Poster 6: Traumatic brain injury as a relevant cause of growth hormone deficiency in adults. Experience from KIMS (pharmacia international metabolic database)

Objective: To compare baseline clinical characteristics and 1-year growth hormone (GH) replacement results in patients with adult onset growth hormone deficiency (GHD) caused by traumatic brain injury (TBI) versus nonfunctioning pituitary adenoma (NFPA). Design: Pharmacoepidemiologic survey of hypopituitary adults with GHD. Setting: Records were selected from the KIMS database, which contains information on >8500 patients with GHD, for 168 of whom TBI was identified as a cause. Participants: Both groups (NFPA group, n=207; TBI group, n=29) were age- (at pituitary disorder onset and entry into the KIMS database) and sex-matched (60% men, 40% women), previously not irradiated, and had not received GH. Interventions: Not applicable. Main Outcome Measures: Values given as mean ± SE. Results: The age at GHD diagnosis was 38.8±2.0 years for the TBI group and 41.5±0.5 years for the NFPA group. In both groups, the most frequent additional hypopituitary deficiency was luteinzing hormone/follicle-stimulating hormone, followed by adrenocorticotropic hormone and thyroid-stimulating hormone. The mean GH peak at diagnosis was 1.25±0.42ng/mL in the TBI group, which was significantly lower than that of the NFPA group (2.38±0.7ng/mL). There were no significant statistical differences in medical history, glucose level, lipids, waist circumference, or body composition measurements. Interestingly, patients with TBI were significantly shorter (168.2±1.5cm) than the NFPA patients (172.5±0.6cm). After 1 year of GH treatment, differences were shown in waist, lean mass, heart rate, glucose levels, quality of life as measured by the Quality of Life Assessment in Growth Hormone Deficient Adults and insulin-like growth factor I. Conclusions: Although hypopituitarism secondary to TBI was described more than 50 years ago, it is only now evident that a considerable number of patients experience severe GHD after TBI. It is suspected that a large number of patients after TBI have undiagnosed GHD. The present results confirm that clinical characteristics and GH treatment effects in GHD caused by TBI are indistinguishable from those in GHD caused by NFPA.     

Adenosine does not bind to the growth hormone secretagogue receptor type-1a (GHS-R1a)

Ghrelin regulates GH secretion and energy homeostasis through the GH secretagogue receptor type-1a (GHS-R1a). This G-protein coupled receptor shows the peculiarity to transduce information provided not just by ghrelin as well as by adenosine through a supposed binding site different from the characterized ghrelin-binding pocket. Indeed, adenosine triggers intracellular calcium rise through a distinct signaling pathway to the one described for ghrelin, although it fails to stimulate GH secretion. Despite multiple active conformations of GHS-R1a, suggested as an explanation for a ligand-dependent activation of the downstream signaling, the concept of adenosine as agonist for GHS-R1a has been re-evaluated. The results revealed that calcium rise of both ghrelin and adenosine appears to be mediated by receptors that did not show the same sensitivity to protein kinase C (PKC) activity in GHS-R1a-transfected HEK 293 cells (HEK-GHS-R1a cells). The binding analyses showed the same number of adenosine-binding sites in both HEK 293 (B(max) = 2.01 +/- 0.15 fmol/cell) and HEK-GHS-R1a cells (B(max) = 1.90 +/- 0.11 fmol/cell). This binding was unaltered by different GHS-R1a antagonists. Western blot analysis showed a similar endogenous expression of endogenous adenosine receptor type-2b and -3 in both cell lines. The K(d) values for adenosine were 1.78 microM in HEK 293 cells and 6.30 microM in HEK-GHS-R1a cells, pointing to a modification of agonist affinity induced by overexpression of the GHS-R1a. Additionally, adenosine failed to induce the GHS-R1a endocytosis, although it attenuates the ghrelin-induced GHS-R1a endocytosis. In conclusion, adenosine is not an agonist of the GHS-R1a and its action is mediated by the endogenous adenosine receptor type-2b and -3, which is able to partially use the intracellular signaling machinery of HEK-GHS-R1a cells.     

A role for novel adipose tissue‐secreted factors in obesity‐related carcinogenesis

Obesity, a pandemic disease, is caused by an excessive accumulation of fat that can have detrimental effects on health. Adipose tissue plays a very important endocrine role, secreting different molecules that affect body physiology. In obesity, this function is altered, leading to a dysfunctional production of several factors, known as adipocytokines. This process has been linked to various comorbidities associated with obesity, such as carcinogenesis. In fact, several classical adipocytokines with increased levels in obesity have been demonstrated to exert a pro‐carcinogenic role, including leptin, TNF‐α, IL‐6 and resistin, whereas others like adiponectin, with decreased levels in obesity, might have an anti‐carcinogenic function. In this expanding field, new proteomic techniques and approaches have allowed the identification of novel adipocytokines, a number of which exhibit an altered production in obesity and type 2 diabetes and thus are related to adiposity. Many of these novel adipocytokines have also been identified in various tumour types, such as that of the breast, liver or endometrium, thereby increasing the list of potential contributors to carcinogenesis. This review is focused on the regulation of these novel adipocytokines by obesity, including apelin, endotrophin, FABP4, lipocalin 2, omentin‐1, visfatin, chemerin, ANGPTL2 or osteopontin, emphasizing its involvement in tumorigenesis.     

Short-term efficacy of topical capsaicin therapy in severely affected fibromyalgia patients

The purpose of this study was to evaluate the short-term efficacy of topical capsaicin treatment in patients severely affected by fibromyalgia. One hundred and thirty fibromyalgia patients were randomly divided into two groups. The control group, 56 women and 4 men who continued their medical treatment, and the capsaicin group, 70 women who apart from continuing their medical treatment, also underwent topical capsaicin 0.075 % 3 times daily for 6 weeks. At the beginning of the program, there were no significant differences between the two groups in any of the analyzed parameters. At the end of the treatment, there were significant improvements in the capsaicin group in the myalgic score (5.21 vs 3.8, p = 0.02) and global subjective improvement (22.8 vs 5 %, p = 0.001). Six weeks after the end of the treatment, the experimental group showed significant differences in Visual Analogue Scale of depression (5.63 vs 7.35, p = 0.02), Fibromyalgia Impact Questionnaire (67.89 vs 77.7, p = 0.02), role limitations due to emotional problems (36.17 vs 17.2, p = 0.05), Fatigue Severity Scale (6.2 vs 6.6, p = 0.04), myalgic score (3.94 vs 2.66, p = 0.02) and pressure pain threshold (79.25 vs 56.71, p = 0.004). In conclusion, patients severely affected by fibromyalgia can obtain short-term improvements following topical capsaicin 0.075 % treatment three times daily for 6 weeks.     

Elevated levels of gonadotrophins but not sex steroids are associated with musculoskeletal pain in middle-aged and older European men

The aim of this study was to determine the association of hormone levels with the occurrence of musculoskeletal pain. Men ages 40 to 79 years were recruited from population registers in 8 European centres. Subjects were asked to complete a postal questionnaire, which enquired about lifestyle and the occurrence of musculoskeletal pain over the past month. Total testosterone (T), oestradiol (E2), luteinising hormone (LH), and follicle-stimulating hormone (FSH) were assayed from a fasting blood sample. The association between pain status and hormone levels was assessed using multinomial logistic regression with results expressed as relative risk ratios (RRR) and 95% confidence intervals (CI). A total of 3206 men had complete data on pain status. Of these, 8.7% reported chronic widespread pain (CWP), whereas 50% had some pain although not CWP and were classified as having some pain. T and E2 were not associated with musculoskeletal pain, whereas significant differences in LH and FSH levels were found between pain groups. After adjustment for age and other possible confounders, the association between pain status and both LH and FSH persisted. Compared with those in the lowest tertile of LH, those in the highest tertile were more likely to report some pain (vs no pain, RRR=1.28; 95% CI 1.09 to 1.50) and also CWP (vs no pain, RRR=1.51; 95% CI 1.10 to 2.07). Similar results were found for FSH. Gonadotrophins, but not sex steroid hormone levels, are associated with musculoskeletal pain in men.     

接受肾移植前维持性血液透析患者生活质量与静脉补充左旋卡尼汀的影响

目的:血液透析患者大多存在卡尼汀尤其是游离卡尼汀的缺乏,透析后补充左旋卡尼汀能够减轻、减少并发症及住院率。观察静脉补充左旋卡尼汀对肾移植前血液透析患者生活质量的影响。方法:选择2005-09/2006-09于柳州市人民医院进行维持性血液透析的患者30例,对治疗方案均知情同意。按随机数字表法分为左旋卡尼汀组和对照组,每组15例。每次透析结束后,左旋卡尼汀组静脉注射左旋卡尼汀20mg/kg,对照组注射等量的生理盐水,用药8周。用药前及用药8周时分别应用SF-36量表进行生活质量评分,由8个方面组成,每项都以0￣100分计,得分越高表示生活质量越好;同时记录透析相关症状及实验室参数,比较两组间差异。结果:30例患者全部进入结果分析。①与用药前相比,用药8周后左旋卡尼汀组SF-36总体评分增加了(18.29±12.71)分,对照组总评分减少了(6.40±16.39)分。与对照组相比,左旋卡尼汀组总评分及生理功能、总体健康、活力、社会功能、精神健康评分均显著增加(P<0.05￣0.01)。②与对照组相比,左旋卡尼汀组血红蛋白、白蛋白含量均显著增加(P<0.01)。结论:静脉补充左旋卡尼汀不仅有助于改善维持性血液透析患者的贫血状况,而且能明显提高其生活质量。