Sheehan's syndrome (SS) is a pituitary failure after delivery. Symptoms depend on which hormonal axis are affected, failure to lactate and resume menstruation is most frequent but cortisol deficiency is most dangerous and may lead to death if undiagnosed. We present a 38 year old female that was diagnosed with SS after repeated visits to health care professionals with typical symptoms of SS. The purpose of this case report is to draw attention to SS and the symptoms of cortisol deficiency.
No available dietary assessment method is without error in measuring dietary intake. This has led to an increased interest in biological markers of dietary intake. This article is a review of the literature investigating whether the concentration of carotenoids in blood can serve as biological markers for the intake of fruit and vegetables. The literature indicates an association between intake of fruit and vegetables and the concentration of total carotenoids, alfa-carotene, beta-carotene, lutein and beta-cryptoxanthin in plasma. The same association was not observed for plasma lycopene. Results from several studies also indicate that plasma alfa-carotene and plasma total carotenoids are more suitable as biological markers of the intake of fruit and vegetables than the other carotenoids. As there are large individual variations in the plasma carotenoid response after intake, carotenoids in blood will be a better marker of intake at group level than individual level. Furthermore, the average value from several measurements of carotenoids in blood will be a better marker of long-term intake than a single measurement. Several factors in addition to fruit and vegetables influence the concentration of carotenoids in blood. It is important to assess these factors when carotenoids in blood are used as biological markers of the intake of fruit and vegetables.
Haemoglobin A(1)c (HbA(1)c) or glycohaemoglobin is one of the most important parameters in the management of patients with diabetes mellitus, but to date there is no international standard for determining HbA(1)c. Most of the routine HbA(1)c assays are standardised against one of the local standardisation schemes like the NGSP (USA) and other schemes (Japan, Sweden). Still, results of HbA(1)c tests diverge considerably, as do the accompanying clinical decision limits.The IFCC Working Group on HbA(1)c Standardisation has developed a reference method and also set up a reference system for HbA(1)c, in which the analyte is defined as beta-N-glycated haemoglobin. This reference system consists of a network of reference laboratories that uses the reference methods and certified reference materials for optimal measurement of HbA(1)c in human blood. The main task of the network is to assign values to secondary reference materials, to be used by manufacturers of routine HbA(1)c assays to calibrate their assays. The high specificity of the reference method results in lower HbA(1)c values in blood samples, since the unspecific components falsely identified as HbA(1)c in routine methods are not measured by the reference method. The reference range for the new reference method was determined as 3 to 4% and the clinical decision limits were translated from existing guidelines: goal of treatment 5% HbA(1)c, change of therapy advised at HbA(1)c greater than 6%. Despite these lower values, worldwide implementation of the IFCC reference system for HbA(1)c is recommended, in order to end the great divergence in HbA(1)c results, with which physicians and patients are confronted today.
Markers of renal function (glomerular filtration rate (GFR)) are frequently used in the Swedish health care. GFR is usually estimated based on plasma creatinine concentration, but plasma cystatin C concentration, creatinine clearance, iohexol clearance, and (51)Cr-EDTA clearance are also used. These markers are all part of the daily patient care, but there is little specific information on the clinical use of these markers. The aim of this study was to compare the use of these various GFR markers in different parts of Sweden and potential changes over time.
Retrospective study using questionnaires to collect information for the years 2006-2009 divided per county on the specific use of GFR markers with type of test reports.
Plasma/serum creatinine concentration (96%) is by far the dominating GFR marker in Sweden, while cystatin C concentration (3.5%), creatinine clearance (0.1%), iohexol clearance (0.1%), and 51Cr-EDTA clearance (0.1%) are less frequently used. The use of GFR markers, including creatinine, continues to increase on a national level with the exception of creatinine clearance and 51Cr-EDTA clearance. There were considerable variations between different counties in the use of GFR markers and the type of test reports that the laboratories provided.
The inter-county variations of GFR markers used in Sweden are large and indicate that savings associated with optimized test utilization in this regard could be substantial. Regional habits and traditions are likely to influence the variations in GFR marker use.
OBJECTIVE: The aim of the present study was to calculate the overall heritability of some routine biochemical analyses. Furthermore, as genetic and environmental influences might differ across various segments, genetic impact in the highest and lowest thirds of the distributions was estimated. METHODS: Ninety-six monozygotic and 120 dizygotic same-sex twin pairs aged 82 and older were tested. Structural equation modelling was used to estimate the genetic and environmental influences on serum levels of albumin, calcium, total cholesterol, HDL-cholesterol, GGT, potassium, sodium, creatinine, urea, urate, cobalamin, folate, homocysteine, free thyroxine and thyroid stimulating hormone (TSH). RESULTS: Additive genetic influence of between 66% and 28% of the variance was accounted for all values except creatinine, for which the genetic influence was marginal. The highest influence was found for homocysteine, cobalamin, folate and HDL-cholesterol. Genetic influence for the tests was mainly in congruence with previous findings in younger samples. When limited to the highest and lowest thirds of distribution, there were substantial differences in the proportion of genetic influence for some tests. CONCLUSION: For the majority of biochemical tests, the magnitude of genetic influence is considerable. Heritability estimates, however, should be considered in a broad context, with age, gender, morbidity and medication taken into account. Notably, for many test values, the genetic impact may differ considerably between the highest and the lowest range of the distribution.
Trace element interactions can affect the absorption, metabolism, or effects of elements. Also, different elements may derive from the same source. Associations in biological media between element concentrations may indicate such phenomena. A large number of correlations were found between 13 trace elements (Co, Cu, Zn, Se, Rb, Rh, Pd, Cd, W, Pt, Hg, Tl, and Pb) in human blood and/or serum, as investigated in 372 Swedish adolescents. Notably, serum Se correlated with blood Pb and blood Hg and Cu and Zn were correlated to each other in both blood and serum. The elements Pt, Pd and Rh, spread in the environment through use of catalytic converters in cars, were closely correlated in both blood and serum. Apart from the correlations with a probable biological or exposure-related explanation, several other correlations, of yet unknown importance and origin, were found.
Measurement of creatine kinase and the more heart-specific creatine kinase B has been a mainstay in the diagnosis of acute myocardial infarction in Denmark since the 1970's. However, an elevated creatine kinase B may reflect other conditions than myocardial damage, for example the presence of other isoenzymes or macro creatine kinase. A case is presented with a review of the literature.