摘要:

SUMMARYSix patients were studied with pituitary adenomas and elevated concentrations of gastrin similar to those found in cases of benign antral gastrinoma syndrome. Chromatography of the serum using Sephadex‐G50 revealed different molecular forms of gastrin according to the type of adenomas. In those cases of acromegaly and gonadotrophinoma, gastrin‐34 and unsulphated gastrins constitute the predominant forms. In contrast, in cases of Cushing's disease, gastrin‐17, sulphated as well as non‐sulphated were the predominant types; the chromatographic pattern was similar to that observed in two patients with antral gastrinoma syndrome who acted as controls. These findings demonstrate that pituitary adenomas might secrete gastrin. Taking into account that gastrin‐34 and unsulphated gastrins were the predominant forms in cases of acromegaly, gonadotrophinoma and non‐functioning adenoma, it is assumed that those molecular forms are mainly produced in the anterior lobe of the hypothysis. Conversely, gastrin‐17 was the principal molecular form in cases of Cushing's disease confirming the close relationship of the synthesis of gastrin and corticotrophin peptides. The cases with Cushing's disease exhibited a serum gastrin pattern similar to that observed in the two cases with antral syndrome in which the predominant immunoreactive form of gastrin in gastrin‐17 exhibiting a degree of sulphation corresponding to that of antral gastrin. It is concluded that the circulating excess of gastrin originated in the pituitary tumour tissue and the molecular form varied with the type of pi

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1987.tb01167.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SUMMARYThe prevalence and characteristics of TSH receptor blocking activity were examined in patients with different thyroid disorders. Studies were also performed on the in‐vitro synthesis and immunoregulation of the blocking antibody. Blocking activity was tested by measuring the inhibition of TSH‐stimulated cAMP production of cultured human thyroid cells by patient immunoglobulin (Ig) preparations. The following patients were investigated (number of cases in parentheses): Hashimoto's thyroiditis (33); primary myxoedema (17); euthyroid ophthalmopathy (8); active Graves’disease (19); cold nodule (5); non‐toxic goitre (14); toxic adenoma (8); toxic multinodular goitre (9) and 22 normal controls. TSH receptor blocking activity was only detected in primary hypothyroidism with the following characteristics: (i) Such activity was present in only 16% of the patients (both goitrous, i.e. Hashimoto's thyroiditis, and non‐goitrous, i.e. primary myxoedema), and in three patients with previously active Graves’hyperthyroidism who had become hypothyroid. (ii) Blocking activity seems to be associated with the Ig fraction of serum as indicated by protein A adsorption, (iii) The block‐positive samples did not bindl25I‐TSH, which seems to rule out an antibody directed against TSH. (iv) The specificity of the blocking activity seems to be directed towards the TSH‐(thyroid stimulating immunoglobulin, TSI) receptor‐mediated cAMP response since no inhibition of prostaglandin E1‐stimulated cAMP production was found. Moreover, all cases in which an inhibitory effect was demonstrated towards TSH also exhibited blocking of TSI‐stimulated cAMP, with a high correlation between the degree of inhibition of the TSH to that of the TSI response (r= 0.89,P<0.001,n= 11). The blocking activity may contribute to the pathogenesis of some cases of primary hypothyroid autoimmune thyroiditis, both goitrous and non‐goitrous, as well as in the evolution of hyper‐ to hypothyroidism. By culturing peripheral blood lymphocytes, as well as B/T lymphocyte co‐cultures isolated from three patients with blocking activity present in serum, the in‐vitro synthesis of the blocking antibody was demonstrated for the first time. Moreover, in‐vitro secretion of the antibody by patients B lymphocytes, as well as T cell regulation of autoant

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1987.tb01168.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SUMMARYPregnancy in patients with Cushing's syndrome is rare. It is associated with a high fetal loss, increased frequency of preterm labour and excessive maternal morbidity. We describe a patient who became pregnant while investigations for hypertension were being done. Cushing's disease was diagnosed and the patient had transsphenoidal pituitary surgery at 22 weeks gestation. To our knowledge this is the first time this operation has been done during pregnancy for this condition. Cushing's disease was controlled, but because of worsening hypertension, she had a caesarean section at 30 weeks gestation. Subsequently her blood pressure fell and her hydrocortisone replacement therapy is being withdrawn. Her daughter is now thriving after initial problems with pneumothoraces.

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1987.tb01169.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SUMMARYWe have investigated the relationship between the plasma PRL concentrations of 98 untreated acromegalic patients and the GH levels during basal and dynamic conditions. Hyperprolactinaemia was present in 27 patients. In patients with marked hyperprolactinaemia (PRL>80 ng/ml or>1600 mU/l), basal plasma PRL and the TRH‐induced response correlated with basal plasma GH (correlation coefficients of 0‐9,P<0 001 and 0‐74,P<0 02, respectively). The PRL response to TRH also correlated with GH response to TRH (r= 0 38,P<0 01). In contrast, in patients with moderately elevated PRL (20 to 80 ng/ ml), and in those with normal plasma PRL (<20 ng/ml or<400 mU/1), no such correlations were found. Immunostaining for PRL was positive in 24 out of 25 adenomas of patients with hyperprolactinaemia, while no PRL was found in the tumour tissue of 10 normoprolactinaemic patients. In conclusion, our data suggest the existence of two populations of acromegalic patients with hyperprolactinaemia, one group with correlations between GH and PRL secretion, and the other wi

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1987.tb01170.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SUMMARYTwo patients with adrenal carcinoma treated with 2,2‐bis (2‐chlorophenyl‐4‐chlorophenyl)‐1, 1‐dichloroethane (o,p'‐DDD) as adjuvant therapy were studied. Both patients developed hypoadrenalism while ono, p'‐DDD and apparently adequate dexamethasone replacement therapy. The hypoadrenalism was overcome by increasing steroid replacement therapy. Dexamethasone levels were measured in the serum by radioimmunoassay and shown to be lowered byo, p'‐DDD therapy. A study of the absorption and disappearance of dexamethasone from the circulation in response to a (1 mg oral dose indicated that the steroid was absorbed normally but was cleared more rapidly from the circulation of these two patients than from normal controls. This may be due to a change in the type of metabolites excreted. It is suggested that many of the reported side‐effects ofo,p'‐DDD may be due to hypoadrenalism and may be controlled by greatly increasing the steroid replacement dose. The adequacy of corticosteroid replacement therapy may best be assessed by monitori

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1987.tb01171.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SUMMARYAthough there is a circadian rhythm in blood melatonin concentrations in humans, the problems associated with frequent blood collection limit the use of this rhythm in the investigation of the circadian system and in the diagnosis and treatment of chronobiological disorders. Therefore, to establish a convenient, non‐invasive technique for monitoring melatonin circadian rhythmicity, we compared the melatonin concentrations in blood samples collected from five subjects every 2‐4 h over a 26 h period, with the melatonin concentrations in saliva samples and with the total amount of 6‐hydroxymelatonin sulphate excreted in the urine during 2‐h periods. There was significant correlation between serum and salivary melatonin concentrations (r= 0.81,P<0.001), and between serum melatonin concentrations and 6‐hydroxymelatonin sulphate excretion rates (r= 0‐72,P<0001). The results demonstrate that both salivary melatonin concentrations and urinary 6‐hydroxymelatonin sulphate excretion rates are reliable indices of serum melatonin concentrations. These measurements, in combination with frequent sample collection, provide two convenient, non‐invasive techniques for monitoring melatonin circad

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1987.tb01172.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SUMMARYInduction of multiple follicular development in women results in supraphysiological serum oestradiol (E2) levels and marked reduction of the endogenous LH surge. To examine whether high serum E2levels at midcycle can suppress gonadotrophin secretion during the LH surge, five normally ovulating women were given an intramuscular injection of 10 mg oestradiol benzoate 6‐42 h before the expected endogenous LH surge. The results were compared with the preceding untreated control cycle. Serum E2levels at the onset of the LH surge (mean ± SEM) were significantly higher in the oestrogen‐treated cycles (13 600 ± 1963 pmol/1) than in the control cycles(1012±116pmol/l)(P<0.001). The duration of the LH surge (64‐8 ± 2‐2 h) and LH peak levels (136 ± 9‐6 mIU/ ml) in the oestrogen treated cycles were similar to those in the control cycles (61.2 ± 3‐9 and 119 ± 9‐4 mlU/ml respectively) (mean ± SEM). The cycle day on which the LH surge started and the size of the dominant follicle, as assessed by ultrasound, did not differ significantly between the two groups of cycles. These results show that in spontaneous cycles the endogenous LH surge is neither reduced nor amplified by the induction of supraphysiological serum E2levels during the immedia

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1987.tb01173.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SUMMARYKetoconazole is an antimycotic agent and a potent inhibitor of gonadal and adrenal steroidogenesis. It has been used successfully as a palliative treatment of Cushing's syndrome due to its ability to lower Cortisol production. However, the effects of ketoconazole on ACTH and aldosterone secretion have not yet been clarified. We evaluated the effect of ovine corticotrophin releasing hormone (oCRH) (100 μg bolus) on plasma ACTH, Cortisol and aldosterone levels in six patients with Cushing's disease before and after 4 to 6 weeks of treatment with ketoconazole 600 mg/d. Before treatment, plasma Cortisol levels were high and significantly increased after oCRH stimulation in all cases, while various patterns of aldosterone secretion were observed. Patients with higher levels showed a greater response to oCRH, while two patients with very low aldosterone showed no response. ACTH showed a marked rise after oCRH administration in all patients with a maximum peak at 30‐45 min. After ketoconazole treatment, both plasma Cortisol and aldosterone were lowered and their response to oCRH was impaired. Basal ACTH levels were increased in four patients and ACTH response to oCRH was enhanced in all, compared to pretreatment. These findings confirm the inhibitory action of ketoconazole on basal and stimulated Cortisol secretion. A similar inhibition affected aldosterone production, indicating that ketoconazole also interferes with the mineralocorti‐coid pathway. The enhanced response of ACTH to oCRH after the administration of ketoconazole argues against an inhibitory effect of this agent at the pituitary level and might best be explained by reduced negative Cortisol feed

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1987.tb01174.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SUMMARYAcute suppression of insulin secretion from pancreatic insulinomas by long‐acting somatostatin analogue SMS 201‐995 has been documented. We report the chronic use of the drug in a patient with persistent hypoglycaemia due to benign pancreatic microadenomatosis with satisfactory control of plasma glucose level and reduction of insulin production. There was no tachyphylaxis or untoward side‐effect noted during the 6‐month treatment

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1987.tb01175.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SUMMARYThe syndrome of inappropriate TSH secretion is described in a euthyroid girl and her father. Based on nuclear T3binding studies in fibroblasts, generalized tissue resistance was associated with a lower binding affinity for T3in nuclear extracts suggestive of a structurally abnormal receptor for T3. Early recognition of the syndrome and observation of the short‐term response to thyroid medication prevented unnecessary trials of antithyroid medication and later radical ablative thyroid treatmen

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1987.tb01176.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY