INTRODUCTION Impaired sensitivity to thyroid hormone is described as any process that interferes with the effectiveness of thyroid hormone and includes defects in thyroid hormone action, transport, or metabolism. Here we present a case of a 60-year-old man with resistance to thyroid hormone (RTH), the most common form of impaired sensitivity. CASE A 60-year-old male presented to the endocrinology clinic with complaints of fatigue, decreased concentration, and impaired memory. He denied neck swelling, neck pain, peripheral edema, or any significant changes in weight, temperature sensitivity, bowel habits, and mood. His family history was significant for difficult to control thyroid disease in his brother and son. Thyroid exam was normal. Seven years ago, he was diagnosed with hypothyroidism of undetermined etiology with an elevated Thyroid Stimulating Hormone (TSH) and started on Levothyroxine. TSH was within normal limits in the first 3 years of therapy but TSH and free T4 remained high since then. MRI of the brain could not be done to rule out TSH secreting adenoma as he had pieces of metal in his face. In the absence of overt signs or symptoms of hyperthyroidism except atrial fibrillation, and a normal alpha subunit, IGF1, and prolactin, a TSH secreting adenoma is considered less likely. Levothyroxine was stopped and thyroid hormone levels were rechecked in 1 month that revealed elevated TSH with normal T3 and T4, representing compensated RTH. Genetic counseling was provided to the patient but he refused genetic testing. DISCUSSION The incidence of RTH is approximately 1 in 50,000 live births. In approximately 85 percent of cases it is due to mutations in the gene encoding the thyroid hormone receptor beta (TR-beta), while the other 15% are yet to be determined. It is characterized by reduced responsiveness of target tissue to thyroid hormones. The hallmark of RTH is the paucity of signs and symptoms of thyroid dysfunction despite the presence of high serum T4 and T3 concentrations. Clinical features include goiters, hyperactivity, and tachycardia. It can be diagnosed after other causes of hyperthyroxinemia are ruled out and confirmed with genetic testing.

Since the introduction of Sodium-glucose cotransporter 2 (SGLT2) inhibitors as guideline therapy for both uncontrolled type 2 diabetes mellitus and heart failure, these medications have become popular options as add-on therapy. This class of medication reduces blood glucose levels via inhibition of glucose reabsorption in the proximal convoluted tubules leading to enhanced renal excretion. Not only do SGLT2 inhibitors provide advantages in improved glucose control, but also have proven to reduce cardiovascular mortality. Generally, SGLT2 inhibitors are well tolerated, however adverse reactions of genitourinary tract infections secondary to glucosuria and hypotension from associated osmotic diuresis have been reported. Less commonly, pancreatitis has been associated with use of SGL2 inhibitors. We present a case of suspected empagliflozin induced pancreatitis notable for delayed onset at approximately 120 days since SGLT2 inhibitor initiation.

Gonadotropin-releasing hormone agonists, used widely in the treatment of metastatic prostate cancer and hormone receptor-positive breast cancer, are associated with a rare but potentially fatal outcome of pituitary apoplexy (PA). An 85-year-old man presented with sudden onset of headache, left eye pain, sensitivity to light, nausea and vomiting. The symptoms started 4 hours after initiation of leuprolide therapy for treatment of recently diagnosed metastatic prostate carcinoma. Radiological imaging of the brain demonstrated a heterogeneously enlarged pituitary gland measuring 19×16×13 mm and T1-hyperintense signal compatible with pituitary haemorrhage. Hormone function tests were indicative of panhypopituitarism, confirming the diagnosis of PA. Due to age, the patient was started on hormonal replacement therapy and eventually symptoms improved.

Diss. (sammanfattning)--Umeå : Umeå universitet, 2009. / Härtill 3 uppsatser.

Introduction Acromegaly is an endocrine disorder characterized by excessive growth hormone production.The most common cause is a benign pituitary adenoma, which can be an isolated tumor or part of a group of concomitant endocrine neoplasms. We present a case of a middle aged woman with sleep apnea and a newly diagnosed acromegaly secondary to a pituitary macroadenoma. Case presentation A 51-year-old woman was seen in the endocrinology clinic for evaluation of hyperparathyroidism and mild hypercalcemia. She had no symptoms related to hypercalcemia. However, she complained of enlargement of her fingers and toes. She also reported galactorrhea and breast engorgement. There was no hyperhidrosis or frontal bossing present and she denied headaches or vision symptoms. Past medical history was significant for obstructive sleep apnea. Insulin like growth factor level was 630 ng/ml (reference 53 - 190 ng/ml), prolactin level was 109 ng/ml (reference 1.9- 25 ng/ml), and Follicular stimulating hormone was 0.4mIU/ml (reference 1.2 - 21.0 mIU/ml). TSH, free T4, ACTH, and cortisol were normal. The labs were consistent with pituitary macroadenoma secreting growth hormone (GH) and prolactin. MRI pituitary showed a 1.9 cm macroadenoma with no evidence of optic nerve compression. Due to the coexisting diagnoses of hyperparathyroidism and pituitary adenoma, CT abdomen was done to evaluate for neuroendocrine tumor and to rule out Multiple Endocrine Neoplasia (MEN) Type 1. She then underwent transsphenoidal resection of the pituitary, with immunostaining reflecting diffuse prolactin and patchy GH expression. Post-surgery IGF, prolactin, thyroid function tests were normal. She was started on hydrocortisone replacement due to abnormal ACTH and cortisol. Her calcium levels normalized, and further genetic testing for MEN was abandoned. Her repeat sleep study also showed resolution of sleep apnea. She did not suffer from further symptoms of acromegaly and was scheduled for periodic surveillance for thyroid axis dysfunction. Discussion Dysregulated growth hormone production seen in acromegaly leads to increased GH and IGF-1 levels. It has many ramifications including debilitating arthritis from osteoarthropathy, glucose intolerance due to insulin resistance, higher propensity for GI neoplasms, and macroglossia with prognathism causing sleep apnea. Average lifespan is decreased by 30% due to cardiovascular and pulmonary dysfunction. Treatment is aimed at decreasing IGF levels and controlling any mass effect or metabolic abnormalities caused by the tumor. Treatment options include invasive procedures for good surgical candidates and medical therapy via somatostatin analogue for patients who are not. Residual or unresectable tumors can be treated with medical therapy or radiation therapy if there is no response to medication.

Effect of Sepsis on Circulating CTRP3 Levels Adam Musick, Madison Shipley, Fei Tu, Chuanfu Li, Valentin Yakubenko, and Jonathan M. Peterson. Adipose tissue is an active endocrine organ which secrets several pro- and anti- inflammatory mediators, collectively called adipokines. Our previous work has identified a novel anti-inflammatory adipokine called C1q TNF Related Protein 3 (CTRP3). Others have previously demonstrated that localized overexpression of CTRP3 protects myocardial tissue from lipopolysaccharide (LPS)-induced sepsis, further supporting the potential protective role of CTRP3. However, endogenous regulation of CTRP3 in response to a sepsis event has not been explored. Further, other adipokines have been identified as diagnostic/prognostic biomarkers for critically ill patients. Therefore, the purpose of this project was to determine the effects of a sepsis event on the circulating CTRP3 levels. METHODS: Gonadal adipose tissue and serum were collected 8 hours after induction of the cecal-puncture and ligation (CLP) model of sepsis or sham control mice. The circulating levels of CTRP3 were quantified by immunoblot analysis. The transcription levels of CTRP3 in adipose tissue were measured by Real-Time PCR. In addition, to explore a potential mechanism for a protective role of CTRP3, thioglycollate-induced peritoneal macrophages were isolated and binding of recombinant CTRP3 was determined by imaging flow cytometry. RESULTS: Circulating CTRP3 levels decreased by approximately 90% compared to sham mice. However, adipose tissue transcription levels of CTRP3 was not difference between CLP and sham mice. Further, imaging flow cytometry demonstrated that CTRP3 binds directly to isolated macrophages. CONCLUSION: The overserved reduction in circulating CTRP3 protein levels and the absence of changes to the CTRP3 transcription, indicate that during sepsis CTRP3 is actively removed from the blood. As CTRP3 binds directly to macrophages and has been previously shown to attenuate LPS-induced macrophage activation these data could indicate that under normal conditions CTRP3 combines with active macrophages to help suppress cytokine overexpression. However, it appears that during sepsis the endogenous CTRP3 levels are quickly depleted. Combine these data support future research to determine if circulating CTRP3 levels are a biomarker indicative of sepsis prognosis and to determine if increasing the circulating levels of CTRP3 could reduce the cytokine storm associated to a sepsis event. Further, as we have demonstrated CTRP3 binds directly to macrophages, future studies are also needed to explore the potential anti-inflammatory mechanism of CTRP3 action on macrophages.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / A nicotina é considerada o principal componente psicoativo do tabaco e esta induz seus efeitos farmacológicos centrais atuando em receptores nicotínicos colinérgicos (nAChRs). A maturação dos sistemas colinérgicos é consolidada durante o período da periadolescência, o que sugere que o cérebro do adolescente é vulnerável aos efeitos de estimulantes colinérgicos. Dados os efeitos deletérios do consumo de tabaco, incluindo a dependência, têm sido desenvolvidas estratégias terapêuticas para facilitar a interrupção do uso. A mais recente é o uso da vareniclina, um agonista parcial dos nAChRs α4β2. Pouco se sabe sobre os efeitos da exposição à nicotina na adolescência e menos ainda dos efeitos de curto e longo prazos dos tratamentos disponíveis para a reversão da dependência ainda durante este período. Neste sentido, os objetivos desse trabalho foram o de estudar os comportamentos associados à ansiedade e busca por novos estímulos e a função adrenal em animais expostos à fumaça do cigarro durante a adolescência e subsequentemente tratados com procedimento para reversão de dependência à nicotina. Esse estudo utilizou 150 camundongos Suíços adolescentes (de ambos os sexos). Os animais foram expostos à solução aquosa de nicotina (50g/ml - NIC) ou de sacarina (2% - SAC) v.o. do 30o dia de vida pós-natal (PN) à PN45 e submetidos aos seguintes tratamentos por gavagem de PN45 à PN56: 1) vareniclina (0,1 ou 1,0 mg/kg/dia, VAR1 e VAR2 respectivamente); 2) veículo (VEH); 3) nicotina na dose utilizada entre PN30 e PN45 (NIC). Sete grupos experimentais foram utilizados: SACVEH, SACVAR1, SACVAR2, NICVEH, NICVAR1, NICVAR2 e NICNIC. Em PN55, os animais foram submetidos ao teste do labirinto em cruz elevado (LCE) por 5 min, e duas depois ao teste do campo vazado (CV) também por 5 min. Os tecidos coletados em PN56 (após o sacrifício dos animais) foram: adrenal esquerda para a verificação do conteúdo de catecolaminas, adrenal direita para avaliação da expressão da tirosina hidroxilase e soro para a dosagem de corticosterona. Os nossos resultados demonstraram que no final da vigência do tratamento não foram encontradas diferenças entre os grupos no comportamentos associados à ansiedade do LCE e nos associados à busca por novos estímulos no CV. Por outro lado, a análise do número de orifícios explorados no centro do CV, também utilizado como medida de ansiedade, sugerem que a vareniclina por si só e a exposição continuada à nicotina são ansiogênicas mas que que o tratamento com vareniclina após a exposição à nicotina mantém os resultados dentro da normalidade. Do ponto de vista endócrino, o conteúdo adrenal de catecolaminas foi corrigido pelo tratamento com vareniclina, os níveis séricos de corticosterona foram aumentados pela exposição à nicotina enquanto o tratamento com vareniclina aumentou a expressão de tirosina hidroxilase. Nosso estudo indica que, no final da vigência do tratamento, tanto aspectos comportamentais como endócrinos estão significativamente afetados em nosso modelo de exposição à nicotina durante a adolescência e tratamento subsequente com vareniclina. Estudos futuros deverão avaliar estes parâmetros em períodos posteriores, com o objetivo de verificar se as alterações observadas persistem na vida adulta. / Nicotine is considered the main psicoactive component of tobacco and it induce its central pharmacological effects by acting on cholinergic nicotinic receptors (nAChRs). The maturation of the cholinergic system is consolidated during the periadolescent period, which suggests that the adolescent brain is vulnerable to the effects of cholinergic stimulants. Considering the deleterious effects of tobacco consumption, including addiction, several therapeutic strategies are being developed to aid in the interruption of consumption. Varenicline treatment, a partial agonist of the α4β2 nAChRs is one of the most recent ones. Little is known regarding the effects of nicotine exposure during adolescence and even less is known regarding the short and long term effects of the available treatments for addiction during this period. In this sense, the aim of the present work is to study the behaviors associated with anxiety and novelty seeking, as well as adrenal function, in animals exposed to nicotine during adolescence and subsequently treated with a procedure to cure addiction to nicotine. This study used 150 adolescent Swiss mice of both sexes. The animals were exposed (orally) to a nicotine (50g/ml - NIC) solution or to a saccharine (2% - SAC) solution from the 30th postnatal day (PN) to PN45 and then treated by gavage with one of the following substances from PN45 to PN56: 1) vareniclina (0.1 or 1.0 mg/kg/day - VAR1 and VAR2 respectively); 2) vehicle (VEH); 3) nicotine (using the dose previously used from PN30 to PN45 - NIC). Seven experimental groups were used: SACVEH, SACVAR1, SACVAR2, NICVEH, NICVAR1, NICVAR2 and NICNIC. On PN55, the animals were tested in the elevated plus maze (EPM) for 5 min and, 2 h later, they were tested for 5 min on the hole board arena (HB). The tissue samples collected on PN56 (after the animals sacrifice) were: left adrenal gland for the analysis of catecholamine content; right adrenal gland for the analysis of tyrosine hidroxilase expression; serum for the analysis of corticosterone concentration. Our results show that by the end of the treatment no differences were observed between groups regarding behaviors associated with anxiety in the EPM and those associated with novelty-seeking in the HB. Conversely, the analysis of the number of explored holes on the center of the HB, also used as a measure of anxiety, suggest that varenicline by itself and the continued exposure to nicotine are anxiogenic but that varenicline treatment following nicotine exposure keeps results within normal levels. Regarding the endocrine system, the catecholamine adrenal content was corrected by varenicline treatment, the serum corticosterone levels were increased by nicotine exposure and the tyrosine hidroxilase expression was increased by varenicline treatment. Our study indicates that, by the end of the treatment, behavioral as well as endocrine parameters were affected in our model of nicotine exposure during adolescence and subsequent varenicline treatment. Further studies will have to address this parameters in later periods with then aim of verifying whether the observed alterations persist up to adulthood.

Thesis (Ph.D. in Molecular Biology) -- University of Colorado Denver, 2007. / Typescript. Includes bibliographical references (leaves 160-175). Free to UCD affiliates. Online version available via ProQuest Digital Dissertations;

O crescimento da população e os aumentos de consumo e da poluição dos recursos hídricos, tem gerado grande preocupação com a qualidade das águas. A indústria metalúrgica gera efluentes com contaminantes, tais como óleo, graxa e metais pesados. Estas substâncias ou uma combinação de substâncias tóxicas são susceptíveis de causar alterações no sistema endócrino dos organismos vivos, como o câncer, puberdade precoce, infertilidade masculina, feminização de animais silvestres, entre outros.O estudo teve como objetivo apontar o que aconteceu com ratos Wistar que consumiram efluente de indústria metalúrgica antes e depois do processo de tratamento, a fim de analisar a presença de substâncias com disfunção endócrina potencial no plasma sanguíneo. Foram avaliados os níveis de glicose, triglicerídeos, colesterol, estradiol, e as enzimas aspartato aminotransferase (AST) e de alanina aminotransferase (ALT). As amostras do plasma dos ratos que consumiram o efluente tratado mostrou altos níveis de glicose e estradiol. Não houve lesões no fígado de camundongos analisados como também não houve alteração nos resultados das enzimas AST e ALT. Sugere-se que essas alterações foram provocadas pelo nonilfenol, um conhecido desregulador endócrino presente na maioria dos detergentes industriais.Os padrões de emissão de efluentes industriais estipulados no nosso país refere-se a contaminantes físicos, químicos e biológicos que podem ser emitidos para o meio ambiente após a realização de tratamento. A legislação ambiental pertinente em nosso país trata desses limites de emissões, mas não deixa claro no que se refere às substâncias consideradas como desreguladores endócrinos. Esta pesquisa tem como objetivo a obtenção de dados através de revisão da literatura, sobre normas de emissões toleráveis, que não prejudiquem as atividades vitais dos seres vivos. A legislação brasileira cita a proibição da utilização de certas substâncias com potencial de desregulação endócrina, mas sem uma abordagem satisfatória. A União Europeia (UE), os Estados Unidos e o Japão têm metas e regulamentações sobre a não utilização de substâncias com potencial de interferência endócrina. / Submitted by Ana Guimarães Pereira (agpereir@ucs.br) on 2015-08-26T19:22:41Z No. of bitstreams: 1 Dissertacao Tassia Fingler Vidor.pdf: 2245595 bytes, checksum: a35c44769d7f08315b035c9ee0a5d779 (MD5) / Made available in DSpace on 2015-08-26T19:22:41Z (GMT). No. of bitstreams: 1 Dissertacao Tassia Fingler Vidor.pdf: 2245595 bytes, checksum: a35c44769d7f08315b035c9ee0a5d779 (MD5) / Population growth and consumption increases and pollution of water resources, has generated great concern about water quality. The metallurgical industry produces effluents with contaminants such as oil, grease, and heavy metals. These substances or a combination of toxic substances are likely to cause changes in the endocrine system of living organisms, such as cancer, early puberty, male infertility, feminization of wild animals, among others. The study aimed to point out what happened to Wistar rats who consumed metallurgical industry effluent before and after the treatment process in order to analyze the presence of substances with potential endocrine dysfunction in blood plasma. We assessed the levels of glucose, triglycerides, cholesterol, estradiol, and the enzymes aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Plasma samples from rats that consumed the treated effluent showed high levels of glucose and estradiol. There were no lesions in the liver of mice examined, as there was no change in the results of AST and ALT enzymes. It is suggested that these changes were caused by nonylphenol, a known endocrine disrupter present in most detergents industrials. The emission standards for industrial wastewater stipulated in our country refers to physical contaminants, chemical and biological that may be issued to the middle environment after the completion of treatment. The relevant environmental legislation in our country comes to these emission limits, but does not make clear in relation to substances considered as endocrine disruptors. This research aims to obtain data through review of the literature on standards of tolerable emissions, not impairing the vital activities of living things. Brazilian law cites the ban on the use of certain substances with endocrine disrupting potential, but without a satisfactory approach. The European Union (EU), the United States and Japan have goals and regulations on non-use of substances with endocrine interference potential.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / A nicotina é considerada o principal componente psicoativo do tabaco e esta induz seus efeitos farmacológicos centrais atuando em receptores nicotínicos colinérgicos (nAChRs). A maturação dos sistemas colinérgicos é consolidada durante o período da periadolescência, o que sugere que o cérebro do adolescente é vulnerável aos efeitos de estimulantes colinérgicos. Dados os efeitos deletérios do consumo de tabaco, incluindo a dependência, têm sido desenvolvidas estratégias terapêuticas para facilitar a interrupção do uso. A mais recente é o uso da vareniclina, um agonista parcial dos nAChRs α4β2. Pouco se sabe sobre os efeitos da exposição à nicotina na adolescência e menos ainda dos efeitos de curto e longo prazos dos tratamentos disponíveis para a reversão da dependência ainda durante este período. Neste sentido, os objetivos desse trabalho foram o de estudar os comportamentos associados à ansiedade e busca por novos estímulos e a função adrenal em animais expostos à fumaça do cigarro durante a adolescência e subsequentemente tratados com procedimento para reversão de dependência à nicotina. Esse estudo utilizou 150 camundongos Suíços adolescentes (de ambos os sexos). Os animais foram expostos à solução aquosa de nicotina (50g/ml - NIC) ou de sacarina (2% - SAC) v.o. do 30o dia de vida pós-natal (PN) à PN45 e submetidos aos seguintes tratamentos por gavagem de PN45 à PN56: 1) vareniclina (0,1 ou 1,0 mg/kg/dia, VAR1 e VAR2 respectivamente); 2) veículo (VEH); 3) nicotina na dose utilizada entre PN30 e PN45 (NIC). Sete grupos experimentais foram utilizados: SACVEH, SACVAR1, SACVAR2, NICVEH, NICVAR1, NICVAR2 e NICNIC. Em PN55, os animais foram submetidos ao teste do labirinto em cruz elevado (LCE) por 5 min, e duas depois ao teste do campo vazado (CV) também por 5 min. Os tecidos coletados em PN56 (após o sacrifício dos animais) foram: adrenal esquerda para a verificação do conteúdo de catecolaminas, adrenal direita para avaliação da expressão da tirosina hidroxilase e soro para a dosagem de corticosterona. Os nossos resultados demonstraram que no final da vigência do tratamento não foram encontradas diferenças entre os grupos no comportamentos associados à ansiedade do LCE e nos associados à busca por novos estímulos no CV. Por outro lado, a análise do número de orifícios explorados no centro do CV, também utilizado como medida de ansiedade, sugerem que a vareniclina por si só e a exposição continuada à nicotina são ansiogênicas mas que que o tratamento com vareniclina após a exposição à nicotina mantém os resultados dentro da normalidade. Do ponto de vista endócrino, o conteúdo adrenal de catecolaminas foi corrigido pelo tratamento com vareniclina, os níveis séricos de corticosterona foram aumentados pela exposição à nicotina enquanto o tratamento com vareniclina aumentou a expressão de tirosina hidroxilase. Nosso estudo indica que, no final da vigência do tratamento, tanto aspectos comportamentais como endócrinos estão significativamente afetados em nosso modelo de exposição à nicotina durante a adolescência e tratamento subsequente com vareniclina. Estudos futuros deverão avaliar estes parâmetros em períodos posteriores, com o objetivo de verificar se as alterações observadas persistem na vida adulta. / Nicotine is considered the main psicoactive component of tobacco and it induce its central pharmacological effects by acting on cholinergic nicotinic receptors (nAChRs). The maturation of the cholinergic system is consolidated during the periadolescent period, which suggests that the adolescent brain is vulnerable to the effects of cholinergic stimulants. Considering the deleterious effects of tobacco consumption, including addiction, several therapeutic strategies are being developed to aid in the interruption of consumption. Varenicline treatment, a partial agonist of the α4β2 nAChRs is one of the most recent ones. Little is known regarding the effects of nicotine exposure during adolescence and even less is known regarding the short and long term effects of the available treatments for addiction during this period. In this sense, the aim of the present work is to study the behaviors associated with anxiety and novelty seeking, as well as adrenal function, in animals exposed to nicotine during adolescence and subsequently treated with a procedure to cure addiction to nicotine. This study used 150 adolescent Swiss mice of both sexes. The animals were exposed (orally) to a nicotine (50g/ml - NIC) solution or to a saccharine (2% - SAC) solution from the 30th postnatal day (PN) to PN45 and then treated by gavage with one of the following substances from PN45 to PN56: 1) vareniclina (0.1 or 1.0 mg/kg/day - VAR1 and VAR2 respectively); 2) vehicle (VEH); 3) nicotine (using the dose previously used from PN30 to PN45 - NIC). Seven experimental groups were used: SACVEH, SACVAR1, SACVAR2, NICVEH, NICVAR1, NICVAR2 and NICNIC. On PN55, the animals were tested in the elevated plus maze (EPM) for 5 min and, 2 h later, they were tested for 5 min on the hole board arena (HB). The tissue samples collected on PN56 (after the animals sacrifice) were: left adrenal gland for the analysis of catecholamine content; right adrenal gland for the analysis of tyrosine hidroxilase expression; serum for the analysis of corticosterone concentration. Our results show that by the end of the treatment no differences were observed between groups regarding behaviors associated with anxiety in the EPM and those associated with novelty-seeking in the HB. Conversely, the analysis of the number of explored holes on the center of the HB, also used as a measure of anxiety, suggest that varenicline by itself and the continued exposure to nicotine are anxiogenic but that varenicline treatment following nicotine exposure keeps results within normal levels. Regarding the endocrine system, the catecholamine adrenal content was corrected by varenicline treatment, the serum corticosterone levels were increased by nicotine exposure and the tyrosine hidroxilase expression was increased by varenicline treatment. Our study indicates that, by the end of the treatment, behavioral as well as endocrine parameters were affected in our model of nicotine exposure during adolescence and subsequent varenicline treatment. Further studies will have to address this parameters in later periods with then aim of verifying whether the observed alterations persist up to adulthood.