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Objective Control of acromegaly may ameliorate blood pressure ( BP) in hypertensive ( HT) patients. We evaluated the impact of acromegaly control on BP values of normotensive ( NT) acromegalics. Design Retrospective cohort study. Patients Fifty-eight naïve patients with acromegaly (39 F; age range, 30-69 years), including 28 NT and 30 HT subjects, participated in the study. Measurements Blood pressure was measured by clinical measurement and 24-h ambulatory monitoring at diagnosis and after 24 months of medical therapy for acromegaly. Results Acromegaly was controlled by medical therapy in 15 NT and 17 HT patients at 24 months. In the NT group, systolic ( SBP) or diastolic ( DBP) BP significantly increased (all P < 0·005) when acromegaly was uncontrolled, but did not change when the disease was controlled. Changes in SBP and DBP were also significantly different between uncontrolled and controlled NT patients. At 24 months, clinical hypertension was detected only in uncontrolled NT patients (46% vs 0%, P < 0·001), whereas ambulatory hypertension was found in 38% of uncontrolled and in 7% of controlled NT subjects ( P = 0·035). In the HT group, ambulatory SBP increased in patients with uncontrolled acromegaly (24-h SBP P = 0·046, day SBP P = 0·005, night SBP P = 0·005), whereas ambulatory DBP decreased in subjects with controlled disease (24-h DBP P = 0·008, day DBP P = 0·026). Conclusions Control of acromegaly has a beneficial effect on BP regulation either in HT or NT subjects; in the latter, it may prevent progression towards hypertension. [ABSTRACT FROM AUTHOR]

Background Acromegalic patients have increased prevalence of colonic polyps. Development of hyperplastic polyps was related to suppressor of cytokine signalling (SOCS) 2 haploinsufficiency in animal models of acromegaly. Objective and patients To evaluate whether variations in SOCS2 expression in the colonic mucosa of acromegalic patients might be associated to hyperplastic polyps, patients with active acromegaly or disease in remission with or without hyperplastic polyps were studied; controls were non-acromegalic subjects age- and sex- matched with or without polyps. Measurements Expression of SOCS1-3 was evaluated by RT-PCR, immunofluorescence and Western blot in the colonic mucosa. Coimmunoprecipatiton was used to evaluate multimeric protein complexes. Results Acromegalic patients with active disease and hyperplastic polyps had higher levels of SOCS2 transcripts; on the contrary, SOCS1 and SOCS3 transcripts did not differ among the study groups. While the expression of SOCS2 and SOCS3 protein was indistinguishable with that of the corresponding transcripts, SOCS1 protein expression was reduced in active acromegalic patients with polyps. SOCS1 protein was reduced owing to its increased proteasome degradation mediated by SOCS2. The increased SOCS2 and reduced SOCS1 led to increased STAT5b expression, suggesting a higher GH signalling transduction. Conclusions Acromegalic patients with active disease and hyperplastic polyps have high levels of SOCS2 and increased SOCS1 degradation, leading to reduced negative feedback on GH signalling, likely favouring a hyperplastic polyps phenotype. [ABSTRACT FROM AUTHOR]

Objective To investigate how North American thyroidologists assess and treat amiodarone-induced thyrotoxicosis (AIT) and to compare the results with those of the same questionnaire-based survey previously carried out among European thyroidologists. Design Members of the American Thyroid Association (ATA) with clinical interests were sent by e-mail a questionnaire on the diagnosis and management of AIT, 115 responses were received from the United States and Canada, representing about one-third of ATA members with clinical interests. Results The majority of respondents (91% vs. 68% in Europe, P < 0·05) see < 10 new cases of AIT per year, and AIT seems less frequent than amiodarone-induced hypothyroidism (AIH) in North America (34% and 66% of amiodarone-induced thyroid dysfunction, respectively, vs. 75% and 25%, respectively, in Europe, P < 0·001). When AIT is suspected, in North America hormonal assessment is mostly based on serum free T4 (FT4) and TSH measurements, while serum free T3 (FT3) determination is requested less frequently than in Europe; thyroid autoimmunity is included in the initial assessment less than in Europe. Most commonly used additional diagnostic procedures include, as in Europe, thyroid colour-flow Doppler sonography, and to a lesser extent, thyroid radioactive iodine uptake and scan, but Europeans tend to request multiple tests more than North Americans. Withdrawal of amiodarone is more often considered unnecessary by North American thyroidologists (21% vs. 10% in Europe in type 1 AIT, P < 0·05, 34% vs. 20% in type 2 AIT, P < 0·05). In type 1 AIT thionamides represent the treatment of choice for North Americans as well as for Europeans, but the former use them as monotherapy in 65% vs. 51% of Europeans ( P < 0·05) who more often consider potassium perchlorate as an useful addition (31% vs. 15% of North Americans, P < 0·01). Glucocorticoids are the selected treatment for type 2 AIT, alone (62% vs. 46% in Europe, P < 0·05) or in association with thionamides (16% vs. 25% in Europe, P = NS). After restoration of euthyroidism, thyroid ablation in the absence of recurrent thyrotoxicosis is recommended in type 1 AIT less frequently by North Americans. If amiodarone therapy needs to be reinstituted, prophylactic thyroid ablation is advised by 76% in type 1 AIT, while a ‘wait-and-see’ strategy is adopted by 61% in type 2 AIT, similar to behaviour of European thyroidologists. Conclusion Similarities and differences exist between expert North American and European thyroidologists concerning the diagnosis and management of AIT. While differences reflect the frequent uncertainty of the underlying mechanism leading to AIT, similarities may represent the basis to refine the diagnostic criteria and to improve the therapeutic outcomes of this challenging clinical situation. [ABSTRACT FROM AUTHOR]

Objective Left ventricular (LV) hypertrophy and myocardial fibrosis are considered the main pathological features of acromegalic cardiomyopathy. The aim of the study was to evaluate the proportion of LV hypertrophy and the presence of fibrosis in acromegalic cardiomyopathy in vivo using cardiac magnetic resonance (CMR). Design and patients Fourteen consecutive patients (eight women, mean age 46 ± 10 years) with untreated active acromegaly were submitted to two-dimensional (2D) colour Doppler and integrated backscatter (IBS) echocardiography and CMR. Measurements LV volume, mass and wall thickness and myocardial tissue characterization (IBS and CMR). Results On echocardiography: mean LV mass (LVM) and LVM index (LVMi) were 209 ± 48 g and 110 ± 24 g/m2, respectively; hypertrophy was revealed in five patients (36%); abnormal diastolic function [evaluated by isovolumic relaxation time (IVRT) or early (E) to late or atrial (A) peak velocities (E/A ratio)] was found in four patients (29%). Systolic function evaluated by measuring LV ejection fraction (LVEF) was normal (mean 72 ± 12%) in all patients. Six patients (43%) had increased IBS (mean 57·4 ± 6·2%). On CMR: mean LVM and LVMi were 151 ± 17 g and 76 ± 9 g/m2, respectively; 10 patients (72%) had LV hypertrophy. Contrastographic delayed hyperenhancement was absent in all patients; on the contrary, mild enhancement was revealed in one patient. Systolic function was normal in all patients (LVEF 67 ± 11%). LVMi was not related to serum IGF-1 concentrations or the estimated duration of disease. Conclusions CMR is considered to be the gold standard for evaluating cardiac hypertrophy, fibrosis and systolic function. Using CMR, 72% patients with untreated active acromegaly had LV hypertrophy, which was only detected in 36% patients by echocardiography. However, cardiac fibrosis was absent in all patients irrespective of the estimated duration of disease. Although a very small increase in collagen content (as suggested by increased cardiac reflectivity at IBS), not detectable by CMR, could not be ruled out, it is unlikely that it would significantly affect cardiac function. [ABSTRACT FROM AUTHOR]

Context Two main forms of amiodarone-induced thyrotoxicosis (AIT) exist. Type 1 AIT is a form of iodine-induced hyperthyroidism. Its management is complex and includes thionamides, potassium perchlorate and, occasionally, thyroidectomy. Type 2 AIT is a destructive thyroiditis, responds to glucocorticoids, and usually does not require further thyroid treatment once euthyroidism has been restored. Objective To assess retrospectively the prevalence and relative proportion of type 1 and type 2 AIT over a 27-year period at a tertiary referral centre in Italy. Patients Consecutive AIT patients ( n = 215) seen at the department of endocrinology of the University of Pisa between 1980 and 2006. Results Type 1 AIT constituted the most frequent AIT form (60%) during the first years covered by this study. The annual mean number of type 1 AIT patients was 3·6 at the beginning of the study period, and 2·5 during the later years. In contrast, the mean annual number of new cases of type 2 AIT progressively increased from 2·4 to 12·5. Likewise, the proportion of type 2 AIT increased in a significant linear manner ( P < 0·0001), currently accounting for 89% of AIT cases. Type 2 AIT patients showed a male preponderance, higher serum FT4/FT3 ratio ( P < 0·002), lower 3-h and 24-h thyroidal radioactive iodine uptake values ( P < 0·0001), and received a higher cumulative dose of amiodarone ( P < 0·0001) than type 1 AIT patients. Conclusions Over a 27-year period, the epidemiology of AIT changed, as the prevalence of type 2 AIT progressively increased and that of type 1 remained constant. Thus, under most circumstances, endocrinologists nowadays deal with type 2 AIT, which is a destructive thyroiditis, generally treated successfully with glucocorticoids. Although no additional treatment is usually required after the destructive process subsides, periodic assessment of thyroid function is warranted, because of the occurrence of hypothyroidism (up to 17%) during long-term follow-up of these patients. [ABSTRACT FROM AUTHOR]

Background Obesity is a clinical feature of patients with Cushing's disease. Peroxisome proliferators-activated receptor (PPAR)γ is the master regulator of adipogenesis; however, the expression of PPARγ isoforms in the subcutaneous adipose tissue (SAT) of patients with Cushing's disease is unknown. Aim and methods The expression of PPARγ1 and PPARγ2 was evaluated by real-time reverse transcription polymerase chain reaction (RT-PCR) and immunofluorescence (PPARγ2 only) in SAT samples of 7 patients with untreated active Cushing's disease (CushingUNTR), 8 with Cushing's disease in remission (CushingREM) after pituitary adenomectomy, 15 normal lean subjects (ControlLEAN), and 15 obese patients (ControlOBE). Results ControlLEAN had a higher degree of PPARγ1 than PPARγ2 (PPARγ2/PPARγ1 ratio, 0·55 ± 0·35). PPARγ2/PPARγ1 ratio decreased in CushingUNTR (0·10 ± 0·043, P < 0·03 vs. ControlLEAN and ControlOBE), because of either increased PPARγ1 or reduced PPARγ2 expression. PPARγ2/PPARγ1 ratio was 0·48 ± 0·07 in CushingREM patients ( P < 0·04 vs. CushingUNTR, P < 0·03 vs. ControlOBE). PPARγ2/PPARγ1 ratio was higher in ControlOBE 0·90 ± 0·38 than in ControlLEAN ( P < 0·005 vs. ControlLEAN, P < 0·03 vs. CushingREM, P < 0·009 vs. CushingUNTR). PPARγ2/PPARγ1 ratio was related to serum cortisol levels only in patients with Cushing'disease ( r = 0·688, P < 0·02). Conclusions CushingUNTR patients had an abnormal expression of PPARγ isoforms in SAT related to serum cortisol levels. Although further studies are necessary, it is conceivable that variations in the expression of PPARγ isoforms might have a role in the abnormal adipogenesis of patients with Cushing's disease. [ABSTRACT FROM AUTHOR]

Background Patients with acromegaly have an increased risk of developing colonic tumours; reduced apoptosis is considered a leading mechanism in tumorigenesis. GH and IGF-1 decrease apoptosis in several cell lines including human colonic adenocarcinoma, but it is unknown whether epithelial cells of colonic mucosa of patients with acromegaly have reduced apoptosis. Aim The aim of the study was to evaluate the degree of apoptosis in a cross-sectional study, in biopsy samples of colonic mucosa obtained from patients with acromegaly. Patients and methods Eleven patients with active, untreated acromegaly (AcroUntr), 16 patients with acromegaly in remission (AcroRem) and 23 controls were enrolled in the study. Samples of colonic mucosa were obtained during colonoscopy; apoptosis was evaluated by either DNA fragmentation or terminal deoxynucleotidyl transferase assay. Results Apoptotic cells were 60·0 ± 2·5% in samples of colonic mucosa of controls, 62·0 ± 3·4% in those from patients with AcroRem ( P = ns vs. controls), and 39·0 ± 4·1% in those from patients with AcroUntr ( P < 0·0001 vs. the other groups). Apoptosis was inversely related to serum IGF-I ( r = 0·771, P < 0·001) or GH ( r = 0·404, P = 0·05) levels and less to the estimated duration of disease ( r = 0·384, P = 0·07). PPARγ is considered to be a tumour suppressor gene the expression of which might be involved in colonic tumorigenesis. The expression of PPARγ was lower in the colonic mucosa of patients with AcroUntr (2845 ± 947 transcripts) than in that of controls (35 200 ± 2450 transcripts) or AcroRem (29 547 ± 3650 transcripts) ( P < 0·005). The recovery of PPARγ expression was associated with apoptosis in most cells. The lower degree of apoptosis in patients with AcroUntr was associated with a reduced expression of the antiapoptotic Bax protein. Conclusion In conclusion, patients with AcroUntr have reduced apoptosis in colonic mucosa that is apparently reversed after acromegaly is cured. It is conceivable that reduced apoptosis may represent an early event in colonic tumorigenesis of patients with acromegaly. [ABSTRACT FROM AUTHOR]

Acromegalic patients have increased left ventricular (LV) mass (M) and impaired diastolic function.Using ultrasonic cardiac tissue characterization, we evaluated the early changes in cardiac fibrosis (IBS) and intrinsic myocardial contractility (CVI) as well as their reversibility after treatment with somatostatin analogues (SMSA) in patients with acromegaly.Twenty-two acromegalic patients with active untreated disease (AcroUNTR) underwent conventional Doppler echocardiography and integrated backscattering; 25 healthy subjects (controls) and eight patients with acromegaly in remission after pituitary adenomectomy (AcroREM) served as controls.As expected, AcroUNTR at baseline had higher LVM than controls or AcroREM (P < 0·001); LVM reduced in acromegalic patients after SMSA (P < 0·005vs.baseline) while LV ejection fraction did not change. LV diastolic function was reduced in all acromegalic patients, either at baseline or after SMSA therapy (E/A ratio, 0·96 ± 0·3 and 1·1 ± 0·3, respectively,P < 0·002vs.controls, 1·6 ± 0·3). CVI was reduced in AcroUNTR (14·3 ± 5·8%,P < 0·003vs.controls, 28·7 ± 7·5%) and greatly improved after SMSA (22·5 ± 4·5%,P < 0·003vs.baseline). Cardiac fibrosis was increased in AcroUNTR (IBSMSI, 53·7 ± 5·3%P < 0·002vs.controls) and reduced after SMSA (43·7 ± 4·2%P <0·002vs.baseline) albeit not reaching values observed in controls. More importantly, five of 22 (23%) AcroUNTR patients had normal LVM, but increased cardiac fibrosis as revealed by back scattering. IBS values and CVI% were related with serum GH and IGF-1 (P <0·0001) levels, and the estimated duration of disease (P < 0·005).The present study demonstrated that active acromegalic patients had early impairment of systolic function and increased cardiac fibrosis; increased fibrosis may precede LV hypertrophy; these changes are related to the activity of disease and might improve during treatment with SMSA. [ABSTRACT FROM AUTHOR]

To determine how expert European thyroidologists assess and treat amiodarone-induced thyrotoxicosis (AIT).Members of the European Thyroid Association (ETA) with clinical interests were asked to answer a questionnaire on the diagnosis and management of AIT. A total of 124 responses were received: 116 from Europe, seven from USA and one from Brazil. After excluding responses coming from the same centre, 101 responses from 24 European countries were analysed, representing approximately 65% of clinically active European ETA members.The majority of respondents (68%) see 1–10 new cases of AIT/year, and AIT seems to be more frequent than amiodarone-induced hypothyroidism in Europe, where in many instances iodine intake is borderline or moderately deficient. A good collaboration with cardiologists exists in most centres, and patients receiving chronic amiodarone treatment are checked for thyroid function most commonly every 4–6 months. When AIT is suspected, a diffuse or nodular goitre is present or in the absence of apparent abnormalities of the thyroid, free thyroxine (FT4), free triiodothyronine (FT3) and TSH are assayed by almost 90% of respondents. Thyroid autoimmunity is evaluated in the initial assessment by> 80%, while evaluation of urinary iodine excretion is unhelpful for > 60%. Most commonly used additional diagnostic procedures include thyroid ultrasonography, particularly colour flow Doppler sonography, and, to a lesser extent, a thyroid uptake scan. If the thyroid gland is apparently normal, measurement of thyroidal radioactive iodine uptake is considered useful by a large proportion of respondents to establish the destructive nature of the process. Differentiation of type I and type II AIT is difficult and, possibly, not correct for 27% of respondents, who believe that mixed (or indefinite) forms are probably more frequent than previously recognized. Approximately 10–20% do not consider amiodarone withdrawal necessary in the therapeutic strategy of AIT, especially if the thyroid gland is apparently normal. Most respondents (82%) treat type I AIT with thionamides, either alone (51%) or in combination with potassium perchlorate (31%), while the preferred treatment for type II AIT is represented by glucocorticoids (46%). Some respondents, in view of diagnostic difficulties, initially treat all cases of AIT with a combination of thionamides and glucocorticoids. After restoration of euthyroidism, ablative therapy is recommended by 34% in type I and only 8% in type II AIT. If amiodarone therapy needs to be reinstituted, prophylactic thyroid ablation is recommended by 65% in type I AIT, while a wait-and-see strategy is adopted by 70% in type II AIT.Areas of certainty and uncertainty concerning AIT are present among expert European thyroidologists, both from a diagnostic and a therapeutic standpoint. Diagnostic criteria need to be refined in order to improve therapeutic outcome. [ABSTRACT FROM AUTHOR]

Summary objective To determine whether acromegalic patients have increased thyroidal vascularity and blood flow on colour flow Doppler sonography (CFDS). design Prospective study of consecutive patients. patients Twenty-four acromegalic patients (11 men, 13 women, age 49 ± 9 years); 38 patients with nontoxic goitre (NTG; 12 men, 26 women, age 50 ± 7 years); 36 normal subjects (controls; 16 men, 20 women, age 46 ± 9 years). Among acromegalic patients, 10 had active, untreated disease (Acro-U), seven were in remission after surgery (Acro-R), seven had active disease under treatment with somatostatin analogues (SMSa) (Acro-SA) (Sandostatin LAR® , 20 mg, every 28 days). measurements CFDS pattern and intrathyroidal peak systolic velocity (PSV) were determined by a colour Doppler system with a 7·5-MHz linear transducer. PSV measurements were made at the level of the intrathyroidal arteries (normal values 3·8 ± 1·0 cm/s). Thyroid volume was calculated by the ellipsoidal model. Assays included measurements of serum GH, IGF-I, free T4, free T3, TSH, antithyroglobulin (anti-Tg) and antithyroperoxidase (anti-TPO) antibodies, TSH-receptor antibodies (TRAb). results Serum GH (± SD) and IGF-I (± SD) levels were: Acro-U: GH 26 ± 31 µg/l, IGF-I 783 ± 299 µg/l; Acro-SA: GH 15 ± 25 µg/l, IGF-I 366 ± 212 µg/l; Acro-R: GH 1·3 ± 1·0 µg/l, IGF-I 241 ± 99 µg/l. To convert values for serum GH to mU/l multiply by 2·6; to convert values for serum IGF-I to nmol/l multiply by 0·13075. All controls had CFDS pattern 0 (absent vascularity or minimal spots); among NTG patients, 36 had pattern 0 and two had pattern I (parenchymal blood flow with patchy uneven distribution). Five patients with acromegaly had pattern 0, 12 had pattern I and seven pattern II (mild increase of colour flow Doppler signal with patchy distribution). Among the five acromegalic... [ABSTRACT FROM AUTHOR]

Summary objective Acromegaly is characterized by an enlargement of various organs. The aim of the present study was to evaluate whether acromegalic patients have an increased volume of submandibular salivary glands. design and subjects Prospective study on 40 consecutive acromegalic patients (18 male, 22 female; mean age ± SD, 50 ± 13 years, range 22–74 years) submitted to submandibular salivary gland ultrasound. Among acromegalic patients, 15 had active and untreated disease (Acro-U), 13 were under long-acting somatostatin analogue therapy (Acro-SA), 12 were in remission after surgery (Acro-R). Two hundred subjects (90 male, 110 female, mean age ± SD, 50 ± 11 years, range 23–74 years) matched for age, sex and body mass index served as controls. measurements Submandibular salivary gland volume was measured in all acromegalic patients and normal subjects by ultrasound and calculated by the ellipsoid model. Serum GH and IGF-I concentrations were measured in all subjects. results Acro-U patients had higher serum IGF-I levels (691 ± 235 µg/l) than Acro-R (174 ± 74 µg/l), Acro-SA (436 ± 239 µg/l) or controls (151 ± 66 µg/l) (P < 0·0001, P = 0·008, P < 0·0001, respectively). The mean submandibular salivary gland volume was higher in acromegalic patients than in controls: Acro-U 18·1 ± 3·3 ml, Acro-SA 16·2 ± 3·3 ml, Acro-R 15·7 ± 3·0 ml and controls 8·2 ± 2·4 ml ( P < 0·0001). Differences among subgroups of Acro patients were not significant. Enlargement of the submandibular salivary glands was present in 35/40 (87·5%) acromegalic patients. A positive correlation between serum IGF-I ( P < 0·0001), GH ( P < 0·0001) and submandibular salivary gland volume was found. conclusions Acromegalic patients have an increased volume of submandibular salivary glands, independently of the activity of disease. [ABSTRACT FROM AUTHOR]

OBJECTIVE Pendred's syndrome is an autosomal recessive disorder characterized by goitre, sensorineural deafness and iodide organification defect. It is one of the most frequent causes of congenital deafness, accounting for about 10% of hereditary hearing loss. It is caused by mutations in the pendrin (PDS) gene, a 21 exon gene located on chromosome 7. The aim of this study was to examine an Italian family affected with Pendred's syndrome at the molecular level. PATIENTS Thirteen subjects belonging to a family from Southern Italy were evaluated for the clinical and genetic features of Pendred's syndrome. MEASUREMENTS Exons 2–21 of the PDS gene were amplified from peripheral leucocytes by the polymerase chain reaction; mutation analysis was performed by single strand conformation polymorphism, direct sequencing and restriction analysis. RESULTS The index patient had the classical triad of the syndrome and harboured two mutations in the PDS gene in the form of compound heterozygosity. He was found to be heterozygous for a cytosine to adenosine mutation at nucleotide 1523 in exon 13 and for a IVS 1001 + 1G → A mutation. The former is a novel mutation which results in a change of 508 threonine to asparagine in the putative eleventh transmembrane domain. The latter mutation in the donor splice site has already been described in other patients and is thought to lead to aberrant splicing and premature protein truncation. Three subjects who were heterozygous for one mutation had normal phenotypes. Two subjects had sensorineural deafness and were heterozygous for a single mutation. Goitre was found only in patients with Pendred's syndrome and was absent in all other individuals, albeit residing in an iodine-deficient area. CONCLUSIONS We have identified a novel mutation in the pendrin gene causing Pendred's syndrome, and confirm that molecular analysis is a useful tool for a definitive diagnosis. This is particularly relevant in cases such as in the subjects... [ABSTRACT FROM AUTHOR]

To determine whether hypercalcemia per se might be responsible for an impairment in GH secretion. Prospective study. Six subjects of two unrelated families with familial hypocalciuric hypercalcaemia (FHH), an autosomal dominant disorder due to inactivating mutations in the calcium receptor gene, leading to an increase in serum calcium levels and inappropriately normal serum PTH concentrations. Forty normal subjects, matched for sex and age served as controls. Serum GH concentrations were measured after GHRH-Arginine (GHRH-Arg) stimulation test; serum IGF-I, ACTH, cortisol, FT4, FT3, TSH, PRL, LH, FSH levels were measured under basal conditions. All subjects (two male, four female, age range 24–74 years) had increased serum ionized calcium levels (range 1·36–1·56 mmol/l) and five of six patients had normal PTH levels (range for all patients was 14–68 ng/l). Basal serum GH concentrations ranged from 0·1 to 7·0 µg/l. Mean serum GH secretory peak after GHRH-Arg stimulation test was reduced in five subjects (mean 9·3 ± 3·6 µg/l, P < 0·006 vs. Controls, mean 67·0 ± 44·0 µg/l, cut-off, 16·0 µg/l) and normal in one subject (38·7 µg/l). However, serum IGF-I levels were reduced only in two patients (29 and 57 µg/l) and normal in four subjects (range 127–208 µg/l). The basal secretion of the other anterior pituitary hormones was within their normal ranges. The results of the present study support the concept that elevated serum calcium levels impair GH secretion. However, the clinical relevance of GH deficiency in FHH remains to be elucidated. [ABSTRACT FROM AUTHOR]

Summary: Context: Therapy with somatostatin analogues (SSAs) may have deleterious effects on glucose metabolism in patients with acromegaly, often leading to the development of diabetes mellitus (DM). Aim: The aim of the study was to evaluate whether DM, developed during therapy with SSAs, may revert after drug withdrawal and cure of acromegaly with pituitary adenomectomy. Design: Retrospective cohort study, in a tertiary referral centre. Patients: Eighteen acromegalic patients without DM at the diagnosis of acromegaly treated with SSAs as a primary therapy, and then cured by pituitary adenomectomy. Methods: Endocrine status and glucose homeostasis were evaluated at diagnosis of acromegaly and at least every 6 months during SSA therapy. At each visit, patients were classified into one of the following classes: normal glucose tolerance, prediabetes, overt diabetes. Results: Median follow‐up after starting SSAs therapy was 69 months (IQR 54.75‐132.25). During SSA therapy, all patients had controlled acromegaly defined by normal serum IGF1 concentrations for the age. Of the 13 euglycaemic patients at diagnosis, three developed prediabetes and three diabetes, whereas, of the five prediabetic patients at diagnosis, two worsened to overt diabetes and three remained in the prediabetic range (P = 0.04). After curing acromegaly with pituitary adenomectomy and subsequent SSA withdrawal, prediabetes reverted in five of six patients, and diabetes in all five patients (three reverted to euglycaemia, while two reverted to prediabetes) (P = 0.01). Conclusions: In acromegalic patients with controlled disease, changes in glycaemic status induced by SSAs are not permanent. Therapy with somatostatin analogues in acromegalic patients may lead to the development of diabetes mellitus. Glycaemic alterations that develop during efficacious therapy with somatostatin analogues revert after drug withdrawal and cure of acromegaly with pituitary adenomectomy. In acromegalic patients with controlled disease, changes in glycaemic status induced by somatostatin analogues are not permanent. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented commenting on the treatment of two patients with type 1 amiodarone-induced thyrotoxicosis with radioiodine after stimulation with recombinant human thyrotropin (TSH).

Examines the efficacy of amiodarone drug in the management of tachyarrhythmias. Observation of side-effects on several organs; Effect of amiodarone on thyroid function tests; Difficulty in diagnosing amiodarone-induced thyrotoxicosis.