A challenging TSH/GH co-secreting pituitary adenoma with concomitant thyroid cancer; a case report and literature review

xlomafota13 shared this article with you from Inoreader A challenging TSH/GH co-secreting pituitary adenoma with concomitant thyroid cancer; a case report and literature review Via radioactive iodine BMC Endocr Disord. 2021 Aug 30;21(1):177. doi: 10.1186/s12902-021-00839-x. ABSTRACT BACKGROUND: Thyroid stimulating hormone (TSH) secreting pituitary adenoma (TSHoma) with coexisting thyroid cancer is extremely rare, and proper treatment of both diseases may pose a unique clinical challenge. When TSHoma has plurihormonality, particularly involving the co-secretion of growth hormone (GH), management can be more complicated. Herein, we present a difficult-to-manage case of papillary thyroid cancer with an incurable TSH/GH-secreting pituitary adenoma. CASE PRESENTATION: A 59-year-old man was referred to our hospital due to memory impairment and inappropriate TSH level. Sella magnetic resonance imaging revealed a huge pituitary mass extending to the suprasellar area. Clinical diagnosis of TSH/GH co-secreting pituitary adenoma was made based on elevated free T4, total T3, serum α-subunit, insulin-like growth factor-1 levels and non-suppressible GH levels after oral glucose loading. Rectal cancer and multifocal papillary thyroid microcarcinoma (PTMC) were diagnosed during initial screening for internal malignancy; lower anterior resection was performed and close observation was planned for PTMC. Long-acting octreotide therapy was commenced, which resulted in a dramatic reduction in TSHoma size and facilitated control of hormonal excess. Total thyroidectomy and radioactive iodine (RAI) therapy were needed during follow up due to the growth of PTMC. After the surgery, the pituitary adenoma represented resistance to somatostatin analogue therapy and the tumor size gradually increased despite the addition of dopamine agonist therapy. Furthermore, TSH suppressive therapy with levothyroxine was impossible and an adequate TSH level for RAI therapy was unmountable. Late debulking pituitary surgery was ineffective, and the patient gradually deteriorated and lost to follow up. CONCLUSION: We report the first aggravated case of TSH/GH co-secreting pituitary tumor after total thyroidectomy for concomitant multifocal PTMC. Deferring of thyroid surgery until the TSHoma is well controlled may be the optimal therapeutic strategy in patients with TSHoma and coexistent thyroid cancer; ablative thyroid surgery may result in catastrophic pituitary tumor growth. PMID:34461869 | DOI:10.1186/s12902-021-00839-x View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Identification of Two Different Phenotypes of Patients with Amiodarone-Induced Thyrotoxicosis and Positive Thyrotropin Receptor Antibody Tests

xlomafota13 shared this article with you from Inoreader Identification of Two Different Phenotypes of Patients with Amiodarone-Induced Thyrotoxicosis and Positive Thyrotropin Receptor Antibody Tests Via liebertpub1 Thyroid, Ahead of Print. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Validity and Reliability of the French Short Version of the Questionnaire of Olfactory Disorders-Negative Statements (sQOD-NS)

xlomafota13 shared this article with you from Inoreader Validity and Reliability of the French Short Version of the Questionnaire of Olfactory Disorders-Negative Statements (sQOD-NS) Via ear nose throat Ear Nose Throat J. 2021 Aug 31:1455613211032004. doi: 10.1177/01455613211032004. Online ahead of print. ABSTRACT OBJECTIVE: To develop a French Short Version of the Questionnaire of Olfactory Disorders-Negative Statements (Fr-sQOD) to assess the quality of life impairments of patients with olfactory dysfunction (OD). METHODS: Patients with OD and controls were enrolled from 2 academic centers. Individuals completed the Fr-sQOD, an OD visual analog scale severity, and th e French version of the sinonasal outcome tool-22 (SNOT-22). Cronbach α was used to measure the internal consistency of Fr-sQOD. The reliability and the external validity of Fr-sQOD were assessed through a test-retest approach and by correlating Fr-sQOD with SNOT-22 scores, respectively. The external validity was assessed by correlation analysis between Fr-sQOD and the result of an assessment of the severity of OD on a visual analog scale. RESULTS: Eighty patients completed the evaluations. The internal consistency was adequate (Cronbach α .96), and the test-retest reliability was high in the entire cohort (rs = 0.877, P < .001). The correlation between Fr-sQOD total scores and the severity of OD was moderate but significant (rs = -0.431; P = .001) supporting an acceptable external validity. Patients with OD had a significantly higher score of Fr-sQOD than healthy individuals (P < .001), indicating a high internal validity. CONCLUSION: The Fr-sQOD is a reliable and valid self-administered tool in the evaluation of the impact of OD on quality of life of French-speaking patients. PMID:34463149 | DOI:10.1177/01455613211032004 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A Preliminary Report on the Correlation Between Nasal Function and the Different Phases of the Nasal Cycle

xlomafota13 shared this article with you from Inoreader A Preliminary Report on the Correlation Between Nasal Function and the Different Phases of the Nasal Cycle Via ear nose throat Ear Nose Throat J. 2021 Aug 31:1455613211041788. doi: 10.1177/01455613211041788. Online ahead of print. ABSTRACT OBJECTIVE: To explore whether the different phases of the nasal cycle have a significant effect on nasal temperature, the nasal mucosal clearance rate, and levels of nasal nitric oxide (nNO) and to investigate the correlation between these nasal conditions. METHODS: The study participants were divided into 2 groups: the control group and the rhinitis group. The participants' nasal temperature, cilia clearance rate, and nNO levels were measured during different phases of the nasal cycle (the congestion phase and decongestion phase) in the control group and before and after undergoing inferior turbinate ablation in the rhinitis group. RESULTS: The temperature of the nasal cavity in the control group was significantly higher in the congestion phase than in the decongestion phase (P = .0025), while in the rhinitis group, the temperature of the nasal cavity decreased significantly after inferior turbinate ablation (P = .001). In the control group, the nasal mucosa clearance time was significantly shorter in the congestion phase than in the decongestion phase (P = .001), and in the rhinitis group, the clearance time of the nasal mucosa was significantly shortened after the operation (P = .0025). In the control group, the levels of nNO were significantly higher in the congestion phase than in the decongestion phase (P = .025), while in the rhinitis group, nNO levels decreased significantly after the operation (P = .005). CONCLUSION: The function of the nasal cavity changes in different phases of the nasal cycle. Therefore, when evaluating the impact of various factors on nasal function, factors associated with the nasal cycle should also be considered. Inferior turbinate plasma ablation can improve the ciliary function of the nasal mucosa, reduce the temperature of the nasal cavity, and reduce nNO levels. PMID:34463151 | DOI:10.1177/01455613211041788 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Depression in the pediatric otolaryngology clinic setting

xlomafota13 shared this article with you from Inoreader Depression in the pediatric otolaryngology clinic setting Via The Laryngoscope Abstract Objectives For most pediatric specialty clinics, mental health is not the primary presenting complaint yet can portend unrecognized morbidity. We describe rates and risk factors of depression and suicidal ideation in adolescents seen at a pediatric specialty clinic and examine changes during COVID-19. Methods Outpatient pediatric otolaryngology clinic encounters of patients ages 12-19 at a tertiary academic medical center were identified from October 2018 to July 2020. Demographic characteristics, ICD-10 primary diagnosis, Patient Health Questionnaire (PHQ)-2 score, and PHQ-9 score (if administered) were obtained. Multivariable regression examined risk factors for PHQ-9 administration, PHQ-9 scores ≥10, and suicidal ideation. Patient characteristics and PHQ scores were compared before and after March 23, 2020 (California COVID-19 Stay-at-Home order). Results 3,609 encounters with PHQ-2 data were identified. Of these, 223 (6.2%) scored ≥3 and underwent PHQ-9 assessment. 121 (3.4% of 3,609) scored ≥10 on the PHQ-9 and 53 (1.5%) endorsed suicidal ideation. Factors associated with PHQ-9 administration were female gender (OR 1.58, p=0.001), obesity (OR 1.48, p=0.043), and Neck Mass/Neoplasm/Cancer diagnosis (OR 1.99, p=0.013). Female gender was also associated with suicidality (OR 2.47, p=0.008). Comparison pre-COVID-19 vs. during COVID-19 showed no differences in depression or suicidality. However subgroup analysis revealed some significant findings. Conclusions We demonstrate substantial prevalence of positive depression screening and suicidal ideation among adolescent pediatric otolaryngology clinic encounters. Depression rates were similar pre-COVID-19 and during COVID-19, yet barriers to screening during this time were substantial. Pediatric specialty providers must remain vigilant for mental health issues in their patients. This article is protected by copyright. All rights reserved. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Can Resident Auditory-Perceptual Voice Assessments Predict Medical Urgency of Voice Disorders?

xlomafota13 shared this article with you from Inoreader Can Resident Auditory-Perceptual Voice Assessments Predict Medical Urgency of Voice Disorders? Via Journal of Voice Growing reliance on telemedicine has created new triaging challenges. This study investigated how effectively otolaryngology resident auditory-perceptual voice assessments performed via telemedicine determined the need for urgent in-person clinic visits. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Glottal Voice Distortions: Nasolaryngoscopic and Spectral Analysis of Anatomophysiologic Changes in Singing Voice

xlomafota13 shared this article with you from Inoreader Glottal Voice Distortions: Nasolaryngoscopic and Spectral Analysis of Anatomophysiologic Changes in Singing Voice Via Journal of Voice The distorted voices, commonly called vocal drives in Brazil and in some other South American countries, are vocal ornaments belonging to the aesthetics of popular singing and desired by singers of different styles. The advances in vocal sciences have allowed the demystification of this type of technique in the last four decades, classifying them as glottal, supraglottic or mixed distortions/drives. The interdisciplinary approach in the evaluation of singers who use glottal distortions is fundamental for a broad understanding of the particularities of each case. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Twelve years of neonatal hearing screening: audiological and etiological results

xlomafota13 shared this article with you from Inoreader Twelve years of neonatal hearing screening: audiological and etiological results Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2021 Aug 31. doi: 10.1007/s00405-021-07060-5. Online ahead of print. ABSTRACT PURPOSE: Most developed countries have implemented some form of universal newborn hearing screening program. Early identification and rehabilitation of congenital hearing loss is important in functional outcome, and the need to identify the cause of hearing impairment has become clear. We aimed to evaluate audiological and etiological outcomes in a large group of patients with failed neonatal hearing screening. METHODS: We performed a retrospective chart analysis of patients who were referred to our tertiary referral center after failing neonatal hearing screening during a 12-year period (2007-2019). Screening was based on automated auditory brainstem response (AABR) or a combined approach of AABR and auditory steady-state response (ASSR) with chirp stimulus. Extensive audiometric testing was performed to confirm and determine the type and degree of hearing loss. In case of permanent hearing loss, a standardized etiological protocol was followed to determine the cause. RESULTS: Of the 802 referred newborns, hearing loss was confirmed by diagnostic ABR in 78%. Main causes of hearing loss included otitis media with effusion (56%, higher in patients screened by AABR/ASSR compared to AABR), a genetic disorder (12%), congenital cytomegalovirus infection (cCMV, 5%) and atresia/stenosis of the external ear canal (5%). Of the patients with permanent hearing loss, 15% showed changes in hearing loss severity over time. CONCLUSION: In the majority of newborns referred after failing universal neonatal hearing screening, hearing loss could be confirmed. The leading cause was reversible hearing loss due to otitis media with effusion, but hearing loss proved permanent in about 35% of referred newborns, with genetics as predominant cause. Follow-up of congenital hearing loss patients is important as deterior ation as well as improvement was observed over time. PMID:34463816 | DOI:10.1007/s00405-021-07060-5 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Clinical Characteristics of Older Adults Seeking Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea

xlomafota13 shared this article with you from Inoreader Clinical Characteristics of Older Adults Seeking Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea Via ear nose throat Ear Nose Throat J. 2021 Aug 31:1455613211042126. doi: 10.1177/01455613211042126. Online ahead of print. ABSTRACT OBJECTIVES: Obstructive sleep apnea (OSA) is a common sleep disorder with numerous clinical correlates. Although effective treatments abound, patient acceptance and adherence is low. Hypoglossal nerve stimulation (HNS) is a surgical treatment alternative for the treatment of OSA; however, the demographic and clinical characteristics of individuals seeking HNS are not well categorized. This study sought to determine the clinical characteristics of older adults seeking HNS for the treatment of OSA. METHODS: Self-report questionnaires were administered to all patients older than 50 years seeking a HNS consultation at a large university medical center. Questionnaires included validated National Institutes of Health Patient-Reported Outcomes Measurement Information System (NIH PROMIS) measures of physical functioning, sleep-related impairment, cognitive abilities, depression, anxiety, and anger along with the Information extracted from electronic medical records included age, sex, race, and apnea-hypopnea index (AHI). RESULTS: Patients included 113 adults (mean age 63.30 years, 57% male, 79% white) with severe OSA (AHI = 33.91, standard deviation = 20.63). Overall, 88% of patients reported elevated insomnia symptoms, 30% reported mild difficulty with physical functioning, and 36% indicated that they had experienced moderate-severe day time impairments attributed to poor sleep. Additionally, we found 28% of sampled individuals reported moderate-severe depressive symptomology, over 19% reported moderate-severe anxiety, and over 17% reported moderate to severe anger issues. Approximately, 38% of the sample reported moderate to severe cognitive difficulties. CONCLUSIONS: The aim of the study was to better understand the clinical characteristics of older patients with OSA seeking HNS treatment. Utilizing NIH PROMIS questionnaires, we identified unique clinical and psychosocial correlates in this sample, which included higher rates of insomnia symptoms, physical dysfunction, cognitive deficits, and depressive symptoms than the general population. Future studies will be needed to investigate these relationships more thoroughly and throughout the course of the treatment. PMID:34464165 | DOI:10.1177/01455613211042126 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Treatment of Postinfectious Olfactory Dysfunction Using Corticosteroids

xlomafota13 shared this article with you from Inoreader Treatment of Postinfectious Olfactory Dysfunction Using Corticosteroids Via ear nose throat Ear Nose Throat J. 2021 Aug 31:1455613211040368. doi: 10.1177/01455613211040368. Online ahead of print. ABSTRACT OBJECTIVE: This study aimed to analyze the efficacy of different doses and forms of corticosteroids in the treatment of postinfectious olfactory dysfunction and to specify the factors related to the curative effects. METHODS: The medical records of patients diagnosed with postinfectious olfactory dysfunction from January 2018 to May 2019 were reviewed. All p atients received different doses of oral corticosteroids for 12 days or inhaled corticosteroids for 1 month. RESULTS: A review of the records of 43 patients showed that the mean follow-up time was 6.66 months, and the overall effective rate of treatment was 48.8%. Postinfectious olfactory dysfunction exhibited distinct seasonality, with the highest incidence in March. The curative effect was significantly related to the olfactory discrimination threshold at the first consultation (P = .022), but not significantly associated with age (P = .325), sex (P = .924), duration of disease (P = .526), follow-up time (P = .489), or treatment program (P = .330). CONCLUSIONS: Different doses and forms of corticosteroids showed no significant difference in the therapeutic effect on postinfectious olfactory dysfunction. The olfactory discrimination threshold at the first consultation was the most important factor influencing the prognosis. < p>PMID:34464164 | DOI:10.1177/01455613211040368 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Optimized fitting of a midface implant to anchor a magnetic nasal prosthesis using 3D printing

xlomafota13 shared this article with you from Inoreader Optimized fitting of a midface implant to anchor a magnetic nasal prosthesis using 3D printing Via hno HNO. 2021 Aug 31. doi: 10.1007/s00106-021-01100-6. Online ahead of print. ABSTRACT BACKGROUND: Plate-based anchorage systems for craniofacial prostheses offer advantages over extraoral solitary titanium implants in terms of the flexible choice of mounting points and higher stability. Disadvantages become apparent in the complex individual intraoperative adaptation of the plate-based systems to the usually poorly accessible bone. The current article presents a method to overc ome these disadvantages and make greater use of the advantages of plate-based systems. MATERIALS AND METHODS: The bony midface of a patient who had undergone rhinectomy for cancer of the nasal entrance was reconstructed as a virtual 3D model based on preoperative CT. The open-source software (3D-Slicer) allowed easy and fast reconstruction as well as adaptation for 3D printing using transparent plastic (MED610; stratasys Ltd., MN, USA). RESULTS: A titanium mini-plate (MEDICON) for anchoring the nasal prosthesis could be fitted extremely precisely on the midface 3D print. Important anatomical structures were spared, and screw placement was selected according to the individual bone thickness. Implantation of the in-advance fitted titanium plate was performed without complications and without further adjustments. CONCLUSION: In-advance fitting of plate-based systems for anchorage of craniofacial prostheses using 3D printing of the midface overcomes their disadvantages of time-consuming and possibly imprecise individual adaptation. This method further exploits the advantages of higher stability through more possible mounting points, even in thinner bone, to prevent loosening. In addition, in-advance fitting of titanium plates on the 3D model enables better identification and protection of important anatomical structures and shortens operative time. PMID:34463790 | DOI:10.1007/s00106-021-01100-6 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.