Medical Therapy of Gonadotropin-Producing and Nonfunctioning Pituitary Adenomas

Clinically nonfunctioning pituitary adenomas are one of the most common types of pituitary tumors. Unless they present with symptoms related to local mass effect, most tumors are detected incidentally when imaging studies are performed for other reasons. Although clinically nonfunctioning, most of these tumors have evidence, in vitro, of gonadotropin hormone or glycoprotein subunit production. The gonadotropins or their monomer submits rarely cause clinically identifiable effects. When these tumors present as macroadenomas, often with associated mass effect and hypopituitarism, primary therapy is neurosurgery. The role for medical therapy will be reviewed here.     

Hypoglycemia Prediction Using Machine Learning Models for Patients With Type 2 Diabetes

Background:Minimizing the occurrence of hypoglycemia in patients with type 2 diabetes is a challenging task since these patients typically check only 1 to 2 self-monitored blood glucose (SMBG) readings per day.Method:We trained a probabilistic model using machine learning algorithms and SMBG values from real patients. Hypoglycemia was defined as a SMBG value < 70 mg/dL. We validated our model using multiple data sets. In addition, we trained a second model, which used patient SMBG values and information about patient medication administration.Results:The optimal number of SMBG values needed by the model was approximately 10 per week. The sensitivity of the model for predicting a hypoglycemia event in the next 24 hours was 92% and the specificity was 70%. In the model that incorporated medication information, the prediction window was for the hour of hypoglycemia, and the specificity improved to 90%.Conclusions:Our machine learning models can predict hypoglycemia events with a high degree of sensitivity and specificity. These models—which have been validated retrospectively and if implemented in real time—could be useful tools for reducing hypoglycemia in vulnerable patients.     

Effectiveness of the novel anti-diabetes medication exenatide in everyday practice: Comparison with clinical trials

We evaluated effectiveness of exenatide in 81 unselected patients and compared the results with clinical trials. Patients achieved a similar reduction in A1C and lost more weight than patients in the clinical trials. Thirty-seven (46%) were treated off-label. Exenatide was effective on and off-label in this unselected patient group.     

Anomalous Inferior Vena Cava Drainage to the Left Atrium With Successful Staged Repair in a 32-Year-Old Woman With Arthritis

This report describes a case involving anomalous drainage of inferior vena cava (IVC) to the left atrium diagnosed when the patient was 32 years old. The tricuspid valve and the right ventricle were small. Successful surgical repair was performed, with significant improvement of the patient’s clinical status. The use of exercise testing with pulse oxymetry monitoring aided in the decision of timing for closure of the iatrogenically created atrial septal defect.     

Effect of Eicosapentaenoic Acid on Bone Changes due to Methylprednisolone in Rats

Abstract: The present study was conducted to investigate the effects of eicosapentaenoic acid on glucocorticoid‐induced bone changes in rats, and to compare them with those of alendronate. Thirty six male Wistar rats, 2.5 months of age, were divided into six groups (n = 6 each) and treated with 0.9% NaCl (control), methylprednisolone 7 mg/kg, once a week subcutaneously, methylprednisolone + alendronate 20 µg/kg, twice a week subcutaneously and methylprednisolone + 80 or 160 or 320 mg/kg eicosapentaenoic acid, per day orally, for 6 weeks. At the end of the experiment, serum and urinary parameters of bone metabolism determined and bone histomorphometric analyses performed on cancellous bone of femoral epiphysis and metaphysis and cortical bone of tibial diaphysis. There were no significant differences in serum and urinary parameters among groups. Decrease of epiphyseal and metaphyseal trabecular width, epiphyseal bone area/tissue area and increase of epiphyseal trabecular separation observed in the methylprednisolone group compared to control. Alendronate restored all of these parameters except metaphyseal trabecular width, which increased significantly by eicosapentaenoic acid at the doses of 80 and 160 mg/kg. Effects of alendronate and 160 mg/kg eicosapentaenoic acid on bone area/tissue area, alendronate and eicosapentaenoic acid at the doses of 80 and 160 mg/kg on trabecular separation and alendronate and eicosapentaenoic acid at doses of 160 and 320 mg/kg on epiphyseal trabecular width were statistically similar. Methylprednisolone did not significantly change cortical bone parameters including cortical width and marrow area/cortical area. Eicosapentaenoic acid, especially, at the dose of 160 mg/kg exerts beneficial effects on methylprednisolone‐induced bone changes in rats; these effects are similar or sometimes even better than alendronate.     

Ethanolic extract of Otostegia persica ameliorates bone loss in diabetic rats irrespective to its glucose lowering effect

The present study was conducted to investigate the effect of ethanolic extract of Otostegia persica on bone loss in streptozotocin (STZ)-treated diabetic rats. Forty male Wistar rats were randomly divided into five equal groups and treated as follows: group 1 (control); group 2 (STZ group), received STZ 50 mg/kg by a single IP injection; groups 3, 4, and 5 treated with STZ as mentioned above +200 mg/kg, 300 mg/kg, and 450 mg/kg of O. persica extract per day by oral gavage, respectively. On day 29, sera harvested and left femoral and tibiofibular bones were dissected for histomorphometric study, while right femoral and tibiofibular bones as well as L4 vertebrate were removed for determination of ash weight. Obvious hyperglycemia was seen in the STZ group as compared to the control. Administration of O. persica extract at the dosage of 300 mg/kg reversed the hyperglycemia. Alkaline phosphatase activity was markedly increased in all experimental groups as compared to control. Epiphyseal and metaphyseal trabecular width as well as epiphyseal bone area/tissue area significantly decreased in STZ group. O. persica extract at the dosage of 200 mg/kg reversed all these parameters to the control level. Marrow area/cortical area in rats treated with 450 mg/kg O. persica extract were highest among groups. No significant difference observed in osteoid thickness among different groups. Although the ash weights of both compact and cancellous bones in STZ group had no significant difference with control, ash weight of L4 vertebrate in rats treated with 300 and 450 mg/kg of extract was significantly lower than other groups. In conclusion, ethanolic extract of O. persica has bone protective effects in STZ-treated rats irrespective to its glucose lowering properties.