摘要:

SUMMARYThe serum prolactin response to intravenous dopamine infusion (5μg.kg−1min−1) was measured in twenty‐one healthy subjects, in seven hyperprolactinaemic patients without evidence of a pituitary tumour, and in twenty‐one patients with prolactinomas. Mean serum prolactin values were significantly suppressed in all three groups, without any significant difference between the degree of suppression. A decrease of serum prolactin to below 50% of basal values occurred in fifteen healthy subjects, in four patients without evidence of pituitary tumour, and in fourteen patients with prolactinomas. These findings demonstrate that most human prolactin‐secreting pituitary adenomas are normally suppressible by exogenously administered dopamine and that dopamine infusion is not able to distinguish between tumorous and non‐tumorous hyper‐prolactinaemia. Since intravenously infused dopamine is believed to inhibit prolactin secretion by acting at pituitary level, it is suggested that a normal functioning of pituitary dopamine receptors is maintained in most human

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1980.tb03419.x

出版商:Blackwell Publishing Ltd    

年代:1980

数据来源: WILEY

摘要:

SUMMARYIt has been reported that administration of nomifensine (Nom) or of L‐dopa + carbidopa (L‐dopa + Carb) potentiates central dopaminergic tonus, resulting in decreased prolactin (PRL) secretion. It has been proposed that these drugs would help to discriminate patients with PRL‐secreting pituitary tumours from those with so‐called ‘functional’ hyperprolactinaemia.In this study, oral Nom (200 mg) was given to forty‐three hyperprolactinaemic patients and L‐dopa + Carb (50 mg Carb every 6 h for four doses followed by L‐dopa 100 mg and Carb 35 mg) to thirty of them and both treatments to ten normal subjects. The hyperprolactinaemic patients were divided into four clinical groups. Group A, twenty patients with proven PRL‐secreting pituitary tumours; Group B, thirteen women with elevated PRL levels (<100 ng/ml) without any radiological evidence of a pituitary tumour (hyperprolactinaemia of unknown aetiology or ‘functional’ hyperprolactinaemia); Group C, four women with polycystic ovarian disease and mildly elevated serum PRL; Group D, six patients with various other disorders associated with hyperprolactinaemia.PRL levels decreased in the normal controls below the basal values by 61.3%±6.2 (SEM) after Nom and 77.6%± 4.2 after L‐dopa + Carb. Decreases in serum PRL of at least 50% (in three consecutive determinations) were found in group A in 20% of patients after Nom and in 25% after L‐dopa + Carb; in group B in 15% and 40% of cases; in most of the hyperprolactinaemic women in group C; and some in group D.In conclusion, these two treatments did not discriminate between tumorous and non‐tumoro

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1980.tb03420.x

出版商:Blackwell Publishing Ltd    

年代:1980

数据来源: WILEY

摘要:

SUMMARYCorrelation between clinical and epidemiological features of Graves' disease and HLA were sought in 175 patients, eighty‐three of whom were typed for HLA DR antigens. The relative risks (x) conferred by HLA‐B8 and DR3 were 3.1 and 5–7 respectively (P<0.0005 uncorrected). The disease occurred at an earlier age in HLA‐DR3 positive patients compared to negative patients (Pand<30‐years‐old). Eighty‐four out of ninety‐two patients could specify the season of onset of hyperthyroidism; an excess of HLA‐B8 positive patients in the summer and a lack of these in the spring and autumn was found. No associations between B8 and exophthalmos and/or soft tissue eye changes were observed. However, significant associations between exophthalmos and either exophthalmos and/or soft tissue changes were found with DR3 (x=3.6 and 3.8 respectively). HLA‐DR3 positive patients were found to be more resistant to radioiodine therapy than patients negative for these antigens. No heterogeneity in the distribution of HLA antigens was found when the following indices were examined: sex, goitre size, severity of disease, pretibial myxoedema, antecedent psychological disorder, consumption of oral contraceptives, family history of Graves' disease or thyroid antibody titre. HLA does not appear to distinguish subvariants of Graves' disease, rather it influences the susceptibility to disease and its persistence once it becomes

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1980.tb03421.x

出版商:Blackwell Publishing Ltd    

年代:1980

数据来源: WILEY

摘要:

SUMMARYTwenty patients with moderately severe ophthalmopathy due to Graves' disease or ophthalmic Graves' disease were treated by supervoltage orbital radiotherapy generated by a linear accelerator. Seven patients (35%) showed some response within 3 weeks of the treatment, four patients (20%) improved minimally while nine patients (45%) were unchanged. Improvement was noted mainly in soft tissue changes while proptosis decreased in only four patients. With one exception, ophthalmoplegia did not improve after the radiotherapy. The benefit obtained with the treatment was not impressive.

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1980.tb03422.x

出版商:Blackwell Publishing Ltd    

年代:1980

数据来源: WILEY

摘要:

SUMMARYAdrenal function in twenty‐three patients with paracoccidioidomycosis (South American Blastomycosis) has been assessed by measuring the response to adrenocortical stimulation with 1–24 ACTH. Two patients with overt Addison's disease showed very low basal levels and the complete absence of an increase in either cortisol or aldosterone secretion. Six patients showed probable diminished adrenal reserve in terms of cortisol and three patients showed diminished reserve in terms of aldosterone function. These findings indicate an incidence of significant hypoadrenalism in 44% of hospitalized patients with disseminated paracoccidioidomyco

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1980.tb03423.x

出版商:Blackwell Publishing Ltd    

年代:1980

数据来源: WILEY

摘要:

SUMMARYLH/hCG binding and concentrations of pregnenolone, progesterone, 17‐hydroxyprogesterone, androstenedione, testosterone and 5α‐dihydrotestosterone were measured in testicular tissue obtained from patients undergoing orchiectomy for prostatic cancer. One group of the orchiectomized patients had received an injection of 80 mg polyestradiol phosphate 1–9 days before the operation, another group were treated with monthly injections of the oestrogen for several months, and the remainder were not treated with oestrogen. In non‐oestrogen treated patients (n= 8) the hCG‐binding capacity was 28.0±15.0 (SD) ng/g and the equilibrium association constant of binding was 0.69±0.38 x 1010M−1.The binding capacity was significantly (P<0.025) lower (10.3±8.7 ng/g) in patients (n= 6) receiving the first oestrogen injection 3–9 days prior to the operation. A further decline to the level of 1.77±1.03 ng/g occurred in patients (n= 3) treated over 3 months with the oestrogen injections. At the same time, no significant changes were observed in peripheral serum LH and FSH levels. In the testicular endogenous steroid levels, statistically significant decreases were seen 9 days after the oestrogen injection in pregnenolone (from 505±315 ng/g to 138±86 ng/g) and in testosterone (from 669±243 ng/g to 254±49 ng/g) whereas no significant changes could be seen in the levels of the other steroids analysed. This study gives further evidence for the direct inhibitory action of oestrogens on human testicular steroidogenesis and suggests that thelossof testicular luteinizing hormone receptors may be one facet of

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1980.tb03424.x

出版商:Blackwell Publishing Ltd    

年代:1980

数据来源: WILEY

摘要:

SUMMARYClinically euthyroid patients on long term maintenance therapy with the non‐steroidal anti‐inflammatory drug fenclofenac (Flenac) show an unusual and abnormal pattern of serum thyroid function tests. In all twelve patients studied, total T4 concentrations were grossly subnormal (mean 28.4±9.9 (SD) nmol/1 and total T3 levels low‐normal (mean 1.4 ± 0.3 (SD) nmol/1), whereas rT3 (mean 0.36 ± 0.06 (SD) nmol/1) and basal TSH levels (mean 1.9 ± 0.5 (SD) mu/1) were within their respective normal ranges. Free T4 levels were low normal (mean 11.0 ± 1.0 (SD) pmol/1) while TSH, T4 and T3 responses to intravenous TRH were similar to those found in euthyroid subjects. These effects appear to be due predominantly toin vivoinhibition of binding of thyroid hormones to carrier proteins in serum, rather thanin vitrodrug interference in the radioimmunoassays employed. Fenclofenac does, however, interfere in those laboratory methods employing serum proteins as binding agents. Thus the Thyopac 4 method for serum total T4 grossly over‐estimates T4 levels, while thyroid hormone binding capacity (Thyopac 3) is low. Since fenclofenac is one of the most potent drugs interfering with routine indices of thyroid status, it is suggested that suspected thyroid dysfunction is excluded before commencing therapy w

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1980.tb03425.x

出版商:Blackwell Publishing Ltd    

年代:1980

数据来源: WILEY

摘要:

SUMMARYThe function of the pituitary‐thyroidal axis was examined in fifty‐three of sixty‐two patients with hyperprolactinaemia and a pituitary tumour and in forty of forty‐four acromegalic patients, in whom one or more indices of the pituitary‐thyroid function were determined before treatment. In the patients with hyperprolactinaemia and a pituitary tumour, sellar + extrasellar tissue (EST) size showed a significant negative correlation with the response of TSH to TRH (ΔTSH) as well as with the circulating T4 and T3 levels. These correlations were not present in the acromegalic patients. In the prolactinoma group a sharp decrease in mean serum T4 and T3 levels was found at sellar + EST sizes exceeding 3 cm2. In twenty‐three patients with a sellar + EST size of 3 cm2or more, thirteen (57%) showed a T4 level of less than 6 μg/dl against none of twenty‐eight patients with a sellar + EST size of less than 3 cm2. For T3, using a limit of 120 ng/dl, the corresponding numbers were eight out of thirteen (62%) and none of ten patients respectively. A positive correlation was observed between ΔTSH and the T3 levels but not between ΔTSH and T4, while in the acromegalic patients there was no correlation between TSH reserve and T3 or T4. In the patients with hyperprolactinaemia and a pituitary tumour positive correlations between basal TSH and ΔTSH as well as between T4 and T3 levels were observed. These correlations were not found in the acromegalic patients.In conclusion: (1) Thyroid function appears to be independent of pituitary tumour size in patients with acromegaly but not in patients with hyperprolactinaemia and a pituitary tumour. (2) In acromegalic patients the high incidence of an impaired TSH response (without hypothyroidism and independent of tumour size) may be caused by suppression of TSH secretion rather than by destruction of

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1980.tb03426.x

出版商:Blackwell Publishing Ltd    

年代:1980

数据来源: WILEY

摘要:

SUMMARYGastric inhibitory polypeptide (GIP) is insulinotropicin vivoandin vitro. It is released following glucose ingestion and is a leading candidate as a mediator of the enteroinsular axis. To investigate the GIP response to increasing amounts of oral glucose, and its relationship to glucose levels and insulin secretion, fourteen normal volunteers ingested 25, 50 and 75 g of glucose at random with 5–7 days between each test. Serum insulin, glucose and GIP concentrations were measured and total integrated incremental responses were determined. Peak mean responses to glucose, insulin and GIP occurred at 30 min following each glucose ingestion. There were no significant differences in glucose concentrations at any interval with the varying glucose doses. Mean peripheral insulin concentrations were significantly increased ater 50 or 75 g of glucose as compared with the 25 g dose (P<0.02). Mean GIP concentrations were significantly greater (P<0.03) between 15 and 180 min with both the 50 and 75 g glucose stimulus. Total integrated areas under the response curves for glucose, insulin and GIP showed a graded increase in circulating insulin and GIP (P<0.01) as the amount of ingested glucose was increased from 25 to 75 g. These findings show that increasing doses of glucose stimulated greater levels of GIP and insulin and further support the insulinotropic properties of endogenous GIP in ma

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1980.tb03427.x

出版商:Blackwell Publishing Ltd    

年代:1980

数据来源: WILEY

摘要:

SUMMARYThe effects of two new ergolines, pergolide and CH29–717, on prolactin secretionin vitroandin vivowere compared with those of bromocriptine. Both ergolines hadin vitropotencies similar to that of bromocriptine, but had a shorter duration of action. However,in vivoboth were longer acting than bromocriptine after a single dose of 100 μg, and effectively suppressed prolactin secretion for greater than 24 h. It would appear that the pharmacokinetics of these ergolines are different to those of bromocriptine, and this may have considerable therapeutic importan

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1980.tb03428.x

出版商:Blackwell Publishing Ltd    

年代:1980

数据来源: WILEY