ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1992.tb00945.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.tb00946.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SUMMARYobjectiveTo assess the value of the combined insulin stress test (IST), thyrotrophin‐releaslng hormone (TRH) and gonadotrophin hormone‐releasing hormone (GnRH) testsdesignA retrospective audit of 232 such tests performed between 1980 and 1989 inclusivepatientsOne hundred and ninety‐seven patients with known or suspected pituitary diseasemeasurementsIST, TRH and GnRH responses were retrieved from laboratory records. Case notes were surveyed for clinical data and additional resultsresultsA basal serum cortisol level of>100 nmol/l (or>200 nmol/l in patients who had recently received glucocorticoid replacement therapy) accurately predicted a subnormal response to hypoglycaemla. All patients with a basal cortisol level of>400 nmol/l, except those who had recently received steroids, showed a normal cortisol response. In retrospect, by consideration of such basal values, 55% of ISTs could have been avoided if the only aim was to assess cortisol reserve. A deficient growth hormone (GH) response to hypoglycaemia was, however, common In patients with a normal cortisol response. Two‐thirds of patients with GH deficiency would have been missed If an IST had been avoided on the basis either of basal cortisol levels alone, or of cortisol responses to an alternative test which did not test GH reserve. There was poor agreement between the pituitary response to TRH and GnRH and basal levels of thyroxlne and gonadotrophins respectively, suggesting that these releasing hormone tests are misleading.conclusionsThe IST provides information regarding pituitary function not provided by other tests of the hypothalamlc‐pltuitary‐adrenal axis, so that the choice between the IST and alternative tests must depend on a critical assessment of what Information is required. Routine TRH and GnRH testing appears to yield little Information of practical cl

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1992.tb00947.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SUMMARYobjectiveWe wished to investigate the role of cAMP In the synergistic effect of corticotrophin‐releasing factor and oxytocin on human myometrial contractilitydesignIsolated human gestational myometrium obtained from Caesarean sections at term was studiedin vitro. Static incubation techniques as well as tension recordings were applied to the tissue obtained.patientsThe subjects were healthy pregnant women undergoing lower segment Caesarean section at term, prior to labourmeasurementsSpecimens obtained were immediately dissected into small strips and either incubated In multiwell trays (strip weight 2·75 mg) or superfused and used for tension recordings (strip weight 2·00 mg). cAMP accumulation was measured after incubation with oxytocin (0·1–10 nm), corticotrophin‐releasing factor (1 nm) or a combination of both peptidesTension generated by the muscie strips was recorded isometrically and response to oxytocin (0·01–10 nm), corticotrophin‐releasing factor (1 nm) and forskolin (10 nm) expressed in force per gram wet tissue (N/g)resultsOxytocin (0·1 nm) causes a statistically significant dose‐related decrease in cAMP when combined with 1 nmcorticotrophin‐releasing factor (P>0·001), as compared with cAMP stimulation by corticotrophin‐releasing factor alone. Time course studies suggest a maximal effect at 1 minute. The hypothesis that an intracellular reduction of cAMP is a prerequisite for the synergistic response In contraction force was tested with tension recordings. Prevention of a decrease in cAMP in the tissue by addition of 10 nM forskolin to the superfusate abolished the potentlation between oxytocin and corticotrophin‐releasing factor.conclusionsThese results indicate that a fall in cAMP concentration plays a vital mediating role in the synergistic interaction between oxytocin and cortico

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1992.tb00948.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SUMMARYobjectiveA number of neoplasms are known to express somatostatin receptors, and the use of somatostatin receptor imaging in their localization has recently been described. We have looked at the use of an123I‐labelled Tyr3‐octreotlde analogue of somatostatin In the visualization and functional characterization of growth hormone‐secreting pituitary adenomas.patientsFifteen patients with biochemically‐proven acromegaly were scanned using this agent. In eight of these we also assessed acute GH responses to octreotide in order to correlate these responses with tumour uptake characteristicsmeasuresPlanar and single‐photon‐emlsslon computerized tomographic (SPECT) images of the head were obtained using a gamma‐camera at 10 minutes, and 4 and 24 hours, after injection of the radiopharmaceutical. Blood for serum GH was sampled for 12 hours after administration of a single dose of 100μg octreotide.resultsTwelve of the acromegalic subjects showed significant uptake of the radiopharmaceutical in the pituitary fossa. Of the eight patients In whom we assessed acute GH responses, five demonstrated a significant fall in GH in response to octreotide. These subjects also showed positive uptake in the pituitary on scanning. The three patients who had no fall in GH had no uptake on scanningconclusionsUptake of123I‐labelled Tyr3‐octreotide in the pituitary fossa appears to correlate closely with the presence of a therapeutic resp

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1992.tb00949.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SUMMARYobjectiveTo estimate the value of some commonly used tests In diagnosing Cushing's disease and to assess the outcome after treatmentdesignFollow‐up of a consecutive group of patients for 4·1 to 109·6 months, median 34·4patientsForty‐six patients assumed to have ACTH dependent hypercorticism (of 50 patients with Cushing's syndrome) were included. Forty‐five underwent trans‐sphenoidal neurosurgery. Ten were treated preoperatively with radiotherapymeasurementsPituitary, adrenal, thyroid and gonadal function, radiology and pituitary histology were evaluatedresultsOne main finding was a significant correlation between the urinary excretion of cortisol before and during administration of dexamethasone. Thus patients with modestly elevated urinary cortisol excretion had an apparently normal suppression. The urinary cortisol values during the dexamethasone test were significantly related to the peak plasma cortisol concentrations at the 30‐minute ACTH tests. Computed tomography failed to Identify an adenoma In 10 of the 19 patients who were histologlcally proved to harbour a corticotroph adenoma. At 6 months after radiotherapy, clinical and biochemical improvement was noted in none. Cure was achieved In 36 after neurosurgery. Eventually, adrenalectomy was needed In eight patients. Sixteen patients developed persisting adrenal Insufficiency after neurosurgery so that the total number of patients on permanent steroid substitution was 24. Post‐operative thyroid and gonadal Insufficiency (In men and women of fertile age) was found In 36 and 49%, respectivelyconclusionsThe diagnostic value of measuring the cortisol excretion during dexamethasone administration appears doubtful. The outcome after neurosurglcal treatment for Cushing's disease Is not entirely satisfactory. Further studies are needed to decide whether adrenalectomy as the first line of therapy should be considered relevant in some patients with Cu

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1992.tb00950.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SUMMARYobjectivesThe aim of the study was to determine whether growth hormone (GH) treatment decreased net protein catabolism of lean tissues in patients receiving chronic glucocorticoid treatmentdesignWhole body leuclne kinetics were measured In post‐absorptive conditions using a 1‐14C‐leucine infusion before and during GH administration (0·0125 mg/kg/day; 0·033 U/kg/day) for 7 days.patientsWe studied four patients (age range 31–71 years) who had taken prednisone (mean ± SEM 0·21·0±03 mg/kg/day, total dose 10–27·5 mg/day) for longer than 5 months for various lung diseasesresultsDuring GH treatment leucine oxidation decreased (baseline 0·44·0±07vsGH 0·37·0±05μmol/kg lean body mass/min,P= 0·01) and non‐oxidative leuclne disposal increased (1·95·0±10vs2·05·0±09μmol/kg lean body mass/min,P= 0·02) but leuclne appearance was unaltered.conclusionsWe conclude that GH decreased amino acid catabolism and improved protein synthesis without altering protein breakdown in patients receiving chronic glucocorticoid treatment. There may be a role for GH in mitigating the protein catabolic side‐effects

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1992.tb00951.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SUMMARYobjectiveTo determine whether duration of exposure to GH and/or rate of change of serum GH concentration are Important factors In determining the growth rate of short childrendesignAn analysis of parameters of occupancy percentage and rate of change of serum GH concentration was performed as part of a prospective study Investigating the relationship between growth and GH In childhoodpatientsSixty‐four short prepubertal children (48 male, 16 female) aged between 4·7 and 11·9 years were studied. Thirty‐one children were growing with a height velocity standard deviation score between 0 and – 0·8 and were defined as short normal. Thirty‐three children were growing with a height velocity standard deviation score less than – 0·8 and were defined as short slowly growingmeasurementsTwenty‐four hour serum GH concentration profiles were constructed by withdrawing samples at 20‐minute intervals. Analysis of occupancy percentage was performed on each data array by determining cumulative distributions and plotting these as linear problts against log serum GH concentration. Estimates of peak (OC45), Intermediate (OC50) and trough (OC5) occupancies were calculated. A first‐order derivative of the concentration‐time data array was determined for each profile as a measure of rate changes.resultsFirst‐order derivative values were significantly greater In the short normal group than In the short slowly growing children (short normal median 1·41 mU/l/min; short slowly growing median 0·72 mU/l/min;P>0·001). OC56values were significantly higher in the short normal group (median 19·31 mU/l) than the short slowly growing group (median 7·69 mU/l) (P>0·001). There was no difference In OC50values. OC5values were lower In short normal children (median 0·20 mU/l) than in the short slowly growing children (0·55 mU/l) (P>0·003).The most Important factor In determining growth rate was the rate of change In serum GH concentration (FOD). Occupancy percentage played no part In the relationship. The regression equation wasHeight velocity SDS =1·16 (In FOD) – 1·03;r= 0·75;P>0·001conclusionsThese data suggest that the pattern of presentation of GH In the circulation Is an Important factor in determining target organ response. Although occupancy percentages at differing serum GH concentrations differ between short slowly growing and short normal children, it Is the rate of change of the hormone in the circulation which appears to be the more Important

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1992.tb00952.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SUMMARYobjectiveWe aimed to assess the effects of prolonged treatment with the dopamine agonist CV 205–502 on tumour volume, visual field defects, and serum gonadotrophin andα‐subunit concentrations in patients with gonadotroph,α‐subunit secreting, or clinically non‐functioning pituitary adenomas.designThe patients were treated with CV 205–502 in a final daily dose of 300μg for at least 1 year. The patients were seen at 2 or 3‐week intervals during the first 3 months of treatment, and thereafter every 1 or 2 months. Computerized tomography and Goldmann perimetry were performed before treatment and during follow‐up. Blood samples were drawn before treatment and at each out‐patient visit.patientsOne patient with gonadotroph, two withα‐subunit secreting, and two with clinically non‐functioning pituitary adenomas were studied.resultsComputerized tomography showed tumour shrinkage in one patient. In two other patients an improvement of visual field defects was observed. In four patients, a significant decrease in serum FSH and/orα‐subunit concentrations occurred within the first 3 months of treatment. In the remaining patient, a significant decrease of serum FSH andα‐subunit concentrations was found after more than 3 months of treatment.conclusionsIn patients with clinically non‐functioning, gonadotroph, orα‐subunit secreting pituitary tumours, long‐term treatment with the dopamine agonist CV 205–502 decreases serum FSH and/orα‐subunit concentrations. This decreased secretory activity from the pituitary tumour may be accompanied by an improvement of visual field defects, or tumour shrinkage on computerized tomography. Therefore, treatment with CV 205–502 may be useful in patients with clinically non‐functioning, gonadotroph, orα‐subunit secretin

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1992.tb00953.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SUMMARYobjectiveTo determine whether abnormalities of pltuitary–ovarian function are associated with minor degrees of endometriosls in women with Otherwise unexplained infertilitydesignComparison of pituitary–ovarian function in a group of 22 patients with that in a control group of 10 healthy fertile womenpatientsTwenty‐two women with minimal or miid endometrlosls and otherwise Unexplained infertilitymeasurementsOvarian ultrasound and radloimmunoassay of pituitary and ovarian hormonesresultsAbnormalities, including lutelnizatlon of unruptured follicles, broad LH surges and low concentrations of progesterone during the luteal phase, were demonstrated in 82% of study cyclesconclusionPituitary‐ovarian dysfunction appears to be associated with minimal or mild endometriosis in women with otherwise unexplained infertility but the diversity of endocrine abnormalities demonstrated suggests that endometriosis is unlikely to be an aetlologlcal factor in their dev

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1992.tb00954.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY