Objective: To investigate the clinicopathological features of Crooke cell tumor of adrenocorticotropic hormone differentiation specific transcription factor (TPIT, also known as transcription factor 19, TBX19) lineage neuroendocrine tumors. Methods: Six cases of Crooke cell tumor diagnosed at the First Affiliated Hospital of University of Science and Technology of China, Hefei, China from October 2019 to October 2023 were collected. The clinical and pathological features of these cases were analyzed. Results: Among the six cases, one was male and five were female, with ages ranging from 26 to 75 years, and an average age of 44 years. All tumors occurred within the sella turcica. Clinical presentations included visual impairment in two cases, menstrual disorders in one case, Cushing\'s syndrome in one case, headache in one case, and one asymptomatic case discovered during a physical examination. Preoperative serum analyses revealed elevated levels of cortisol and adrenocorticotropic hormones in two cases, elevated cortisol in two cases, elevated adrenocorticotropic hormone in one case, and one case with a mild increase in prolactin due to the pituitary stalk effect. Magnetic resonance imaging revealed uneven enhancement of masses with maximum diameters ranging from 1.7 to 3.2 cm, all identified as macroadenomas. Microscopically, tumor cells exhibited irregular polygonal shapes, solid sheets, or pseudo-papillary arrangements around blood vessels. The cell nuclei were eccentric or centrally located, varying in size, with abundant cytoplasm. Some tumor cells showed perinuclear halo. Immunohistochemistry demonstrated diffuse strong positivity for TPIT in five cases, focal weak positivity for TPIT in one case, diffuse strong positivity for adrenocorticotropic hormone in all cases, and faint staining around the nuclei in a few cells. CK8/18 showed a strong positive ring pattern in more than 50% of tumor cells, focal weak positive expression of p53, and the Ki-67 positive index ranged 1%-5%. Periodic acid-Schiff staining revealed positive cytoplasm and negative perinuclear areas. Conclusions: Crooke cell tumor is a rare type of pituitary neuroendocrine tumors. Its pathological characteristics include a distinctive perinuclear clear zone and immunohistochemical markers, such as CK8/18 exhibiting a ring or halo pattern. This entity represents a high-risk subtype among pituitary neuroendocrine tumors, displaying a high risk of invasion and a propensity for recurrence. Accurate diagnosis is crucial for the postoperative follow-up and multimodal treatment planning.
目的： 探讨垂体Crooke型促肾上腺皮质激素分化特异性转录因子（TPIT，又称transcription factor 19，TBX19）谱系神经内分泌肿瘤的临床及病理学特点。 方法： 收集中国科学技术大学附属第一医院2019年10月至2023年10月诊断的垂体Crooke型TPIT谱系神经内分泌肿瘤6例，分析其临床及病理学特点。 结果： 6例中男性1例，女性5例，年龄26~75岁，平均年龄44岁，均发生于鞍内。临床表现为视觉障碍2例，月经紊乱1例，库欣综合征1例，头痛1例，无症状体检发现1例。术前血清学检查2例皮质醇、促肾上腺皮质激素（ACTH）同时升高，2例皮质醇升高，1例ACTH升高，1例仅出现垂体柄效应引起的泌乳素轻度升高。磁共振成像均显示增强扫描不均匀强化占位，直径1.7~3.2 cm，均为大腺瘤。镜下观察：肿瘤细胞呈不规则多边形，实性片状或围绕血管呈假乳头状排列，细胞核偏位或居中，大小不一，细胞质丰富，部分肿瘤细胞可见核周环状透明样变区域。免疫组织化学显示TPIT 5例弥漫强阳性，1例局灶弱阳性，ACTH细胞膜或细胞质弥漫强阳性，少数细胞核周可见淡染区，细胞角蛋白（CK）8/18可见>50%肿瘤细胞呈环状、戒圈状强阳性，p53局灶性弱阳性表达，Ki-67阳性指数1%~5%。过碘酸雪夫染色显示细胞质近胞膜处阳性，核周阴性。 结论： 垂体Crooke型TPIT谱系神经内分泌肿瘤是一种罕见的垂体神经内分泌肿瘤，病理学特点主要表现为特征性核周环状透明样变及免疫标记CK8/18环状、戒圈状强阳性。该肿瘤属垂体神经内分泌肿瘤的高危亚型之一，侵袭性强，易复发，明确诊断对患者术后随访及多模式治疗具有重要意义。.

Hypoxia is a globally pressing environmental problem in aquatic ecosystems. In the present study, a comprehensive analysis was performed to evaluate the effects of hypoxia on physiological responses (hematology, cortisol, biochemistry, hif gene expression and the HIF pathway) of hybrid sturgeons (Acipenser schrenckii ♂ × Acipenser baerii ♀). A total of 180 hybrid sturgeon adults were exposed to dissolved oxygen (DO) levels of 7.00 ± 0.2 mg/L (control, N), 3.5 ± 0.2 mg/L (moderate hypoxia, MH) or 1.00 ± 0.1 mg/L (severe hypoxia, SH) and were sampled at 1 h, 6 h and 24 h after hypoxia. The results showed that the red blood cell (RBC) counts and the hemoglobin (HGB) concentration were significantly increased 6 h and 24 h after hypoxia in the SH group. The serum cortisol concentrations gradually increased with the decrease in the DO levels. Moreover, several serum biochemical parameters (AST, AKP, HBDB, LDH, GLU, TP and T-Bil) were significantly altered at 24 h in the SH group. The HIFs are transcription activators that function as master regulators in hypoxia. In this study, a complete set of six hif genes were identified and characterized in hybrid sturgeon for the first time. After hypoxia, five out of six sturgeon hif genes were significantly differentially expressed in gills, especially hif-1α and hif-3α, with more than 20-fold changes, suggesting their important roles in adaptation to hypoxia in hybrid sturgeon. A meta-analysis indicated that the HIF pathway, a major pathway for adaptation to hypoxic environments, was activated in the liver of the hybrid sturgeon 24 h after the hypoxia challenge. Our study demonstrated that hypoxia, particularly severe hypoxia (1.00 ± 0.1 mg/L), could cause considerable stress for the hybrid sturgeon. These results shed light on their adaptive mechanisms and potential biomarkers for hypoxia tolerance, aiding in aquaculture and conservation efforts.

With advancements in medical oncology, immune checkpoint inhibitors (ICIs) have become the first-line treatment for many malignancies. ICIs play a significant role in improving cancer prognosis, but a series of immune-related adverse events (irAEs), including immune-related endocrine events (irEEs), caused by ICIs have also aroused concerns. Rapid clinical identification of irAEs caused by ICIs is particularly important. We describe a case of secondary adrenocortical insufficiency (AI) after PD-1 treatment in a postoperative patient with endometrial cancer. A 73-year-old female patient developed anorexia, nausea, vomiting, malaise, electrolyte disturbances, ineffective symptomatic treatment, and decreased serum adrenocorticotropin and cortisol levels six months after retifanlimab treatment. The vomiting resolved, and the electrolyte levels were corrected after 3 days of treatment with glucocorticoids (hydrocortisone, intravenous, 200 mg/day). When patients present with gastrointestinal symptoms, such as poor appetite and nausea, not only symptomatic treatment but also a search for the etiology behind the symptoms is needed, especially in immunotherapy patients who should undergo a thorough evaluation of the endocrine system and be alert for adrenocortical insufficiency.

BACKGROUND: Noise pollution in the operating room can have adverse effects on the physical and mental well-being of patients. Since the mid-20th century, music therapy has been increasingly used in clinical practice. Soothing music has a beneficial effect in maintaining the efficacy of intraoperative sedation and regulating patients\' emotions.
OBJECTIVE: To investigate the effects of soothing music on the intraoperative management of patients undergoing tension-free herniorrhaphy.
METHODS: We retrospectively analyzed the clinical data of 244 patients who underwent open tension-free herniorrhaphy under local anesthesia at the Fourth Affiliated Hospital of Nanchang University from June 2019 to May 2021. According to the different included time periods, the hospital implemented soothing music management from June 2020 to May 2021, and 110 patients admitted during this period were classified as the study group. One hundred thirty-four patients who underwent clinical routine management from June 2019 to May 2020 were classified as the control group. The patients in the two groups received corresponding management modes during surgery. The perioperative indicators, stress response, anxiety, depression, and clinical efficacy of the two groups were analyzed.
RESULTS: No significant differences in the operative time, intraoperative blood loss, postoperative off-bed activity time, and hospitalization time between the two groups (P > 0.05). The study group exhibited lower postoperative cortisol (213.30 (203.40, 229.00) nmol/L) and anxiety (9.00 (7.00, 12.00) points) levels than the control group (246.85 (230.50, 258.40) nmol/L; 14.00 (12.00, 15.00) points) (P < 0.001). Moreover, no significant differences were noted in the norepinephrine and depression levels and the severity of illness, global improvement, and efficacy index scores between the two groups (P > 0.05).
CONCLUSIONS: Soothing music therapy, as a clinical auxiliary method, has a positive impact on the intraoperative management of patients undergoing open tension-free herniorrhaphy, leading to reduced cortisol levels and alleviation of anxiety.

Fibroblast growth factor 5 (FGF5) plays key roles in promoting the transition from the anagen to catagen during the hair follicle cycle. The sheep serves as an excellent model for studying hair growth and is frequently utilized in various research processes related to human skin diseases. We used the CRISPR/Cas9 system to generate four FGF5-edited Dorper sheep and only low levels of FGF5 were detected in the edited sheep. The density of fine wool in GE sheep was markedly increased, and the proportion of fine wool with a diameter of 14.4-20.0 μm was significantly higher. The proliferation signal in the skin of gene-edited (GE) sheep was stronger than in wild-type (WT) sheep. FGF5 editing decreased cortisol concentration in the skin, further activated the activity of antioxidant enzymes such as Glutathione peroxidase (GSH-Px), and regulated the expression of Wnt signaling pathways containing Wnt agonists (Rspondins, Rspos) and antagonists (Notum) in hair regeneration. We suggest that FGF5 not only mediates the activation of antioxidant pathways by cortisol, which constitutes a highly coordinated microenvironment in hair follicle cells, but also influences key signals of the Wnt pathway to regulate secondary hair follicle (SHF) development. Overall, our findings here demonstrate that FGF5 plays a significant role in regulating SHF growth in sheep and potentially serves as a molecular marker of fine wool growth in sheep breeding.

OBJECTIVE: Laparoscopic sleeve gastrectomy (LSG) is a widely recognized effective bariatric surgery. However, variable weight loss outcomes post-surgery remained a clinical challenge. Currently, there is no established consensus on the factors influencing weight loss failure following LSG. This study aimed to explore the association between preoperative cortisol secretion autonomy and postoperative weight loss in obese patients undergoing LSG.
METHODS: A cohort of 181 patients with simple obesity (BMI ≥ 28 kg/m2) who underwent LSG and were followed up for one year was analyzed. Weight loss was measured by the percentage of excess weight loss (%EWL), and cortisol secretion autonomy was evaluated using a 1 mg dexamethasone suppression test (DST). Regression models were used to analyze the correlation between preoperative 1 mg DST results and %EWL one year after laparoscopic sleeve gastrectomy (LSG).
RESULTS: Cortisol secretion autonomy was significantly lower in the %EWL ≥ 75% group and higher in the %EWL < 75% group, showing a negative correlation with %EWL (R = -0.336, p = 0.001). Logistic regression analysis indicated that high cortisol secretion autonomy was significantly correlated with %EWL < 75% after LSG. The likelihood of %EWL being < 75% was 10.47 times greater in patients with high cortisol secretion autonomy compared to those with low cortisol secretion autonomy (odds ratio 10.472, confidence interval: 1.660-66.048, p = 0.012).
CONCLUSIONS: Cortisol secretion autonomy emerges as an independent predictor of weight loss outcomes in Asian patients undergoing LSG. This finding suggests the potential for cortisol secretion autonomy to inform preoperative assessments and personalized treatment strategies in bariatric surgery.

BACKGROUND: Currently, there is a scarcity of cases and diagnostic data regarding ectopic adrenocortical adenomas, particularly in relation to their impact on gonadal function and localization diagnostic techniques. We report a typical case of ectopic adrenocortical adenomas and the data of treatment follow-up, and review the literature of 31 available cases of ectopic adrenocortical adenomas.
METHODS: A 27-year-old Chinese female patient was admitted to our hospital for hypertension, hyperglycaemia and primary amenorrhea. The patient was functionally diagnosed with ACTH-independent CS and hypogonadotropic hypogonadism. Radiological evaluations, including Computed Tomography (CT) and functional imaging, identified a mass at the left renal hilum. Histological assessments post-surgical excision confirmed the mass to be an ectopic adrenocortical adenoma. A subsequent 3-month follow-up showed no signs of disease recurrence, a swift recovery of the cortisol axis was observed, with a partial recuperation of the gonadal axis.
METHODS: Our literature review shows that the most common ectopic areas of cortisol adenomas are renal hilum and hepatic region. The most positive biomarker is Melan A, and only a few cases have been diagnosed with functional localization.
CONCLUSIONS: Ectopic adrenocortical adenomas may be asymptomatic in the early stage and can impact gonadal function. Physicians who treat hypogonadism must be aware of the need to test cortisol levels and perform functional localization in patients with lumps present.

The objective of this study was to explore the effects of a 7-week short sprint interval training (SSIT) with differing in programming volume-loads including progressive (P-SSIT) and nonprogressive (NP-SSIT) approaches on the immunoendocrine, physical fitness attributes and physiological parameters in male wrestlers during the pre-season. Thirty young freestyle wrestlers at the collegiate national-level were included in the study and were divided into three groups: P-SSIT (n = 10), NP-SSIT (n = 10), and an active control group (n = 10). The wrestlers engaged in their specific wrestling training three days weekly, while the P-SSIT and NP-SSIT groups underwent a 7-week SSIT, with scheduling in either progressed or nonprogressed volume-based overloads, three times per week. Before and after the intervention, various aspects of physical fitness (such as 20-m sprint, 4×9-m shuttle run, and maximal strength) and physiological parameters (including cardiorespiratory fitness and anaerobic power output), as well as immunoendocrine responses (such as immunoglobulin-A, testosterone, and cortisol) were measured. Following the training intervention, the control group did not show any significant changes in the variable measured; however, both the P-SSIT and NP-SSIT groups experienced significant improvements (p = 0.001) in physical fitness attributes and physiological parameters with effect sizes ranging from small to very large, and also more adaptive responses compared with control group (p < 0.05). In addition, there were no statistically significant changes observed among the P-SSIT and NP-SSIT groups in terms of immunoendocrine response to training, and physical fitness, as well as physiological parameters (p > 0.05). In conclusion, neither the progressed nor nonprogressed approaches of SSIT demonstrated superior effects on adaptations compared to one another. Therefore, it is recommended for strength and conditioning coaches in wrestling to incorporate both P-SSIT and NP-SSIT into their annual training plan, especially during the pre-season phase, to maximize the physical fitness and physiological parameters of their wrestlers while minimizing changes in immunoendocrine responses.

Present study aimed to compare the effects of SSIT intervention with varying rest distributions on hormonal, physiological, and performance adaptations in soccer players. Thirty-six players were randomly divided into three SSIT groups, each performing 4 sets of 6-10 repetitions of 6-second all-out running with rest intervals at ratios of 1:3, 1:6, and 1:9. Prior to and following the 7-week training period, aerobic fitness indices and anaerobic power were evaluated using a graded exercise test with a gas collection system and a lower-body Wingate test, respectively. Also, sport-specific bio-motor abilities were determined by measuring vertical jump, 20-m sprint, and T-test change of direction speed, Yo-Yo IR1 and maximal kicking distance. Hormonal status was also monitored by evaluating testosterone and cortisol levels. Following the 7-week training period, all SSIT interventions resulted in significant enhancements (p < 0.05) in soccer-related performance, physiological parameters, and hormonal adaptations, exhibiting effect sizes that ranged from small to large. Comparative analysis indicated that the 1:9 SSIT results in greater adaptive responses (p < 0.05) in the vertical jump, peak power, testosterone, and cortisol compared to the 1:3 SSIT group. By contrast, the 1:3 SSIT group induced more adaptive responses (p < 0.05) in the mean power output, maximum oxygen consumption (V̇O2max), and Yo-Yo IR1 compared to the 1:9 SSIT group. Hence, for enhancing physical performance, especially vertical jump height, anaerobic peak power, and hormonal adaptations, the 1:9 SSIT ratio is preferable. Conversely, shorter rest intervals (specifically, the 1:3 SSIT ratio) are better suited for eliciting heightened adaptive responses in mean power output, V̇O2max, and Yo-Yo IR1 over the 7-week training period among young male soccer players.

OBJECTIVE: Thyroid disorders have been reported in hypercortisolism patients. Endogenous Cushing\'s syndrome (CS) potentially complicates its metabolic sequelae. We investigated thyroid function in CS patients to determine this relationship.
METHODS: In this cross-sectional study, we screened CS patients from 2016 to 2019 at our hospital. Patient demographic, medical history, and laboratory data were collected. Additionally, we performed a meta-analysis to demonstrate the prevalence of thyroid dysfunction in patients with CS.
RESULTS: Among 129 CS patients, 48.6% had triiodothyronine (TT3), 27.9% had thyroxine (TT4), 24.6% had free T3 (FT3), 27.7% had free T4 (FT4), and 6.2% had thyroid-stimulating hormone (TSH) levels below the reference values. Those with clinical CS showed more pronounced thyroid suppression than did those with subclinical CS. Cortisol levels were markedly greater in patients with pituitary hypothyroidism (P < 0.001). Serum cortisol levels throughout the day and post low-dose dexamethasone-suppression test (LDDST) results correlated with thyroid hormone levels, particularly in ACTH-independent CS. Correlations varied by thyroid status; FT3 and TSH were linked to cortisol in euthyroid individuals but not in those with low T3 or central hypothyroidism. TSH levels notably halved from the lowest to highest cortisol tertile post-LDDST. Finally, meta-analysis showed 22.7% (95% CI 12.6%-32.9%) central hypothyroidism in 528 CS patients of nine studies.
CONCLUSIONS: Thyroid hormone levels are significantly correlated with cortisol levels and are impaired in patients with CS. However, the physiological adaptation and pathological conditions need further study.