Hypothalamic hypopituitarism after hemiparesis.

Anterior pituitary insufficiency developed over 15 years in a man who had had a sudden episode of left hemiparesis and slurred speech at the age of 45 years. At age 60 radiographic studies revealed no evidence of a sellar or suprasellar neoplasm, and endocrinologic studies, including stimulation with thyrotropin releasing hormone and luteinizing hormone releasing hormone, yielded results consistent with hypopituitarism of hypothalamic origin. Response to thyroid, adrenocortical and testosterone therapy was good.     

Symptomatic hypopituitarism revealing primary suprasellar lymphoma

Background

Cause-specific mortality is a commonly used endpoint of clinical trials or prospective studies. However, it is sometimes difficult for physician to determine the underlying-cause-of-death (UCD), especially for diabetic patients coexisted with cardiovascular diseases (CVD). The aim of this survey was to examine whether internists with different specialties have different opinions on the reporting of diabetes as the UCD.

Methods

A total of 549 physicians completed the questionnaire in Taiwan, which comprised seven hypothetical case scenarios, each indicating a different level of contribution of diabetes in initiating the chain of events leading to death.

Results

As a whole, endocrinologists were more likely than cardiologists and nephrologists to report diabetes as the UCD. The differences were more prominent when the diabetic patient had a coexisting CVD. In scenario 3 (a diabetic patient with hypertension who died from acute myocardial infarction), the percentage was 56% in endocrinologists, which was significantly higher than in cardiologists (42%) and nephrologists (41%). In scenario 4 (a diabetic patient with hypertension who died from cerebrovascular infarction), the percentage was 45% in endocrinologists, and only 31% in cardiologists and 36% in nephrologists.

Conclusions

Internists of different sub-specialties do have different opinions on the reporting of diabetes as the UCD, especially when the diabetic patient has a coexisting CVD.     

Hypothalamic neurosecretion and metamorphosis inXenopus laevis

Summary The frontal brain was removed from premetamorphic larvae ofXenopus laevis. Part of the animals was kept in a 0.01% propylthiouracil (PTU) solution for 21, 30 or 90 days, together with unoperated controls. Others were reared in tap water for the same length of time. The hypothalamus, the pituitary and the thyroids were studied in sagittal sections stained with aldehyde fuchsin or pseudoisocyanine (PIC).Operated tadpoles lacking the telencephalon only, could not be distinguished from unoperated controls. Extirpation of the preoptic region of the hypothalamus lowered the activity of the thyrotropic (TSH) cells and of the thyroids, and blocked metamorphosis. In animals with intact PIC-positive cells in the dorsal preoptic region, PTU induced a degranulation of these cells, stimulated the TSH cells and caused a strong hypertrophy of the thyroids. It is concluded that these neurosecretory cells in the dorsal preoptic region produce a thyrotropin-releasing factor (TRF), indispensable for the endocrine regulation of metamorphosis, and that the thyroid hormones have a negative feed-back influence upon the TRF cells.In part of the animals lacking the rostral hypothalamus, new PIC-positive cells were observed to develop immediately behind the preoptic region. In these animals PTU was somewhat less effective than in the animals with an intact dorsal preoptic region. This means either that the newly differentiated PIC-positive cells have a TRF function or that the thyroids can exert a direct negative feed-back upon the TSH cells. The latter possibility is supported by the fact that even in the absence of any neurosecretory cell PTU stimulated the thyroids.Blocking of thyroid hormone production by PTU inhibited the differentiation of the hypothalamus, of the median eminence and of the portal vessels. It may be deducted that during metamorphosis the general morphogenetic effect of the thyroid hormones stimulates the differentiation of the structures necessary for the augmentation of the TSH activity.The author thanks Prof. Dr.P.G.W.J. van Oordt for his active interest and helpful advices, MissTineke Aafjes for technical assistance and Mr.H. van Kooten for making the diagrams and photographs.     

Hypothalamic lipotoxicity and the metabolic syndrome

Ectopic accumulation of lipids in peripheral tissues, such as pancreatic β cells, liver, heart and skeletal muscle, leads to lipotoxicity, a process that contributes substantially to the pathophysiology of insulin resistance, type 2 diabetes, steatotic liver disease and heart failure. Current evidence has demonstrated that hypothalamic sensing of circulating lipids and modulation of hypothalamic endogenous fatty acid and lipid metabolism are two bona fide mechanisms modulating energy homeostasis at the whole body level. Key enzymes, such as AMP-activated protein kinase (AMPK) and fatty acid synthase (FAS), as well as intermediate metabolites, such as malonyl-CoA and long-chain fatty acids-CoA (LCFAs-CoA), play a major role in this neuronal network, integrating peripheral signals with classical neuropeptide-based mechanisms. However, one key question to be addressed is whether impairment of lipid metabolism and accumulation of specific lipid species in the hypothalamus, leading to lipotoxicity, have deleterious effects on hypothalamic neurons. In this review, we summarize what is known about hypothalamic lipid metabolism with focus on the events associated to lipotoxicity, such as endoplasmic reticulum (ER) stress in the hypothalamus. A better understanding of these molecular mechanisms will help to identify new drug targets for the treatment of obesity and metabolic syndrome.     

下丘脑KATP通道与糖代谢

下丘脑葡萄糖反应神经原表面ATP敏感的钾离子（KATP）通道对于血糖浓度调节发挥着重要的作用.胰岛素、长链脂肪酸、葡萄糖及其代谢物等均可以激活KATP通道,通过迷走神经而限制肝脏的葡萄糖生成,以保持血糖浓度的相对恒定.KATP通道调节异常可能导致Ⅱ型糖尿病等的发生,因此下丘脑KATP通道与糖代谢关系的研究为相关疾病的治疗带来新的希望.