Faculty Bibliography

OBJECTIVE: Many women stopped hormone therapy (HT) or estrogen therapy (ET) after the Women's Health Initiative results were published in 2002. This study assessed the incidence of hypertension, weight gain, and dyslipidemia; conditions that predispose to chronic diseases; medication use; and quality of life in women who used HT/ET for at least 5 years and subsequently stopped its use compared with those who continued its use. METHODS: A retrospective study was conducted. All consenting eligible women (aged 56-73 y) in physicians' offices were interviewed, and measurements of weight, height, waist-to-hip ratio, and body fat were performed. Standardized quality-of-life and menopausal and medical questionnaires were administered. Three groups were compared: group 1, women who have remained on HT/ET; group 2, women who have resumed HT/ET after stopping for at least 6 months; and group 3, women who have stopped HT/ET and have not resumed. RESULTS: One hundred fifty-nine women were enrolled in group 1, 43 women were enrolled in group 2, and 108 women were enrolled in group 3. Women's characteristics were similar, except that group 3 was 1.5 (0.5) years older and had 4.4 (0.7) years less HT/ET use than groups 1 and 2. Utian Quality of Life scores were significantly lower in group 3 (83.4 [12.5]) than in groups 1 and 2 (87.6 [13.3], P < 0.02), particularly in the occupational satisfaction scale. About 16.6% and 16.3% of women in groups 1 and 2 were on antihypertensive medication, respectively, compared with 27.4% in group 3 (P < 0.04). CONCLUSIONS: Discontinuation of HT/ET may predispose some women to the risk of hypertension and may affect their quality of life.

In this case-control study of euthyroid first-cycle IVF patients >/= 38 years old with singleton baby, miscarriage, biochemical pregnancy, and no pregnancy outcomes from 2005-2008, we assayed frozen serum for autoimmune thyroid disease (AITD) and thyroid function at cycle start, trigger, and 4 and 5 weeks' gestation. AITD prevalence in older infertile women was similar across clinical outcomes, and although AITD was associated with a higher baseline TSH, TSH remained within acceptable ranges, suggesting that T(4) supplementation may not affect maternal outcomes in older euthyroid AITD patients through 5 weeks gestation

Objective: To report a rare case of an adenomatoid tumor (AT) of the adrenal gland. Methods: We present a case report, including clinical, radiologic, and pathologic findings, and review the relevant literature. Results: We describe a 60-year-old man in whom an AT of the adrenal gland was discovered incidentally, and review the literature. Fewer than 20 cases of these tumors are reported. The tumors range in size from 0.5 to 11 cm, are more common in men, and are more frequently located in the left adrenal gland. A specific imaging phenotype has not been characterized. Histologic features, including infiltration into the surrounding tissue, and presence of signet ring cells, may raise concern of a more aggressive neoplasm. Immunologic staining for mesothelial and endothelial markers may be necessary to establish a definitive diagnosis. Conclusion: ATs of the adrenal gland are rare benign lesions. They are difficult to differentiate from more common adrenal tumors by computerized tamography (CT) or magnetic resonance imaging (MRI). Pathologic findings also can present challenges in distinguishing these lesions from more aggressive neoplasms. ATs should be considered in the differential diagnosis of adrenal masses, whether discovered as incidental radiologic, surgical, or pathologic findings, or at autopsy, so that the potential consequences of misdiagnosis may be avoided

OBJECTIVE: To determine if women could measure their vaginal pH as accurately as could physicians. METHODS: Each participant measured her vaginal pH using a swab, completed a survey, and then was seen by her physician, who also performed a vaginal pH test. The physician did not have access to the patient's pH reading; only the study coordinator recorded patient results. Accuracy of patient measurements compared with physician results was analyzed by the kappa statistic. RESULTS: A total of 161 women were enrolled in the study. The average difference between the patients' pH readings and the physicians' readings was <0.5. Overall, 85% of the patients' readings were in agreement with the physicians' readings, and the kappa statistic was 0.6. CONCLUSIONS: Study participants could accurately measure vaginal pH through self-testing. Vaginal pH self-testing may be a convenient tool to help women determine whether they should use an over-the-counter (OTC) antifungal medication or go to a physician for diagnostic workup

Interferon-alpha (IFNalpha) is a major treatment modality for several malignant and nonmalignant diseases, especially hepatitis C. Prospective studies have shown that up to 15% of patients with hepatitis C receiving IFNalpha develop clinical thyroid disease, and up to 40% were reported to develop thyroid antibodies. Some of these complications may result in discontinuation of interferon therapy. Thus, interferon induced thyroiditis (IIT) is a major clinical problem for patients receiving interferon therapy. IIT can be classified as autoimmune type and non-autoimmune type. Autoimmune IIT may manifest by the development of thyroid antibodies without clinical disease, or by clinical disease which includes both autoimmune hypothyroidism (Hashimoto's thyroiditis) and autoimmune thyrotoxicosis (Graves' disease). Non-autoimmune IIT can manifest as destructive thyroiditis or as hypothyroidism with negative thyroid antibodies. Early detection and therapy of these conditions is important in order to avoid complications of thyroid disease such as cardiac arrhythmias. While it is not clear which factors contribute to the susceptibility to IIT, recent evidence suggests that genetic factors, gender, and hepatitis C virus infection may play a role. In contrast, viral genotype and therapeutic regimen do not influence susceptibility to IIT. The etiology of IIT is unknown and may be secondary to immune modulation by IFNalpha and/or direct effects of interferon on the thyroid. In this review we discuss the clinical and pathophysiological aspects of IIT, and we are proposing a new, etiology-based classification of IIT, as well as an algorithm for diagnosis and treatment of IIT