摘要:

SUMMARYThe effects of an i.v. infusion of synthetic human β‐endorphin on the hormonal, metabolic and cardiovascular responses to surgery were investigated in female patients undergoing pelvic surgery. A β‐endorphin infusion (2 μg/kg as a bolus at induction of anaesthesia + 10 μg/kg/h for the first hour of surgery) increased plasma β‐endorphin immunoreactivity to values at least 100‐fold greater than those seen during surgery in a control group of patients. In spite of this massive increase the only significant findings were a transient augmentation of the expected hyperglycaemic response and increased plasma glucagon values. There were no significant changes in ACTH, GH, insulin and Cortisol secretion, in blood concentrations of lactate or glycerol, or in cardiovascular variables. Complete dissociation between plasma and cerebrospinal fluid concentrations of β‐endorphin was found even when plasma values exceeded 10000 pmol/1 in the presence of anaesthesia and surgery. These results show that the increases in circulating β‐endorphin immunoreactivity associated with clinical stress states are unlikely to modulate the associated hormonal, metabolic and card

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1987.tb00823.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SUMMARYWe studied a young woman with surgical hypoparathyroidism who, on her usual maintenance dose of calcitriol, developed hypercalcaemia 9 d postpartum when lactation was established. Serum values of 1,25‐dihydroxyvitamin D3(1,25(OH)2D3) values were very high (127 pg/ml). The patient remained without exogenous calcitriol treatment for 40 d, during which time serum 1,25(OH)2D3levels remained within the normal range and serum calcium fell with a half‐time of 27 d. The requirements for calcitriol increased to antepartum levels when lactation had ceased. There was a close negative correlation between requirements for calcitriol and serum PRL values. After weaning, an episode of hypercalcaemia was induced by increasing the dose of calcitriol. On stopping calcitriol the serum 1,25(OH)2D3fell to low values (4 pg/ml) within 2 d and serum calcium fell with a half‐time of 3 d, necessitating the early reintroduction of calcitriol. We conclude that in hypoparathyroidism exogenous vitamin D requirements fall during lactation because of enhanced endogenous production of 1,25(OH)2D3. The lactation‐associated increase in circulating 1,25(OH)2D3concentrations thus results from a parathyroid hormone‐independent mechanism, possibly by an effect of PRL on the la‐

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1987.tb00824.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SUMMARYReduction of human and rat testicular FSH receptors by hMG was studiedin vivoandin vitro.After a single injection of hMG, the number of high affinity FSH receptors were significantly reduced for 5 and 3 d in human and rat testes, respectively, without affecting their affinity. FSH receptor numbers recovered to pretreatment values by 14 d after the injection. Radioactivity in rat testes found 48 h after a s.c. injection of125I‐labelled human FSH was less than 10% of the maximum found 10 h after the injection, showing that the prolonged reduction of FSH receptors after hMG injection was not due to occupancy of the binding sites. Occupied FSH receptors measured in rat testes accounted for about 15% of all receptors on the day after an injection of hMG and for less than 5% after the third day. In experimentsin vitrousing organ culture techniques, an exposure to hMG for 24 h induced a dose‐related significant loss of the specific FSH binding sites for 7 and 5 d in human and rat testes, respectively. Thereafter, the loss was gradually recovered. These findings suggest that the reduction in FSH receptors in human and rat testes by hMG is mainly due to down‐regulation of the binding sites and that the testicular organ culture method used in the present study is useful to study hormonal regulation of testicular function, especially in human t

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1987.tb00825.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SUMMARYThe lysosomal acid protease is thought to be a main enzyme in hydrolysis of thyroglobulin. The protease activity of lysosome‐rich fractions of various diseased thyroid glands were assayed by the sensitive and reproducible method developed in our laboratory. They included 78 diseased thyroid glands; 37 thyrotoxic goitres, five irradiated thyroids, five Hashimoto's thyroiditis, one granulomatous thyroiditis, six multinodular goitres, 14‘cold’ adenomas, four‘hot’ adenomas with three paranodular tissues, and six carcinomas. Fifteen paranodular tissues of cold and solitary thyroid nodules were served as controls. The protease activities were significantly increased in thyroid tissues of thyrotoxic goitres, Hashimoto's thyroiditis, adenomas and adenocarcinomas. In thyrotoxic goitres, the protease activity correlated well with the mean area size of colloid follicles. The‘hot’ adenomas had higher protease activity than‘cold’ ones. The protease activity of multinodular goitres was nearly normal. Only the irradiated thyroid glands had low protease activities. Therefore the high protease activities in hyperfunctioning goitres seem to reflect hormone secretory activities. On the other hand, cold neoplastic goitres seem to have lysosomal protease activities which are not associated with thyroidal secretory process. The assay of acid protease activity will be useful to understand the pathophysiology of lysosomal system in diseas

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1987.tb00826.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SUMMARYThe treatment of choice for gastric acid hypersecretion in MEN type I has now changed from total gastrectomy to the long‐term administration of H2receptor blockers or similar agents. However, the importance of parathyroidectomy for the concomitant hypercalcaemia is not fully realized. A case is reported of a subject with MEN type I, who was initially treated with parathyroidectomy and H2receptor blockade. Following parathyroidectomy, there was a rapid fall of the markedly elevated gastrin levels to the upper limit of the normal range. During follow‐up of 2–5 years, there has been no increase in serum gastrin, and the subject's gastric symptoms have resolved, despite the cessation of H2 blockade. Infusion of calcium to pre‐operative levels and superimposed secretin stimulation after this period of time closely reproduced the pre‐operative hypergastrinaemia. On screening, the subject's only child was found to have hypercalcaemia but normal serum gastrin levels and pituitary function; parathyroidectomy has been carried out. No abnormality of gastrin secretion has been found during follow‐up. This case highlights the importance of early parathyroidectomy in th

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1987.tb00827.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SUMMARYA patient with primary aldosteronism had bilateral adrenal tumours on computed tomography. Selenocholesterol scintigraphy showed uptake by the larger right adrenal gland and a tumour in the gland was also visualized by venography. In contrast, measurements of aldosterone concentrations in adrenal venous blood lateralized to the left side. At surgery the left adrenal gland contained an aldosteronoma and the right adrenal gland a large nonfunctioning adenoma. Thus, selenocholesterol scintigraphy incorrectly localized the functioning adrenal tumour.

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1987.tb00828.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SUMMARYTwo patients are described with pituitary‐dependent Cushing's syndrome who had successful transsphenoidal selective removal of basophil microadenomas. After a period of adrenal insufficiency the clinical signs and the Cortisol secretion rate became normal after 12–18 months, together with the return of a normal feedback response to glucocorticoids (dexcamethasone suppression), a normal diurnal rhythm of plasma Cortisol, and a normal response to stress (increase of plasma Cortisol to insulin‐induced hypoglycaemia). However, pituitary‐dependent Cushing's syndrome recurred 38 and 56 months after operation. This was preceded by gradual changes of the results of the dexamethasone tests, disappearance of the diurnal rhythm of Cortisol, and of the responses of plasma Cortisol to hypoglycaemia.‘True recurrence’ should be defined as the return of the clinical and biochemical characteristics of Cushing's syndrome after a successful transsphenoidal operation, with a normal hypothalamic‐pituitary‐adrenal axis as evidenced by a normal response to dexamethasone, a normal diurnal rhythm of Cortisol and a normal increase of plasma Cortisol with insulin‐indu

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1987.tb00829.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SUMMARYBone mineral metabolism was studied in 10 subjects with familial hypocalciuric hypercalcaemia (FHH) and 10 age‐, sex‐ and surface area matched healthy controls. Bone turnover was estimated by urinary calcium and hydroxyproline excretions relative to creatinine (Ca/Creat and OHPr/Creat, respectively), serum bone Gla‐protein (S‐BGP) and serum alkaline phosphatase (S‐ALP). Bone status was evaluated by measurement of bone mineral content (BMC) on both forearms and X‐ray examinations of the hands. Ca/Creat and OHPr/Creat (indices of bone resorption) were both significantly higher in the FHH group than in the controls. S‐BGP and S‐ALP (indices of bone formation) tended towards a higher level in the FHH subjects, but the differences were not significant. The BMC values were similar in the two study groups and did not change with time. We conclude that these patients with FHH might have a bone turnover higher than normal, and that the increased bone resorption must be paralleled by an increased

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1987.tb00830.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SUMMARYSerum TSH was measured using a high sensitivity immunochemiluminometric assay (ICMA) in patients receiving anticonvulsant drugs, heparin or nonsteroidal anti‐inflammatory agents (NSAIs) and the results compared with those from groups of age‐ and sex‐matched controls. The TSH results have also been compared with those of estimates of free thyroid hormone levels using Amerlex analogue method reagents. All patients were clinically euthyroid and TSH concentrations were in the normal, euthyroid range and did not differ significantly in any group studied. In contrast, Amerlex free T4 levels were significantly reduced in the patients treated with phenytoin (P<0001), carbamazepine (P<001), sodium valproate (P<001) and heparin (P<0001). Patients treated with NSAI agents showed no significant change in free T4 levels. Amerlex free T3 levels were also significantly reduced in the patients treated with phenytoin (P<0–005), carbamazepine (P<0–005) and heparin (P<0–001) but not in those treated with sodium valproate or NSAIs. These data support the view that measurement of circulating TSH with an assay of sufficient precision in the relevant range provides a reliable way of assessing thyroid status and could be used to exclude hyperthyroidism in patients taking the medications investigated in

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1987.tb00831.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1987.tb00832.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY