Endocrine function and morphological findings in patients with disorders of the hypothalamo-pituitary area: a study with magnetic resonance

Article Abstract:

Structural abnormalities are often difficult to detect in patients with endocrine disorders involving the hypothalamus and pituitary. Magnetic resonance imaging (MRI), a diagnostic method in which electromagnetic energy is used to provide images of internal structures, can be effectively used to visualize the pituitary gland and stalk. MRI has been used to evaluate children with hypopituitarism, or decreased secretion of pituitary hormone; diabetes insipidus, excessive urination and thirst due to the deficient secretion of antidiuretic hormone from the posterior pituitary; and other hypothalamo-pituitary disorders. The relation between hypothalamo-pituitary structural defects and type and severity of endocrine disorders was assessed by examining the sellar area, a portion of bone which houses the pituitary gland. MRI was performed on 101 patients with hypopituitarism; diabetes insipidus; hypogonadotrophic hypogonadism, the deficient secretion from the gonads or sex organs; and central precocious puberty, abnormally early development of sexual maturity. Twenty-three patients with multiple pituitary deficiency had abnormalities of the stalk and posterior pituitary, and four of five patients with pituitary deficiency associated with diabetes insipidus had an abnormal stalk. Five of 42 patients with growth hormone deficiency had abnormalities of the sellar area. The posterior pituitary lobe was absent in two of four patients with diabetes insipidus, whereas patients with hypogonadotrophic hypogonadism appeared normal. Three of 21 patients with precocious puberty developing before age two years had hypothalamic hamartoma, a tumor in the hypothalamus. Seventeen of 18 patients with precocious puberty developing between ages two to seven years had normal MRIs. Thus, the incidence of structural abnormalities of the hypothalamus and pituitary is high among patients with multiple pituitary deficiency, diabetes insipidus, and early-onset precocious puberty. Patients with growth hormone deficiency, hypogonadotrophic hypogonadism, and late-onset precocious puberty appear to have only functional abnormalities. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Magnetic resonance imaging, Endocrine gland diseases, Endocrine diseases, Hypothalamo-hypophyseal system

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Absence of effect of dipyridamole on renal and platelet function in diabetes mellitus

Article Abstract:

The effect of the drug dipyridamole on the function of the kidney and platelets (blood cells involved in clotting) was assessed for one year in 53 children with insulin-dependent diabetes mellitus (IDDM). Dipyridamole is an antiplatelet drug and is used with aspirin to prevent thrombosis, the formation of blood clots which can block blood vessels. Dipyridamole was shown to decrease the excretion of the blood protein albumin in the urine and to improve the survival of platelets in patients with kidney disease. This agent may act by influencing platelet function or by dilating blood vessels in the kidneys, thereby increasing the filtering of blood through the kidney. The excretion of albumin in the urine was determined by the ratio of albumin to creatinine (UA/UC) levels in the urine, and was measured every three months. The UA/UC ratio was similar at 12 months in children treated with dipyridamole and children receiving a placebo with no therapeutic effect. In addition, at 12 months, the two groups were similar in terms of glomerular filtration rates (the speed at which blood is filtered through the kidney), excretion of retinol binding protein in the urine, levels of the hormone N-acetyl-beta-glucosaminidase (NAG), blood pressure, and aggregation of platelets. The UA/UC ratio remained high in four children treated with dipyridamole and four children given a placebo. The UA/UC ratio progressed to a high level in two children treated with dipyridamole and one child given a placebo. These 11 children had higher urinary excretion of retinol binding protein and NAG, larger kidneys, and high blood pressure than the remaining 42 children. Platelet aggregation was similar in both groups. The relation between UA/UC and other measurements of kidney function suggests that measurement of proteins in the kidney tubules and blood pressure may help to identify persons at risk of developing kidney disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Risk factors, Physiological aspects, Diabetic nephropathies, Blood platelets, Dipyridamole, Cell aggregation, Kidney function tests

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Cranial magnetic resonance imaging in patients with tuberous sclerosis and normal intellect

Article Abstract:

Tuberous sclerosis is a disease that causes brain tumors, epileptic seizures, and mental disability in young children. It occurs in 1 out of every 6,000 births. Most of the children who experience seizures during their first year of life become mentally handicapped, but some develop with normal intellect. It is difficult to predict the outcome of this disease. It is has been suggested that the number of brain tumors present may predict mental development. To investigate this theory, magnetic resonance imaging (MRI) was performed on 11 patients with tuberous sclerosis. All patients were over the age of five and had normal intellect. Two of the patients had completely normal MRI brain scans. Seven of the patients had between one and five tumors visible on the MRI scan, and nine of the patients had between two and nine tumors. The results of this study indicate that mental development in patients with tuberous sclerosis cannot be predicted based on the number of brain tumors. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prognosis, Brain, Tuberous sclerosis

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