The addition of paclitaxel to best supportive care significantly improved survival and time to disease progression compared with best supportive care in patients with advanced NSCLC and may improve some aspects of QOL.
Objective To examine determinants of serum 25-hydroxyvitamin D [25(OH)D] and bone mineral density (BMD) in young physicians, a group not well studied previously. Methods We analyzed data from a questionnaire completed by young physicians as well as results of serum 25(OH)D, serum parathyroid hormone, and BMD measurements. Results Among 104 study subjects, 42% were white, 46% were Asian, 12% were “other” (10 Hispanic and 2 African American subjects), and 75% were women. The mean age and body mass index (BMI) were 28.1 years and 23.0 kg/m2, respectively. White subjects had a higher mean serum 25(OH)D level (27.3 ng/mL) than did Asian subjects (15.9 ng/mL) and other subjects (22.3 ng/mL) (P<.0001). White subjects tended to have higher Z-scores than Asian subjects and other subjects for the hip (P = .06), trochanter (P = .08), and lumbar spine (P = .08). The serum 25(OH)D level was negatively associated with serum parathyroid hormone (r = -0.44; P<.01) but not with BMD. The prevalence of vitamin D insufficiency [serum 25(OH)D <30 ng/mL, 77% for the entire group] was higher (P<.01) in Asian subjects (93%) than in white subjects (61%) and other subjects (73%). Significant determinants of serum 25(OH)D included age, ethnicity, exposure to sunlight, use of vita-min D supplements, and family history of osteoporosis (P<.05 for all), and together with sex, calcium supplements, exercise, and BMI, these factors explained 49% of serum 25(OH)D level variability. Significant determinants of low BMD (osteopenia plus osteoporosis, prevalence 37.5%) included sex (P = .002) and BMI (P<.0001) but not serum 25(OH)D; Asian ethnicity reached borderline significance (P = .088). Age, sex, ethnicity, smoking, and BMI explained 20% to 30% of the Z-score variations. Conclusion In young physicians with a healthful lifestyle, determinants of low serum 25(OH)D and BMD included modifiable risk factors. Vitamin D insufficiency and low BMD could be important contributors to future osteoporotic fractures in this population.
Objective: We present a case of a 45-year-old woman with history of Graves disease treated with thyroidectomy who developed panhypopituitarism due to granulomatous hypophysitis.Methods: The details of the case presentation, evaluation, diagnosis, and treatment are reviewed. On routine follow-up visits for thyroid condition, the patient complained of symptoms of hyperthyroidism, despite being on a previously adequate dose of levothyroxine. Work-up led to the diagnosis of hypophysitis.Results: The patient responded to corticosteroid therapy, but 5 months later, magnetic resonance imaging of the brain showed recurrence of the disease. Eventually, the patient underwent partial transsphenoidal hypophysectomy, later developed recurrence of disease, and had total hypophysectomy. The postoperative pathology report was consistent of granulomatous hypophysitis.Conclusion: Granulomatous hypophysitis is an uncommon inflammatory disease affecting the pituitary. It is commonly misdiagnosed as a macroadenoma because of its clinical presentation. (AACE Clinical Case Rep. 2018;4:e329-e333) Abbreviations: FT4 = free thyroxine; GH = granulomatous hypophysitis; LH = lymphocytic hypophysitis; MRI = magnetic resonance imaging; TSH = thyroid-stimulating hormone CASE REPORTHypophysitis is a rare inflammatory process of the pituitary gland that mimics pituitary macroadenomas. It can be idiopathic or manifest as a part of a systemic autoimmune disease. Granulomatous hypophysitis (GH) and lymphocytic hypophysitis (LH) are the most common subtypes reported in literature (1-3). We present a case of a 45-year-old female with past medical history of hypothyroidism after total thyroidectomy for Graves disease and surgical history of hysterectomy. On presentation, she complained of hyperthyroid symptoms (e.g., fatigue, excess sweating, hot flashes, presyncope, weight loss, and headaches), despite being on a previously adequate levothyroxine dose. Two months prior, her thyroid-stimulating hormone (TSH) and free thyroxine (FT4) were normal. Her physical exam was unremarkable except for a surgically absent thyroid. Laboratory evaluation revealed TSH <0.006 mU/L (normal range, 0.34 to 5.6 mU/L) and FT4 of 1.1 ng/dL (normal range, 0.58 to 1.64 ng/dL); thus, her levothyroxine dose was decreased. Despite this, she continued to have symptoms and low TSH. Secondary hypothyroidism was suspected, as TSH was undetectable and FT4 0.47 ng/dL off levothyroxine. Severe headache, insomnia, and worsening fatigue developed, so imaging was done and magnetic resonance imaging (MRI) revealed a large bilobed enhancing pituitary mass with suprasellar extension and thickening of the pituitary stalk (Fig. 1). Laboratory results showed low am cortisol, estrogen, follicle-stimulating hormone (FSH), insulin-like growth factor See accompanying article, p. e350.
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