David Unuane - Academia.edu (original) (raw)
Papers by David Unuane
HAL (Le Centre pour la Communication Scientifique Directe), Mar 21, 2023
Acta Clinica Belgica, Sep 1, 2012
European thyroid journal, Jun 1, 2021
Endocrine Abstracts, 2020
European Thyroid Journal, 2020
Severe thyroid dysfunction may lead to menstrual disorders and subfertility. Fertility problems m... more Severe thyroid dysfunction may lead to menstrual disorders and subfertility. Fertility problems may persist even after restoring normal thyroid function, and then an assisted reproductive technology (ART) may be a solution. Prior to an ART treatment, ovarian stimulation is performed, leading to high oestradiol levels, which may lead to hypothyroidism in women with thyroid autoimmunity (TAI), necessitating levothyroxine (LT4) supplements before pregnancy. Moreover, women with the polycystic ovarian syndrome and idiopathic subfertility have a higher prevalence of TAI. Women with hypothyroidism treated with LT4 prior to ART should have a serum TSH level <2.5 mIU/L. Subfertile women with hyperthyroidism planning an ART procedure should be informed of the increased risk of maternal and foetal complications, and euthyroidism should be restored and maintained for several months prior to an ART treatment. Fertilisation rates and embryo quality may be impaired in women with TSH >4.0 mI...
Human Reproduction, 2017
Does thyroid autoimmunity (TAI) predict live birth rate in euthyroid women after one treatment cy... more Does thyroid autoimmunity (TAI) predict live birth rate in euthyroid women after one treatment cycle in IUI patients? SUMMARY ANSWER: TAI as such does not influence pregnancy outcome after IUI treatment.
Oxford Textbook of Endocrinology and Diabetes 3e, 2021
Severe thyroid dysfunction may lead to menstrual disorders and infertility. Fertility problems ma... more Severe thyroid dysfunction may lead to menstrual disorders and infertility. Fertility problems may persist even after restoring normal thyroid function, and then an assisted reproductive technology (ART) may be considered as a therapeutic option. Prior to an ART treatment, an ovarian hyperstimulation is performed, leading to high oestradiol levels, which may lead to hypothyroidism in women with thyroid autoimmunity (TAI), necessitating thyroid hormone supplements (LT4) before pregnancy. Moreover, women with the polycystic ovarian syndrome and idiopathic infertility have a higher prevalence of TAI. Women with a known hypothyroidism before pregnancy and treated with LT4 should have a serum TSH <2.5 mIU/L, both in case of assisted and spontaneous pregnancies. Women with Graves’ disease desiring pregnancy should be advised of the increased risk of maternal and fetal complications and about the possible side effects of antithyroid drugs. If necessary, pregnancy must be postponed until...
Journal of endocrinological investigation, Jan 7, 2015
European journal of endocrinology / European Federation of Endocrine Societies, 2014
Klinefelter syndrome (KS) is the most common sex chromosomal disorder in males. Key findings in o... more Klinefelter syndrome (KS) is the most common sex chromosomal disorder in males. Key findings in older adolescents and young men are small testes with variable hypo-androgenism, but almost universal azoospermia, most frequently in combination with a history of learning difficulties and behavior problems. Males with KS may come to medical attention through different medical presentations, given its association with several congenital malformations, and psychiatric, endocrine, and metabolic disorders. Preventive care is to be provided from diagnosis, preferentially through a multidisciplinary approach, including that from an endocrinologist, clinical psychologist or psychiatrist, neurologist, urologist, geneticist, sexologist, and a fertility team. Accurate information about the condition and assessment of associated medical conditions should be offered at diagnosis and should be followed by psychological counseling. Medical treatment during transition into adulthood is focused on fert...
Acta clinica Belgica
In Cushing's disease clinical symptoms are usually related to the ACTH hypersecretion. On dia... more In Cushing's disease clinical symptoms are usually related to the ACTH hypersecretion. On diagnosis these secreting tumours tend to be small due to their ability to reach clinical detection early. However, symptoms may also be caused by mass-related effects such as the depression of secretion of other pituitary hormones. Furthermore growth related symptoms may occur due to the invasion of the suprasellar region with compression of the visual system. As we illustrate in a case report, when spreading of pituitary adenoma occurs to the infrasellar region, Cushing disease may manifest itself by rather atypical initial symptoms that are more related to ear-nose-throat (ENT) complaints. In these invasive macro adenomas multimodal therapy is usually required to achieve control of hypersecretion and mass related symptoms.
BMJ case reports, 2012
A 57-year-old woman was admitted to the emergency department, presenting with episodes of altered... more A 57-year-old woman was admitted to the emergency department, presenting with episodes of altered consciousness and behaviour which, upon further examination, were linked to periods of recurrent hypoglycaemia. Imaging revealed a large mass in the right thoracic cavity while blood analysis demonstrated diminished C-peptide, (pro-)insulin, insulin-like growth factor 1 (IGF-I) and IGF binding protein 3 levels. Based on these findings, an IGF-II secreting tumour was suspected. Before the excision of the tumour, euglycaemia could only be achieved by means of intravenous glucose administration and the use of oral corticosteroids. Anatomopathologically the diagnosis of a solitary fibrous tumour (SFT) was confirmed. Immunoblot analysis on the serum revealed elevated 'big'-IGF-II levels, confirming our initial diagnosis of Doege-Potter syndrome in SFT.
BMJ case reports, 2012
A 16-year-old girl with a history of Graves' disease presented with two episodes of generalis... more A 16-year-old girl with a history of Graves' disease presented with two episodes of generalised tonic-clonic seizures, necessitating intensive care admission. Laboratory examination demonstrated a suppressed thyroid-stimulating hormone level with dramatically elevated free triiodothyronine, free thyroxine and thyroid-stimulating immunoglobulins. Cerebrospinal fluid analysis showed oligoclonal banding in the absence of pleocytosis, thyroid peroxidase antibodies or infection. Neuroimaging revealed the presence of a congenital arachnoid cyst in the right temporal lobe. Despite restoration of euthyroidism and administration of antiepileptic and antiviral drugs, neurological features persisted. Subsequently, intravenous corticoids were administered to exclude the contribution of an underlying autoimmune encephalopathy. The patient gradually recovered and, in retrospect, elevated serum N-methyl-D-aspartic acid-receptor (NMDA-R) antibodies were detected. Although this patient presented...
Thyroid, 2013
Background: Thyroid autoimmunity (TAI) is frequent in infertile women, but to what extent thyrogl... more Background: Thyroid autoimmunity (TAI) is frequent in infertile women, but to what extent thyroglobulin autoantibodies (Tg-Abs) contribute to TAI is unclear in the literature. The aims of the present study were to determine the prevalence of TAI in women consulting for fertility problems and to investigate the impact of isolated Tg-Abs, isolated thyroid peroxidase autoantibodies (TPO-Abs), and the presence of both autoantibody types on thyroid function. Furthermore, thyroid function was compared between women with and without TAI and between infertile and fertile women. Methods: A cross-sectional data analysis nested within an ongoing prospective cohort study was performed in order to determine the prevalence of TAI in unselected women consulting our tertiary referral center for reproductive medicine (CRM). The women underwent a determination of serum thyrotropin (TSH), free thyroxine (FT4), TPO-Abs, and Tg-Abs. The cause of infertility, age, body-mass index (BMI), and smoking habits were recorded. Results: The prevalence of TAI was 16% (163/992). In 8% of cases, both types of autoantibodies were present, in 5% isolated positive Tg-Abs were found, and 4% had isolated positive TPO-Abs ( p = 0.025 and p = 0.003 respectively). The prevalence of TAI was significantly higher in infertile women as compared to that in fertile controls (19% vs. 13%; p = 0.047). The median serum TSH level was significantly higher in the women with TAI and with isolated positive Tg-Abs compared to that in women without TAI (1.83 [1.44] and 1.90 [0.85] vs. 1.47 [0.94] mIU/L; p <0.001 respectively). The median FT4, age, BMI, and smoking habits were comparable between the study groups. Conclusions: The prevalence of TAI was higher in infertile women as compared to fertile women consulting our CRM. Five percent of the women had isolated positive Tg-Abs and a significantly higher serum TSH compared to that in women without TAI.
Human Reproduction Update, 2013
BACKGROUND Previous meta-analyses of observational data indicate that pregnant women with subclin... more BACKGROUND Previous meta-analyses of observational data indicate that pregnant women with subclinical hypothyroidism have an increased risk of adverse pregnancy outcome. Potential benefits of levothyroxine (LT4) supplementation remain unclear, and no systematic review or meta-analysis of trial findings is available in a setting of assisted reproduction technologies (ART). METHODS Relevant trials published until August 2012 were identified by searching MEDLINE, EMBASE, Web of Knowledge, the Cochrane Controlled Trials Register databases and bibliographies of retrieved publications without language restrictions. RESULTS From 630 articles retrieved, we included three trials with data on 220 patients. One of these three trials stated 'live delivery' as outcome. LT4 treatment resulted in a significantly higher delivery rate, with a pooled relative risk (RR) of 2.76 (95% confidence limits 1.20-6.44; P = 0.018; I(2) = 70%), a pooled absolute risk difference (ARD) of 36.3% (3.5-69.0%: P = 0.030) and a summary number needed to treat (NNT) of 3 (1-28) in favour of LT4 supplementation. LT4 treatment significantly lowered miscarriage rate with a pooled RR of 0.45 (0.24-0.82; P = 0.010; I(2) = 26%), a pooled ARD of -31.3% (-48.2 to -14.5%: P < 0.001) and a summary NNT of 3 (2-7) in favour of LT4 supplementation. LT4 treatment had no effect on clinical pregnancy (RR 1.75; 0.90-3.38; P = 0.098; I(2) = 82%). In an ART setting, no data are available on the effects of LT4 supplementation on premature delivery, arterial hypertension, placental abruption or pre-eclampsia. CONCLUSIONS Our meta-analyses provide evidence that LT4 supplementation should be recommended to improve clinical pregnancy outcome in women with subclinical hypothyroidism and/or thyroid autoimmunity undergoing ART. Further research is needed to determine pregnancy outcome after close monitoring of thyroid function to maintain thyroid-stimulating hormone and free T4 levels within the trimester-specific reference ranges for pregnancy.
Fertility and Sterility, 2011
Objective: To investigate the impact of ovarian hyperstimulation syndrome (OHSS) on thyroid funct... more Objective: To investigate the impact of ovarian hyperstimulation syndrome (OHSS) on thyroid function in women without thyroid disorders and to compare it with that in women with uncomplicated controlled ovarian hyperstimulation (COH). Design: Retrospective analysis. Setting: Tertiary referral fertility center. Patient(s): A total of 77 women undergoing COH of whom 25 developed OHSS and 52 had no OHSS. Women with the presence of thyroid disorders were excluded, and only women pregnant after assisted reproductive technology were included. Intervention(s): Serum TSH and free T4 (fT4) levels were measured before and 2, 4, and 6 weeks after embryo transfer (ET), and thyroid peroxidase and thyroglobulin antibody levels were measured before ET to exclude thyroid autoimmunity. The diagnosis of OHSS was based on clinical, ultrasonographic, and biologic features. Main Outcome Measure(s): Thyroid function, OHSS. Result(s): Serum TSH and fT4 levels increased 2 weeks after ET in both study groups compared with prestimulation levels. In the OHSS group: TSH, 1.9 AE 0.8 mIU/L vs. 3.1 AE 1.9 mIU/L; fT4, 12.3 AE 1.4 ng/L vs. 13.4 AE 2.1 ng/L. In the no-OHSS group: TSH, 2.1 AE 1.1 mIU/L vs. 2.6 AE 1.9 mIU/L; fT4, 13.0 AE 1.7 ng/L vs. 13.8 AE 1.6 ng/L. The increment was comparable between both study groups. Conclusion(s): Serum TSH levels increased significantly after COH in a comparable way in both study groups, when no thyroid disorders were present. (Fertil Steril Ò 2011;96:241-5.
European Journal of Human Genetics, 2013
Multiple endocrine neoplasia type 1 (MEN1) is an autosomal-dominant cancer syndrome that is cause... more Multiple endocrine neoplasia type 1 (MEN1) is an autosomal-dominant cancer syndrome that is caused by a germline mutation in the MEN1 gene encoding a tumour-suppressor protein, menin. MEN1 causes a combination of endocrine tumours such as parathyroid adenomas, pituitary adenomas, glucagonomas, gastrinomas, insulinomas, adrenocortical adenomas and nonendocrine tumours. We here present a large MEN1 family where the carriers developed mild hyperparathyroidism, multiple welldifferentiated functionally active neuroendocrine tumours of the pancreas and no pituitary tumour. The causal mutation is a new double substitution in the coding region of exon 2 in the MEN1 gene c.[428T4A; 429C4T], p.Leu143His. This new mutation in the MEN1 gene is clinically relevant leading to a limited penetrance and specific phenotype.
Best Practice & Research Clinical Endocrinology & Metabolism, 2011
Female infertility occurs in about 37% of all infertile couples and ovulatory disorders account f... more Female infertility occurs in about 37% of all infertile couples and ovulatory disorders account for more than half of these. The ovaries are in continuous interaction with the other endocrine organs. The interplay may account for infertility occurring at different levels and may render the diagnosis of infertility a difficult exercise for the involved physician. A hypothalamic cause of female infertility should be considered in an appropriate clinical context, with tests pointing to a hypogonadotropic hypogonadism. It can be functional, physiological or related to organic causes. Hyperprolactinemia has well characterized effects on the normal gonadal function and treatment is well established. Acromegaly and Cushing's disease may impair fertility at different levels, mechanisms involved however remain ill defined. Thyroid disorders, both hyperthyroidism and hypothyroidism, can interact with the ovaries, through a direct effect on ovarian function, but autoimmunity may be involved, as well as alterations of the sex hormone binding protein levels. Primary ovarian disorders, such as the polycystic ovary syndrome and primary ovarian insufficiency are frequent diseases, for which novel treatments are currently being developed and discussed. We will propose an algorithm for the diagnosis and approach of the female patient presenting with infertility on the basis of the available evidence in literature.
Acta Neurologica Belgica, 2013
The purpose of this study is to evaluate long-term results in acromegaly patients who received su... more The purpose of this study is to evaluate long-term results in acromegaly patients who received surgery as first-line treatment. Repeated surgery, radiation therapy and medical treatment were considered in patients showing no postoperative remission or who suffered a relapse. Thirty-five patients suffering from acromegaly were operated on between 1993 and 2009. The patients with persistent hypersecretion received a new surgery when postoperative imaging showed localized residual lesion. The other cases with persistent hypersecretion were treated medically using dopamine agonists, somatostatin analogs or pegvisomant according to the efficiency obtained. Radiotherapy was considered when medical treatment failed to normalize hormonal hypersecretion. The overall remission rate with surgery alone was 57 % (20/35):84 % (16/19) with non-invasive adenomas and 25 % (4/16) with invasive adenomas. Fifteen patients showing no remission after surgery received additional medical and/or radiation therapy resulting in hormonal control in ten of them. Recurrences after initial postoperative remission were observed in six patients who were controlled with subsequent therapy. Using a multimodal treatment approach, the disease was brought under control in 86 % (30/35) of acromegaly patients. Surgery alone produced satisfactory initial results in non-invasive adenomas, but additional treatments were required for most of the invasive lesions.
HAL (Le Centre pour la Communication Scientifique Directe), Mar 21, 2023
Acta Clinica Belgica, Sep 1, 2012
European thyroid journal, Jun 1, 2021
Endocrine Abstracts, 2020
European Thyroid Journal, 2020
Severe thyroid dysfunction may lead to menstrual disorders and subfertility. Fertility problems m... more Severe thyroid dysfunction may lead to menstrual disorders and subfertility. Fertility problems may persist even after restoring normal thyroid function, and then an assisted reproductive technology (ART) may be a solution. Prior to an ART treatment, ovarian stimulation is performed, leading to high oestradiol levels, which may lead to hypothyroidism in women with thyroid autoimmunity (TAI), necessitating levothyroxine (LT4) supplements before pregnancy. Moreover, women with the polycystic ovarian syndrome and idiopathic subfertility have a higher prevalence of TAI. Women with hypothyroidism treated with LT4 prior to ART should have a serum TSH level <2.5 mIU/L. Subfertile women with hyperthyroidism planning an ART procedure should be informed of the increased risk of maternal and foetal complications, and euthyroidism should be restored and maintained for several months prior to an ART treatment. Fertilisation rates and embryo quality may be impaired in women with TSH >4.0 mI...
Human Reproduction, 2017
Does thyroid autoimmunity (TAI) predict live birth rate in euthyroid women after one treatment cy... more Does thyroid autoimmunity (TAI) predict live birth rate in euthyroid women after one treatment cycle in IUI patients? SUMMARY ANSWER: TAI as such does not influence pregnancy outcome after IUI treatment.
Oxford Textbook of Endocrinology and Diabetes 3e, 2021
Severe thyroid dysfunction may lead to menstrual disorders and infertility. Fertility problems ma... more Severe thyroid dysfunction may lead to menstrual disorders and infertility. Fertility problems may persist even after restoring normal thyroid function, and then an assisted reproductive technology (ART) may be considered as a therapeutic option. Prior to an ART treatment, an ovarian hyperstimulation is performed, leading to high oestradiol levels, which may lead to hypothyroidism in women with thyroid autoimmunity (TAI), necessitating thyroid hormone supplements (LT4) before pregnancy. Moreover, women with the polycystic ovarian syndrome and idiopathic infertility have a higher prevalence of TAI. Women with a known hypothyroidism before pregnancy and treated with LT4 should have a serum TSH <2.5 mIU/L, both in case of assisted and spontaneous pregnancies. Women with Graves’ disease desiring pregnancy should be advised of the increased risk of maternal and fetal complications and about the possible side effects of antithyroid drugs. If necessary, pregnancy must be postponed until...
Journal of endocrinological investigation, Jan 7, 2015
European journal of endocrinology / European Federation of Endocrine Societies, 2014
Klinefelter syndrome (KS) is the most common sex chromosomal disorder in males. Key findings in o... more Klinefelter syndrome (KS) is the most common sex chromosomal disorder in males. Key findings in older adolescents and young men are small testes with variable hypo-androgenism, but almost universal azoospermia, most frequently in combination with a history of learning difficulties and behavior problems. Males with KS may come to medical attention through different medical presentations, given its association with several congenital malformations, and psychiatric, endocrine, and metabolic disorders. Preventive care is to be provided from diagnosis, preferentially through a multidisciplinary approach, including that from an endocrinologist, clinical psychologist or psychiatrist, neurologist, urologist, geneticist, sexologist, and a fertility team. Accurate information about the condition and assessment of associated medical conditions should be offered at diagnosis and should be followed by psychological counseling. Medical treatment during transition into adulthood is focused on fert...
Acta clinica Belgica
In Cushing's disease clinical symptoms are usually related to the ACTH hypersecretion. On dia... more In Cushing's disease clinical symptoms are usually related to the ACTH hypersecretion. On diagnosis these secreting tumours tend to be small due to their ability to reach clinical detection early. However, symptoms may also be caused by mass-related effects such as the depression of secretion of other pituitary hormones. Furthermore growth related symptoms may occur due to the invasion of the suprasellar region with compression of the visual system. As we illustrate in a case report, when spreading of pituitary adenoma occurs to the infrasellar region, Cushing disease may manifest itself by rather atypical initial symptoms that are more related to ear-nose-throat (ENT) complaints. In these invasive macro adenomas multimodal therapy is usually required to achieve control of hypersecretion and mass related symptoms.
BMJ case reports, 2012
A 57-year-old woman was admitted to the emergency department, presenting with episodes of altered... more A 57-year-old woman was admitted to the emergency department, presenting with episodes of altered consciousness and behaviour which, upon further examination, were linked to periods of recurrent hypoglycaemia. Imaging revealed a large mass in the right thoracic cavity while blood analysis demonstrated diminished C-peptide, (pro-)insulin, insulin-like growth factor 1 (IGF-I) and IGF binding protein 3 levels. Based on these findings, an IGF-II secreting tumour was suspected. Before the excision of the tumour, euglycaemia could only be achieved by means of intravenous glucose administration and the use of oral corticosteroids. Anatomopathologically the diagnosis of a solitary fibrous tumour (SFT) was confirmed. Immunoblot analysis on the serum revealed elevated 'big'-IGF-II levels, confirming our initial diagnosis of Doege-Potter syndrome in SFT.
BMJ case reports, 2012
A 16-year-old girl with a history of Graves' disease presented with two episodes of generalis... more A 16-year-old girl with a history of Graves' disease presented with two episodes of generalised tonic-clonic seizures, necessitating intensive care admission. Laboratory examination demonstrated a suppressed thyroid-stimulating hormone level with dramatically elevated free triiodothyronine, free thyroxine and thyroid-stimulating immunoglobulins. Cerebrospinal fluid analysis showed oligoclonal banding in the absence of pleocytosis, thyroid peroxidase antibodies or infection. Neuroimaging revealed the presence of a congenital arachnoid cyst in the right temporal lobe. Despite restoration of euthyroidism and administration of antiepileptic and antiviral drugs, neurological features persisted. Subsequently, intravenous corticoids were administered to exclude the contribution of an underlying autoimmune encephalopathy. The patient gradually recovered and, in retrospect, elevated serum N-methyl-D-aspartic acid-receptor (NMDA-R) antibodies were detected. Although this patient presented...
Thyroid, 2013
Background: Thyroid autoimmunity (TAI) is frequent in infertile women, but to what extent thyrogl... more Background: Thyroid autoimmunity (TAI) is frequent in infertile women, but to what extent thyroglobulin autoantibodies (Tg-Abs) contribute to TAI is unclear in the literature. The aims of the present study were to determine the prevalence of TAI in women consulting for fertility problems and to investigate the impact of isolated Tg-Abs, isolated thyroid peroxidase autoantibodies (TPO-Abs), and the presence of both autoantibody types on thyroid function. Furthermore, thyroid function was compared between women with and without TAI and between infertile and fertile women. Methods: A cross-sectional data analysis nested within an ongoing prospective cohort study was performed in order to determine the prevalence of TAI in unselected women consulting our tertiary referral center for reproductive medicine (CRM). The women underwent a determination of serum thyrotropin (TSH), free thyroxine (FT4), TPO-Abs, and Tg-Abs. The cause of infertility, age, body-mass index (BMI), and smoking habits were recorded. Results: The prevalence of TAI was 16% (163/992). In 8% of cases, both types of autoantibodies were present, in 5% isolated positive Tg-Abs were found, and 4% had isolated positive TPO-Abs ( p = 0.025 and p = 0.003 respectively). The prevalence of TAI was significantly higher in infertile women as compared to that in fertile controls (19% vs. 13%; p = 0.047). The median serum TSH level was significantly higher in the women with TAI and with isolated positive Tg-Abs compared to that in women without TAI (1.83 [1.44] and 1.90 [0.85] vs. 1.47 [0.94] mIU/L; p <0.001 respectively). The median FT4, age, BMI, and smoking habits were comparable between the study groups. Conclusions: The prevalence of TAI was higher in infertile women as compared to fertile women consulting our CRM. Five percent of the women had isolated positive Tg-Abs and a significantly higher serum TSH compared to that in women without TAI.
Human Reproduction Update, 2013
BACKGROUND Previous meta-analyses of observational data indicate that pregnant women with subclin... more BACKGROUND Previous meta-analyses of observational data indicate that pregnant women with subclinical hypothyroidism have an increased risk of adverse pregnancy outcome. Potential benefits of levothyroxine (LT4) supplementation remain unclear, and no systematic review or meta-analysis of trial findings is available in a setting of assisted reproduction technologies (ART). METHODS Relevant trials published until August 2012 were identified by searching MEDLINE, EMBASE, Web of Knowledge, the Cochrane Controlled Trials Register databases and bibliographies of retrieved publications without language restrictions. RESULTS From 630 articles retrieved, we included three trials with data on 220 patients. One of these three trials stated 'live delivery' as outcome. LT4 treatment resulted in a significantly higher delivery rate, with a pooled relative risk (RR) of 2.76 (95% confidence limits 1.20-6.44; P = 0.018; I(2) = 70%), a pooled absolute risk difference (ARD) of 36.3% (3.5-69.0%: P = 0.030) and a summary number needed to treat (NNT) of 3 (1-28) in favour of LT4 supplementation. LT4 treatment significantly lowered miscarriage rate with a pooled RR of 0.45 (0.24-0.82; P = 0.010; I(2) = 26%), a pooled ARD of -31.3% (-48.2 to -14.5%: P < 0.001) and a summary NNT of 3 (2-7) in favour of LT4 supplementation. LT4 treatment had no effect on clinical pregnancy (RR 1.75; 0.90-3.38; P = 0.098; I(2) = 82%). In an ART setting, no data are available on the effects of LT4 supplementation on premature delivery, arterial hypertension, placental abruption or pre-eclampsia. CONCLUSIONS Our meta-analyses provide evidence that LT4 supplementation should be recommended to improve clinical pregnancy outcome in women with subclinical hypothyroidism and/or thyroid autoimmunity undergoing ART. Further research is needed to determine pregnancy outcome after close monitoring of thyroid function to maintain thyroid-stimulating hormone and free T4 levels within the trimester-specific reference ranges for pregnancy.
Fertility and Sterility, 2011
Objective: To investigate the impact of ovarian hyperstimulation syndrome (OHSS) on thyroid funct... more Objective: To investigate the impact of ovarian hyperstimulation syndrome (OHSS) on thyroid function in women without thyroid disorders and to compare it with that in women with uncomplicated controlled ovarian hyperstimulation (COH). Design: Retrospective analysis. Setting: Tertiary referral fertility center. Patient(s): A total of 77 women undergoing COH of whom 25 developed OHSS and 52 had no OHSS. Women with the presence of thyroid disorders were excluded, and only women pregnant after assisted reproductive technology were included. Intervention(s): Serum TSH and free T4 (fT4) levels were measured before and 2, 4, and 6 weeks after embryo transfer (ET), and thyroid peroxidase and thyroglobulin antibody levels were measured before ET to exclude thyroid autoimmunity. The diagnosis of OHSS was based on clinical, ultrasonographic, and biologic features. Main Outcome Measure(s): Thyroid function, OHSS. Result(s): Serum TSH and fT4 levels increased 2 weeks after ET in both study groups compared with prestimulation levels. In the OHSS group: TSH, 1.9 AE 0.8 mIU/L vs. 3.1 AE 1.9 mIU/L; fT4, 12.3 AE 1.4 ng/L vs. 13.4 AE 2.1 ng/L. In the no-OHSS group: TSH, 2.1 AE 1.1 mIU/L vs. 2.6 AE 1.9 mIU/L; fT4, 13.0 AE 1.7 ng/L vs. 13.8 AE 1.6 ng/L. The increment was comparable between both study groups. Conclusion(s): Serum TSH levels increased significantly after COH in a comparable way in both study groups, when no thyroid disorders were present. (Fertil Steril Ò 2011;96:241-5.
European Journal of Human Genetics, 2013
Multiple endocrine neoplasia type 1 (MEN1) is an autosomal-dominant cancer syndrome that is cause... more Multiple endocrine neoplasia type 1 (MEN1) is an autosomal-dominant cancer syndrome that is caused by a germline mutation in the MEN1 gene encoding a tumour-suppressor protein, menin. MEN1 causes a combination of endocrine tumours such as parathyroid adenomas, pituitary adenomas, glucagonomas, gastrinomas, insulinomas, adrenocortical adenomas and nonendocrine tumours. We here present a large MEN1 family where the carriers developed mild hyperparathyroidism, multiple welldifferentiated functionally active neuroendocrine tumours of the pancreas and no pituitary tumour. The causal mutation is a new double substitution in the coding region of exon 2 in the MEN1 gene c.[428T4A; 429C4T], p.Leu143His. This new mutation in the MEN1 gene is clinically relevant leading to a limited penetrance and specific phenotype.
Best Practice & Research Clinical Endocrinology & Metabolism, 2011
Female infertility occurs in about 37% of all infertile couples and ovulatory disorders account f... more Female infertility occurs in about 37% of all infertile couples and ovulatory disorders account for more than half of these. The ovaries are in continuous interaction with the other endocrine organs. The interplay may account for infertility occurring at different levels and may render the diagnosis of infertility a difficult exercise for the involved physician. A hypothalamic cause of female infertility should be considered in an appropriate clinical context, with tests pointing to a hypogonadotropic hypogonadism. It can be functional, physiological or related to organic causes. Hyperprolactinemia has well characterized effects on the normal gonadal function and treatment is well established. Acromegaly and Cushing's disease may impair fertility at different levels, mechanisms involved however remain ill defined. Thyroid disorders, both hyperthyroidism and hypothyroidism, can interact with the ovaries, through a direct effect on ovarian function, but autoimmunity may be involved, as well as alterations of the sex hormone binding protein levels. Primary ovarian disorders, such as the polycystic ovary syndrome and primary ovarian insufficiency are frequent diseases, for which novel treatments are currently being developed and discussed. We will propose an algorithm for the diagnosis and approach of the female patient presenting with infertility on the basis of the available evidence in literature.
Acta Neurologica Belgica, 2013
The purpose of this study is to evaluate long-term results in acromegaly patients who received su... more The purpose of this study is to evaluate long-term results in acromegaly patients who received surgery as first-line treatment. Repeated surgery, radiation therapy and medical treatment were considered in patients showing no postoperative remission or who suffered a relapse. Thirty-five patients suffering from acromegaly were operated on between 1993 and 2009. The patients with persistent hypersecretion received a new surgery when postoperative imaging showed localized residual lesion. The other cases with persistent hypersecretion were treated medically using dopamine agonists, somatostatin analogs or pegvisomant according to the efficiency obtained. Radiotherapy was considered when medical treatment failed to normalize hormonal hypersecretion. The overall remission rate with surgery alone was 57 % (20/35):84 % (16/19) with non-invasive adenomas and 25 % (4/16) with invasive adenomas. Fifteen patients showing no remission after surgery received additional medical and/or radiation therapy resulting in hormonal control in ten of them. Recurrences after initial postoperative remission were observed in six patients who were controlled with subsequent therapy. Using a multimodal treatment approach, the disease was brought under control in 86 % (30/35) of acromegaly patients. Surgery alone produced satisfactory initial results in non-invasive adenomas, but additional treatments were required for most of the invasive lesions.