by ROS [4]. ROS have a high reactivity potential, therefore they are toxic and can lead to oxidative damage in cellular macromolecules such as proteins, lipids and DNA [5].

Background We are hereby investigating for the first time the effect of the association ethinylestradiol30μg-drospirenone 3mg (DRP/EE30μg) plus metformin and weight loss on endothelial status and C-reactive protein (hsCRP) levels in polycystic ovary syndrome (PCOS). Methods 25 young women with PCOS (mean age 22.76 ± 0.83 years, body mass index (BMI): 28.44 ± 6.23) who completed the study were prospectively evaluated. The oral contraceptive- DRP/EE30μg (21 days/month) and metformin (1700 mg daily) were administered for 6 months to the PCOS group. Additionally, the 15 overweight and obese patients (BMI > 25 kg/m2) were instructed in a diet of no more than 1500 cal daily. Primary outcome measures were surrogate markers of cardiovascular disease and included endothelial function, i.e. flow-mediated dilatation (FMD) on the brachial artery and endothelin-1 levels, as well as hsCRP concentrations, body composition (measured by whole-body dual-energy X-ray-absorptiometry) and insulin resistance. Variables were assessed at baseline, as well as after our medical intervention. Results The combination between DRP/EE30μg plus metformin combined with weight loss triggered a significant improvement in the FMD values (FMD-PCOSbasal 3.48 ± 1.00 vs FMD-PCOS6 months7.43 ± 1.04, p = 0.033), as well as body composition and insulin insensitivity (p 6months – PCOSbasal) difference. Conclusion A 6-month course of metformin- DRP/EE30μg (associated with weight loss) improves the endothelial dysfunction in PCOS and shows neutral effects on hsCRP concentrations as an inflammation marker. These data demand for reevaluation of the medical therapy in PCOS, particularly in women with additional metabolic and cardiovascular risk factors (ClinicalTrials.gov Identifier: NCT01459445).

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age with a prevalence estimated at 4–8% (Azziz et al., 2004; Moran & Teede, 2009). It is associated with a range of reproductive, obstetric, metabolic and psychological features. Reproductive and obstetric manifestations include hyperandrogenism, menstrual dysfunction, infertility and pregnancy complications, such as early pregnancy loss, gestational diabetes, pregnancy-induced hypertensive disorders and neonatal complications (Boomsma et al., 2006). Additionally, women with PCOS cluster risk factors for cardiovascular disease (CVD) and type 2 diabetes mellitus (DM) as well as the metabolic syndrome (MS). As a consequence, metabolic complications and potential major long-term sequelaes include: an elevated risk of impaired glucose tolerance (IGT), type 2 DM (Legro, 1999, as cited in Moran & Teede, 2009), as well as an increased rate of hypertension and CVD (Shaw et al., 2008). Although there are still aspects to be cleared regarding the longterm consequences of these well-known cardiovascular (CV) risk factors, the research that has been conducted so far seems to indicate that patients with PCOS are at increased risk for adverse CV morbidity and mortality. Of utmost importance is the fact that these women are likely to develop CV disease early, and that even very young and nonobese patients may be affected (Moran & Teede, 2009; Lorenz & Wild, 2007).