Paragangliomas are neuroendocrine tumors that arise in relation to the sympathetic or parasympathetic ganglia of the autonomic nervous system. Rarely, they are reported in unusual locations such as the urinary bladder...Paragangliomas are neuroendocrine tumors that arise in relation to the sympathetic or parasympathetic ganglia of the autonomic nervous system. Rarely, they are reported in unusual locations such as the urinary bladder, prostate, and uterus. Herein, we report a case of primary cutaneous paraganglioma of the scalp in a child. The tumor was studied histologically, immunohistochemically,and ultrastructurally. This case might represent an aberrant migration of neural crest cells in their descent toward the branchial arches. In addition, it highlights the complex interaction of the neural crest and branchial arches/clefts during embryogenesis.展开更多
Objective This study was undertaken to compare clinical and biochemic al charac teristics of the insulin resistant (IR) and non-IR subphenotypes of polycystic ovary syndrome (PCOS). Study design Infertile PCOS women w...Objective This study was undertaken to compare clinical and biochemic al charac teristics of the insulin resistant (IR) and non-IR subphenotypes of polycystic ovary syndrome (PCOS). Study design Infertile PCOS women were classified as IR ( n=32) or non-IR(n=46) on the basis of fasting glucose and insulin levels. The i ncidence of acanthosis nigricans (AN), hirsutism, and ovulation in response to c lomiphene citrate (CC) was compared between the 2 groups, along with serum level s of gonadotropins, and sex steroids. Blood samples from 28 PCOS patients and 8 controls were analyzed by enzymatic immunoassay for autophosphorylated insulin r eceptor (APIR) and total insulin receptor (TIR) content. Results Insulin resista nce was associated with obesity (odds ratio <OR]=3.5, P < .05), AN (OR=6.0, P < .05), hirsutism (OR=3.1, P < .05), and resistance to CC (OR=5.0, P < .05). Mean levels of LH, LH/FSH ratios, and testosterone were lower in women with IR (11.5 ±6.8mIU/mL, 2.0 ±1.0, and 56.6 ±29.0 ng/dL, respectively) compared with women without IR (15.0 ±13.4 mIU/mL, 2.4 ±1.5, and 72.5 ±29.8 ng/dL, respectively) (P < .05). Mean APIR/TIR ratios in IR women were lower than in non-IR women (P < .05 at 100 nmol/L of insulin) and controls (P < .01 at 1, 10 and 100 nmol/L i nsulin). Conclusion Patients with IR are more likely to be obese and have AN, hi rsutism, resistance to CC, and lower LH, LH/FSH ratios, and testosterone levels. Furthermore, IR patients appear to have defective autophosphorylation of the in sulin receptor, a key element in insulin action, and a possible mechanism for IR in PCOS.展开更多
Objective: To evaluate the signs and symptoms associated with hyperprolactinemia and establish guidelines for a minimal serum PRL level for which pituitary imaging is indicated. Design: Retrospective study. Setting: R...Objective: To evaluate the signs and symptoms associated with hyperprolactinemia and establish guidelines for a minimal serum PRL level for which pituitary imaging is indicated. Design: Retrospective study. Setting: Reproductive endocrinology clinic in a university hospital. Patient(s): One hundred four consecutive patients with hyperprolactinemia, mean age 30 ± 6.5 (range 19- 44) years. Intervention(s): Classification of clinical symptoms, serum hormone measurements, and pituitary magnetic resonance imaging (MRI). Main Outcome Measure(s): Incidence of presenting symptoms, serum PRL levels, and pituitary tumor size. Result(s): Median (range)- PRL value was 82.6 ng/mL (25- 1,342). Reported symptoms from most to least common were infertility (48% ), headaches (39% ), oligoamenorrhea (29% ), galactorrhea (24% ), and visual changes (13% ). Hypothyroidism was diagnosed in 2 of 104 (1.9% ) patients. Of 86 patients who had pituitary imaging, 23 (26% ) had normal findings and 63 (74% ) had pituitary tumor; of these, 47 (55% of total imaged) had microadenomas and 16 (19% of total imaged) had macroadenomas. There was a statistically significant association between the tumor sizeand the PRL level. However, 11% of the patients with microadenomas had PRL levels >200 ng/mL, and 44% of the patients with macroadenomas had PRL levels between 25 and 200 ng/mL. Conclusion(s): The most common symptoms in the population studied were infertility and headaches. Coexisting thyroid disease was an uncommon finding. Most patients had a pituitary tumor on MRI. Although tumor size correlated with the serum PRL level, some macroadenomas were detected in women with only moderately elevated PRL values. On the basis of these findings, pituitary imaging should be obtained to identify pituitary tumors in all patients with persistently elevated PRL levels.展开更多
文摘Paragangliomas are neuroendocrine tumors that arise in relation to the sympathetic or parasympathetic ganglia of the autonomic nervous system. Rarely, they are reported in unusual locations such as the urinary bladder, prostate, and uterus. Herein, we report a case of primary cutaneous paraganglioma of the scalp in a child. The tumor was studied histologically, immunohistochemically,and ultrastructurally. This case might represent an aberrant migration of neural crest cells in their descent toward the branchial arches. In addition, it highlights the complex interaction of the neural crest and branchial arches/clefts during embryogenesis.
文摘Objective This study was undertaken to compare clinical and biochemic al charac teristics of the insulin resistant (IR) and non-IR subphenotypes of polycystic ovary syndrome (PCOS). Study design Infertile PCOS women were classified as IR ( n=32) or non-IR(n=46) on the basis of fasting glucose and insulin levels. The i ncidence of acanthosis nigricans (AN), hirsutism, and ovulation in response to c lomiphene citrate (CC) was compared between the 2 groups, along with serum level s of gonadotropins, and sex steroids. Blood samples from 28 PCOS patients and 8 controls were analyzed by enzymatic immunoassay for autophosphorylated insulin r eceptor (APIR) and total insulin receptor (TIR) content. Results Insulin resista nce was associated with obesity (odds ratio <OR]=3.5, P < .05), AN (OR=6.0, P < .05), hirsutism (OR=3.1, P < .05), and resistance to CC (OR=5.0, P < .05). Mean levels of LH, LH/FSH ratios, and testosterone were lower in women with IR (11.5 ±6.8mIU/mL, 2.0 ±1.0, and 56.6 ±29.0 ng/dL, respectively) compared with women without IR (15.0 ±13.4 mIU/mL, 2.4 ±1.5, and 72.5 ±29.8 ng/dL, respectively) (P < .05). Mean APIR/TIR ratios in IR women were lower than in non-IR women (P < .05 at 100 nmol/L of insulin) and controls (P < .01 at 1, 10 and 100 nmol/L i nsulin). Conclusion Patients with IR are more likely to be obese and have AN, hi rsutism, resistance to CC, and lower LH, LH/FSH ratios, and testosterone levels. Furthermore, IR patients appear to have defective autophosphorylation of the in sulin receptor, a key element in insulin action, and a possible mechanism for IR in PCOS.
文摘Objective: To evaluate the signs and symptoms associated with hyperprolactinemia and establish guidelines for a minimal serum PRL level for which pituitary imaging is indicated. Design: Retrospective study. Setting: Reproductive endocrinology clinic in a university hospital. Patient(s): One hundred four consecutive patients with hyperprolactinemia, mean age 30 ± 6.5 (range 19- 44) years. Intervention(s): Classification of clinical symptoms, serum hormone measurements, and pituitary magnetic resonance imaging (MRI). Main Outcome Measure(s): Incidence of presenting symptoms, serum PRL levels, and pituitary tumor size. Result(s): Median (range)- PRL value was 82.6 ng/mL (25- 1,342). Reported symptoms from most to least common were infertility (48% ), headaches (39% ), oligoamenorrhea (29% ), galactorrhea (24% ), and visual changes (13% ). Hypothyroidism was diagnosed in 2 of 104 (1.9% ) patients. Of 86 patients who had pituitary imaging, 23 (26% ) had normal findings and 63 (74% ) had pituitary tumor; of these, 47 (55% of total imaged) had microadenomas and 16 (19% of total imaged) had macroadenomas. There was a statistically significant association between the tumor sizeand the PRL level. However, 11% of the patients with microadenomas had PRL levels >200 ng/mL, and 44% of the patients with macroadenomas had PRL levels between 25 and 200 ng/mL. Conclusion(s): The most common symptoms in the population studied were infertility and headaches. Coexisting thyroid disease was an uncommon finding. Most patients had a pituitary tumor on MRI. Although tumor size correlated with the serum PRL level, some macroadenomas were detected in women with only moderately elevated PRL values. On the basis of these findings, pituitary imaging should be obtained to identify pituitary tumors in all patients with persistently elevated PRL levels.
