Objective To observe the efficacy and safety of recombinant human growth hormone ( rhGH) replacement therapy in GHD childhood with craniopharyngioma after surgery. Methods This study retrospectively reviewed the records of 18 inpatients with secondary GHD diagnosed by insulin tolerance test ( ITT ) after craniopharyngioma surgery at the Department of Endocrinology, Beijing Tiantan Hospital, from January 2012 to December 2015. The clinical benefits and risks of 18 patients were evaluated systematically, and then were divided into rhGH treatment group(n=9) and control group(n=9). The parameters of height, growth velocity(GV), height standard deviation score (HtSDS), insulin-like growth factors-1 (IGF-Ⅰ), insulin-like growth factor binding protein 3 (IGFBP3) and adverse events rate were recorded after treatment for six months. MRI was followed up every 3 to 6 months to observe the difference of the tumor recurrence and second malignant neoplasm between two groups. Results All 18 patients with craniopharyngioma presented with multiple pituitary-target glands hormone deficiency after surgery. Among these patients, 17 cases (95% ) presented with hypothyroidism or adrenal insufficiency, 7 cases (39% ) with delayed puberty, and 12 cases(67% ) with central diabetes insipidus. Based on pituitary-target gland axis function deficiency, these patients were given appropriate L-thyroxine, prednisone, and desmopressin(DDAVP) replacement therapy, respectively. The median time of 9 patients starting rhGH replacement was 48(36,72)months after surgery. The levels of height, GV, IGF-Ⅰ, HtSDS, and IGFBP3 were significant increased after rhGH treatment for 6 months as compared with pre-treatment and control group (all P<0. 05). In addition, changes of height, GV, HtSDS, and IGF-Ⅰ levels before and after treatment in rhGH treatment group were significantly higher than those in control group (all P< 0. 05). During the period of treatment, there were no serious adverse events to be observed in rhGH treatment group, except 1 case of mild headache in the control group. The differences of biochemical and endocrine parameters such as thyroid function, liver and renal function, blood glucose, etc. were without statistical significance compared with pre-treatment after rhGH treatment ( P > 0. 05 ). The tumor recurrence and second malignant neoplasm were not detected by MRI scanning in rhGH treatment group,but there were 3 cases in the control group. Conclusion Multiple pituitary-target glands axis deficiencies were observed in childhood patients with craniopharyngioma after neurosurgery, and the evident deficiency of GH-IGF-Ⅰ axis was observed. rhGH replacement therapy in short-term would significantly improve the parameters of growth and development of patients with GHD after craniopharyngioma neurosurgery. No recurrence tumor in situ and second malignant neoplasms were detected during the period of rhGH replacement therapy.

Objective To investigate the clinical characteristics and the risk factors for chronic complications in hospitalized early-onset type 2 diabetic mellitus patients. Methods The clinical data of 462 hospitalized type 2 diabetic mellitus patients were retrospectively analyzed. The patients were divided into early-onset group (age of diagnosis ≤40 years, 120 cases) and late-onset group (age of diagnosis>40 years, 342 cases) according to the age of diagnosis of diabetes. The clinical characteristics were compared and risk factors for chronic complications of early-onset type 2 diabetes were explored. Results The percentage of family history of diabetes, fasting plasma glucose, triglyceride and diastolic blood pressure in early-onset group were significantly higher than those in late-onset group:70.0％(84/120) vs. 52.3％(179/342), (8.68 ± 3.08) mmol/L vs. (8.07 ± 2.74) mmol/L, 1.69 (1.06, 2.92) mmol/L vs. 1.48 (1.07, 2.24) mmol/L and (84 ± 10) mmHg (1 mmHg = 0.133 kPa) vs. (81 ± 10) mmHg, and there were statistical differences (P<0.01 or <0.05). The incidence of hypertension, systolic blood pressure and 2h C-peptide in early-onset group were significantly lower than those in late-onset group: 44.2％(53/120) vs. 60.2％ (206/342), (134 ± 17) mmHg vs. (138 ± 18) mmHg and (3.99 ± 2.47) μg/L vs. (4.75 ± 2.65) μg/L, and there were statistical differences (P<0.01 or < 0.05). There were no statistical differences in smoking percentage, body mass index, glycated hemoglobin, total cholesterol, low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) between 2 groups (P>0.05). The incidences of peripheral vasculopathy and cerebrovascular disease in early-onset group were significantly lower than those in late-onset group:13.3％(16/120) vs. 24.3％(83/342) and 11.7％(14/120) vs. 22.8％(78/342), but the incidence of diabetic nephropathy was significantly higher than that in late-onset group: 37.5％ (45/120) vs. 27.8％ (95/342), and there were statistical differences (P<0.05 or <0.01). There were no statistical differences in incidences of coronary heart disease, diabetic retinopathy and diabetic neuropathy between 2 groups (P>0.05). Multivariate Logistic stepwise regression analysis result showed that age, duration of diabetes, hypertension, smoking, levels of glycated hemoglobin and triglyceride were the risk factors for chronic complications in early-onset type 2 diabetic mellitus patients. Conclusions The clinical characteristics are different between early-onset and late-onset type 2 diabetic mellitus patients. Early-onset patients are more prone to diabetic nephropathy, while late-onset patients are prone to macrovascular diseases such as peripheral vascular disease and cerebrovascular disease. Comprehensive management should be administered for early-onset type 2 diabetic mellitus patients to prevent chronic complications especially microvascular complications.

Objective To compare the impact of the mass effects in situ ( MEIS ) of the sella tumor on neuroendocrine function in children and adolescents with craniopharyngioma before surgery. Methods A total of 227 inpatients with craniopharyngioma in Beijing Tiantan Hospital, Capital Medical University, from October 2009 to October 2014, were retrospectively analyzed. These patients were divided into children group ( n = 167 ) and adolescent group(n=60) according to the age at the time of the first diagnosis. The clinical characteristics and damage degrees of neuroendocrine function by MEIS of sella tumor were analyzed and compared between these two groups before surgery. Result (1) Clinical characteristics of neuroendocrine function:Among hypothalamic dysfunctional manifestations, central diabetes insipidus showed the highest percentage(children group 35. 93%vs adolescent group 31. 67%), followed by the abnormal appetite and obesity ( children group 19. 76% vs adolescent group 28. 33%). The incidences of abnormal body temperature regulation, sleeping disorder, personality abnormality, and cognitive abnormality all were less than 5%. There were no statistical significant differences in the aforementioned hypothalamic dysfunction parameters between two groups (P=0. 524). Among pituitary-target glands dysfunction parameters, growth hormonce ( GH )-insulin-insulin like growth factor Ⅰ( IGF-Ⅰ) axis dysfunction showed the highest percentage ( children group 64. 07% vs adolescent group 50. 0%), followed by pituitary-gonad axis dysfunction in adolescent group (53. 33%), hyperprolactinemia ( children group 31. 14% vs adolescent group 43. 33%), pituitary-thyroid dysfunction(children group 22. 16%vs adolescent group 28. 33%), pituitary-adrenal gland dysfunction(children group 20. 36%vs adolescent group 25%). There were no statistical significant differences intheseabnormalpituitary-targetglandaxes(exceptpituitary-gonadaxis)betweentwogroups(P=0.475). (2) Comparison of damage degrees of neuroendocrine dysfunction: The patients with normal neuroendocrine function accounted for 10. 2%in children group and 8. 3%in adolescent group. The patients with 1 to 4 items of neuroendocrine dysfunction accounted for 75. 6%in children group and 73. 3%in adolescent group. The patients with more than 5 items of neuroendocrine dysfunction accounted for 14. 4%in children group and 18. 4%in adolescent group. There were no significant differences between two groups(Z=-1. 63,P=0. 103). Conclusions There were no significant differences in characteristics and damage degrees of MEIS of the sella tumor on neuroendocrine dysfunction between children and adolescents with craniopharyngioma. It suggests that systematical evaluation on hypothalamus-pituitary-targets axis function is very important for reducing the risks of further neuroendocrine dysfunction in young patients with craniopharyngioma after surgery.

Objective To explore the clinical characteristics,changes of neuroendocrine hormone before and aftter operation in patients with craniopharyngioma,so as to provide the basis for the replacement therapy after operation and educational practice.Methods The clinical data of 183 patients with craniopharyngioma were retrospectively analyzed. Results (1)Symptoms mainly were headache with nausea,disevesight,the second symptom was polydipsia and polyuria,in child,growth and development retardation was more,and another was hypothalamus syndrome.(2)Functions in endocrine:functions in thyreoid,adrenal and gonad(except PRL),the dysfunctions in neurohypophysis was displayed with completed insipidus and immaturity insipidus,contrasted it anteoperation to that postoperation,it was obvious in statishcs meanings (P＜0.05). Conclusions In patients with craniopharyngioma,children and adolescent is more than the other people,clinical situation is complicated,neuroendocrine hormone is derangement before and after operation,tumor itself to oppress and operation trauma are the basic reasons for the hypofunction of neuroendocrine hormpne,hormones replacement therapy and monitoring should be catch earlier.

Objective:To investigate the effects of exogenous melatonin on Hypothalamus-Pituitary-Adrenal(HPA) axis and immune function which inhibited by exogenous corticosterone.Methods:By means of radioimmunoassay and cytoimmunology techniques respectively, we observed the effects of two doses exogenous melatonin on the plasma concentrations of ACTH ,corticosteron0e as well as the variations of lymphocytes proliferating response, natural killer cytotoxicity(NKCC) and the level of IL-2 induced by ConA of rat model which Hypothalamus-Pituitary-Adrenal axis and immune function were inhibited by exogenous corticosterone.Results:After 14 consecutive days melatonin injection(i.p.),there were an increasing trends of plasma concentration of ACTH, corticosterone which inhibited by exogenous corticosterone were observed in the melatonin 100 ?g/kg treated group, but no significance in statistics, otherwise, there were significant increasing of plasma concentration of ACTH, corticosterone were observed in the melatonin 200 ?g/kg treated group( P

Objective To investigate the effects of melatonin on oxidative stress and metabolisms of glucose and lipid of diabetic patients.Methods By means of random,single-blind,placebo-parallel control clinical trial,91 of diabetic patients were randomly divided into melatonin group and placebo group.The parameters of Glutathione Peroxidase (GSH-Px),Superoxide Dismutase(SOD)and Malondialdehyde(MDA),as well as the profiles of glycemia and lipidemia were observed before and after 8 weeks treatments,respectively.Results Before treatment,both the serum levels of GSH-Px and SOD of diabetic patients were decreased significantly,whereas the serum level of MDA increased significantly.After 8 weeks consecutive melatonin treatment,the serum levels of GSH-Px and SOD increased significantly,whereas the serum level of MDA decreased significantly compared with pre-treatment in the melatonin group.There were no significant variations of serum levels of GSH,SOD and MDA observed before and after treatment in the placebo group.There were significan benefit on FBG and HbA1c after 8 weeks treatment compared with pre-treatment.The other profile of glycemia and lipidemia such as PBG,TG,TC,LDL-C and HDL-C hed no significant variations compared with pre-treatment.There were no significant variations of the profiles of glycemia and lipidemia compared with pre-treatment in the placebo group.Conclusion Melatonin significantly inhibits oxidative stress provoked by hyperglycemia and has beneficial effects on the glucose homeostasis of diabetic patients.

Objective To observe the efficacy and safety of arginine vasopressin receptor antagonist tolvaptan for treating hyponatremia caused by syndrome of inappropriate secretion of antidiuretic hormone (SIADH).Methods Six patients diagnosed with SIADH were enrolled in this study.Four cases were allocated to tolvaptan group (oral tolvaptan 15-60 mg/d,the dosage was adjusted based on the level of serum sodium).Two cases were allocated to regular treatment group (liquid was limited 1 000 ml/d,intravenous drip was less than 3％ sodium chloride and/or oral salt capsule 10-15 g/d several times was adjusted based on the level of serum sodium).Data of the level of serum sodium at 4,7 d,baseline value of serum sodium,serum sodium at the first normal time,24 h urine and weight change were collected.Safety assessment was given before and after treatment,including medical history,physical examination,electrocardiogram,laboratory tests,and incidence of adverse events.Results The level of serum sodium in tolvaptan group increased from the first day of the treatment.During the period of treatment,serum sodium at 4 d increased 22,16,14,11 mmol/L compared with the baseline value respectively.No obvious change of sodium was observed in regular treatment group compared with the baseline value.For 7 d treatment,serum sodium level increased 14,13,14,13 mmol/L in tolvaptan group compared with the baseline level respectively.Only 2 cases in regular treatment group increased 4 mmol/L,and sodium level in regular treatment group did not reach the lower limit of normal level of serum sodium.In tolvaptan group,all patients urine output increased after 1 d treatment and began to stabilize in 3 d.24 h urine putouts were much more than 1 500 ml during treatment.Urine putouts 780-1 400 ml were observed in regular treatment group.There was no difference before and after treatment.Although weight dropped after treatment in the two groups,weight in tolvaptan group fell obviously.In the two groups,there was no difference in blood pressure and heart rate before and after treatment.There were no serious complications and adverse events.Conclusions Compare with regular treatment,arginine vasopressin receptor antagonist is more effective therapy because it can correct the SIADH in patients with hyponatremia and reduce water retention.It also has a good security.

Objective To compare the effect of occupy effects of tumor in situ before surgery(OETS) and after neurosurgery (ANS) on neuroendocrine dysfunction and grading of neuroendocrine function in children with craniopharyngioma. Methods The grading evaluation criteria of neuroendocrine dysfunction in children with craniopharyngioma were drew up according to references and the endocrine feedback principle. Based on these grading evaluation criteria, the clinical date of 227 cases of children with craniopharyngioma who underwent neurosurgical treatment were retrospectively studied. These children were divided into pre-pubertal group (167 cases) and pubertal group (60 cases). The neuroendocrine impairment status before and after the surgery were evaluated separately. Results Among 227 children with craniopharyngioma, after the surgery, the incidence of the hypothalamus-pituitary-thyroid dysfunction increased from 16.74%(38/227) to 67.40%(153/227), the incidence of the hypothalamus-pituitary-adrenal gland dysfunction increased from 14.54%(33/227) to 44.49%(101/227), and the the incidence of pituitary function impairment increased from 17.62%(40/227) to 21.15%(48/227). Meanwhile, the incidence of body temperature dysregulation, sleeping disorder, personality abnormality and cognitive abnormality all increased after the surgery. The scoring and grading on neuroendocrine dysfunction in pre-pubertal group were increased after the surgery (Z=-5.20, P<0.01; Z=-4.94, P<0.01,). The scoring and grading on neuroendocrine dysfunction in pubertal group were increased after the surgery( Z=-4.10, P<0.01;Z=-4.25, P<0.01). Conclusions Both the mass effect of tumor in situ of craniopharyngioma and the neurosurgical treatment can be harmful to the neuroendocrine function. Even though the surgery can remove the mass effect of tumor in situ in the saddle area, it can increase the level of grading of neuroendocrine dysfunction. The status of neuroendocrine dysfunction can be evaluated by the grading evaluation criteria of neuroendocrine dysfunction in children with craniopharyngioma, which then provides an effective evaluation tool for the reconstruction and rehabilitation of neuroendocrine function.

Objective:To explore the clinical characteristics of patients with pituitary thyrotropin-secreting adenoma and evaluate the effect of preoperative short-acting octreotide treatment on hyperthyroidism.Methods:A retrospective analysis was performed in 40 patients with pituitary thyrotropin adenoma diagnosed in Beijing Tiantan Hospital from January 2008 to January 2018. The general data, laboratory examinations and imaging findings were reviewed and analyzed. The clinical effect of preoperative octreotide on hyperthyroidism was evaluated.Results:The age of onset year of the 40 patients (male: female = 24∶16) was (30.5±5.1) years. Among them, 35 patients (87.5%) were with macroadenoma. The most common symptoms were thyroid hypermetabolism syndrome, followed by headache, dizziness, visual field damage and hypogonadism. The thyroid function of 30 patients (75%) recovered to normal within 3-5 days after the octreotide treatment. The total effective rate of the octreotide was 90.0%. The level of free thyroxine (FT 4) before treatment in patients with more than 10 times of effective cumulative dose was significantly higher than that in patients with less than 10 doses. Conclusions:Thyroid hypermetabolism syndrome and pituitary occupying effect are the most common clinical manifestations of thyrotropin-secreting adenoma. Preoperative octreotide treatment can effectively control hyperthyroidism. The level of FT 4 is a crucial factor affecting the efficacy of octreotide.

Objective To evaluate the clinical significance of quantitative sensory testing (QST) in screening diabetic peripheral neuropathy of the early stage. Methods One hundred patients with type 2 diabetes mellitus were examined by nerve conduction velocity (NCV) and QST examination. With the NCV positive as the gold criterion for screening diabetic peripheral neuropathy of the early stage, the sensitivity and specificity of QST was further analyzed for diagnosis of the early stage diabetic peripheral neuropathy. Results Among the 100 patients with type 2 diabetes mellitus,there were 41 cases positive and 59 cases negative in NCV examination. On the other hand,there were 74 cases positive,and 26 cases negative in QST. The sensitivity and specificity of QST for the diagnosis of early stage diabetic peripheral neuropathy was 97.56% (40/41) and 42.37% (25/59). Conclusions In the screening of early stage diabetic peripheral neuropathy,QST shows higher detection sensitivity,but lower specificity than NCV examination. Therefore, QST may be an examination for the supplement of the routine electromyography.