ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1991.tb03554.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1991.tb03555.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Summary.objectiveTo study the time‐course production of gonadotrophin surge attenuating factor (GnSAF) after the onset of FSH treatment in women.designNormally cycling women were treated with FSH injections (225 IU per day) starting on cycle day 2 (0800 h). The response of LH to an i.v. Injection of 10μg GnRH (GnSAF bioactivity) was investigated 12, 24, 36 and 48 hours after the first FSH Injection, as well as during the early follicular phase of an untreated spontaneous cycle. PATIENTS Six normally ovulating women with long‐standing unexplained infertility were studied. The women were used as their own controls during the spontaneous cycles. MEASUREMENTS Pituitary response to GnRH was calculated as the net Increase in LH at 30 min (ALH30) above the basal value.resultsδLH30 was significantly attenuated 12, 24, 36 and 48 hours after the first FSH injection as compared to the spontaneous cycles. In the latter cycles, ALH30 decreased significantly from day 2 (12 hours) to day 4 (48 hours). Serum oestradiol levels at 12 and 24 hours did not differ significantly between the FSH and the spontaneous cycles.conclusionsThese results demonstrate that in superovulated women, a marked attenuation in the pituitary response to GnRH occurs as early as 12 hours from a single injection of FSH before any significant Increase In serum oestradiol levels. It is suggested that FSH is a potent stimulus of GnSAF production in

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1991.tb03556.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Summary.objectivesTo investigate whether growth hormone (GH) absorption is site dependent.design and measurementsHuman growth hormone (hGH, Norditropin) 4 IU, was injected subcutaneously on two separate occasions: into the thigh on one occasion and into the abdomen on a second occasion. Blood was sampled for GH, insulin, glucose, non‐esterified fatty acids and glycerol at baseline and hourly for 12 hours. Serum insulin‐like growth factor I was measured at baseline, and after 12 and 24 hours.subjectsEleven healthy young adults (8 M, 3 F).resultsFollowing the injection serum GH had risen by 1 hour and peaked by 3–6 hours. The peak GH and growth hormone area under the curve were significantly higher after injection in the abdomen compared with the thigh (GH peak (mean±SEM) 103.20 vs 41 .8 mU/l,P= 0.002 and GH area 528.88 vs 239.34 mU/l h,P= 0.003 respectively). Serum insulin‐like growth factor I at 12 and at 24 hours showed a significant rise from the baseline level, but no significant difference was observed between the two injection sites. No significant difference in plasma insulin, glucose, non‐esterified fatty acids or glycerol was observed between the two methods of injection.conclusionSubcutaneously injected GH is better absorbed from the abdominal site than from

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1991.tb03557.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Summary.objectivesTo establish a normal range for urinary growth hormone in adults and to investigate the urinary growth hormone levels in patients with acromegaly, comparing these with the serum growth hormone results of a glucose tolerance test. We also studied the molecular Identity of the growth hormone recognized by our assay method.designOvernight urine samples and, in some cases, timed urine samples taken during the day were obtained from healthy volunteers and acromegalic patients. A standard glucose tolerance test with serum growth hormone measurements was performed on the acromegalic patients.patientsOne hundred and thirty‐five normal adults and 33 acromegalic patients were studied.measurementsUrinary growth hormone was measured using a sensitive and precise assay developed previously. RESULTS in healthy volunteers overnight urinary growth hormone values fell gradually with increasing age, but there was no significant difference between men and women in any decade or between smokers and non‐smokers. Sexual intercourse had no detectable effect on the values, but there was a large increase following strenuous exercise. Studies of the diurnal patterns in normal and abnormal adults suggested that it might be possible to diagnose acromegaly on a random urine sample. Gel filtration studies on a urine sample from an acromegalic patient showed a single peak of molecular weight 22000. Using overnight collections there was clear discrimination between the values given by the normal adults and the acromegalic patients and an excellent correlation between urinary growth hormone levels in acromegatlc patients and the mean serum growth hormone in a glucose tolerance test.conclusionsin contrast to some other groups we conclude that urinary growth hormone provides a useful, non‐invasive screening test for acromegaly, but this conclusion depends crucially on the assay being sensitive and precise at low v

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1991.tb03558.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Summary.objectiveTo report meningitis occurring as a late complication of both medical and surgical treatment of pituitary tumour.designTwo case reports.patientsOne patient developed meningitis 9 years after she underwent transsphenoidal hypophysectomy for Nelson's syndrome. The second patient developed rhinorrhoea while on treatment with bromocriptine for a prolactin‐secreting pituitary adenoma and subsequently developed meningitis.measurementsIn Patient 1, CT scanning identified a small defect in the floor of the sells turcica. In Patient 2, CT scan examinations performed with a 3‐year interval demonstrated marked shrinkage of a pituitary tumour which had invaded the sphenoid sinus so that the tumour no longer plugged the erosion.resultsBoth patients experienced rhinorrhoea for over a year prior to the onset of meningitis. Both patients dismissed the occurrence of rhinorrhoea as insignificant and did not bring it to medical attention. In Patient 1, rhinorrhoea and presumably the entry site for pneumococaal infection was through a defect in the floor of the sella turcica consistent with transsphenoidal hypophysectomy performed 9 years previously. In Patient 2, rhinorrhoea and presumably entry of infection was facilitated by unplugging of a defect in the wall of the sphenoid sinus by bromocriptine‐induced shrinkage of the pituitary adenoma.conclusionsMeningitis can occur as a late complication of surgical or medical treatment of pituitary tumours. This may be preceded by rhinorrhoea which should be regularly enquired for as the symptom may not prompt patients to disclose its presence spontaneously. These reports document only the third occurrence of meningitis as a late complication of transsphenoidal hypophysectomy and the first occurrence of meningitis as a consequence of treatment of a pituitary tumour with bromocri

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1991.tb03559.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Summary.objectiveTo explore a possible Interaction of the serotonin neurotransmitter system and posterior pituitary function, we have looked at the effect of fluoxetine treatment on osmoregulated vasopressin secretion in normal men in two placebo controlled studies.designin each study subjects took in random order for 7 days one capsule daily of placebo or 40 mg fluoxetine. On the 8th day subjects underwent assessment. Study 1 A hypo‐osmotic stimulus of an oral water load of 20 ml/kg. Study 2 A hyperosmotic stimulus of intravenous infusion of 5% (855 mmol/l) saline at 0.06 ml/kg/min for 120 minutes.patientsNormal, healthy male volunteers. Study 1, 9; Study 2, 10.measurementsin both studies regular measures of plasma osmolality, sodium and vasopressin were made. In Study 1 urine osmolality was measured together with urine volume at set time points and an accumulative measure of percentage of water load excreted. Free water clearance was calculated. In Study 2 the relationship of plasma vasopressin to change in plasma osmolality was calculated for each subject by linear regression analysis. RESULTS Serotonin agonism had no effect on baseline measurements in either study. Study 1 After 4 hours subjects excreted 95 and 99% of the water load after placebo and fluoxetine respectively (P= 0.407). There was no effect of fluoxetine compared to placebo on the pattern or extent of change of plasma osmolality (nadir 285.9±1.4 mosm/kg placebo, 283.1±1.1 mosm/kg fluoxetine,P= 0.145) or on free water clearance or maximum urine dilution after oral water loading. Plasma vasopressin suppressed to a minimum concentration after both treatments in response to hypo‐osmolality 0.510±1 pmol/l (placebo), 0.3±0.01 pmol/l (fluoxetine),P= 0.195. Study 2 Fluoxetine had no significant effect on the sensitivity of vasopressin release to change in plasma osmolality (0.33±0.06 pmol/l per mosm/kg placebo, 0.36±0.06 pmol/l per mosm/kg fluoxetine,P= 0.347). Nor was there a significant effect on the theoretical osmotic threshold for release of vasopressin (287.011.21 mosm/kg placebo, 286.9±1.09 mosm/kg fluoxetine,P= 0.700).conclusionWe have found no evidence of a physiologically relevant effect of serotonin agonism on osmoregulated vasopressin release, or on the ability of normal man to excrete a water load. The possible reasons for this contrast to animal work are

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1991.tb03560.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Summary.objectiveSince LH secretion occurs as a series of pulses, relationships between mean LH levels and LH pulse characteristics are to be expected. The aim of this study was to determine whether such relationships are similar in normal women and anovulatory patients.designWe studied the correlations between mean LH levels and the products amplitude X frequency and area X frequency of LH pulses in normal women and In patients with disorders of ovulation. Blood samples were taken from each subject every 10 minutes during 6 hours on the 8th day after the last menses.patientsThe patients were divided into three groups: patients with polycystic ovary syndrome (n= 11), patients with idiopathic anovulatlon (n= 14) and patients with short luteal phase (n=13). Their results were compared to those of 12 normal women.measurementsLH was evaluated with an Immunoradlometric assay. LH data were analysed with a 3 standard deviation threshold criterion for significant peaks, and with cluster analysis algorithm using 1, 2.5 and 5% false positive error rates and ‘optimal parameters’ (which give less than 5% false positive and false negative error rates in LH male data).resultsHighly significant correlations between amplitude x frequency, area x frequency and mean LH were found In normals and patients with short luteal phase; no significant correlation was found in patients with polycystic ovary syndrome, while significant correlations were found in patients with idiopathic anovulatlon only with some of our criteria for peak detection.conclusionThe differences that we found between the groups suggest that when commonly used methods are employed to determine LH pulse characteristics, most of the significant LH pulses are taken Into account in normals and patients with short luteal phase, but not in anovulatory patients, especially in patients with poiycystic ovary syndrome. This method using two correlations appears to be a simple and useful way to show the differences In the mechanisms by which mean LH levels are achieved In normal subjects and patie

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1991.tb03561.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Summary.objectiveWe have evaluated an alternative method of preparation of hyperthyroid patients for surgery, using betamethasone, lopanoic acid and propranolol.designBetamethasone (0.5 mg every 6 hours), lopanoic acid (500 mg every 6 hours) and propranolol (40 mg every 8 hours) were given orally for 5 days; thyroidectomy was performed on the 6th day. We analysed patient acceptability, clinical and hormonal effects, ease of surgery and final outcome.patientsThirteen females and 1 male, aged 16–59 years, ten with diffuse goitre and four with nodular goitre were submitted to subtotal thyroidectomy because antithyrold drugs had failed to control thyrotoxicosis or because hyperthyroidism coexisted with other conditions (pregnancy, hypertensive disease).measurementsDaily clinical assessments were made together with T3, T4 and rT3 serum concentrations before and while on drug treatment, during the surgical procedure and post‐operatively.resultsDaily assessment showed progressive clinical improvement so that on day 5 the patients were considered clinically euthyroid. Serum levels of T3 (mean ± SD) showed significant decrease (by 38.2±24.9%,P<0.01) as early as 24 hours after medication was started, reaching almost euthyroid levels on day 3; on the day of operation T3 had diminished by 64.5±16.6% (P<0.0001). Serum T4 concentration showed a slight but significant decrement only from day 4 on and never reached euthyrold levels. Serum rT3 values exhibited a brisk Increment at 24 hours (+ 333.194%,P<0.0001) and remained elevated between 8 and 10 nmol/l until medication was stopped. Drug tolerance was considered as excellent since no serious side‐effects were noted, even in pregnant patients. There were no anaesthetic incidents or post‐operative complications and patients were discharged 48–72 hours after operation. The final outcome has been satisfactory and pregnant patients continued their pregnancies without Incident, bearing normal children.conclusionsPharmacological combination of betamethasone, lopanoic acid and propranolol has proved to be safe and effective and is of low cost. Provided there Is adequate supervision of the patients, it may be used in patients requiring urgent thyroidectomy or In those who for reasons of non‐compliance need a short preop

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1991.tb03562.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Summary.objectiveTo study the effects of thyroxine on orocaecal transit time In a group of elderly hypothyroid patients on long‐term thyroxine replacement therapy.designMeasurement of the effect of withdrawal and subsequent replacement of thyroxine replacement therapy on orocaecal transit time.patientsFifteen elderly, previously hypothyroid patients on full replacement therapy with oral thyroxine were studied. There were 11 females and four males, aged 60–94 years (median 78 years) receiving initially 50–200μg of oral thyroxine daily (median 100μg).measurementsSerum TSH and FT4 were measured by radioimmunoassay and orocaecal transit time assessed using a lactulose hydrogen breath test. These tests were repeated 7 days after withdrawal of thyroxine replacement and again 7 days after subsequent reinstatement of therapy.resultsOn withdrawal of therapy, the median transit time Increased from 75.0 to 135 minutes (P<0.01), the median TSH Increased from 1.8 to 2.3 mU/l (P= NS) and the median FT4 decreased from 13.7 to 10.6 pmol/l (P<0.01). On reinstatement of therapy, the median transit time decreased to 95 minutes (P= NS), the median TSH decreased to 1.1 mU/I (P= NS) and the median FT4 increased to 14.1 pmol/l (P<0.01).conclusionsThese findings demonstrate the sensitivity of the small bowel to changes in thyroid hormone status and suggest that constipation arising as a result of this hypomotility may well be an early physical manifestation of hypothy

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1991.tb03563.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY