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Unlabelled: Maternal hypertiroidism is a relative rare disorder, which can seriously complicate pregnancy in each of its periods. There are several maternal and fetal complications during pregnancy, delivery and postpartum period. Correct management includes an accurate diagnosis, rigorous individualized treatment and minutious follow-up. We are presenting a retrospective study of 38 pregnant women who delivered in the Obstetric Unit of the University Emergency Bucharest Hospital in the past five years. We established a follow-up protocol in collaboration with endocrinologists. Precocious diagnosis of pregnancy is, in our opinion, mandatory. Accurate diagnosis of hormonal status beginning from the first week of pregnancy is of great importance. Maternal (weight, BP, TSH, thyroid hormones, ECG, etc.) and fetal (ultrasound, non-stress test, Doppler study) evaluation during pregnancy were rigorous performed., Results: abortion rate was 5%; 15% of pregnant women delivered prematurely; cesarean section rate was 22%; fetal outcome was excellent. Treatment adjustment during pregnancy was frequent, 28% of pregnant women had no hormonal treatment in the last trimester of pregnancy. Maternal complications were rare (poor weight gain, tachycardia). Fetal complications included low birth weight (24%), fetal respiratory distress (10%)., Conclusions: team work with experienced endocrinologists and understanding of versatility of disease leads to good prognosis of mother and fetus in presence of hypertiroidism.

Dual-energy X-ray absorptiometry (DXA) is commonly used in the care of patients for diagnostic classification of osteoporosis, low bone mass (osteopenia), or normal bone density; assessment of fracture risk; and monitoring changes in bone density over time. The development of other technologies for the evaluation of skeletal health has been associated with uncertainties regarding their applications in clinical practice. Quantitative ultrasound (QUS), a technology for measuring properties of bone at peripheral skeletal sites, is more portable and less expensive than DXA, without the use of ionizing radiation. The proliferation of QUS devices that are technologically diverse, measuring and reporting variable bone parameters in different ways, examining different skeletal sites, and having differing levels of validating data for association with DXA-measured bone density and fracture risk, has created many challenges in applying QUS for use in clinical practice. The International Society for Clinical Densitometry (ISCD) 2007 Position Development Conference (PDC) addressed clinical applications of QUS for fracture risk assessment, diagnosis of osteoporosis, treatment initiation, monitoring of treatment, and quality assurance/quality control. The ISCD Official Positions on QUS resulting from this PDC, the rationale for their establishment, and recommendations for further study are presented here.

The CDK inhibitor p27 plays a pivotal role in controlling cell proliferation during development, and has been implicated in tumorigenesis. Previous studies have demonstrated changes in p27 protein expression, but not in mRNA levels, in human pituitary tumors. It seems probable that the fall in p27 is due to increased degradation through the ubiquitin-proteasome pathway. Skp2 (S-phase kinase-interacting protein) is a specific F-box protein that allows the recognition and binding of phosphorylated p27 to the ubiquitin complex. The aim of our study was thus to investigate the possible role of Skp2 in pituitary tumorigenesis. A total of 59 human pituitary samples, 7 normal and 52 adenomas, were assessed for transcriptional expression of Skp2; 51 pituitary samples were assessed for protein expression. Real-time RT-PCR was performed on cDNA of reverse-transcribed mRNA for relative quantification of the Skp2 transcript. Immunostaining was performed using mouse monoclonal anti-Skp2 antibody. Skp2 mRNA and protein was detectable in every sample studied. Our results showed no significant difference between the pituitary tumors and normal pituitary tissue in Skp2 mRNA or nuclear protein expression. Individual tumor types had similar mRNA expression and variable protein expression. However, samples with high p27 protein expression showed significantly less Skp2 expression than samples with low p27 staining. Our data suggest that increased p27 degradation through the ubiquitin-proteasome pathway could be regulated in pituitary tumors by changes in Skp2 expression, although other factors probably also play a role.

The aim of the study was to evaluate the osteoporotic fracture risk in premenopausal women with hyperprolactinemia due to prolactinoma. Bone mineral density (BMD) was measured in 20 white, premenopausal women with prolactinoma and in 60 healthy control white women, using quantitative ultrasound (QUS) at the os calcis, with an Achilles Lunar Plus device. We measured all three parameters of QUS: broadband ultrasound attenuation (BUA), speed of sound (SOS) and stiffness. BMD results were expressed also as T- and Z-scores. Age and body mass index (BMI) were not statistically significantly different between the two groups. Comparative analysis showed reduced values of QUS parameters in women with prolactinoma versus controls. Only the difference in SOS parameter was statistically significant between the two studied groups (p = 0.0001). The Z-score was significant lower in women with prolactinoma than in healthy women. These data reveal a significant bone loss in women with prolactinoma compared to controls. The SOS parameter showed a good negative correlation with age, and all the QUS parameters were positively correlated with BMI. The relative risk for developing osteoporosis in women with prolactinoma was found to be 4.5, indicating that hyperprolactinemia in women is a major risk factor for osteoporosis.

Growth hormone (GH), prolactin (PRL) and gonadotropins (LH and FSH) of cerebrospinal fluid (CSF) and serum were radioimmunologically measured in basal condition in 75 cases and during the stimulation with releasing hormones in 24 of cases, i.e. with TRH plus LRH i.v. Samples were obtained from 75 patients of the following groups: A. control group of 9 patients without endocrine diseases; B. 8 patients with nontumoral diseases, of whom 4 with organic cranial diabetes insipidus and 4 with empty sella syndromes; C. 36 patients with invasive tumors i.e. 6 hypothalamic metastatic carcinomas and 300 invasive pituitary adenomas; D. 22 patients with enclosed tumors, i.e. 1 suprasellar dermoid cyst and 21 enclosed pituitary adenomas. Minimum 3 pituitary hormones were measured in each analyzed sample, and only those hormones, not secreted by the tumoral cells, were analyzed for their differential penetration into the CSF. An increase of the permeability of the blood-CSF barrier (BCB) was frequently observed in the group of invasive tumors and occasionally in the other tumoral or non-tumoral groups. The serum/CSF ratios of gonadotropins become significantly lower than the ratios of GH and PRL in the invasive groups (p less than 0.02), and here the CSF level was correlated to the increases of the serum levels during LRH plus TRH i.v. test only for gonadotropins. These data suggest that the specificity of BCB is not lost, but altered by the tumors of the hypothalamo-hypophyseal region, with an increase of the permeability for gonadotropins more than for GH or PRL.