摘要:

SUMMARYData are presented concerning a 60‐year‐old woman with untreated congenital adrenocortical hyperplasia due to 21‐hydroxylase deficiency, who presented with a tumour of the left adrenal gland. Steroid excretion was partly suppressed with dexamethasone. After removal of the tumour, the excretion of several steroid fractions decreased substantially, but suppression by dexamethasone remained inadequate. Preoperatively, plasma ACTH was elevated in the afternoon and decreased only slightly after dexamethasone administration. After surgery, cortisol secretion decreased markedly, whereas ACTH dysregulation became more prominent. Negative feedback failure precluded the use of normal suppressive therapy with low doses of glucocorticosteroids and led to the therapeutic removal of the right adrenal gland, which showed histological signs of nodular hyperp

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1981.tb00617.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

SUMMARYForty‐five women and fifteen men with prolactinomas have been treated surgically. Patients with large tumours received pituitary irraditation and postoperative hyperprolactinaemia was treated with bromocriptine. The patients have been followed‐up for 6–36 months following the operation. The tumours were larger and the levels of production higher in men as compared with women. All women had amenorrhoea. Galactorrhoea was present in forty‐three women but not in the men. After surgery serum prolactin levels fell significantly in all women but remained above normal in thirty‐six; prolactin remained high in twelve men. Bromocriptine effectively decreased the postoperative hyperprolactinaemia. The surgical complications were oculomotor nerve paresis in one woman and one man. After surgery six (23%) women developed impaired GH secretion, six (15%) impaired thyroid function, eight (18%) impaired cortisol secretion and five (17%) impaired LH secretion in isolation or combination which had not been present preoperatively. Three patients relapsed.Fifteen women menstruated after surgery and ten began to do so during the subsequent bromocriptine treatment. Thus, menstruation was restored in all six women with microadenomas, in sixteen of twenty patients with intrasellar macroadenomas and three of nineteen patients with suprasellar adenomas. The preoperative LH‐reserve proved to be an important prognostic indicator. Nine patients, i.e. 50% of patients desiring fertility became pregnant. In the men gonadal function deteriorated in four patients and did not improve in any without testosteron

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1981.tb00618.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

SUMMARYSerum prolactin was measured in single blood samples collected from 219 nursing mothers of the Kivu region (Zaïre) during 30 post‐partum months. In addition the number of feeding episodes per day and the amount of milk given to the child in 24 h were recorded. The mean serum prolactin levels remained around 1000 mu/l during the first 15 months of lactation and fell during the next 3 months to 550 mu/l. A decline in milk production per day occurred during the second year, but it was less marked than that of prolactin. This decline seemed to be associated with the decline in suckling frequency as the quantity of milk given per feed remained almost unchanged throughout lactation. The average amount of milk given by mothers with serum prolactin levels in the range of values seen in non‐lactating and non‐pregnant women (about 500 mu/l) is nevertheless of some 35 g per feeding or 260 g per day. These results demonstrate that milk production can be maintained in women with normal levels of prolactin and suggest that prolactin plays a permissive role in established lac

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1981.tb00619.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

SUMMARYIn a group of eight patients with cirrhosis the rate of renal excretion of the 18‐glucuronide metabolite of aldosterone (UAldoV) was found to be closely related to the aldosterone secretion rate (ASR). UAldoV was therefore used as an index of ASR in a further group of fifty patients in order to evaluate the possible importance of factors known to regulate aldosterone secretion. UAldoV showed statistically significant relationships to both plasma renin activity (PRA) and the plasma sodium concentration (PNa), but not to the plasma potassium concentration (PK) or the renal excretion of cortisol (UCortV), the latter used as an index of adrencorticotrophic hormone activity. The plasma aldosterone concentration (PAido) was determined in fifty‐eight patients and also found to show statistically significant relationships to PRA and PNa. PAldoshowed a weak, though statistically significant, relationship to PK, but not to UCortV. These findings are in keeping with a role for the renin‐angiotensin system in the control of aldosterone secretion in cirrhosis although evidence from other studies suggest other factors to be involved also. Whether PNawas another determinant of ASR, or whether aldosterone was a determinant of PNathrough regulating sodium reabsorption by the proximal tubule of the nephron, is unce

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1981.tb00620.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

SUMMARYThe endocrine environment necessary for human lactation has not yet been clearly defined. In particular the role of prolactin is uncertain, since levels of this hormone usually fall to the normal non‐lactating range during the course of prolonged lactation. We have found that the immediate post‐partum peak of serum lactalbumin associated with lactogenesis was abolished by treatment with bromocriptine. This suggests a direct relationship between prolactin and lactalbumin production at this t

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1981.tb00621.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

SUMMARYThyroid hormones were serially measured over a 2‐week period in thirty‐four consecutive patients with acute myocardial infarction (AMI). A transient increase in plasma rT3 and a decrease in plasma T3 was found, with the maximum changes occurring on the third day after the onset of AMI. The changes in plasma rT3 and T3 were greater in the seventeen patients with a complicated AMI (mean peak SGOT 145 u/l) than in the seventeen patients with an uncomplicated AMI (mean peak SGOT 79 u/l). A correlation was found between infarct size (as estimated by the peak SGOT value) and the following indices: ΔrT3, ΔT3, highest rT3/T3 and highest rT3/T4 ratios. A transient increase in plasma TSH (peak on days 4 and 5) and in plasma T4 and FT4 index (peak on days 6 and 7) was also observed, whereas T3 resin uptake (T3U) decreased. These findings suggest that the following sequence of events occurs in thyroid hormone metabolism during AMI: (1) inhibition of the 5′‐deiodination of T4, resulting in increased plasma rT3 and decreased plasma T3 values, and in a lower metabolic clearance of T4. (2) Increased secretion of TSH (provoked by the lower T3 levels) resulting in increased thyroidal secretion of T4 and T3, which is then switched off by the negative feedback of thyroid hormones on the

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1981.tb00622.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

SUMMARYThe aim of the present study was to measure the PRL response to metoclopramide (MET) and chlorpromazine (CPZ) in seventeen patients with primary testicular failure and eight patients with isolated gonadotrophin deficiency (IGD). The responses were compared with those to TRH. Basal gonadotrophins and peak responses to LHRH were increased in testicular failure and reduced in IGD. Basal PRL levels were normal in both groups of patients. However, when compared with controls, the PRL response to both MET and CPZ as well as to TRH was exaggerated in primary testicular failure, whereas the responses were decreased in IGD. In both patient groups, as well as in the controls, the PRL response to MET exceeded that to TRH and CPZ. It is suggested that alterations in the steroid milieu are responsible for the exaggerated PRL response to MET, CPZ and TRH in primary testicular failure and the reduced response observed in IGD.

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1981.tb00623.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

SUMMARYOpiate peptides are known to influence the secretion of several anterior pituitary hormones under basal conditions. Further studies on prolactin, GH and TSH have therefore been performed in normal subjects, under basal and stimulated conditions, using an opiate agonist and antagonist. Sixteen mg naloxone had no effect on the basal release of prolactin or GH, but lowered TSH. An infusion of the met‐enkephalin analogue DAMME (1 mg) increased GH, and produced an exaggerated response of both prolactin and TSH to 200 μg TRH i.v. The peak responses of both prolactin and GH to hypoglycaemia were unaffected by pretreatment with either low‐dose (0·4 mg) or high‐dose (25 mg) naloxone, or DAMME (0·25 mg). These results suggest that opiate peptides are unlikely to play a major role in the tonic or hypoglycaemia‐stimulated release of prolactin and GH, although they may be of importance in the cont

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1981.tb00624.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

SUMMARYSerum prolactin concentrations have been measured at 15 min intervals for 2 h on 240 occasions in 227 patients with symptoms which could have been due to hyperprolactinaemic gonadal dysfunction. Of the 227, 138 had at least one elevated random prolactin level. Overall, 22% showed no significant fluctuation in prolactin. In 38% the levels fell progressively from the start of the sampling period, this pattern being found most commonly in patients complaining of infertility. The sampling method yielded a basal or unstressed prolactin concentration which was, on average, 27% lower than random prolactin concentrations. However, a comparison with clinical data, the radiological appearances of the pituitary fossa, and the response to bromocriptine therapy, has shown that there is no predictive information in the multiple sampling results that could not have been obtained from two or three random prolactin levels.

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1981.tb00625.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

SUMMARYA 4‐year‐old girl presented with severe clinical and radiological rickets, and alopecia since the age of 1 year. Laboratory studies revealed: hypocalcaemia, hypophosphataemia, secondary hyperparathyroidism, abnormally low intestinal calcium absorption, and markedly elevated circulating 1,25(OH)2D3levels. A normal calcaemic response to parathyroid extract was obtained. Treatment attempts with vitamin D2, 1 α (OH)D3and 1,25(OH)2D3were totally ineffective. Intestinal resistance to the action of 1,25(OH)2D3appeared well established in this case. Refractoriness of bone to this hormone seems less certain. From this new entity of‘Vitamin D resistant rickets due to end organ unresponsiveness', six cases have been hitherto reported in the literature. However, only two have enough resemblance to our case, to constitute a distinct and well denned nosologic subunit. The molecular basis of this disorder(s) remains to be eluc

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1981.tb00626.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY