摘要:

SUMMARYPlasma glucose, insulin and triglyceride changes in response to a standard breakfast and an oral glucose tolerance test have been studied in normal, obese and diabetic subjects. Mild diabetics with an abnormal oral glucose tolerance test may have normal or near‐normal incremental glucose responses to a standard breakfast. A raised fasting plasma glucose is the predominant day‐to‐day glucose abnormality of mild diabetes. Diabetics have decreased insulin responses to oral glucose compared with the meal, and the deficient insulin response to glucose probably accounts for both the raised fasting plasma glucose levels and the abnormal oral GTT. The initial insulin response to a meal is normal in mild diabetics, and is probably stimulated by secretogogues other than glucose. The oral glucose tolerance test is apposite for the diagnosis of diabetes in view of the impaired insulin response to glucose, but accurate measurement of the basal plasma glucose may be of equal value. The diabetic and obese subjects had normal triglyceride levels, and there was no detectable impairment of disposal of the exogenous triglyceride following the brea

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1977.tb02009.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

SUMMARYPenile length and circumference were measured in twenty boys with isolated gonadotrophin deficiency, before and during the administration of androgen therapy. Their age ranged between 3 and 20 years. Considering as normal, measurements above the tenth centile, in all the patients but four the penile length was below normal, and in two it was borderline. Penis circumference was normal in two, borderline in four and subnormal in sixteen. Regular administration of androgen therapy increased penile length in eleven out of fourteen patients with achievement of normal length in four.It is concluded that congenital lack of LH and testicular androgen activation causes small sized penises, even in the prepubertal period. Gonadotrophin deficiency should be looked for in patients with measurements below the tenth centile. Early diagnosis and institution of androgen therapy between 11 and 12 years is likely to increase penile size and prevent the psychological side effects of undersized genitals and delayed puberty.

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1977.tb02010.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

SUMMARYSix patients with multiple pituitary hormone deficiencies (MPHD) were initially treated with separate courses of methandrostenolone and growth hormone and later with the two drugs combined. During the basal period the mean growth velocity was 2.8 cm/year. Methandrostenolone alone, 0.02‐0.05 mg/kg/day given to four of the patients led to an acceleration of the growth velocity to a mean of 5.0 cm/year, while growth hormone 6 mg/week alone accelerated the growth rate to a mean of 6.0 cm/year. Combined therapy led to a striking increase in the mean growth rate to 9.3 cm/year. The shortcoming of the combined growth hormone‐androgen therapy was the fast acceleration in skeletal maturation even after short‐term administr

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1977.tb02011.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

SUMMARYIn order to determine whether glucagon levels of diabetic subjects are suppressible, alpha cell responsiveness to acute insulin administration (0.1 units/kg intravenously) was determined in fourteen juvenile onset, healthy diabetic and eight control subjects. In the diabetics, insulin produced a significant but slow fall in blood glucose over 60 min (P<0.01). On the other hand, glucagon levels fell dramatically in all diabetics to undetectable levels (P<0.001). Only one diabetic became hypoglycaemic and he alone showed a rebound rise of glucagon at 60 min. The rate of fall of blood glucose in the diabetic subjects was not influenced by the basal glucagon level (r= 0.13) or the rate of fall of plasma glucagon (r= 0.04). The glucose and glucagon responses of control subjects to insulin administration were in sharp contrast to the diabetics: blood glucose levels fell rapidly to hypoglycaemic levels and were associated with a major rise in glucagon levels (mean rise 116 pmol/1,P<0.001).We conclude that alpha cell hyperfunction in human diabetes can be completely suppressed by insulin administrtion and is therefore not autonomous, and that the slow rate of fall of blood glucose following insulin administration in diabetics is not secondary to glucagon excess.

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1977.tb02012.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

SUMMARYFive patients with Bloom's syndrome aged from 2 8/12 to 27 years, all of whom had hypogonadism, were subjected to an i.v. LHRH test and two of them to an i.m. HCG test. There was increased responsiveness of plasma LH and FSH, indicating that the hypogonadism is primary in nature and of early development. The tubular element of the testis seems to be mainly affected, as indicated by the particularly high FSH response to LHRH stimulation, a history of sterility in the two adult patients and documented azoospermia in one of them. The Leydig cells seem to be less affected and secrete sufficient androgens to enable puberty within acceptable normal limits. Hypogonadism seems to be a major characteristic of Bloom's syndrome.

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1977.tb02013.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

SUMMARYA simple, reproducible extraction method has been developed, which is capable of measuring calcitonin in normal individuals. Normal calcitonin levels show a circadian variation, with a peak around midday and respond to known stimuli for calcitonin release.

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1977.tb02014.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

SUMMARYBasal LH, FSH, 17ß‐oestradiol and testosterone and the gonadotrophin responses to luteinizing hormone releasing hormone (LHRH) were studied in male patients with leprosy (twenty‐four with lepromatous and six with tuberculoid leprosy). The mean basal LH and FSH was significantly elevated in the lepromatous group and was associated with an excessive response of both gonadotrophins following LHRH administration.The mean basal testosterone and 17ß‐oestradiol values of the lepromatous group were significantly lower than those of the tuberculoid and control groups.The abnormal gonadotrophin and sex steroid values in the lepromatous group are in keeping with the testicular atrophy and gynaecomastia accompanying this form of leprosy. However, the lack of a significant correlation between basal FSH and testicular atrophy should be noted. In addition, no correlation between any of these hormonal values and gynaecomastia could be demonstrated.The patients with tuberculoid leprosy had essentially normal hormonal profiles (except for two who had raised 17ß‐oestradiol values). This is compatible with the lack of gonadal involvement in thes

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1977.tb02015.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

SUMMARYAn evaluation of a new 3 h metyrapone test is presented. The test consists of one oral dose of metyrapone given at 08.00‐09.00 hours, and determination of plasma deoxycortisol from a single capillary blood sample taken 3 h later. The test has been assessed in children and adolescents in conjunction with a 5 day metyrapone test, insulin test, vasopressin test, and ACTH test in forty‐five reference subjects, in thirty‐six hypopituitary subjects with normal or deficient ACTH secretion, in three subjects with primary adrenocortical disease and in ten subjects prior to and after pharmacological prednisone medication.During the first hour after metyrapone the plasma cortisol level decresed to almost the low level maintained for the rest of the 3 h period. The plasma deoxycortisol concentration was basally<35 nmol/1 and increased continously during the 3 h period to the mean level of 299 (95% confidence interval 133‐669) nmol/1 in the reference subjects. The new test proved to be as accurate as the insulin test in detecting ACTH deficiency.No significant rise was observed in the plasma somatotrophin (GH) level in those children who had a normal GH response to insulin hypogl

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1977.tb02016.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

SUMMARYThe urinary excretion of arginine vasopressin (AVP) was measured by bioassay in normal subjects at rest, on reduced physical activity and on routine everyday activity. The values obtained under rest conditions were all less than 10 mu/24 h with a mean less than 6.6 mu/24 h. Excretion of vasopressin increased with increasing activity, despite free access to water, to mean values of 17 mu/24 h and 29 mu/24 h under conditions of reduced and routine every day activity respectively.The syndrome of inappropriate secretion of antidiuretic hormone is being reported in an increasing number of disorders (Moseset al., 1976). For absolute diagnosis increased production of arginine vasopressin (AVP), the antidiuretic hormone in humans, should be demonstrated in addition to the criteria stated by Bartter&Schwartz (1967). Plasma levels of AVP reflect the situation at a fixed point in time only and do not necessarily relate directly to overall water metabolism. Estimations of 24 h urine AVP output have been employed for several years and are useful for studying AVP secretion over a prolonged period. Such samples also avoid the problem found in short‐term studies of an increased AVP output with increased urine flow rate (Fabianet al., 1969).Howevwer, the total daily excretion of AVP by normal subjects has not been extensively investigated. Reported mean levels vary from 8 mu/24 h (Lee, 1963) to over 51 mu/16 h (Goldman&Luchsinger, 1956). The values reported by various authors are listed in Table 1. There may have been variations in the conditions of collecting the urine samples, and although the method of collection, pH, temperature, and type of container used is usually stated, rarely has comment been made about the activity of the subject throughout the collection period. Similarly it has been shown that smoking is a powerful stimulus to AVP secretion (Mayer, 1960; Taylor&Walker, 1951; Burn&Grewal, 1951) and yet smoking habits of subjects have not always been ascertained in studies on 24 h AVP excretion. Further, there appears to be no report concerned with the effect of posture and everyday activity on urinary AVP excretion. Kozlowskiet al. (1967) have measured changes in blood concentration of AVP during physical exercise but only in short‐term (20 min) studies. Segar&Moore (1968) also used plasma concentration to assess variations of AVP with posture, but again not over a prolonged period of time.This paper reports an investigation of urinary AVP excretion under resting conditions and the effect upon it of crude increments of physical activity during which fluid intake was unrestric

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1977.tb02017.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

SUMMARYPatients treated with inorganic iodide weeks to years following131I therapy for hyperthyroidism do not adapt to its antithyroid effect. To determine whether such adaptation occurs soon after131I therapy, serum thyroxine (T4) and triiodothyronine (T3) concentrations were measured daily for 9‐14 days following131I therapy in seventeen hyperthyroid patients. Nine patients received 150 mg KI daily starting 48 h after131I administration; eight received only131I. Serum T4 and T3 concentrations did not change significantly in the patients who received only131I. In the patients who received131I and KI, serum T4 and T3 concentrations fell promptly, reaching nadir values 2‐10 days after initiation of iodide, and then increased despite continuation of KI therapy. The mean maximal fall in serum T4 was 34% and in serum T3 42%. These results show that ‘escape’ from the acute antithyroid effect of iodide occurs when it is given immediately after131I therapy, thus limiting the utility of iodide as a therapeutic agent at this time.131I‐iodide is a widely used and effective form of therapy for hyperthyroidism. Reduction in thyroid hormone does not occur within the first weeks after131I therapy. Exacerbation of hyperthyroidism may occur shortly after131I administration, with frequency ranging from 0 to 11% in several large species (Chapmanet al., 1954; Cassidy&Astwood, 1959; Lamberget al., 1959; Green&Wilson, 1964). Such exacerbations are thought to reflect acute thyroid radiation necrosis and subsequent hormone release, and may limit the use of131I therapeutically.Inorganic iodide is a rapidly, but usually transiently, effective antithyroid agent when used alone. No reports are available concerning the efficacy of iodide when given immediately following131I therapy. Since some hormone release after131I therapy may reflect thyroid destruction, rather than secretion, it is possible iodide might be less effective in this setting. On the other hand, if iodine is effective immediately after131I therapy, especially if its action is sustained (as occurs in patients treated with131I months or years previously; Hagenet al., 1967; Bravermanet al., 1969), it might be a useful adjunct for certain hyperthyroid patients treated with131I. This report describes the result of a study of patients s

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1977.tb02018.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY