Mutation and genomic amplification of the PIK3CA proto-oncogene in pituitary adenomas

The tumorigenesis of pituitary adenomas is poorly understood. Mutations of the PIK3CA proto-oncogene, which encodes the p110-α catalytic subunit of PI3K, have been reported in various types of human cancers regarding the role of the gene in cell proliferation and survival through activation of the PI3K/Akt signaling pathway. Only one Chinese study described somatic mutations and amplification of the PIK3CA gene in a large series of pituitary adenomas. The aim of the present study was to determine genetic alterations of PIK3CA in a second series that consisted of 33 pituitary adenomas of different subtypes diagnosed by immunohistochemistry: 6 adrenocorticotropic hormone-secreting microadenomas, 5 growth hormone-secreting macroadenomas, 7 prolactin-secreting macroadenomas, and 15 nonfunctioning macroadenomas. Direct sequencing of exons 9 and 20 assessed by qPCR was employed to investigate the presence of mutations and genomic amplification defined as a copy number ≥4. Previously identified PIK3CA mutations (exon 20) were detected in four cases (12.1%). Interestingly, the Chinese study reported mutations only in invasive tumors, while we found a PIK3CA mutation in one noninvasive corticotroph microadenoma. PIK3CA amplification was observed in 21.2% (7/33) of the cases. This study demonstrates the presence of somatic mutations and amplifications of the PIK3CA gene in a second series of pituitary adenomas, corroborating the previously described involvement of the PI3K/Akt signaling pathway in the tumorigenic process of this gland.

Arginine induces GH gene expression by activating NOS/NO signaling in rat isolated hemi-pituitaries

The amino acid arginine (Arg) is a recognized secretagogue of growth hormone (GH), and has been shown to induce GH gene expression. Arg is the natural precursor of nitric oxide (NO), which is known to mediate many of the effects of Arg, such as GH secretion. Arg was also shown to increase calcium influx in pituitary cells, which might contribute to its effects on GH secretion. Although the mechanisms involved in the effects of Arg on GH secretion are well established, little is known about them regarding the control of GH gene expression. We investigated whether the NO pathway and/or calcium are involved in the effects of Arg on GH gene expression in rat isolated pituitaries. To this end, pituitaries from approximately 170 male Wistar rats (~250 g) were removed, divided into two halves, pooled (three hemi-pituitaries) and incubated or not with Arg, as well as with different pharmacological agents. Arg (71 mM), the NO donor sodium nitroprusside (SNP, 1 and 0.1 mM) and a cyclic guanosine monophosphate (cGMP) analogue (8-Br-cGMP, 1 mM) increased GH mRNA expression 60 min later. The NO acceptor hemoglobin (0.3 µM) blunted the effect of SNP, and the combined treatment with Arg and L-NAME (a NO synthase (NOS) inhibitor, 55 mM) abolished the stimulatory effect of Arg on GH gene expression. The calcium channel inhibitor nifedipine (3 µM) also abolished Arg-induced GH gene expression. The present study shows that Arg directly induces GH gene expression in hemi-pituitaries isolated from rats, excluding interference from somatostatinergic neurons, which are supposed to be inhibited by Arg. Moreover, the data demonstrate that the NOS/NO signaling pathway and calcium mediate the Arg effects on GH gene expression.

A clinical follow-up of 35 Brazilian patients with Prader-Willi Syndrome

OBJECTIVE: Prader-Willi Syndrome is a common etiology of syndromic obesity that is typically caused by either a paternal microdeletion of a region in chromosome 15 (microdeletions) or a maternal uniparental disomy of this chromosome. The purpose of this study was to describe the most significant clinical features of 35 Brazilian patients with molecularly confirmed Prader-Willi syndrome and to determine the effects of growth hormone treatment on clinical outcomes. METHODS: A retrospective study was performed based on the medical records of a cohort of 35 patients diagnosed with Prader-Willi syndrome. The main clinical characteristics were compared between the group of patients presenting with microdeletions and the group presenting with maternal uniparental disomy of chromosome 15. Curves for height/length, weight and body mass index were constructed and compared between Prader-Willi syndrome patients treated with and without growth hormone to determine how growth hormone treatment affected body composition. The curves for these patient groups were also compared with curves for the normal population. RESULTS: No significant differences were identified between patients with microdeletions and patients with maternal uniparental disomy for any of the clinical parameters measured. Growth hormone treatment considerably improved the control of weight gain and body mass index for female patients but had no effect on either parameter in male patients. Growth hormone treatment did not affect height/length in either gender. CONCLUSION: The prevalence rates of several clinical features in this study are in agreement with the rates reported in the literature. Additionally, we found modest benefits of growth hormone treatment but failed to demonstrate differences between patients with microdeletions and those with maternal uniparental disomy. The control of weight gain in patients with Prader-Willi syndrome is complex and does not depend exclusively on growth hormone treatment.

Immunohistochemical study of pituitary cells in wild and captive Salminus hilarii (Characiformes: Characidae) females during the annual reproductive cycle

Freshwater fish that live exclusively in rivers are at particular risk from fragmentation of the aquatic system, mainly the species that migrate upriver for reproduction. That is the case of Salminus hilarii, an important migratory species currently classified as “almost threatened” in the São Paulo State (Brazil), facing water pollution, dam construction, riparian habitat destruction and environmental changes that are even more serious in this State. Additionally, this species show ovulation dysfunction in captivity. Our studies focused on the identification and distribution of the pituitary cell types in the adenohypophysis of S. hilarii females, including a morphometric analysis that compares pituitary cells from wild and captive broodstocks during the reproductive annual cycle. The morphology of adenohypophysial cells showed differences following the reproductive cycle and the environment. In general, optical density suggested a higher cellular activity during the previtellogenic (growth hormone) and vitellogenic (somatolactin) stages in both environments. Additionally, the nucleus/cell ratio analysis suggested that growth hormone and somatolactin cells were larger in wild than in captive females in most reproductive stages of the annual cycle. In contrast, prolactin hormone showed no variation throughout the reproductive cycle (in both environments). Morphometrical analyses related to reproduction of S. hilarii in different environmental conditions, suggest that somatolactin and growth hormone play an important role in reproduction in teleost and can be responsible for the regulation of associated processes that indirectly affect reproductive status.

Il craniofaringioma nel bambino e nell'adolescente. Luci ed ombre durante il follow-up

Introduction. Craniopharyngioma (CF) is a malformation of the hypothalamicpituitary region and it is the most common nonglial cerebral tumor in children with an high overall survival rate. In some case severe endocrinologic and metabolic sequelae may occur during follow up. 50% of patients (pts), in particular those with radical removal of suprasellar lesions, develop intractable hyperphagia and morbid obesity, with dyslypidemia and high cardiovascular risk. We studied the auxological and metabolic features of a series of 29 patients (18 males) treated at a mean age of 7,6 years, followed up in our Centre from 1973 to 2008 with a mean follow up of 8,3 years. Patients features at the onset. 62% of pts showed as first symptoms of disease visual impairment and neurological disturbancies (headache); 34% growth arrest; 24% signs of raised intracranial pressure and 7% diabetes insipidus. Diagnosis. Diagnosis of CF was reached finally by TC or MRI scans which showed endo-suprasellar lesion in 23 cases and endosellar tumour in 6 cases. Treatment and outcome. 25/29 pts underwent surgical removal of CF (19 by transcranial approach and 6 by endoscopic surgery); 4 pts underwent stereotactic surgery as first line therapy. 3 pts underwent local irradiation with yttrium-90, 5 pts post surgery radiotherapy. 45% of pts needed more than one treatment procedure. Results. After CF treatment all patients suffered from 3 or more pituitary hormone deficiencies and diabetes insipidus. They underwent promptly substitutive therapy with corticosteroids, l-thyroxine and desmopressin. In 28/29 pts we found growth hormone (GH) deficiency. 20/28 pts started GH substitutive therapy and 15 pts reached final height(FH) near target height(TH). 8 pts were not GH treated for good growth velocity, even without GH, or for tumour residual. They reached in 2 cases FH over TH showing the already known phenomenon of growth without GH. 38% of patients showed BMI SDS >2 SDS at last assessment, in particular pts not GH treated (BMI 2,5 SDS) are more obese than GH treated (BMI 1,2 SDS). Lipid panel of 16 examined pts showed significative differencies among GH treated (9 pts) and not treated (7 pts) with better profile in GH treated ones for Total Cholesterol/C-HDL and C-LDL/C-HDL. We examined intima media thickness of common carotid arteries in 11 pts. 3/4 not GH treated pts showed ultrasonographic abnormalities: calcifications in 2 and plaque in 1 case. Of them 1 pt was only 12,6 years old and already showed hypothalamic obesity with hyperphagia, high HOMA index and dyslipidemia. In the GH treated group (7) we found calcifications in 1 case and a plaque in another one. GH therapy was started in the young pt with carotid calcifications, with good improvement within 6 months of treatment. 5/29 pts showed hypothalamic obesity, related to hypothalamic damage (type of surgical treatment, endo-suprasellar primitive lesion, recurrences). 48% of patients recurred during follow up ( mean time from treatment: 3 years) and underwent, in some cases up to 4 transcranial surgical treatments. GH seems not to increase recurrence rate since 40% of GH treated recurred vs 66,6% of not GH treated pts. Discussion. Our data show the extereme difficulties that occur during follow up of craniopharyngioma treated patients. GH therapy should be offered to all patients even with good growth velocity after CF treatment, to avoid dislypidemia and reduce cardiovascular risk. The optimal therapy is not completely understood and whether gross tumor removal or partial surgery is the best option remains to be decided only on one patient tumour features and hypothalamic involvement. In conclusion the gold standard treatment of CF remains complete tumour removal, when feasible, or partial resection to preserve hypothalamic function in endosuprasellar large neoplasms.

Mechanismen der Caveolin-Genregulation in neuralen Zellsystemen

Caveolae sind vesikuläre Invaginationen der eukaryontischen Zellmembran, die bei einer Vielzahl zellbiologischer Prozesse eine bedeutende Rolle spielen. Die strukturellen und funktionellen Hauptbestandteile der Caveolae sind die Caveolin-Proteine, welche von drei homologen Genen (Caveolin-1,-2,-3) kodiert werden. Die Caveoline stellen die Struktur-Organisatoren der Caveolae dar, und regulieren direkt die Aktivität von zahlreichen Caveolae-assoziierten Rezeptorproteinen und Signalmolekülen. Oftmals werden die pleiotropen Effekte der Caveoline über eine Veränderung der Caveolin-Genexpressionsstärke moduliert. In der vorliegenden Arbeit wurden drei unterschiedliche biologische Steuerfaktoren identifiziert, unter deren Kontrolle die Caveolin-Genexpression in neuralen Zellsystemen steht. Bei diesen Faktoren handelt es sich um das Steroidhormon Oestrogen und seine Rezeptoren, den Wachstumsfaktor TGFa und den sekundären Botenstoff zyklisches AMP (cAMP). Oestrogen wirkt über die Aktivierung von Oestrogen-Rezeptoren (ERs) im zentralen Nervensystem in der Regel als neurotropher Faktor. In der vorliegenden Arbeit konnte erstmalig gezeigt werden, daß in humanen Neuroblastom-Zellen (SK-N-MC) die stabile, rekombinante Expression des ERa-Subtyps zu einer drastischen Reduktion der Caveolin-1/-2-Transkription führt, und daß in der Folge die zelluläre Caveolin-Biosynthese eingestellt wird. Eine Analyse des Caveolin-1-Gens ergab, daß einhergehend mit der Inaktivierung der Caveolin-1-Transkription eine Vielzahl der im Promoter enthaltenen CpG-Dinukleotide methyliert vorliegen. Durch pharmakologische Inhibition der nukleären DNA-Methyltransferasen sowie der Histon-Deacetylasen konnte die Caveolin-1-Transkription teilweise wiederhergestellt werden. Diese Befunde lassen auf die Existenz eines DNA-Methylierungs-abhängigen Stilllegungsmechanismus der Caveolin-Genexpression durch ERa schließen. Dagegen führte die Überexpression des ERb-Subtyps in SK-N-MC-Zellen zu keiner Veränderung der Caveolin-1/-2-Expression. Interessanterweise wurde die supprimierende Wirkung des ERa durch die gleichzeitige Überexpression des ERb vollständig aufgehoben. Der mitogene Wachstumsfaktor TGFa wurde als zweites extrazelluläres Signalmolekül identifiziert, welches eine Reduktion der Caveolin-1/-2-Genexpression bewirkt. In primären kortikalen Astrozyten konnte gezeigt werden, daß TGFa seine supprimierende Wirkung auf die Caveolin-1-Expression partiell über die Aktivierung des PI3-Kinase-abhängigen Signalweges vermittelt. Zudem wurde die supprimierende Wirkung von TGFa durch einen Inhibitior der Histon-Deacetylasen relativiert. Daher scheinen sowohl für den ERa als auch für TGFa epigenetische Prozesse bei der Suppression der Caveolin-1-Genexpression eine entscheidende Rolle zu spielen. Intrazellulär wirkte neben der PI3-Kinase auch der Botenstoff cAMP in kortikalen Astrozyten als Suppressor der Caveolin-Genexpression. Es wäre denkbar, daß die Caveolin-Suppression funktioneller Bestandteil des seit langem etablierten Effekts der cAMP-induzierten Astrozyten-Differenzierung ist. Desweiteren wiesen der cAMP- und TGFa-abhängige Signalweg ein überlappendes, Gehirnregion-spezifisches Regulationsprofil der Caveolin-Expression in Astrozyten auf: während in Kortex und Striatum eine Regulation durch cAMP und TGFa erfolgte, blieb diese in Klein- und Zwischenhirn aus. Somit bewirken drei zentrale regulatorische Faktoren der Proliferation und Differenzierung neuraler Zellen eine Reduktion in der Konzentration der pleiotrop funktionellen Caveoline. Zukünftige Studien müssen zeigen, inwieweit die reduzierte Caveolin-Expression für die morphologischen und biochemischen Primärwirkungen dieser Faktoren während der Entwicklung und im Zuge der Tumorgenese mitverantwortlich ist. Außerdem könnten über die Beobachtungen der zellbiologischen Auswirkungen reduzierter Caveolin-Spiegel neue Erkenntnisse über die Funktion dieser Proteine gewonnen werden.

Genetische Analyse des Somatostatin-Systems

Somatostatin ist ein Molekül mit multifunktinonellem Charakter, dem Neurotransmitter-, Neuromodulator- und (Neuro)-Hormoneigenschaften zugeschrieben werden. Gemäß seiner ubiquitären Verteilung in Geweben beeinflusst es Stoffwechsel- und Entwicklungsprozesse, bis hin zu Lern-und Gedächtnisleistungen. Diese Wirkungen resultieren aus dem lokalen und zeitlichen Zusammenspiel eines Liganden und fünf G-Protein gekoppelter Rezeptoren (SSTR1-5). Zur Charakterisierung der biologischen Bedeutung des Somatostatin-Systems im Gesamtorganismus wurde eine Mutationsanalyse einzelner Systemkomponenten durchgeführt. Sie umfaßte die Inaktivierung der Gene für das Somatostatin-Präpropeptid und die der Rezeptoren SSTR3 und SSTR4 durch Gene Targeting. Die entsprechenden Ausfallmutationen belegen: Weder die Rezeptoren 3 und 4, noch Somatostatin sind für das Überleben des Organismus unter Standardhaltungsbedingungen notwendig. Die entsprechenden Mauslinien zeigen keine unmittelbar auffälligen Einschränkungen ihrer Biologie. Die Somatostatin-Nullmaus wurde zum Hauptgegenstand einer detaillierten Untersuchung aufgrund der übergeordneten Position des Liganden in der Signalkaskade und verfügbaren Hinweisen zu seiner Funktion. Folgende Schlußfolgerungen konnten nach eingehender Analyse gezogen werden: Der Ausfall des Somatostatin-Gens hat erhöhte Plasmakonzentrationen an Wachstumshormon (GH) zur Konsequenz. Dies steht im Einklang mit der Rolle Somatostatins als hemmender Faktor der Wachstumshormon-Freisetzung, die in der Mutante aufgehoben ist. Durch die Somatostatin-Nullmaus wurde zudem deutlich: Somatostatin interagiert als wesentliches Bindeglied zwischen der Wachstums- und Streßachse. Permanent erhöhte Corticosteron-Werte in den Mutanten implizieren einen negativen tonischen Einfluß für die Sekretion von Glukocorticoiden in vivo. Damit zeigt die Knockout-Maus, daß Somatostatin normalerweise als ein entscheidendes inhibierendes Kontrollelement der Steroidfreisetzung fungiert. Verhaltensversuche offenbarten ein Defizit im motorischen Lernen. Somatostatin-Nullmäuse bleiben im Lernparadigma “Rotierender Stabtest” hinter ihren Artgenossen zurück ohne aber generell in Motorik oder Koordination eingeschränkt zu sein. Diese motorischen Lernvorgänge sind von einem funktionierenden Kleinhirn abhängig. Da Somatostatin und seine Rezeptoren kaum im adulten, wohl aber im sich entwickelnden Kleinhirn auftreten, belegt dieses Ergebnis die Funktion transient in der Entwicklung exprimierter Neuropeptide – eine lang bestehende, aber bislang experimentell nicht nachgewiesene Hypothese. Die Überprüfung weiterer physiologischer Parameter und Verhaltenskategorien unter Standard-Laborbedingunggen ergab keine sichtbaren Abweichungen im Vergleich zu Wildtyp-Mäusen. Damit steht nun ein Tiermodell zur weiterführenden Analyse für die Somatostatin-Forschung bereit: In endokrinologischen, elektrophysiologischen und verhaltens-biologischen Experimenten ist nun eine unmittelbare Korrelation selektiv mit dem Somatostatin-Peptid bzw. mit den Rezeptoren 3 und 4 aber auch in Kombination der Ausfallmutationen nach entsprechenden Kreuzungen möglich.

Studio della funzionalità respiratoria in soggetti con sindrome di Turner

The aim of this study is to evaluate the pulmonary function in subjects with diagnosis of Turner Syndrome, in charge at the Syndromology Ward of the Paediatric Clinic of S.Orsola-Malpighi hospital. There are very few datas about lung function in patients with Turner syndrome’s genotype and phenotype in medical literature. Since the thorax of these subjects have peculiar anatomic shape (as “shield” or “overturned triangle”), we presupposed that these subjects could have also a peculiar respiratory function. Moreover we look for the possibility of correlation between pulmonary function and estroprogestinic replacement therapy and/or growth hormone (GH) replacement therapy. Material and methods: we studied 48 patients, with diagnosis of Turner Syndrome; they all made spirometry voluntarily and, when capable, also plethismografy. Results: - the parametres of pulmonary function are a little higher of the predicted values for age and sex but they are a little lower if they're corrected for each patient’s ideal high and weight: so we can conclude that in Turner Syndrme subjects pulmonary function is normal; -there’s not a statistically significant correlation between pulmonary function and GH therapy; -there’s not a statistically significant correlation between GH therapy’s length and pulmonary function except for Total Lung Capacity which increases with the number of years of GH therapy; - there’s not a statistically significant correlation between pulmonary function and estroprogestinic replacement herapy.

Genexpressionsanalyse der fötalen Wachstumsfuge des Rindes

Erkrankungen des Skelettapparats wie beispielsweise die Osteoporose oder Arthrose gehören neben den Herz-Kreislauferkrankungen und Tumoren zu den Häufigsten Erkrankungen des Menschen. Ein besseres Verständnis der Bildung und des Erhalts von Knochen- oder Knorpelgewebe ist deshalb von besonderer Bedeutung. Viele bisherige Ansätze zur Identifizierung hierfür relevanter Gene, deren Produkte und Interaktionen beruhen auf der Untersuchung pathologischer Situationen. Daher ist die Funktion vieler Gene nur im Zusammenhang mit Krankheiten beschrieben. Untersuchungen, die die Genaktivität bei der Normalentwicklung von knochen- und knorpelbildenden Geweben zum Ziel haben, sind dagegen weit weniger oft durchgeführt worden. rnEines der entwicklungsphysiologisch interessantesten Gewebe ist die Epiphysenfuge der Röhrenknochen. In dieser sogenannten Wachstumsfuge ist insbesondere beim fötalen Gewebe eine sehr hohe Aktivität derjenigen Gene zu erwarten, die an der Knochen- und Knorpelbildung beteiligt sind. In der vorliegenden Arbeit wurde daher aus der Epiphysenfuge von Kälberknochen RNA isoliert und eine cDNA-Bibliothek konstruiert. Von dieser wurden ca. 4000 Klone im Rahmen eines klassischen EST-Projekts sequenziert. Durch die Analyse konnte ein ungefähr 900 Gene umfassendes Expressionsprofil erstellt werden und viele Transkripte für Komponenten der regulatorischen und strukturbildenden Bestandteile der Knochen- und Knorpelentwicklung identifiziert werden. Neben den typischen Genen für Komponenten der Knochenentwicklung sind auch deutlich Bestandteile für embryonale Entwicklungsprozesse vertreten. Zu ersten gehören in erster Linie die Kollagene, allen voran Kollagen II alpha 1, das mit Abstand höchst exprimierte Gen in der fötalen Wachstumsfuge. Nach den ribosomalen Proteinen stellen die Kollagene mit ca. 10 % aller auswertbaren Sequenzen die zweitgrößte Gengruppe im erstellten Expressionsprofil dar. Proteoglykane und andere niedrig exprimierte regulatorische Elemente, wie Transkriptionsfaktoren, konnten im EST-Projekt aufgrund der geringen Abdeckung nur in sehr geringer Kopienzahl gefunden werden. Allerdings förderte die EST-Analyse mehrere interessante, bisher nicht bekannte Transkripte zutage, die detaillierter untersucht wurden. Dazu gehören Transkripte die, die dem LOC618319 zugeordnet werden konnten. Neben den bisher beschriebenen drei Exonbereichen konnte ein weiteres Exon im 3‘-UTR identifiziert werden. Im abgeleiteten Protein, das mindestens 121 AS lang ist, wurden ein Signalpeptid und eine Transmembrandomäne nachgewiesen. In Verbindung mit einer möglichen Glykosylierung ist das Genprodukt in die Gruppe der Proteoglykane einzuordnen. Leicht abweichend von den typischen Strukturen knochen- und knorpelspezifischer Proteoglykane ist eine mögliche Funktion dieses Genprodukts bei der Interaktion mit Integrinen und der Zell-Zellinteraktion, aber auch bei der Signaltransduktion denkbar. rnDie EST-Sequenzierungen von ca. 4000 cDNA-Klonen können aber in der Regel nur einen Bruchteil der möglichen Transkripte des untersuchten Gewebes abdecken. Mit den neuen Sequenziertechnologien des „Next Generation Sequencing“ bestehen völlig neue Möglichkeiten, komplette Transkriptome mit sehr hoher Abdeckung zu sequenzieren und zu analysieren. Zur Unterstützung der EST-Daten und zur deutlichen Verbreiterung der Datenbasis wurde das Transkriptom der bovinen fötalen Wachstumsfuge sowohl mit Hilfe der Roche-454/FLX- als auch der Illumina-Solexa-Technologie sequenziert. Bei der Auswertung der ca. 40000 454- und 75 Millionen Illumina-Sequenzen wurden Verfahren zur allgemeinen Handhabung, der Qualitätskontrolle, dem „Clustern“, der Annotation und quantitativen Auswertung von großen Mengen an Sequenzdaten etabliert. Beim Vergleich der Hochdurchsatz Blast-Analysen im klassischen „Read-Count“-Ansatz mit dem erstellten EST-Expressionsprofil konnten gute Überstimmungen gezeigt werden. Abweichungen zwischen den einzelnen Methoden konnten nicht in allen Fällen methodisch erklärt werden. In einigen Fällen sind Korrelationen zwischen Transkriptlänge und „Read“-Verteilung zu erkennen. Obwohl schon simple Methoden wie die Normierung auf RPKM („reads per kilo base transkript per million mappable reads“) eine Verbesserung der Interpretation ermöglichen, konnten messtechnisch durch die Art der Sequenzierung bedingte systematische Fehler nicht immer ausgeräumt werden. Besonders wichtig ist daher die geeignete Normalisierung der Daten beim Vergleich verschieden generierter Datensätze. rnDie hier diskutierten Ergebnisse aus den verschiedenen Analysen zeigen die neuen Sequenziertechnologien als gute Ergänzung und potentiellen Ersatz für etablierte Methoden zur Genexpressionsanalyse.rn

Adulthood with Turner Syndrome: Quality of life, psychosocial adjustment and clinical management in 70 Italian women

Abstract Background: Turner syndrome (TS) is a chromosomal abnormality (total or partial absence of one of the sexual chromosomes in some or all cells of the body), which affects approximately 1:2000 female. Principal characteristics are short stature and gonadal disgenesis. Clinical management consist of Growth Hormone (GH) treatment and oestrogen replacement therapy (HRT), to induce development of secondary characteristics and to avoid the sequelae of oestrogen deficiency. Aim of the study: To assess clinical management, quality of life (QoL) and general psychosocial adjustment of women with TS. Population: 70 adult Caucasian females with TS (mean age: 27.8, ± 7.6; range 18-48 y.). Setting: Specialist service for Rare Disease care, University Hospital. Methods: Subjects were required to fill in questionnaires collecting ASR, WHOQOL, and 8 open questions. Data were compared with those of the Italian population or to those collected in a comparison group (70 healthy females, mean age: 27.9, ±7.3, range 21-48 y.). Results: Women with TS are educated as well as the Italian Population, but they have a less successful professional life. They show good QoL in general, but they appeared less satisfied in social area. They had statistically higher scores than the comparison group for depression, anxiety and withdrawal. Are less involved in a love relationship. Diagnosis communication was mostly performed by doctors or parents, satisfaction was higher when information was given by parents. Main preoccupation about TS are infertility, feeling of being different and future health problem. Conclusions: Italian people with TS were generally well adapted and have a good QoL, but lived more often with parents and show impaired sentimental and sexual life. They have higher degree of psychological distress compared to a comparison group. Psychological intervention should firstly address parents in order to encourage an open communication on diagnosis issues and on sexual education.

Perioperative metabolic changes in patients undergoing cardiac surgery

Perioperative metabolic changes in cardiac surgical patients are not only induced by tissue injury and extracorporeal circulation per se: the systemic inflammatory response to surgical trauma and extracorporeal circulation, perioperative hypothermia, cardiovascular and neuroendocrine responses, and drugs and blood products used to maintain cardiovascular function and anesthesia contribute to varying degrees. The pathophysiologic changes include increased oxygen consumption and energy expenditure; increased secretion of adrenocorticotrophic hormone, cortisol, epinephrine, norepinephrine, insulin, and growth hormone; and decreased total tri-iodothyronine levels. Easily measurable metabolic consequences of these changes include hyperglycemia, hyperlactatemia, increased aspartate, glutamate and free fatty acid concentrations, hypokalemia, increased production of inflammatory cytokines, and increased consumption of complement and adhesion molecules. Nutritional risk before elective cardiac surgery-defined as preoperative unintended pathologic weight loss/low amount of food intake in the preceding week or low body mass index-is related to adverse postoperative outcome. Improvements in surgical techniques, anesthesia, and perioperative management have been designed to minimize the stressful stimulus to catabolism, thereby slowing the wasting process to the point where much less nutrition is required to meet metabolic requirements. Early nutrition in cardiac surgery is safe and well tolerated.

Adjuvant or radical fractionated stereotactic radiotherapy for patients with pituitary functional and nonfunctional macroadenoma

Purpose To evaluate the efficacy and toxicity of stereotactic fractionated radiotherapy (SFRT) for patients with pituitary macroadenoma (PMA). Methods and Materials Between March 2000 and March 2009, 27 patients (male to female ratio, 1.25) with PMA underwent SFRT (median dose, 50.4 Gy). Mean age of the patients was 56.5 years (range, 20.3 - 77.4). In all but one patient, SFRT was administered for salvage treatment after surgical resection (transphenoidal resection in 23, transphenoidal resection followed by craniotomy in 2 and multiple transphenoidal resections in another patient). In 10 (37%) patients, the PMAs were functional (3 ACTH-secreting, 3 prolactinomas, 2 growth hormone-secreting and 2 multiple hormone-secretion). Three (11.1%) and 9 (33.3%) patients had PMA abutting and compressing the optic chiasm, respectively. Mean tumor volume was 2.9 ± 4.6 cm3. Eighteen (66.7%) patients had hypopituitarism prior to SFRT. The mean follow-up period after SFRT was 72.4 ± 37.2 months. Results Tumor size decreased for 6 (22.2%) patients and remained unchanged for 19 (70.4%) other patients. Two (7.4%) patients had tumor growth inside the prescribed treatment volume. The estimated 5-year tumor growth control was 95.5% after SFRT. Biochemical remission occurred in 3 (30%) patients with functional PMA. Two patients with normal anterior pituitary function before SFRT developed new deficits 25 and 65 months after treatment. The 5-year survival without new anterior pituitary deficit was thus 95.8%. Five patients with visual field defect had improved visual function and 1 patient with no visual defect prior to SFRT, but an optic chiasm abutting tumor, had a decline in visual function. The estimated 5-year vision and pituitary function preservation rates were 93.2% and 95.8%, respectively. Conclusions SFRT is a safe and effective treatment for patients with PMA, although longer follow-up is needed to evaluate long-term outcomes. In this study, approximately 1 patient with visual field defect out of two had an improved visual function.

A novel GH-1 gene mutation (GH-P59L) causes partial GH deficiency type II combined with bioinactive GH syndrome

Despite the differences in the main characteristics between the autosomal dominant form of GH deficiency (IGHD II) and the bioinactive GH syndrome, a common feature of both is their impact on linear growth leading to short stature in all affected patients.

Genetic evaluation of short stature

After a proper medical history, growth analysis and physical examination of a short child, followed by radiological and laboratory screening, the clinician may decide to perform genetic testing. We propose several clinical algorithms that can be used to establish the diagnosis. GH1 and GHRHR should be tested in children with severe isolated growth hormone deficiency and a positive family history. A multiple pituitary dysfunction can be caused by defects in several genes, of which PROP1 and POU1F1 are most common. GH resistance can be caused by genetic defects in GHR, STAT5B, IGF1, IGFALS, which all have their specific clinical and biochemical characteristics. IGF-I resistance is seen in heterozygous defects of the IGF1R. If besides short stature additional abnormalities are present, these should be matched with known dysmorphic syndromes. If no obvious candidate gene can be determined, a whole genome approach can be taken to check for deletions, duplications and/or uniparental disomies.

Effects of nutrient restriction on mammary cell turnover and mammary gland remodeling in lactating dairy cows

The aim of this study was to investigate the effects of a severe nutrient restriction on mammary tissue morphology and remodeling, mammary epithelial cell (MEC) turnover and activity, and hormonal status in lactating dairy cows. We used 16 Holstein x Normande crossbred dairy cows, divided into 2 groups submitted to different feeding levels (basal and restricted) from 2 wk before calving to wk 11 postpartum. Restricted-diet cows had lower 11-wk average daily milk yield from calving to slaughter than did basal-diet cows (20.5 vs. 33.5 kg/d). Feed restriction decreased milk fat, protein, and lactose yields. Restriction also led to lower plasma insulin-like growth factor 1 and higher growth hormone concentrations. Restricted-diet cows had lighter mammary glands than did basal-diet cows. The total amount of DNA in the mammary gland and the size of the mammary acini were smaller in the restricted-diet group. Feed restriction had no significant effect on MEC proliferation at the time of slaughter but led to a higher level of apoptosis in the mammary gland. Gelatin zymography highlighted remodeling of the mammary extracellular matrix in restricted-diet cows. Udders from restricted-diet cows showed lower transcript expression of alpha-lactalbumin and kappa-casein. In conclusion, nutrient restriction resulted in lower milk yield in lactating dairy cows, partly due to modulation of MEC activity and a lower number of mammary cells. An association was found between feed restriction-induced changes in the growth hormone-insulin-like growth factor-1 axis and mammary epithelial cell dynamics.