Background: Female sexual dysfunction (FSD) is diagnosed when an impairment in the sexual response cycle is associated with distress in women. The association between obstructive sleep apnea (OSA) and FSD has been poorly investigated with conflicting results.Aim: To assess the role of OSA in determining FSD in pre menopausal obese women.Methods: Forty-six women underwent standard polysomnography. Data on sexual function and sexual-related distress were obtained using the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale (FSDS). Women with both abnormal FSFI and FSDS scores were classified as having FSD.Results: Thirty-one women were classified as having OSA. Fourteen (30.4%) women had both sexual difficulties and sexual distress resulting in FSD; they showed higher values of sleep time spent with SpO(2) <90% (T-90 16.8 +/- 24.4 vs. 3.2 +/- 5.2%; p=0.004). FSD was present in 10 women with OSA (32.2%); in this group T-90 was higher (23.5 +/- 26.3) in women with FSD than in those without FSD (4.8 +/- 5.8; p=0.003). In a logistic multiple regression analysis, T90 was the only factor associated with an increased risk for FSD (odds ratio [OR] 1.07) (confidence interval [CI]) 1.006-1.13]; p=0.03).Conclusions: In premenopausal obese women the presence of FSD is correlated with OSA only when nocturnal hypoxia is present. (C) 2013 Elsevier B.V. All rights reserved.

Clinical EndocrinologyVolume 78, Issue 1 p. 152-153 Letters to the Editor Improvement of intra-epidermal nerve fibre density in hypothyroidism after L-thyroxine therapy Flavia Magri, Flavia Magri Unit of Internal Medicine and Endocrinology, Fondazione Salvatore Maugeri I.R.C.C.S., University of Pavia, Pavia, ItalySearch for more papers by this authorMichelangelo Buonocore, Michelangelo Buonocore Unit of Clinical Neurophysiology & Neurodiagnostic Skin Biopsy, Fondazione Salvatore Maugeri I.R.C.C.S., Pavia, ItalySearch for more papers by this authorAntonella Camera, Antonella Camera Unit of Internal Medicine and Endocrinology, Fondazione Salvatore Maugeri I.R.C.C.S., University of Pavia, Pavia, ItalySearch for more papers by this authorValentina Capelli, Valentina Capelli Unit of Internal Medicine and Endocrinology, Fondazione Salvatore Maugeri I.R.C.C.S., University of Pavia, Pavia, ItalySearch for more papers by this authorAntonio Oliviero, Antonio Oliviero FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, SpainSearch for more papers by this authorMario Rotondi, Mario Rotondi Unit of Internal Medicine and Endocrinology, Fondazione Salvatore Maugeri I.R.C.C.S., University of Pavia, Pavia, ItalySearch for more papers by this authorAnna Gatti, Anna Gatti Unit of Clinical Neurophysiology & Neurodiagnostic Skin Biopsy, Fondazione Salvatore Maugeri I.R.C.C.S., Pavia, ItalySearch for more papers by this authorLuca Chiovato, Luca Chiovato [email protected] Unit of Internal Medicine and Endocrinology, Fondazione Salvatore Maugeri I.R.C.C.S., University of Pavia, Pavia, ItalySearch for more papers by this author Flavia Magri, Flavia Magri Unit of Internal Medicine and Endocrinology, Fondazione Salvatore Maugeri I.R.C.C.S., University of Pavia, Pavia, ItalySearch for more papers by this authorMichelangelo Buonocore, Michelangelo Buonocore Unit of Clinical Neurophysiology & Neurodiagnostic Skin Biopsy, Fondazione Salvatore Maugeri I.R.C.C.S., Pavia, ItalySearch for more papers by this authorAntonella Camera, Antonella Camera Unit of Internal Medicine and Endocrinology, Fondazione Salvatore Maugeri I.R.C.C.S., University of Pavia, Pavia, ItalySearch for more papers by this authorValentina Capelli, Valentina Capelli Unit of Internal Medicine and Endocrinology, Fondazione Salvatore Maugeri I.R.C.C.S., University of Pavia, Pavia, ItalySearch for more papers by this authorAntonio Oliviero, Antonio Oliviero FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, SpainSearch for more papers by this authorMario Rotondi, Mario Rotondi Unit of Internal Medicine and Endocrinology, Fondazione Salvatore Maugeri I.R.C.C.S., University of Pavia, Pavia, ItalySearch for more papers by this authorAnna Gatti, Anna Gatti Unit of Clinical Neurophysiology & Neurodiagnostic Skin Biopsy, Fondazione Salvatore Maugeri I.R.C.C.S., Pavia, ItalySearch for more papers by this authorLuca Chiovato, Luca Chiovato [email protected] Unit of Internal Medicine and Endocrinology, Fondazione Salvatore Maugeri I.R.C.C.S., University of Pavia, Pavia, ItalySearch for more papers by this author First published: 27 May 2012 https://doi.org/10.1111/j.1365-2265.2012.04447.xCitations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1Magri, F., Buonocore, M., Oliviero, A. et al. (2010) Intraepidermal nerve fiber density reduction as a marker of preclinical asymptomatic small-fiber sensory neuropathy in hypothyroid patients. European Journal of Endocrinology, 163, 279–284. 10.1530/EJE-10-0285 CASPubMedWeb of Science®Google Scholar 2Lauria, G., Cazzato, D., Porretta-Serapiglia, C. et al. (2011) Morphometry of dermal nerve fibers in human skin. Neurology, 77, 242–249. 10.1212/WNL.0b013e318225ab51 CASPubMedWeb of Science®Google Scholar 3Penza, P., Lombardi, R., Camozzi, F. et al. (2009) Painful neuropathy in subclinical hypothyroidism: clinical and neuropathological recovery after hormone replacement therapy. Neurological Sciences, 30, 149–151. 10.1007/s10072-009-0026-x PubMedWeb of Science®Google Scholar 4Hollowell, J.G., Staehling, N.W., Flanders, W.D. et al. (2002) Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). The Journal of Clinical Endocrinology & Metabolism, 87, 489–499. 10.1210/jcem.87.2.8182 CASPubMedWeb of Science®Google Scholar 5Cooper, D.S. (2004) Subclinical thyroid disease: consensus or conundrum? Clinical Endocrinology, 60, 410–412. 10.1111/j.1365-2265.2004.02031.x PubMedWeb of Science®Google Scholar Citing Literature Volume78, Issue1January 2013Pages 152-153 ReferencesRelatedInformation

SD in premenopausal obese women is frequent but the association with OSA has not been well recognized. We enrolled 35 women (age 41.4±7.7 yrs; BMI 42.8±5 kg/m2, waist circumference 130.6±10.3 cm) that were evaluated by means of Female Sexual Function Index (FSFI), Female Sexual Distress Scale (FSDS), General Health Questionnaire (GHQ), Perceived Stress Scale (PSS), as well as hormonal and metabolic assessment. The presence of OSAS was assessed by a full standard polysomnography. The FSFI total score was 24.2±11.1 with 10 women scoring 15. Mean GHQ score was 4.3±3.7 and PSS median score 21.3±8.4, suggesting psychological distress. Mean LH, FSH and Estradiol values were in the normal range for the age. 22 women meet the criteria for OSAS diagnosis and 15 showed excessive daytime sleepiness. A statistically significant difference between women with abnormal or normal FSDS score was found for AHI (39.4±38 vs 18.8±15, p=0.03), GHQ (5.9±3.5 vs 2.9±3.3, p<0.01) and PSS (25.1±8.4 vs 18.1±7, p<0.01), respectively. A statistically significant correlations was found between AHI and FSDS (r=0.48, p=0.003), GHQ (r=0.42, p=0.01), or PSS score (0.39, p=0.02) but not with FSFI score that was only correlated to BMI (r=0.4, p=0.01). We conclude that obese women with OSAS showed an high prevalence of SD. Sexual function seems to be related to obesity itself while the sexual distress to the severity of OSA.

AIMTo evaluate, by using skin biopsy technique, the intraepidermal nerve fiber (IENF) density in a group of untreated patients with hypothyroidism, either overt (OH) or subclinical (SH), who did not complain of neurologic symptoms.METHODSWe evaluated 18 neurologically asymptomatic patients newly diagnosed with OH or SH. Fifteen healthy, age-matched, controls were also studied. A nerve conduction study was performed. Skin biopsy was carried out from the skin of upper thigh and distal leg. Nerve fiber density was measured using an immunofluorescence technique. The density of innervation was calculated by counting only fibers crossing the basement membrane.RESULTSElectroneurographic parameters were similar in patients and controls. When compared with healthy controls, patients with OH or SH showed a significantly lower IENF density. As assessed by the proximal/distal fiber density ratio, the hypothyroid neuropathy was length dependent. When individually considered, an abnormally reduced IENF was observed in 60% of patients with OH at the distal leg and in 20% at the proximal site. In patients with SH, an abnormal IENF density was found at the distal leg in 25% of cases and at the proximal thigh in 12.5% of cases.CONCLUSIONSOur study provides the first direct demonstration of reduced IENF density in patients with OH or SH. In all patients, the IENF density reduction was length dependent. These findings suggest that a considerable number of untreated hypothyroid patients may have preclinical asymptomatic small-fiber sensory neuropathy.

Background: Most solitary hyperfunctiong regions on thyroid scan consist of benign tissue. Here we report a patient with a Burkitt-like lymphoma that was infilterated into a region containing a hyperfunctioning nodule.Summary: A 56-year-old man was referred to our Endocrine Unit in May 2009 due to the incidental discovery of a large left thyroid lobe nodule by a computed tomography study. This had been performed to search for a primitive tumor in a patient with bone metastasis. He was clinically and biochemically thyrotoxic with no evidence of humoral thyroid autoimmunity. The nodule had a dyshomogenous appearance at neck ultrasonography, with multiple hypoechogenic areas and calcifications. (99m)-Technetium thyroid scintiscan revealed a hot nodule with suppression of the contralateral lobe. Fine-needle aspiration cytology indicated the presence of neoplastic cells not of thyroid origin. Remission of hyperthyroidism was obtained with methimazole, and the patient was submitted to left lobe thyroidectomy and istmectomy. Histological analysis of the surgical specimen led to a diagnosis of Burkitt-like large B-cell lymphoma harbored within a thyroid adenoma. After further staging, the final diagnosis was stage IV E Burkitt-like lymphoma with the involvement of the bone and the thyroid. This is the first description of an aggressive Burkitt-like lymphoma that infiltrated an hyperfunctioning thyroid adenoma, thus presenting as a hot nodule at thyroid scintiscan. In our patient there was no humoral or histological evidence of thyroid autoimmunity, thus suggesting a metastatic seeding of the lymphoma within the hyperfunctioning thyroid nodule.Conclusions: Involvement of the thyroid gland by Burkitt-like lymphoma is extremely rare as is close localization of malignancy and a hyperfunctioning thyroid nodule. As highlighted by the present report, performing fine-needle aspiration cytology should be always considered in the clinical context of a metastatic disease of unknown origin or when there are ultrasonography signs suggesting malignancy, even when the nodule is hyperfunctioning.

SummaryPurpose: Neuroactive sex steroids influence neuron excitability, which is enhanced by estradiol (E2) and decreased by progesterone (Pg). In epilepsy, the production, metabolism, biologic availability, and activity of sex hormones may be affected by seizures themselves or by antiepileptic drugs (AEDs). This cross‐sectional observational study was aimed at evaluating the relationships between sex steroids, seizure frequency, and other clinical parameters in women with partial epilepsy (PE) on AED treatments.Methods: Serum E2, Pg, sex hormone binding globulin (SHBG) levels, free E2 (fE2), and E2/Pg ratios were determined during the follicular and luteal phases in 72 adult women with PE, and in 30 healthy controls. Hormonal data were correlated with seizure frequency, age, body weight, body mass index (BMI), disease onset and duration, and AED therapies.Results: In patients, E2, fE2, and Pg levels were lower in both ovarian phases, whereas those of SHBG were higher than in controls. No significant changes in hormone levels and in prevalence of anovulatory cycles were observed between patients grouped according to their seizure frequency. However, when compared with those in healthy controls, luteal fE2 and Pg levels were chiefly impaired in women with more frequent seizures, mostly undergoing AED polytherapies, but not in those with absent or rarer seizures.Conclusions: The actual changes in sex steroid levels and E2/Pg ratios did not explain an increased seizure frequency in adult women with AED‐treated PE, but patients with more severe disease showed more relevant changes in their sex hormone profile and impaired Pg levels during the luteal phase.