Histological findings often display an association between papillary thyroid carcinomas (PTC) and autoimmune thyroiditis (AIT) and so differ significantly from follicular thyroid carcinomas (FTC). The aim of this interdisciplinary, retrospective study was to evaluate the association of AIT in patients with PTC and FTC and a control group of benign nodular goiters. One hundred thyroidectomies with histologically confirmed differentiated thyroid carcinomas, 67 with PTC and 33 with FTC, were submitted for examination. The two control groups consisted of 60 patients with euthyroid nodular goiter, displaying no signs for malignancy (no surgery) and 100 patients (second control group) with surgery of a benign nodular goiter. Controls were collected to obtain data about the incidence of significantly increased TPOAbs in the first group and of lymphocytic infiltrates (LI) in the second group. High TPOAbs were found in 35% (23/67) of patients with PTC. LI were detected by histology in 48% (32/67) of PTC. Ten patients (10/32) of this group showed the clinical and histological manifestation of a classic AIT with diffuse dense LI as well as diffuse hypoechogeneity in ultrasonography. In 7/32 cases, the histological report described focal dense LI (fAIT) and in 15/32 cases scant scattered LI. AIT and fAIT, together 25% of all PTC (17/67), showed germinal centers and can therefore be characterized as chronic autoimmune thyroiditis. In this group, high TPOAb could be detected in 94% (16/17). Scan scattered LI without germinal centers (15/32) do not represent a fAIT, although TPOAb are high in 47% (7/15). The younger age group (<45 years) showed significantly more often high TPOAbs (p<0.023) in comparison with the age-group older than 60 years. In contrast to PTC, only 4/33 (12%) patients with FTC had high TPOAb levels. We conclude that in contrast to benign euthyroid goiters and to FTC, different degrees of LI are often associated with high TPOAb levels and seem to be significantly increased in PTC, particularly prominent in younger age. There is a high coincidence between LI and high TPOAb levels. In the presence of hypoechoic thyroid nodule, signs of thyroid autoimmunity such as the presence of high TPOAbs, lymphocytic infiltration in cytology, and/or characteristic ultrasonic features, are arguments that might favor the decision for surgery if a cytologically indeterminate thyroid nodule is found and focal autonomy is excluded by szintiscan.

OBJECTIVES:Sleep apnoea has been consistently reported to occur in acromegaly. In uncontrolled patients, the severity of sleep apnoea influences physical activity in the daytime. We investigated the influence of disease activity on tongue volume and sleep apnoea treated with the GH receptor antagonist pegvisomant in poorly controlled patients with acromegaly under octreotide.DESIGN AND METHODS:A total of 12 patients with active acromegaly (six females; six males; mean age 57+/-15 years; body mass index 29.4+/-4.2 kg/m(2); mean+/-S.D.) were treated with pegvisomant (13.5+/-5.0 mg/die) for 6 months. Tongue volume was examined by magnetic resonance imaging, and sleep apnoea was characterized by polysomnography before and after 6 months of treatment with pegvisomant. The mandibular length was determined by lateral X-ray films.RESULTS:IGF1 levels decreased after 6 months in all patients (407+/-114 to 199+/-23 microg/l; P=0.0001). The tongue volume decreased (105+/-33 to 83+/-33 ml; P=0.007) as well as the apnoea-hypnoea index (23+/-22 to 18+/-18/h; P=0.0066). The mandibular length correlated with the initial tongue volume (r(2)=0.6072, P=0.0028).CONCLUSION:In conclusion, successful treatment with pegvisomant can decrease tongue volume, which has benefits for coexisting sleep disordered breathing.

In children with Prader-Willi syndrome (PWS), fasting levels of plasma ghrelin, the orexigenic, stomach-derived hormone, are großly elevated. This is thought to contribute to the hyperphagia typical for this syndrome. The cause of the ghrelin elevation and the regulation of ghrelin in PWS are incompletely understood. Whereas the capacity of a mixed meal to suppress ghrelin is maintained in PWS patients, growth hormone (GH) treatment appeared to have no effect on basal ghrelin concentrations in previous studies.

Objectives: For somatostatin, five receptor subtypes (sst1–5) have been identified that are widely distributed in various endocrine tissues and tumors. Potent somatostatin analogs like octreotide, lanreotide and the new multiligand SOM230– with different binding properties to the receptor subtypes – have been developed.

Approximately 50% of patients with severe AGHD (defined by the international consensus criteria, peak GH <3ng/ml) have a normal age- and gender-related IGF-I. It remains unclear whether in these individuals IGF-I is GH-dependent.

The recent approval of the first GH receptor antagonist Pegvisomant (Somavert®) has augmented the therapeutic armamentarium for the treatment of acromegaly. The limited longterm experience with this drug has prompted the need for systematic data capture and evaluation. Between Jan and end of Jul 2004, 102 pat. (52m, 50f) were enrolled pro- and retrospectively in a German Pegvisomant Observational Study. Mean pat. age was 47.5±13.1yrs. Mean age at diagnosis was 37.2yrs. 94% had previously undergone operation, 51% had received radiation therapy. Previous medical treatment comprised of dopamine agonists (54%) and/or somatostatin analogues (92%). Mean time of observation was 41.4wks. Efficacy analysis was performed in 71 pat. with an available follow-up investigation 23.4±14.8wks after baseline. Locally measured IGF-I at baseline was elevated in 86% of these pat.. During this early treatment phase with dose titration not escalated to normalize IGF-I in some, IGF-I declined to normal in 68% (mean dose 15.5mg/d, range 10–40mg/d). Elevated liver function tests (LFTs) occurred in 6/102 pat. 7–35wks after start of treatment, in 4 pat. >3x the upper limit of normal. In 4/6 pat., Pegvisomant was continued with spontaneous normalization of LFTs during follow-up in 2 cases. In 2 pat., levels normalized after treatment discontinuation. Progression of remnant pituitary adenoma was observed in 2 pat.. In both cases the slow and constant adenoma growth was documented to progress from before initiation of Pegvisomant and no change in growth rate was noted since Pegvisomant initiation. Lipohypertrophy at the injection site was noted in 3 pat. One pat. with uncontrolled disease for >20yrs and known preexisting cardiomyopathy has died. In conclusion, the Pegvisomant safety profile according to this initial evaluation is in agreement with the previously published experience. For the continued information about this new drug, this observational study should be carried forward and regularly be evaluated.

Short stature due to growth hormone deficiency (GHD) is an indication for substitution with recombinant growth hormone (GH) until final height is reached. Since a significant proportion of all patients with isolated GHD has transient GHD, re-evaluation of GH secretory capacity is recommended at that time. This study compared the results of GH stimulation tests during childhood and adulthood in patients with childhood-onset GHD of various etiologies.

Clinically non-functioning tumors (NFA) are characterized by the absence of symptoms of hormone excess. Reliable distinction from nonendocrine tumors in the pituitary region is necessary to guide treatment and follow-up of these tumors. Increased serum concentrations of the alpha-subunit (aSU) have been demonstrated in a minority of NFA. However, the diagnostic yield of aSU in the differential diagnosis and follow-up is largely unknown.

Summary: With an incidence of 5 % of fertile women, polycystic ovary syndrome (PCOS) is among the most common endocrine/gynecological disorders. The National Institutes of Health consensus conference in 1990 defined PCOS as the presence of oligo- or amenorrhea in combination with clinical or biochemical hyperandrogenemia and the exclusion of pituitary, adrenal, or ovarian disease. By this definition, the originally eponymous polycystic ovaries (PCO) are found only in 70 % of affected women. The chief complaints in PCOS are hirsutism, infertility, and obesity. Most patients suffer from defective insulin secretion and insulin resistance: PCOS thus resembles the metabolic syndrome (type 2 diabetes mellitus, hypertension, lipid disorders, atherosclerosis). Accordingly, PCOS patients suffer from sequelae of the latter later in life: coronary artery disease, myocardial infarction, stroke, and peripheral arterial occlusion. The complex diagnostic procedures and differential diagnosis of PCOS require a close interdisciplinary cooperation of endocrinologists and gynecologists.

TS H-Rezeptor-Antikörper zur Verfügung.Ziel der Arbeit war es, Sensitivität, Spezifität und Präzision des TRAK-Assay® an einem großen Patientenkollektiv (n = 495) festzulegen und seine klinische Wertigkeit zu prüfen.Untersucht wurden 150 Patienten mit M. Basedow, 305 Patienten mit anderen Schilddrüsenerkrankungen und 40 schilddrüsengesunde Personen.Unter Einbeziehung einer TSH-Standardreihe als Bezugssystem und Festlegung einer Normgrenze von W m U/ml wurde bei 32/35 (91%) Patienten mit frischem, unbehandeltem M. Basedow und bei keiner der schilddrüsengesunden Personen (n = 40) ein positiver Antikörpernachweis geführt TSH-Rezeptor-Antikörper wurden bei anderen Schilddrüsenerkrankungen wie Strumen (2/108; 2%), autonomen Adenomen (1/88; 1 %) oder bei wegen Schilddrüsenkarzinomen ablativ behandelten Patienten (0/62; 0%) nur ausnahmsweise nachgewiesen.Bei Patienten unter thyreostatischer Therapie (Dauer: 6-12 Monate, n = 65) lag die Inzidenz im Vergleich zu unbehandelten Patienten deutlich niedriger (60% vs. 91%).Von 18 Patienten, die während einer thyreostatischen Therapie mit Methimazol und über weitere 18 Monate nach Absetzen der Medikation engmaschig kontrolliert wurden, kam es bei 8 Patienten zu einem Rezidiv der Erkrankung.Hier konnte in 5 Fällen ein positiver und in 3 Fällen ein negativer Antikörpernachweis bei Therapieende geführt werden.4/35 euthyreote Patienten mit 5-10 Jahre zurückliegender Erkrankung an M. Basedow zeigten eindeutig erhöhte Antikörpertiter.Der TRAK-Assay stellt somit eine sensitive und spezifische Methode zum Nachweis von TS H-Rezeptor-Antikörper dar.Seine wesentliche Bedeutung liegt in der Differenzierung immunogener und nicht immunogene Formen der Hyperthyreose.Diese Differenzierung ist insbesondere wichtig bei der Indikationsstellung und bei der Festlegung der Dosis einer Radiojodtherapie.Im Verlauf