摘要:

SummaryOBJECTIVES The aim of the study was to review our long‐term use of subcutaneous oestradiol (E2) Implant therapy for the treatment of climacteric symptoms In post‐menopausal women. On the grounds that the aim Is to restore premenopausal serum E2levels, our declared clinical policy Is not to repeat Implants even in the presence of symptoms If serum E2levels are>400pmol/l. Therapy was with 50 mg E2implants inserted subcutaneously In the lower abdominal wall.DESIGN All women who had attended the gynaecological/endocrinological clinic who had received subcutaneous E2implants for the relief of climacteric symptoms between December 1981 and 1992 were Included.RESULTS Between December 1981 and December 1992, 275 women received a total of 759.50 mg E2Implants. The median length of Implant therapy was 34.2 months (range 3.7–109.5 months), and the median number of implants per patient was 4 and ranged from 1 to 13. One hundred and twenty‐nine women had more than four implants and their mean recorded serum E2level was 425±187 (mean ±SD) pmol/l; the mean level over the first 24 months of therapy was 408±157pmol/l. This was not different from the mean value of the remaining period of therapy (439±168pmol/l). Following the second Implant there was no significant progressive rise in serum E2with time and implant number and the mean E2level per patient was no higher in those patients who received implants more frequently. The mean time between the first two implants was 9.7±0.4 months and between subsequent ones was 11.7±0.5 months. After the first two Implants there was no progressive change in this interval with time.CONCLUSION This study shows that effective, safe and sympathetic management of women with oestrogen deficient symptoms may be achieved by use of two criteria to determine re‐treatment; the return of symptoms, and a serum E2level no higher than 400pmol/l. Once therapy is established, E2Implants may need to be prescribed only on an annual basis. There appears to be no justification for giving E2Implants more frequently as this policy achieves satisfactory (physiological) premenopausal E2levels and good symptomatic relief without any evidence for accumulation of E2or

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1995.tb02660.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1995.tb02661.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SummaryOBJECTIVE The prevalence of sporadic forms of medullary thyroid carcinoma (MTC) has been studied In patients living in an area of moderate iodine deficiency. Such forms of MTC are usually diagnosed after surgery and have little chance of definitive cure. Using the measurement of basal serum calcitonin (CT) levels in a large series of patients with both thyroid disease and normal 24‐hour urinary Iodine excretion, we assessed the prevalence of MTC and, in patients affected with the disease, we also evaluated the stage of the disease according to surgical findings and post surgical plasma CT levels.PATIENTS A prospective study of 657 patients with thyroid disease (469 with nodular and 188 with non‐nodular thyroid disease). As controls, 40 normal subjects were also studied.MEASUREMENTS In all patients: (1) measurement of basal serum CT, free T4, total T3, TSH levels and serum TSH‐receptor, peroxidase and thyroglobulin (Tg) antibody concentrations, (2) thyroid ultrasonography, (3) fine needle aspiration cytology (FNAC). In patients with Increased basal CT levels: (1) measurement of serum CT levels during pentagastrin test prior to surgery, (2) histological examination and immunostaining with both anti‐CT and anti‐Tg antibodies of all the nodular thyroid tissue surgically removed, (3) measurement of basal and pentagastrin stimulated serum CT values after surgery.RESULTS All the patients with non‐nodular thyroid disease had normal basal CT levels. Four patients (0.84%) with nodular thyroid disease (2 with uninodular and 2 with multinodular goitre) had both elevated basal and pentagastrin stimulated CT levels. In the two patients with uninodular goitre, FNAC was suggestive of MTC in 1 (nodular diameter 8.0 cm) and of follicular carcinoma In 1 (nodular diameter 2.5 cm). Histological examination of the nodules confirmed these histotypes. Immunostaining with anti‐CT antibodies was positive In the former patient but also In the latter. FNAC was suggestive of benign adenomatous tissues in the two patients with multinodular goitre. Histological examination of all the thyroid nodules confirmed the cytological findings. However, serial sections through the gland in each of these two patients showed an occult follicular carcinoma which had, however, positive staining with anti‐CT antibodies. Furthermore, immunostaining with anti‐Tg antibodies was negative In the patient with MTC but positive in the 3 patients with follicular carcinoma. Finally, both basal and pentagastrin stimulated CT levels remained elevated after total thyroidectomy only in the patient with FNAC suggesting MTC.CONCLUSIONS This study demonstrates a surprisingly high prevalence of sporadic forms of medullary thyroid carcinoma in patients with nodular thyroid disease. Such forms of medullary thyroid carcinoma seem to be unrelated to iodine intake and may be pure or mixed with a follicular carcinoma. In these mixed thyroid carcinomas, only the neoplastic follicular pattern was seen on both cytological and histological examination. Routine measurements of serum calcitonin levels should therefore be considered an integral part of the diagnostic evaluation of thyroid nodules. Indeed, increasing the accuracy of diagnosis of medullary thyroid carcinoma encourages the surgeon to perform more radical treatment, thus achieving more frequent normalization of post‐operative seru

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1995.tb02662.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SummaryOBJECTIVE There have been few studies of adrenarche In patients with congenital adrenal hyperplasia (CAH). We have therefore sought to detect the onset of adrenarche In CAH patients and to investigate whether its evolution was influenced by the severity of the disease, the age at the onset of substitution therapy, or both.DESIGN AND PATIENTS Sixteen female CAH patients were studied longitudinally for 4–11 years. They were all given substitution therapy and treatments were well controlled as judged by repeated hormonal evaluations. The patients were divided into two groups: group A consisted of 10 girls with a severe classic (congenital) form, while group B included 6 girls presenting with a non‐classic form.MEASUREMENTS Circulating levels of dehydroepiandrosterone sulphate (DHEAS), were determined as an indicator of adrenarche. Hormonal assessments Included measurements of 17‐hydroxyprogesterone (17‐OHP), testosterone, ACTH and plasma renin activity. All were estimated by conventional specific assays.RESULTS Mean levels were analysed in consecutive two‐year age periods. In group A, DHEAS levels were significantly lower at any age than in control subjects, and lower than In patients with non‐classic CAH. DHEAS levels showed no increment with age. In group B, plasma DHEAS levels were surprisingly high for the age at the time of diagnosis, declining gradually on substitution therapy, although they remained somewhat higher than in group A.CONCLUSIONS The high DHEAS levels observed In untreated girls of group B are probably the result of chronic hypersecretion of ACTH. Under well controlled, non‐suppressive substitution therapy, patients with congenital adrenal hyperplasia showed no rise in DHEAS levels at the physiological age of adrenarche whatever the degree of the enyzme defect and whatever the age at ons

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1995.tb02663.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SummaryOBJECTIVE Previous studies of preoperative pituitary function in patients with craniopharyngioma have been limited in scope and have focused on children. We have evaluated the impact of craniopharyngiomas and their surgical treatment on pituitary function In a large group of mostly adult patients.DESIGN We performed a retrospective study of patients treated at our centre between 1980 and 1992.PATIENTS Twenty‐two men and 13 women, most of them adults, treated surgically for craniopharyngioma during the above period.MEASUREMENTS Serum glucose, GH, LH, FSH, TSH and Cortisol were measured both before and after a combined insulin induced hypoglycaemia, GnRH and TRH test. Basal concentrations of thyroid hormones, PRL and gonadal steroids were also measured. Preoperative computed tomographic scan was performed in all patients, and a detailed study of visual function before and after surgery was available for 32 of them. Endocrine function was reevaluated post‐operatively.RESULTS In preoperative studies, 29 patients had some anterior pituitary deficit and 13 had diabetes insipidus. The most common abnormality was gonadotrophin deficiency, followed by GH deficiency. Dynamic studies suggested a hypothalamic origin for these deficits. In post‐surgical evaluation, Impaired pituitary function was observed in most patients. Panhypopituitarism was present in 28 cases and diabetes insipidus in 24.CONCLUSIONS Our report illustrates the high Incidence of endocrine deficits in patients with craniopharyngioma. Additional hypothalamic‐pituitary dysfunction usually occurs following surgical treatment of these

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1995.tb02664.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SummaryOBJECTIVE A previously published study has identified that anovulatory women with PCOS have an increased response of 17α‐hydroxyprogesterone (170HP) and androstenedione to a GnRH analogue suggesting dys‐regulation of cytochrome P450c17α. The object of this study was to compare the responses of the pituitary‐ovarian axis to a single dose of a long‐acting GnRH agonist (GnRHa) in both ovulatory and anovulatory women with PCOS with those in normal subjects.DESIGN Comparative study of responses of LH, FSH and ovarian steroids to bueerelin and the adrenal steroid response to synthetic ACTH in two groups of women with hyperandrogenaemia and polycystic ovaries: those with anovulatory menses or amenorrhoea and those with equally elevated serum testosterone concentrations but regular menses. Results In both groups of women with PCO were compared with those in normal subjects.SUBJECTS AND METHODS Twenty‐four women with hyperandrogenism and PCO (14 had oligo or amenorrhoea, 10 regular cycles) and 12 weight matched controls with normal ovaries, regular cycles and neither clinical nor biochemical evidence of hyperandrogenism. Subjects were given synthetic ACTH (Synacthen) 250 μgl.v. on day 1 of the study and blood collected at 30 and 60 minutes thereafter. On the evening of day 1, dexametha‐sone treatment was commenced to suppress adrenal androgens. GnRHa 100μg s.c. was given on day 2 and blood samples collected at 30‐mlnute Intervals for 4 hours and once more at 24 hours after the injection.RESULTS The acute responses of both Immunoactive and bioactfve L H to GnRHa were significantly greater in the ovulatory PCO group (ovPCO) than controls but the response was greater In anovulatory women with polycystic ovaries (anovPCO) than in either ovPCO or controls, throughout the 24‐hour study period. Despite the discrepancy in L H concentrations, basal serum concentrations of androstenedione were equally elevated In anovulatory and ovulatory women with P C O, compared with controls. There was a small but significant increase In androstenedione following GnRHa In both PCO groups at 24 hours but not in controls. A similar pattern was observed in the response of 170HP to GnRHa although the response was significantly higher than controls in anovPCO women only. By contrast, the responses of both androstenedione and 170HP to 250μg synthetic ACTH were similar in P C O women to those in controls.CONCLUSIONS These data provide evidence for ovarian hypersecretion of androgens In ovulatory, as well as anovulatory women with PCO, supporting the concept of abnormal regulation of 17‐hydroxylase and (17,20‐lyase activity In the ovary. The finding of an equal degree of hyperandrogenaemia In ovPCO and anovPCO groups, even though LH levels were much higher in the latter, suggests that hypersecretion of L H Is not the primary cause of ovarian hyperandrogenism. Hyperandrogenism in PCOS may therefore represent an intrinsic abnormality of ovarian theca‐

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1995.tb02665.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SummaryBACKGROUND Apart from the rare association with type I multiple endocrine neoplasia (MEN‐1), familial types of prolactinoma have not been reported.PATIENTS AND MEASUREMENTS Eight hyperprolacti‐naemic patients in four families and 18 of their first and second‐degree relatives (parents, children and grandchildren) were examined. Hormone levels were measured, as well as other biochemical parameters.RESULTS Prolactinoma was diagnosed In more than one member of each of the four families.CONCLUSION Familial prolactinoma Is a distinct entity which Is probably due to a genetic mutation promoting lactotroph prolifer

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1995.tb02666.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SummaryOBJECTIVE In the rat, prolactin receptors (PRL‐R) have been identified In normal pituitary cells and In anterior pituitary tumours induced by oestradiol. No published data are available concerning PRL‐R in the human pituitary. The aim of our study was therefore to detect the presence of PRL‐R in the normal human pituitary gland and human pituitary adenomas.DESIGN Evaluation of free and total PRL‐R In the normal pituitary gland and different pituitary tumours characterized by Immunocytochemical analysis.PATIENTS Twenty‐six unselected patients (14 M, 12 F) who underwent surgery for pituitary adenoma (3 prolactinomas, 4 GH‐PRL adenomas, 5 GH adenomas, 1 ACTH adenoma, 9 glycoprotein and/or α‐subunlt adenomas, 4 null ceils adenomas) were studied. Nine pltultaries from subjects whose death was unrelated to brain and endocrine diseases, were also studied as a control group in the PRL binding studies.MEASUREMENTS Free PRL‐R in microsomal membranes were determined by in‐vitro radioreceptor assay using125l‐labelled human PRL as llgand. Total PRL‐R were also measured In the same membrane fractions by removing endogenous PRL bound to its receptors using 4mMgCl2.Serum PRL levels were also evaluated in all patients before surgery using an IRMA method.RESULTS Specific binding values for PRL (free PRL‐R) were 0.39±0.03% (range 0–1.96%) In the pituitary adenomas. These binding values were Identical to those observed in normal pltultaries (0.38±0.07%, range 0.1–0.78%). Elevated PRL binding (1.25% and 1.96%) was found in two patients with PRL secreting adenomas and very high serum PRL levels (5768 and 11240 mU/l. No PRL binding was shown In 4 patients. Treatment of membranes with 4 M MgCl2increased the specific binding (total PRL‐R) In both pituitary tumours (0.5±0.11%;P<0.001) and normal pituHarles (0.47±0.07%;P<0.02).CONCLUSIONS Our data have demonstrated the presence of prolactin receptors in normal cadaveric pituitary and in most pituitary adenomas, Irrespective of histological classification. In particular, elevated prolactin receptor levels were shown In PRL‐secreting tumours from patients with markedly increased serum PRL levels. Our study may support several lines of experimental evidence for a specific functional role for PRL in t

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1995.tb02667.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SummaryBACKGROUND AND OBJECTIVE Bone mass Is often reduced In patients with primary hyperparathyroidism (pHPT) and Is usually partially reversible after parathyroidectomy. However, site specific and overall skeletal benefits of surgery in mild asymptomatic pHPT remain uncertain.DESIGN Cross‐sectional and longitudinal studies.PATIENTS Fourteen patients (12 women and 2 men) with pHPT.MEASUREMENTS Baseline bone mass was assessed at the lumbar spine, left hip and whole body using dual‐energy X‐ray absorptiometry, and at the left os calcls using broad‐band ultrasound attenuation. Changes in bone mass, serum Intact PTH and osteocalcin, and urinary pyrldlnium cross‐link excretion were recorded In 10 patients followed for 6 months after surgery.RESULTS (1) Cross‐sectional study: Baseline measurements at the lumbar spine and hip were Inversely related to both the serum PTH concentration and the weight of the parathyroid gland removed at surgery. (2) Longitudinal study: Six months after adenectomy, bone mass had Increased significantly at the femoral neck, greater trochanter, whole body and os calcis, but not at the lumbar spine or Ward's area. Serum PTH, osteocalcin and pyrldlnium cross‐link excretion all fell significantly after surgery. The percentage Increment In whole body bone mineral content at 6 months was proportional to the baseline PTH.CONCLUSION In primary hyperparathyroidism, preoperative reductions and post‐operative gains in bone mass are proportional to the Initial serum PTH concentration. Mild primary hyperparathyroidism probably does not cause appreciable bone loss at clinically relevant fracture sites such as the spine and hip, and In such cases the overall skeletal benefits of surgery are likely t

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1995.tb02668.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SummaryOBJECTIVE The mechanism underlying the slight hypoandrogenism associated with normal ageing remains unclear. We have therefore examined age related changes in the activity of the pituitary‐testicular axis In healthy normal males.DESIGN Random blood samples were obtained from 219 normal men whose ages ranged from 20 to 79 years. At the time of the study, none of the men had received treatment or had ever had any endocrine dysfunction diagnosed.MEASUREMENTS Luteinizing hormone was measured In the subjects' plasma using a commercially available immunoradiometric assay (IRMA, Serono Malaclone) and a fully validated In‐vitro bioassay. Testosterone and FSH were measured using standard radioimmunoassays (RIA) whilst sex hormone binding globulin was assayed by an IRMA.RESULTS Levels of total testosterone (total‐T) and bioactive LH fell with age (r=−0.231 and −0.189 respectively) by 5.9nmol/l and 2.3IU/I respectively between grouped patients aged 20‐39 years (Group A) and 60–79 years (Group C). In contrast, immunoreactlve LH remained unchanged. The LH B:I ratio also fell with age (P<0.0001) being 5.0±0.3 (group A) and 3.3±0.2 (group C), representing a fall of 33%. Since Immunoreactivlty remained constant, this fall primarily represented the decline in LH bioactivity. Bioactive, but not immunoreactlve LH correlated to total‐T (P=0.009,n=209) and the total‐T:LH ratios fell by over 30% between groups A and C using the IRMA, but remained unchanged by bioassay.CONCLUSIONS There Is an underlying decline In both total‐testosterone and free‐testosterone index, and bioactive LH levels with advancing age, suggestive of a hypothalamo‐pituitary defect which leads to lower bioactive LH levels which in turn are responsible for the diminished gonadal steroidogenesis. Elucidation of the mechanism underlying this slight decline in hypothalamo‐pituitary testicular activity Is complicated by differences between the data obtained

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1995.tb02669.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY