Tehran University Medical Journal

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This study was performed in order to improve the knowledge about Craniopharyngioma tumors, and tried to present extensive datas about the signs and symptoms, the clinical process and the treatments and their complications of the patients with Craniopharyngioma, admitted in the hospitals of Tehran university during 15 years (1355-70). Ultimately, these datas have been compared with those in the reputable books and new medical papers And the results are present at the end of the discussion. Undoubtedly, this study is not free of the limitations of retrospective studies. Our patients-contrary to the textbooks are predominantly males And also their most common chief complaints are neurological manifestations, and headache (82%) is the most common one. There is only a little difference in the prevalence of some of the endocrinologic and ophthalmic manifestations between our datas and what in the texts, while, in some others, we can see a great diversity between the 2. For instance, decreased libido in men and amenorrhea in women, among our patients are prominently less than what we study in the books And blood pressure disturbances, sensory and motor symptoms and urinary incontinence have not been seen in our patients. In most cases, CT scan leads to diagnosis and its diagnostic accuracy in 2 times higher than that of the simple radiography and it can show the sella enlargement obviously. In a majority of cases (More than 95%), excision a part of the tumor (From just limited to the biopsy area to 90% of tumor mass) was the only therapeutic measure. In only a few patients, tumor excision was followed by radiotherapy, that showed the better results. The most common delayed complication was the recurrence of the disease.

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Nelson's syndrome is usually characterized by hyperpigmentation, elevated level of ACTH, and pituitary adenoma, which is frequently available as macroadenoma. It is usually occurred in the patients suffering from Cushing's syndrome. Growth of tumor has been revealed in 10-30% of the patients following adrenalectomy. Tumors are often benign in Nelson's syndrome. The selected treatment of Nelson's syndrome are transsphenoidal or transfrontal microsurgery. The role of radiation as prophylactic effect in the patients following adrenalectomy is unknown. In this research Nelson's syndrome have been studied on the patients records who have been hospitalized in Dr.Shariati hospital during the last 10 years. The achieved results show that, among the 49 patients suffering from Cushing syndrome who have referred after operation, 11 patients (22.4%) of them have been affected with Nelson's syndrome. The syndromes have been appeared after 3-9 months and with regard to occurrence of Nelson's syndrome in some patients immediately after bilateral adrenalectomy, it is recommended that selecting of the patients for bilateral adrenalectomy should be studied accurately

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Some of the endocrinologic diseases, especially Acromegaly, Cushing and Pheochromocytoma have multiple effects on blood glucose metabolism and regulation in non-diabetic patients. In this retrospective survey, records of patients of Tehran Medical Sciences University hospitals have been reviewd. Of 124 Acromegals, GTT was performed for 51 patients, being impaired in 18%. To evaluate diabetes, FBS and BS of 90 patients were checked, overt diabetes was detected in 27%. Among 90 Cushing patients, blood glucose was checked in 60 cases, 47% of these patients had levels above the normal range, and 39% had glucosuria. Among 80 Pheochromocytoma patients, 16 cases (26.5%) had overt diabetes. In comparison with other studied, we have obtained a little different results concerning diabetes and impaired GTT prevalence

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Infection is one of the important causes of morbidity and mortality in diabetic patients. It has been reported that poorly controlled patients are more susceptible to infection, hence we examined the chemiluminescence of leukocytes from Insulin dependent diabetic patients in response to a soluble (Phorbol meristate acetate) and particular stimulus (Opsonized zymosan). The patients were divided into 2 separate groups, only controlled and well controlled, in regard to their blood glucose. Using PMA as a stimulus leukocytes from both groups, patients showed no significant difference comparing with healthy controls, but that of the 2 groups of patients were significantly different (P<0.05). When opsonized zymosan was used as the stimulus, no statistically significant difference was observed between all of the coupled groups. However, the chemiluminescence of leukocytes from poorly controlled patients was lower than the other groups.

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Intra-operative measurement of intact Parathyroid hormone (iPTH) using a rapid assay technique is useful as an aid in determining adequacy of resection and leads to reduce re-operative cases.
Materials and Methods: In a prospective case series study, PTH level determined before and after (intra-operative and one day after) Parathyroidectomy in 34 patients with primary hyperthyroidism that refer to Shariati hospital during 18 months between year 2000 and 2001.
Results: The average PTH levels before and after parathyroidectomy were 563 pgr/lit and 121 pgr/lit. All patients had significant decrease in PTH levels after Parathroidectomy (mean = 78%). One day after operation, this level decreased to 42 pgr/lit (mean = 87% decrease compared with before operation)
Conclusion: In this study, like the same other studies from other countries there was significant decrease in PTH levels in rapid intra-operative assay that can demonstrate the reliability of PTH monitoring for intra-operative management and overall operative success rates.