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Article ; Online: Nelson syndrome and perinatal challenges: A case report and systematic review of the literature.

Jones, Kate / Reis, Ines / Levy, Miles J / Potdar, Neelam

International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics

2023 Volume 163, Issue 1, Page(s) 89–95

Abstract: Nelson syndrome is a rare and potentially life-threatening complication of treatment with total bilateral adrenalectomy for women with Cushing disease. A successful term pregnancy following fertility treatment in a patient with Nelson syndrome is ... ...

Abstract	Nelson syndrome is a rare and potentially life-threatening complication of treatment with total bilateral adrenalectomy for women with Cushing disease. A successful term pregnancy following fertility treatment in a patient with Nelson syndrome is presented. Our study provides guidance in the prenatal and intrapartum management of this condition. A case report and a systematic review of 14 papers describing 50 pregnancies are presented. An electronic database search included Medline (1946 to September 2022), Embase (1980 to September 2022), Cochrane Library, and UKOSS. A small number of pregnancies in women with Nelson syndrome are reported in literature, but there are no guidelines. Some authors detail the prenatal care provided to their patients. Four studies report prenatal monitoring with visual field checks and two report monitoring with X-rays. Five studies report the use of parenteral hydrocortisone at the time of delivery. Where described, women delivered appropriately grown newborns at term, with timing and mode of delivery dictated by obstetric indications. Preconception counseling and optimization of maternal health status improve pregnancy outcomes in women with Nelson syndrome. Multidisciplinary review in a combined obstetric-endocrine prenatal clinic is ideal. Awareness about potential complications during pregnancy and the postnatal period is crucial in providing optimal care to the mother and baby.
MeSH term(s)	Pregnancy ; Infant ; Humans ; Infant, Newborn ; Female ; Nelson Syndrome ; Pregnancy Outcome ; Prenatal Care
Language	English
Publishing date	2023-05-02
Publishing country	United States
Document type	Systematic Review ; Case Reports ; Journal Article ; Review
ZDB-ID	80149-5
ISSN	1879-3479 ; 0020-7292
ISSN (online)	1879-3479
ISSN	0020-7292
DOI	10.1002/ijgo.14791
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Article ; Online: A review of the pathophysiology of functional hypothalamic amenorrhoea in women subject to psychological stress, disordered eating, excessive exercise or a combination of these factors.

Morrison, Amy E / Fleming, Suzannah / Levy, Miles J

Clinical endocrinology

2021 Volume 95, Issue 2, Page(s) 229–238

Abstract: Introduction: Functional hypothalamic amenorrhoea (FHA) is a common form of secondary amenorrhoea without an identifiable structural cause. Suppression of gonadotrophin-releasing hormone (GnRH) pulsatility results in reduced luteinizing hormone (LH) ... ...

Abstract	Introduction: Functional hypothalamic amenorrhoea (FHA) is a common form of secondary amenorrhoea without an identifiable structural cause. Suppression of gonadotrophin-releasing hormone (GnRH) pulsatility results in reduced luteinizing hormone (LH) levels, with subsequent reduction in oestradiol, anovulation and cessation of menstruation. GnRH pulsatility suppression is a recognized complication of psychological stress, disordered eating, low body weight, excessive exercise or a combination of these factors. Pathophysiology of fha: Individuals with FHA demonstrate low energy availability (EA), body fat percentage and energy expenditure. Documented adipocytokine changes notably, raised adiponectin, ghrelin, PYY, and decreased leptin, are associated with GnRH suppression. Other endocrine responses seen in this low EA state include low insulin levels, low total T3, increased basal cortisol levels and a reduced response to corticotrophin-releasing hormone (CRH) administration. FHA is associated with raised growth hormone (GH) and low insulin-like growth factor (IGF-1), suggesting relative GH resistance. Kisspeptins are a group of polypeptides, recently discovered to play a major role in the regulation of the reproductive axis through influencing GnRH release. KNDy (kisspeptin/neurokinin B/dynorphin) act on GnRH neurons and a multitude of factors result in their release. Implications for future treatment: Management of FHA is imperative to prevent adverse outcomes in bone density, cardiovascular risk profile, psychological well-being and fertility. Outwith modification of nutritional intake and exercise, limited therapeutic strategies are currently available for women with FHA. Advancements in the understanding of the pathophysiological basis of this under-recognized and under-treated clinical entity will aid management and may result in the development of novel therapeutic approaches.
MeSH term(s)	Amenorrhea ; Feeding and Eating Disorders ; Female ; Gonadotropin-Releasing Hormone ; Humans ; Kisspeptins ; Luteinizing Hormone ; Stress, Psychological
Chemical Substances	Kisspeptins ; Gonadotropin-Releasing Hormone (33515-09-2) ; Luteinizing Hormone (9002-67-9)
Language	English
Publishing date	2021-01-11
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	121745-8
ISSN	1365-2265 ; 0300-0664
ISSN (online)	1365-2265
ISSN	0300-0664
DOI	10.1111/cen.14399
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Article ; Online: Point-of-care ultrasound is a useful adjunct tool to a clinician's assessment in the evaluation of severe hyponatraemia.

Rahman, Latif R / Melson, Eka / Alousi, Salam Al / Sardar, Muhammad / Levy, Miles J / Shafiq, Shahriar / Rahman, Faizanur / Coats, Tim / Reddy, Narendra L

Clinical endocrinology

2024 Volume 100, Issue 6, Page(s) 595–601

Abstract: Introduction: Hyponatraemia is the most common electrolyte disorder in inpatients resulting mainly from an imbalance in water homeostasis. Intravascular fluid status assessment is pivotal but is often challenging given multimorbidity, polypharmacy and ... ...

Abstract	Introduction: Hyponatraemia is the most common electrolyte disorder in inpatients resulting mainly from an imbalance in water homeostasis. Intravascular fluid status assessment is pivotal but is often challenging given multimorbidity, polypharmacy and diuretics use. We evaluated the utility of point-of-care ultrasound (POCUS) as an adjunct tool to standard practice for fluid assessment in severe hyponatraemia patients. Methods: Patients presenting with severe hyponatremia (Serum Sodium [Na] < 120 mmol/L; Normal range: 135-145 mol/L), managed by standard care were included. Hyponatraemia biochemistry work-up and POCUS examination were undertaken. Both clinician and POCUS independently assigned one of the three fluid status groups of hypovolaemia, hypervolaemia or euvolaemia. The final diagnosis of three fluid status groups at admission was made at the time of discharge by retrospective case review. Clinician's (standard of care) and POCUS fluid assessments were compared to that of the final diagnosis at the time of discharge. Results: n = 19 patients were included. Median Na on admission was 113 mmol/L (109-116), improved to 129 ± 3 mmol/L on discharge. POCUS showed the higher degree of agreement with the final diagnosis (84%; n = 16/19), followed by the clinician (63%; n = 12/19). A trend towards higher accuracy of POCUS compared to clinician assessment of fluid status was noted (84% vs. 63%, p = 0.1611). Biochemistry was unreliable in 58% (n = 11/19) likely due to renal failure, polypharmacy or diuretic use. Inappropriate emergency fluid management was undertaken in 37% (n = 7/19) of cases based on initial clinician assessment. Thirst symptom correlated to hypovolaemia in 80% (4/5) cases. Conclusion: As subjective clinical and biochemistry assessments of fluid status are often unreliable due to co-morbidities and concurrent use of medications, POCUS can be a rapid objective diagnostic tool to assess fluid status in patients with severe hyponatraemia, to guide accurate emergency fluid management.
MeSH term(s)	Humans ; Hyponatremia/diagnostic imaging ; Point-of-Care Systems ; Female ; Male ; Ultrasonography/methods ; Aged ; Aged, 80 and over ; Middle Aged ; Retrospective Studies ; Adult
Language	English
Publishing date	2024-01-16
Publishing country	England
Document type	Journal Article
ZDB-ID	121745-8
ISSN	1365-2265 ; 0300-0664
ISSN (online)	1365-2265
ISSN	0300-0664
DOI	10.1111/cen.15024
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Article ; Online: Health in the UK.

Mani, Hamidreza / Liarakos, Alexandros-Leonidas / Levy, Miles J

Lancet (London, England)

2019 Volume 394, Issue 10201, Page(s) 828

MeSH term(s)	Global Burden of Disease ; Quality of Life ; Systems Analysis ; United Kingdom
Language	English
Publishing date	2019-08-20
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	3306-6
ISSN	1474-547X ; 0023-7507 ; 0140-6736
ISSN (online)	1474-547X
ISSN	0023-7507 ; 0140-6736
DOI	10.1016/S0140-6736(19)31242-5
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Article ; Online: The association of pituitary tumors and headache.

Levy, Miles J

Current neurology and neuroscience reports

2010 Volume 11, Issue 2, Page(s) 164–170

Abstract: Pituitary tumors may give rise to headache via numerous mechanisms. The traditional explanation for headache is dural stretch and cavernous sinus invasion, although this is not borne out by clinical studies. Certain functional pituitary tumors are ... ...

Abstract	Pituitary tumors may give rise to headache via numerous mechanisms. The traditional explanation for headache is dural stretch and cavernous sinus invasion, although this is not borne out by clinical studies. Certain functional pituitary tumors are associated with headache, notably growth hormone and prolactin-secreting tumors. The observation that somatostatin analogues can have a dramatic analgesic effect in acromegaly suggests that biochemical properties of the tumor may be important. The genetic predisposition of the patient to primary headache also determines whether headache occurs with pituitary tumors. This article attempts to outline the clinical features, management strategies, and key academic questions regarding the subject of pituitary tumors and headache.
MeSH term(s)	Acromegaly/etiology ; Acromegaly/pathology ; Brain Neoplasms/complications ; Brain Neoplasms/pathology ; Brain Neoplasms/physiopathology ; Headache/classification ; Headache/diagnosis ; Headache/etiology ; Human Growth Hormone/metabolism ; Humans ; Magnetic Resonance Imaging ; Pituitary Neoplasms/complications ; Pituitary Neoplasms/pathology ; Pituitary Neoplasms/physiopathology ; Prolactin/metabolism
Chemical Substances	Human Growth Hormone (12629-01-5) ; Prolactin (9002-62-4)
Language	English
Publishing date	2010-12-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	2057363-7
ISSN	1534-6293 ; 1528-4042
ISSN (online)	1534-6293
ISSN	1528-4042
DOI	10.1007/s11910-010-0166-7
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Article ; Online: Polycystic ovary syndrome: An underestimated problem in primary care.

Mani, Hamidreza / Levy, Miles J / Khunti, Kamlesh

International journal of clinical practice

2018 Volume 72, Issue 4, Page(s) e13081

Language	English
Publishing date	2018
Publishing country	England
Document type	Letter
ZDB-ID	1386246-7
ISSN	1742-1241 ; 1368-5031
ISSN (online)	1742-1241
ISSN	1368-5031
DOI	10.1111/ijcp.13081
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Article ; Online: A study of acromegaly-associated headache with somatostatin analgesia.

Kaniuka-Jakubowska, Sonia / Levy, Miles J / Pal, Aparna / Abeyaratne, Dayakshi / Drake, William M / Kyriakakis, Nikolaos / Murray, Robert D / Orme, Steve M / Gohil, Shailesh / Brooke, Antonia / Leese, Graham P / Korbonits, Márta / Wass, John Ah

Endocrine-related cancer

2023 Volume 30, Issue 3

Abstract: The aim of this study is to characterise somatostatin analogue-responsive headache in acromegaly, hitherto not systematically documented in a significant cohort. Using the UK pituitary network, we have clinically characterised a cohort of 18 patients ... ...

Abstract	The aim of this study is to characterise somatostatin analogue-responsive headache in acromegaly, hitherto not systematically documented in a significant cohort. Using the UK pituitary network, we have clinically characterised a cohort of 18 patients suffering from acromegaly-related headache with a clear response to somatostatin analogues. The majority of patients had chronic migraine (78%) as defined by the International Headache Society diagnostic criteria. Headache was present at the time of acromegaly presentation and clearly associated temporally with disease activity in all cases. Short-acting somatostatin analogues uniquely resolved pain within minutes and the mean duration of analgesia was 1-6 h. Patients on long-acting analogues required less short-acting injections (mean: 3.7 vs 10.4 injections per day, P = 0.005). 94% used somatostatin analogues to control ongoing headache pain. All patients presented with macroadenoma, most had incomplete resection (94%) and headache was ipsilateral to remnant tissue (94%). Although biochemical control was achieved in 78% of patients, headache remained in 71% of them. Patients selected for this study had ongoing headache post-treatment (mean duration: 16 years after diagnosis); only four patients reached headache remission 26 years (mean range: 14-33) after the diagnosis. Headache in acromegaly patients can be persistent, severe, unrelieved by surgery, long-lasting and uncoupled from biochemical control. We show here that long-acting analogues allow a decrease in the number of short-acting analogue injections for headache relief. Further studies are needed to understand the mechanisms, markers and tumour tissue characteristics of acromegaly-related headache. Until then, this publication serves to provide the clinical characteristics as a reference point for further study.
MeSH term(s)	Humans ; Acromegaly/complications ; Acromegaly/drug therapy ; Octreotide/therapeutic use ; Somatostatin/therapeutic use ; Headache/drug therapy ; Analgesia
Chemical Substances	Octreotide (RWM8CCW8GP) ; Somatostatin (51110-01-1)
Language	English
Publishing date	2023-02-16
Publishing country	England
Document type	Journal Article
ZDB-ID	1218450-0
ISSN	1479-6821 ; 1351-0088
ISSN (online)	1479-6821
ISSN	1351-0088
DOI	10.1530/ERC-22-0138
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Article ; Online: Audit of long-term treatment outcomes of thyrotoxicosis in a single-centre virtual clinic: The utility of long-term antithyroid drugs.

Levy, Miles J / Reddy, Narendra / Price, David / Bhake, Ragini / Bremner, Emma / Barrowcliffe, Mary / Kieffer, Veronica / Robinson, Carole / Zaccardi, Francesco / Howlett, Trevor A

Clinical endocrinology

2022 Volume 97, Issue 5, Page(s) 643–653

Abstract: Objective: To investigate the long-term outcomes and prognosis of thyrotoxicosis in a large number of patients in a single UK county (Leicestershire).: Design: Retrospective cohort analysis of 56,741 thyroid function test (TFT) results, treatment ... ...

Abstract	Objective: To investigate the long-term outcomes and prognosis of thyrotoxicosis in a large number of patients in a single UK county (Leicestershire). Design: Retrospective cohort analysis of 56,741 thyroid function test (TFT) results, treatment modalities and outcomes in a well-established virtual thyrotoxicosis clinic database. Patients: One thousand four hundred and eighty-nine patients were included with a median length of follow-up of 10.9 years. The aetiology of thyrotoxicosis was autoimmune (85.9%), nodular (9.1%) and mixed (5.0%). Treatment modalities included antithyroid drugs (ATDs), radioiodine (RAI; 555 MBq fixed dose) and thyroidectomy. Methods: We analysed both individual TFTs and groups of sequential TFTs on or after the same thyroid treatment(s), which we describe as 'phase of thyroid care' (POTC). Patients studied entered the virtual clinic between 1 January 1995 and 1 January 2010; we exported data on every TFT sample up to April 2020. Results: ATD had been used in 99.2% (median 2, maximum seven courses) with long-term ATD (>2 years) in 48%. RAI and thyroidectomy were used more commonly with nodular and mixed aetiology. Overall, T4 was more often controlled than thyroid-stimulating hormone (TSH), and at the latest follow-up, T4 was normal in >96%, TSH in >79% and both in >76% of different aetiologies. The mean percentage control of T4 was 85% and TSH 50%; in long-term ATD courses, this improved to 89% and 62%, respectively. In the latest POTC, control of T4 and TSH was best in cases off treatment (95%/87%) and on T4 without ablative therapy (94%/72%), but was broadly similar in patients on long-term ATD (90%/68%), after RAI (92%/60%) or after thyroidectomy (91%/58%). After the first course of ATD, remission or hypothyroidism was seen in 47.3% autoimmune, 20.9% nodular and 32.5% mixed, with 90% relapses seen within 4 years. Relapse was more common in patients with ophthalmopathy, but there was no difference between the sexes. Conclusions: Thyrotoxicosis can be well controlled with minimal specialist clinic attendance using a software-supported virtual shared-care scheme. Long-term ATD appears to be a valid patient choice achieving TFT control comparable to that seen after RAI or surgery. In patients with autoimmune disease, relapse is more common in patients with ophthalmopathy, and hypothyroidism is common after RAI. In nodular disease, we found that spontaneous remission may occur.
MeSH term(s)	Antithyroid Agents/adverse effects ; Graves Disease/drug therapy ; Humans ; Hypothyroidism/drug therapy ; Iodine Radioisotopes/therapeutic use ; Recurrence ; Retrospective Studies ; Thyrotoxicosis/drug therapy ; Thyrotropin/therapeutic use ; Treatment Outcome
Chemical Substances	Antithyroid Agents ; Iodine Radioisotopes ; Thyrotropin (9002-71-5)
Language	English
Publishing date	2022-03-20
Publishing country	England
Document type	Journal Article
ZDB-ID	121745-8
ISSN	1365-2265 ; 0300-0664
ISSN (online)	1365-2265
ISSN	0300-0664
DOI	10.1111/cen.14721
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Article ; Online: Long-term outcome of hyperthyroidism diagnosed in childhood and adolescence: a single-centre experience.

Gill, Daniel S / Greening, James E / Howlett, Trevor A / Levy, Miles J / Shenoy, Savitha D

Journal of pediatric endocrinology & metabolism : JPEM

2018 Volume 32, Issue 2, Page(s) 151–157

Abstract: Background The objective of the study was to evaluate the long-term outcome of paediatric-onset hyperthyroidism with follow-up into adulthood and to identify any early predictors of a need for definitive therapy (DT). Methods In a retrospective analysis ... ...

Abstract	Background The objective of the study was to evaluate the long-term outcome of paediatric-onset hyperthyroidism with follow-up into adulthood and to identify any early predictors of a need for definitive therapy (DT). Methods In a retrospective analysis of patients diagnosed with hyperthyroidism under the age of 18 years and at follow-up, a comparison was made by categorising them into those who underwent definitive therapy (DT group), i.e. thyroidectomy/radioactive iodine (RAI), those who remained on antithyroid drugs (ATD) (CBZ group) and those who had complete remission (RE group). Results Sixty-one (49 females, 12 males) patients with a median age of 15.1 years (range: 3.6-18) at diagnosis were studied. The duration of the first course of ATD varied from <1 year (7%), 1-2 years (26%), >2 years (46%) and ATD never discontinued (21%). Disease relapsed in 69% of patients with <1 year of ATD vs. 79% with >2 years of ATD. At follow-up, the median duration since diagnosis was 8.75 years (range 2.0-20.7 years) and the median age at follow-up was 23.2 years (8-36 years). Thirty-three percent (20/61) had undergone DT (DT group) - with 16.5% (n=10) on RAI and 16.5% (n=10) on surgery, 36% (22/61) were on ATD (CBZ group), whilst 32% (19/61) had undergone full remission (RE group). The comparison did not identify any statistically significant difference for predictor factors at diagnosis including age, T4 and free T4 levels, thyroid peroxidise antibody levels (TPO) and the duration of the first course of carbimazole (CBZ) treatment. Conclusion Long-term complete remission of paediatric-onset hyperthyroidism in our study was 31%. There were no predictors identified that could help predict the long-term outcome, especially into adulthood.
MeSH term(s)	Adolescent ; Antithyroid Agents/therapeutic use ; Child ; Female ; Follow-Up Studies ; Humans ; Hyperthyroidism/pathology ; Hyperthyroidism/therapy ; Iodine Radioisotopes/therapeutic use ; Male ; Remission Induction ; Retrospective Studies ; Thyroid Function Tests ; Thyroidectomy/methods ; Treatment Outcome
Chemical Substances	Antithyroid Agents ; Iodine Radioisotopes
Language	English
Publishing date	2018-12-27
Publishing country	Germany
Document type	Clinical Trial ; Journal Article
ZDB-ID	1231070-0
ISSN	2191-0251 ; 0334-018X
ISSN (online)	2191-0251
ISSN	0334-018X
DOI	10.1515/jpem-2018-0385
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Article: Expert opinion: Headache and pituitary tumors.

Evans, Randolph W / Levy, Miles J

Headache

2008 Volume 48, Issue 2, Page(s) 280–283

MeSH term(s)	Adult ; Female ; Headache/etiology ; Headache/pathology ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Pituitary Neoplasms/complications ; Pituitary Neoplasms/pathology
Language	English
Publishing date	2008-02
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	410130-3
ISSN	1526-4610 ; 0017-8748
ISSN (online)	1526-4610
ISSN	0017-8748
DOI	10.1111/j.1526-4610.2007.01020.x
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