ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1992.tb02293.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1992.tb02294.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

OBJECTIVE The evidence that some women with the polycystic ovary syndrome (PCOS) are hyperinsulinaemic has brought into question their risk of developing early coronary artery disease. We have focused on three cardiac risk factors which have been associated with hyperinsullnaemia by measuring glucose tolerance, fasting serum lipid concentrations and blood pressure in women with PCOS.DESIGN Comparison of clinical and biochemical measurements in lean and obese women with PCOS and in women with normal ovaries. Determinants of the risk factors for coronary artery disease were assessed by multiple regression analysis.PATIENTS One hundred and two women with ultrasound diagnosed PCOS and 19 lean women with normal ovaries were studied. Patients were recruited from a reproductive endocrine clinic.MEASUREMENTS Fasting total cholesterol, triglycerides, high density lipoproteins (HDL), HDL2, glucose tolerance, fasting and stimulated insulin, gonadotrophins, testosterone and androstenedione were measured during a 2‐hour oral glucose tolerance test. Recumbent blood pressure was measured automatically.RESULTS Lean women with PCOS were found to be hyperinsulinaemic and have reduced serum HDL and HDL2concentrations compared to women with normal ovaries; serum insulin concentrations correlated positively with plasma glucose and blood pressure measurements in multiple regression analysis. Obese women with PCOS were in addition found to have higher systolic blood pressure, serum triglyceride and plasma glucose concentration than lean women with PCOS and controls.CONCLUSIONS These results support the evidence that hyperinsulinaemic women with PCOS have an increased risk of developing cardiovascular disease and therefore form a population in whom metabolic screening is advisabl

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1992.tb02295.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

OBJECTIVE We wished to determine the prevalence of polycystic ovaries (PCO) and relate morphological appearance to fertility.DESIGN We sent postal invitations to a random sample of women born in the years 1952–1969 from a list of a single Group Practice to attend for reproductive history questionnaire, examination, ultrasound scan of the ovaries and hormone measurements within 5 days of the onset of menstruation.SUBJECTS Of 1065 women potentially available for study, 571 (54%) replied of whom 353 (62%) agreed to participate. One hundred and ninety (18%) completed the study, 163 were deferred (57 because of current or very recent pregnancy, 106 because of inconvenience at time approached), and 18 additional women volunteered.MEASUREMENTS Prevalence of polycystic ovaries, ovarian size and morphology, menstrual history, features of androgen excess, fertility status, serum hormone levels. RESULTS The prevalence of PCO was 22% (41/190). PCO and non‐PCO women were similar with respect to age, body mass index, oral contraceptive pill (OCP) usage, acne, and menstrual pattern but hirsutism (Ferrlman and Gallwey score>7) was significantly (P= 0.006) more frequent among PCO women. Proven prior fertility was the same in PCO (56%) and non‐PCO (64%) women and an equal proportion in each group had not yet tested their fertility. Of those women with previously proven fertility, self‐perceived difficulty in conception occurred in similar proportions of women with and without PCO. Unresolved primary or secondary infertility (2.5–4%) was similar in both groups. Ovarian volume (each ovary separately) was larger in women with PCO irrespective of current OCP usage. Serum levels of oestradiol and FSH were similar in PCO and non‐PCO women, but LH was distributed around a higher median in PCO women. Median testosterone and androstenedione levels were the same in PCO and non‐PCO women.CONCLUSIONS The prevalence of polycystic ovarian morphology is high but, in this sample of women, was accompanied by minimal clinical manifestations and apparently no deleterious effects on earlier fertility. An isolated finding of polycystic ovaries may be a normal variation and should not necessarily imply altered fertil

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1992.tb02296.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

OBJECTIVE TSH receptor stimulating antibodies are restricted to the IgG1subclass suggesting an ollgoclonal origin. We wished to determine whether thyroid stimulation blocking antibodies, which also bind to the TSH receptor but may cause hypothyroidism, are similarly IgG subclass restricted.DESIGN Sera containing TSH receptor blocking antibody activity were separated into IgG subclasses by negative depletion of all other subclasses on affinity columns of subclass‐specific monoclonal antibodies or protein A as appropriate.PATIENTS Eleven patients from two centres were studied. All had autoimmune hypothyroidism and TSH receptor blocking antibodies but no thyroid stimulating antibodies. MEASUREMENTS TSH receptor blocking antibody activity was measured by assessing inhibition of TSH‐stimulated cAMP production by human thyroid cells (five Israeli samples) or by the FRTL‐5 rat thyroid cell line (six Korean samples).RESULTS IgG1was the most important subclass containing TSH receptor blocking antibody activity but complete restriction to this subclass was never seen. Clearly detectable activity was found in the IgG2subclass in eight patients, in the IgG3subclass in three patients, and in the IgG4subclass in six patients. The percentage recovery of activity in the sum of the separated fractions generally corresponded to the activity in whole immunoglobulin, being 117 ± 66% in the nine patients in whom this could be assessed, although in one of these, the activities in the sum of the fractions was much higher (284%).CONCLUSIONS Unlike thyroid stimulating antibodies, thyroid stimulation blocking antibodies are not subclass restricted and are therefore likely to have a polyclonal origin. The IgG subclass distribution of these blocking antibodies resembles that of thyroglobulin and thyroid peroxidase anti

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1992.tb02297.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Previous studies of HLA and Hashimoto's thyroiditis have shown weak associations between the disease and various HLA‐DR antigens.OBJECTIVE To define better the contribution of HLA class II alleles to susceptibility to Hashimoto's thyroiditis.DESIGN AND MEASUREMENTS Comparison of HLA‐DRB, DQA and DQB restriction fragment length polymorphisms in patients with Hashimoto's thyroiditis and control subjects, and meta‐analysis of this and other published studies.PATIENTS Fifty Caucasian patients with Hashimoto's thyroiditis and 93 racially‐matched control subjects.RESULTS A 4.6 kb Taq 1 DQA restriction fragment length polymorphism occurred in 60% of patients compared with 35.5% of controls,Pc<0.025. No other restriction fragment length polymorphism was significantly associated with the disease. Meta‐analysis of several studies demonstrated weak, positive associations between the disease and DR3 and DR4. An association with DR5 was not significant.CONCLUSIONS DR antigens are unlikely to determine disease susceptibility directly. These findings indicate that any contribution of HLA genes to inherited susceptibility to Hashimoto's thyroiditis is small and requires confirmation in family studies.We thank Professor R. Thompson for assaying antibody litres, and Professor P. A. Peterson for the gift of the cDNA clones. DJ was supported by Eli Lilly (UK), MAP by the Medical Research Council (UK), KHJ by the British Diabetic Association, CHM by the Wellc

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1992.tb02298.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

OBJECTIVE Primary hyperparathyroidism (pHPT) is associated with hypertension, hyperinsulinaemia, and insulin resistance. The present study investigated the causes of these metabolic disturbances by quantifying insulin sensitivity and glucose effectiveness, and by assessing the time course of β‐cell insulin secretion and hepatic insulin extraction, during a dynamic condition such as after an intravenous glucose load. In addition, we evaluated the possible link between metabolic disorders and high blood pressure.SUBJECTS We studied 16 patients with pHPT, before and 12 weeks after parathyroldectomy; eight of these patients were re‐evaluated one year after surgery. The control group consisted of 18 healthy volunteers.DESIGN AND MEASUREMENTS All subjects underwent an oral and a frequently sampled intravenous glucose tolerance test. The data from the intravenous glucose tolerance test were analysed by means of the minimal model technique which yields relevant parameters to comprehend the metabolic status of the single individual.RESULTS The glucose intolerance condition was characterized by a severely impaired insulin sensitivity in pHPT (3.2 ± 0.5 vs 9.5 ± 1.5 x 104/min/(μU/ml) of control subjects;P<0.001), as well as by a reduced glucose effectiveness, (0.02 ± 0.002 vs 0.03 ± 0.003/min of control subjects;P<0.04). Total insulin secretion during the 4 hours of the test was almost twofold elevated in comparison to the control subjects (32795 ± 4769 vs 16864 ± 1850 pM,P<0.004) and its basal component significantly correlated with the high blood pressure. Hepatic extraction of insulin was significantly increased in pHPT (85.2 vs 76.2%,P<0.03), possibly as a compensatory mechanism of hypersecretion, which however did not prevent peripheral hyperinsulinaemia in pHPT. Patients with pHPT were divided into two subgroups with normal and impaired glucose tolerance. The patients with impaired glucose tolerance had a significant reduction of first phase insulin response, although their basal and stimulated insulin levels were higher. Tissue insulin sensitivity and glucose effectiveness did not significantly differ between the two subgroups. After surgery, all the biochemical parameters (former hypercalcaemia, hypophosphataemia, elevated parathormone levels) were normalized, insulin sensitivity significantly improved (6.1 x 104/min/(μU/ml),P<0.001), whereas glucose effectiveness remained completely unchanged. Basal and stimulated insulin responses were insignificantly lowered after surgery, and hepatic extraction did not change either.CONCLUSIONS Patients with pHPT exhibited decreased insulin sensitivity and insulin hypersecretion. The latter is only partially amellorated by increased hepatic insulin extraction. After surgery, although the biochemical abnormalities were fully reversible, the metabolic changes improved on

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1992.tb02299.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

DESIGN Patients were studied before and after 1 year of bromocriptine or 6 months of SMS 201–995 treatment, for prolactinomas or GH‐secreting adenomas, respectively. PATIENTS Seventeen patients with intrasellar pituitary tumour (ten prolactinomas, all females; seven GH‐secreting adenomas, four males and three females) and the presence of relative or absolute scotomas, were examined.MEASUREMENTS We used computed tomodensitometry, Goldman perimeter and computer‐assisted perimetry.RESULTS The patients were divided into three groups according to their response to medical treatment as proved by computed tomodensitometry which revealed the disappearance of the tumour in four prolactinomas (group 1), a reduction<40% in three prolactinomas and in three acromegalics (group 2) and no significant variation in the diameter of the adenoma in three prolactinomas and in four acromegalics (group 3).Comparison by the pairedt‐test of the visual fields before and after treatment revealed a significant positive change (P<0.01) for all patients in groups 1 and 2 and for one patient in group 3, with disappearance of the scotomas in all cases in group 1 and in two cases in group 2.Visual field defects were detected by means of the Goldman perimeter in only one patient with prolactinoma and in two acromegalics, although the computer‐assisted perimetry showed that, in 15 out of 17 patients, visual impairment was unilateral and in all cases the presence of relative scotomas was concentrated in the upper temporal quadrant.The visual defects observed with computer‐assisted perimetry and the pituitary tumour dimension evaluated with computed tomodensitometry did not show significative correlations (r= 0.059,PNS).CONCLUSIONS Computer‐assisted perimetry was most useful in the diagnosis and follow‐up of patients with pituitary adenoma, especially in the evaluation of small masses without subjective symptoms of visual loss, when the Goldman perimeter does not usually allow us to recognize minimal chiasmatic involvements or the improvement of visual field as a result of th

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1992.tb02300.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

OBJECTIVE The aim of this study was to investigate the presence of interleukin‐6 (IL‐6) in human pituitary adenomas.DESIGN Immunocytochemistry was performed in 15 cases of pituitary adenomas obtained at transsphenoldal surgery.PATIENTS Fifteen cases of pituitary adenomas were examined; these included five GH‐secreting adenomas, four prolactinomas, four ACTH‐secreting adenomas and two null‐cell (‘functionless’) adenomas.MEASUREMENTS Each tumour was stained for the presence of IL‐6 by means of the avidin‐blotin‐peroxidase complex (ABC) technique, and was also stained for GH, prolactin, ACTH and α‐subunit by conventional immunocytochemistry.RESULTS Fourteen of the 15 tumours examined, excepting one GH‐secreting tumour, demonstrated clusters of IL‐6 positively stained cells; the specificity of the staining was established by a significant decrease in staining in parallel sections of all tumours studied when the anti IL‐6 antibody was preabsorbed with recombinant human IL‐6. CONCLUSIONS It is concluded that IL‐6 immunoreactivity is present in human pituitary tumours, and is independent of the specific secretory cell product. The role of this cytokine in the pathogenesis of such tumour

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1992.tb02301.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

OBJECTIVES We compared a sensitive assay for GH (ELISA) with a conventional immunoradiometric (IRMA) assay with particular reference to the oscillatory activity detected by Fourier transformation and the estimation of trough concentrations using occupancy analysis.DESIGN Eight healthy adult male volunteers underwent 24‐hour profiles during which samples were drawn at 20‐minute intervals. Samples were analysed by an ELISA and an IRMA system.MEASUREMENTS The 24‐hour serum GH concentration profiles were subjected to Fourier transformation and to occupancy analysis.RESULTS No additional GH periodicities could be determined in the ELISA data other than the well documented 180–200‐minute periodicity. Median observed concentrations (OC) at 5% occupancy were 0.035 mU/l (range 0.004–0.22) for the ELISA and 0.035 mU/l (range 0.001–0.50) for the IRMA. For all OC parameters, 5,50 and 95%, there was a good correlation between the ELISA and IRMA systems. The mean difference (bias) between the ELISA and IRMA were ‐ 0.05, ‐ 0.28 and ‐1.40 mU/l at OC values of 5, 50 and 95% respectively and the standard deviations of the difference at the same OC values were 0.10, 0.50 and 1.61 mU/l.CONCLUSION Although there is a qualitative improvement on visual inspection of individual 24‐hour serum GH profiles obtained using the ELISA system, there is little additional information gained in terms of pulse periodicity

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1992.tb02302.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY