摘要:

SUMMARYThe exogenous administration of bovine parathyroid hormone or parathyroid extract has been used to differentiate states of parathyroid hormone resistance and parathyroid gland secretory failure, and in recent years to test renal 1,25‐dihydroxyvitamin D (1,25‐(OH)2‐D) secretion. We evaluated the effect of synthetic human parathyroid hormone (hPTH‐(1–34)) administration on the renal 1,25‐(OH)2‐D, phosphaturic and cyclic‐AMP responses in eleven normal young adults. The intravenous administration of 200 units of hPTH‐(1–34) over 10 min produced a 1.3‐5.4 fold increase (P<0.01) in renal phosphate clearance and a 19–75 fold increase (P<0.0001) in urinary cyclic‐AMP excretion. Serum 1,25‐(OH)2‐D levels showed a small and insignificant change at 2‐5 h and a significant (P<0.05) but small (21 ± 24 pmol/1) increase at 7 h after the first injection. In eight subjects a second injection of hPTH‐(1–34) was given at 7 h. In these individuals serum 1,25‐(OH)2‐D levels at 24 h were 40 ± 14 pmol/1 (44%) higher than baseline (P<0.01), but were variable over the 24 h period. The present study shows that hPTH‐(1–34) produces renal phosphaturic and cyclic‐AMP responses in normals similar to those produced by bovine PTH preparations. However, the serum 1,25‐(OH)2‐D response to one or two intravenous injections of hPTH‐(1–34) is small, variable, and inconsistent and, therefore, will not provide a con

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1984.tb03432.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

SUMMARYSix girls and one boy with precocious puberty were treated with a superactive LHRH analogue (D‐TRP6‐LHRH) for periods ranging from 1 year to 2 years and 3 months. In the first phase of the treatment it was administered in combination with cyproterone acetate (CyA) to counteract an early stimulatory effect until inhibition of gonadotrophin secretion was achieved. The gonadotrophin‐dependent signs i.e. gonadarche, showed sustained arrest and even regression. Gonadal sex steroids decreased but the adrenal androgens were unaffected. In four patients who showed progression of the angrogen‐dependent signs (adrenarche), despite suppression of gonadotrophins, increasing the dosage of the LHRH analogue was ineffective and combined therapy with CyA was reinstituted in three of them because of accelerated growth and bone maturation. It is concluded that at present the treatment of choice for precocious puberty is the daily administration of a superactive LHRH analogue such as D‐TRP6‐LHRH, together with CyA in the initial stage, and at a later state if adrenarche progresses

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1984.tb03433.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

SUMMARYThe adrenolytic agent, 2,2‐bis [2‐chlorophenyl‐4‐chlorophenyl] 1,1 dichloroethane (o.p'‐DDD), was used over a 20‐month period following surgery in a 2 3/12‐year‐old girl for treatment of adrenocortical carcinoma. The child remained free of disease and was maintained on glucocorticoid and mineralo‐corticoid supplements for 7 years. Hormonal evaluation was undertaken at 9 9/12 years of age to determine remaining adrenal steroidogenic capacity. Following discontinuation of both hydrocortisone and 9α‐fludrocortisone, she remained stable and asymptomatic. Immediately after discontinuing 9α‐fludrocortisone, the adrenal glomerulosa was able to respond to stimulation by the renin‐angiotensin system as shown by the ability to achieve renal sodium conservation on a restricted sodium intake (<10 mEq/d for 5 d). The response of the adrenal fasciculata to ACTH stimulation showed a slower recovery. Baseline levels of cortisol were in the low normal range, but there was no increase in plasma cortisol or urinary 17‐hydroxysteroids following stimulation with ACTH. The responses of cortisol, deoxycorticosterone, and corticosterone to ACTH stimulation gradually improved to achieve normal stimulated levels 18 months after stopping medications. Serum testosterone and δ4‐androstenedione were initially increased for level of puberty, while levels of dehydroepian‐drosterone were prepubertal. Testosterone and δ4‐androstenedione did not suppress with dexamethasone (2 mg/d for 2 d; 4 mg/d for 2 d), and dehydroepiandrosterone decreased only slightly. However, administration of norethindrone (Norlutin) (10 mg orally, three times a day for 3 d) resulted in suppression while human chorionic gonadotrophin (hCG; 5000 U i.m. daily for 3 d) produced stimulation of testosterone, δ4‐androstenedione and dehydroepiandrosterone. Thus the androgens were felt be predominantly of ovarian origin. Dehydroepiandrosterone rose to low normal levels by 18 months after discontiution of hydrocotesone. We thus demonstrate for the first time that both the adrenal glomerulosa and fasiculata have the capacity to recover normal function following treatment with o,p'‐DDD. Further, we suggest that early exposure to excess adrenal androgens may resul

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1984.tb03434.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

SUMMARYForty‐six patients with GH‐secreting pituitary tumours were treated with conventional external pituitary irradiation through two opposed fields to a total dose of 3750 cGy over 15 fractions. Thirty‐patients received external radiotherapy as primary treatment and 16 received radiotherapy combined with pituitary surgery. The mean (± SD) serum GH in the former group was 74.3 ± 74.8 mU/1 before treatment, falling by 28% per year over 0–5 years and by 16% per year over 0–20 years. The mean (± SD) serum GH in the latter group was 265.4 ± 209.3 mU/1 before treatment, falling by 76% in the first year—a direct result of surgical removal of tumour—then by 30% per year over 1–5 years and 16% per year over 1–20 years. Progressive failure of normal anterior pituitary function developed by 10 years, with variable loss of gonadotrophin, corticotrophin and thyrotrophin function. The respective figures for patients treated with radiotherapy alone were 47.4, 29.6 and 16.0% and for the combined group were 70.2, 53.9 and 38.1%. Whilst external pituitary irradiation appears to reduce serum GH concentrations in patients with GH‐secreting pituitary tumours the major disadvantages of this form of treatment are the time taken to achieve a cure and the high incidence of hypopituitarism. Nevertheless there did not appear to be any oth

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1984.tb03435.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

SUMMARYIncreased circulating adrenaline produces systemic hypokalaemia by the stimulation of a membrane bound Na/K ATPase. In man, this enzyme appears to be linked to an adrenoceptor of the β‐subtype. We have further studied the subtype of β‐adrenoceptor involved by infusing adrenaline intravenously in normal volunteers after pretreatment with either a selective β2 antagonist (ICI 118551) or placebo. During the adrenaline infusion the serum potassium fell from 4.08 ± 0.21 to 3.32 ± 0.25 mmol/1 (P<0.002). This adrenaline induced hypokalaemia was completely blocked by ICI 118551 (3.82 ± 0.13 to 4.03 ± 0.22 mmol/1, NS). Adrenaline also caused electrocardiographic changes of T wave flattening (–1.8 ± 1.5 mm,P<005) whereas the T wave height increased after ICI 118551 (51.0 ± 0.9 mm,P<005). This suggests that adrenaline acts via β2 adrenoceptors in man to cause potassium influx and system

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1984.tb03436.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

SUMMARYChanges in the pulsatile pattern of LH secretion in relation to the resumption of ovarian activity post partum have been studied in breast feeding mothers. Basal concentrations of LH were significantly lower than normal both when ovarian activity was completely suppressed and when there was evidence of some follicular development prior to the resumption of menstruation. Once menstruation resumed basal concentrations of LH were unchanged whether ovulation occurred or not. No difference in the frequency or amplitude of pulses in LH secretion could be found at any stage post partum in either breast or bottle feeding women. FSH levels remained constant throughout the post partum period while mean concentrations of prolactin fell as ovarian activity returned to normal. However, during the period of complete suppression of ovarian activity in breast feeding women, two patterns of pulsatile secretion of LH were observed. In 76% of observation periods, basal levels of LH were lower than normal and were characterized by low frequency and low amplitude pulses of LH. In contrast, in the remaining 24% of observation periods, basal levels and pulse amplitude and frequency of LH were similar to those in the follicular phase of normal menstrual cycles in these women. Individual women showed either or both of these patterns of secretion during the period of ovarian suppression post partum. The data suggests that the failure to maintain ovarian follicular development post partum in breast feeding women may be due to: (1) a direct block of LH action at ovarian level, perhaps by the high levels of prolactin associated with lactation and/or (2) an inability of the hypothalamic‐pituitary axis—as a result of the suckling stimulus and/or prolactin—to maintain pulsatile secretion of LH in the face of the negative feedback effects of the increased oestrogen secretion resulting from the initiation of follicular develo

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1984.tb03437.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

SUMMARYA total of 230 healthy women attending family planning clinics took part in a cross‐sectional study, comparing contraceptive histories and serum prolactin levels. It was found that the distribution histogram of serum prolactin was markedly skewed to the right in all main groups, but that the distribution profile was not affected by use of oestrogen‐containing contraceptives. Neither the dose of oestrogens nor duration of their use affected prolactin levels. We have thus found that currently available combined oral contraceptive agents have no effect on serum prolactin. Analysis of the skewed raw data yields a ‘normal’ range of 110‐700 mU/I, higher than that usually

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1984.tb03438.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

SUMMARYThyroid and pituitary function tests using hypothalamic releasing factors were performed in seven patients with thalassaemia and secondary haemosiderosis and in a control group of seven healthy subjects. The TSH level in the thalassaemic patients (18.07± 1.10 μU/ml) was higher than in the controls (1.01±0.14 μU/ml, P<0.001). After TRH administration the TSH values increased less than in the controls. Serum thyroxine and FT4I values were lower in the group of patients with thalassaemia (76.7 ± 7.8 nmol/1 and 19.3 ± 2.2) compared to the controls (116.1±6.9 nmol/1,P<0.005 and 38.6 ± 3.6,P<0001). The basal prolactin values did not differ significantly between the two groups, but after TRH administration the increment was significantly lower in thalassaemics than in controls (P<0.005). The basal LH values were lower in the thalassaemic patients (1.37±0.24 ng/ml) than in the controls (3.23 ± 0.50 ng/ml) and did not increase significantly after LHRH administration. The FSH values were also lower in the thalassaemic group (0.46±0.15 ng/ml) compared to the controls (2.06±0.08 ng/ml,p<0.001), and increased only slightly after LHRH administration. We conclude that in thalassaemia pituitary deficiency exists, mostly of gonadotrophs, but possibly also for the thyrotrophs and the lactotrophs. Latent primary hypothyroidism has also been found in the thalassaemic group. The functional abnormalities found in both endocrine glands are best explained as a consequence of coexisting hae

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1984.tb03439.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

SUMMARYThyroid function was evaluated in 20 patients aged 8‐30 years who were suffering from homozygous β‐thalassaemia. All patients have been receiving frequent blood transfusions and treated for the resulting transfusional iron overload with intramuscular injections of Desferrioxamine. Total thyroxine (T4), T3‐uptake, total triiodothyronine (T3), and reverse triiodothyronine (rT3) were measured. In addition a standard TRH stimulation test was performed and blood samples were checked for the presence of thyroid antibodies. It was found that total T4 was significantly lower in the patients than in the controls. Total T3 and rT3 levels were similar in both patients and controls and all patients were negative for thyroid antibodies. T3 uptake in the patients was also statistically different from the controls resulting in significantly lower free thyroxine index (FTI). Basal TSH values were not different from the controls but the TSH increase following TRH stimulation was significantly higher in the patients suggesting, together with the low total T4 and FTI, a state of compensated hypothyr

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1984.tb03440.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

SUMMARYPlasma arginine vasopressin was assessed by radioimmunoassay in dehydrated elderly patients and healthy young and elderly control subjects. The elderly control subjects' AVP levels were higher than the young control subjects (Kruskal‐Wallis rank sumsz= 3.29;P<0.001). Despite similar plasma osmolalities, after correction for the osmotic contribution of urea, the patients' AVP levels were higher than the elderly controls (z= 4.16;P<0.001) and were in the range reported to evoke a maximal antidiuretic response. It is concluded that the dehydration which often accompanies acute illness in the elderly is not primarily a consequence of inadequate AVP releas

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1984.tb03441.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY