ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1991.tb03522.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.tb03523.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Summary.Isolated ACTH deficiency is a rare disorder. We report four cases of this disease which presented to the Department of Endocrinology at Leeds General Infirmary over a one‐year period. The diagnostic clinical and biochemical features of each case are discussed and the pertinent literature is reviewed. The clinical investigations vary somewhat between cases as the four patients presented in markedly different ways. Well validated dynamic endocrine investigations were employed including glucagon stimulation test (GST) and the corticotrophin releasing hormone (CRH) test (using 100 μg of human CRH with samples for ACTH and cortisol). Two patients probably had CRH deficiency and two had ACTH deficiency. All the cases are instructive, illustrating different features of this heterogeneous condition.We conclude that the diagnosis of this condition may be difficult due to the varied clinical presentation. We suggest that it is commoner than previously thought and that the precision of diagnosis can be improved using the CRH te

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1991.tb03524.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.tb03525.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Summary.objectiveTo examine the osmotic and non‐osmotic regulation of thirst and AVP release In patients with compulsive water drinking.designA 2‐hour Intravenous Infusion of hypertonic (855 mmol/l) sodium chloride solution, followed by a 2‐hour drinking period.patientsSeven patients with compulsive water drinking, seven patients with diabetes insipidus and seven healthy controls.measurementsPlasma AVP, osmolality, sodium and haematocrit, thirst ratings on a visual analogue scale and the volume of water drunk in 2 hours following Infusion. RESULTS Plasma AVP responses to osmotic stimulation, and non‐osmotic inhibition by drinking, were normal In patients with compulsive water drinking. Basal thirst ratings were higher in compulsive water drinking than in either diabetes (P<0.001) or controls (P<0.001), despite lower basal plasma osmoialities. There was a significant rise In thirst ratings during saline infusion, which correlated closely with plasma osmolality, in all three groups, but the final thirst ratings were higher in compulsive water drinkers, who subsequently drank more water than In either diabetes insipidus (P<‐0.01) or controls (P<0.001). Drinking rapidly lowered thirst ratings in controls and diabetes insipidus before changes occurred in plasma osmolality, but remained elevated in patients with compulsive water drinking. Linear regression analysis defined a lower osmotic threshold for thirst in compulsive water drinking compared with controls or diabetes insipidus.conclusionsThere are abnormalities of the osmotic stimulation and non‐osmotic inhibition of thirst in compulsive water drinking, suggesting that the underlying defect is one of interpretation of osmotic and non‐osmotic inputs. Measurement of thirst responses during hypertonic saline infusion and subsequent water drinking may provide useful diagnostic Information in the differentiation of po

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1991.tb03526.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Summary.objectiyesTo assess whether drinking and oropharyngeal stimuli mediate the release of plasma atrial natrluretic peptide (ANP) in man.designHypertonic saline was infused into male volunteers to stimulate thirst. In order to avoid any effect of volume change on ANP release, the studies were performed with the subject in the seated position.subjectsSeated normal male volunteers (n= 6) were Infused with hypertonic saline at a rate of 0.06 ml/kg/min for 90 min on two separate occasions. After a 15‐min equilibrium period, subjects were allowed to drink for the following 45‐min period on one occasion, but no drinking was permitted on the other occasion.measurementsAliquots of blood were withdrawn at 30‐min intervals for 90 min during hypertonic saline Infusion, and +3, 6, 9, 12, 15, 30 and 45 min during the drinking/control period for the measurement of plasma ANP, plasma vasopressin, plasma osmolality, serum sodium and haematocr

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1991.tb03527.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Summary.objectiveit has been postulated that a decrease in thyroid size can be achieved by thyroxine treatment in patients with goitrous Hashimoto's thyroiditis but no objective data are available. We have therefore Investigated the Influence of thyroxine treatment on ultrasonically determined thyroid size. We also measured serum antithyroid peroxldase antibodies.designConsecutive patients with goitrous Hashimoto's thyroiditis was studied.patientsThirteen women participated; all had goitrous thyroiditis.treatmentTo render them euthyroid thyroxine was given for 24 months.measurementsThyroid size was measured ultra‐sonically and antithyroid peroxidase antibodies were measured using a commercial radloimmunological method.resultConcomitant with the gradual increase in serum free thyroxine and free triiodothyronlne Index values and a fall in serum thyrotrophin level, a gradual decrease in thyroid volume from 50.4 ± 6.8 ml (mean ± SEM) to 34.1 ± 5.7 ml (32%),P<0.001 was demonstrated. Anti‐thyroid peroxidase antibodies were present In high concentrations in all subjects but the mean serum level was not significantly changed at 24 months after. Initiation of treatment.conclusionA clinically significant reduction in thyroid volume related to normalization of thyroid function but unrelated to changes in antithyroid peroxidase antibody can be achieved duringl‐thyroxine treatment of hypothyrold goitrous Hashimoto's thy

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1991.tb03528.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Summary.objectiveWe have assessed whether in‐situ hybridization for prolactin messenger RNA (mRNA) provides additional Information for the classification of pituitary macroadenomas associated with hyperproiactinaemla.designin‐situ hybridization for PRL mRNA was performed on surgical biopsies of pituitary adenomas and the results correlated with serum PRL levels and PRL immunoreactivity.patientsTwenty‐one patients (11 men, 10 women) were included; five had normal serum PRL levels, 11 mild hyperprolactinaemia (3000 mU/I and in one of 11 patients with mild hyperprolactinaemla. Positive signal for PRL mRNA was detected in four of five immunopositive cases studied, in a further two cases with mild hyperprolactinaemia, and in one tumour associated with normal serum PRL level.conclusionsIn‐situ hybridization provides evidence of PRL gene activation in the absence of immunoreactivity for prolactin. This may reflect low levels of hormone storage or defective translation of

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1991.tb03529.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Summary.objectiveTo develop a method for quantifying the distribution of concentrations present in hormone profiles, which would allow an observer‐unbiased estimate of the time concentration attribute and to make an assessment of the baseline.designThe log‐transformed concentrations (regardless of their temporal attribute) are sorted and allocated to class intervals. The number of observations in each Interval are then determined and expressed as a percent‐age of the total number of samples drawn In the study period. The data may be displayed as a frequency distribution or as a cumulative distribution. Cumulative distributions may be plotted as sigmoidal ogives or can be transformed into discrete probabilities (linear probits), which are then linear, and amenable to regression analysis. Probability analysis gives estimates of the mean (the value below which 50% of the observed concentrations lie, which we term ‘OC50’). ‘Baseline’ can be defined in terms of percentage occupancy—the ‘Observed Concentration for 5%’ (which we term ‘OCs’) which is the threshold at or below which the hormone concentrations are measured 5% of the time.patientsWe report the use of applying this method to 24–hour growth hormone (GH) profiles from 63 children, 26 adults and one giant.resultsWe demonstrate that GH effects (growth or gigantism) In these groups are more related to the baseline OCs concentration than peak concentration (0C5± 95% confidence limits: adults 0.05 ± 0.04, peakheight‐velocity pubertal 0.39 ± 0.22, giant 8.9 mU/I).conclusionsPulsatile hormone profiles can be analysed using this method in order to assess baseline a

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1991.tb03530.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Summary.objectivePolycystic ovary syndrome (PCOS) Is said to be associated with hyperinsulinaemia. Insulin stimulates androgen production by ovarian tissuein vitroand previous studies have identified a positive correlation of Insulin with androstenedione. The aim of the present study was to discover whether insulin levels correlate with clinical presentation and with markers of androgen trans‐port and metabolism In women with PCOS.designWithin‐group analysis of clinical and biochemical characteristics of a consecutive series of women with PCOS, focusing on correlations of plasma insulin with clinical presentation and androgens. Insulin levels were also compared with a control group of normal women.patientsForty‐seven women who presented with hirsutlsm, cycle abnormalities or both, with ultrasound proven PCOS, were recruited. Mean age was 26.6±0.7 years (mean±SEM), BMI 27.3±1.2 kgtm2.measurementsPlasma Insulin levels were measured at 30‐minute intervals for 3 hours following a 75 g glucose load. Blood was also taken for measurement of testosterone (T), androstenedione (A), free testosterone (f T), sex hormone binding globulin (SHBG) and Insulin‐like growth factor‐i (IGF‐I). Androsterone glucoronide (AG), a marker of peripheral androgen metabolism, was also measured. RESULTS Neither basal Insulin nor the sum of Insulin measurements during the glucose tolerance test (sumINS) in women with PCOS were significantly different from a control group with normal ovaries. Within the PCOS group, basal insulin was greater in women with Irregular cycles or amenorrhoea than In those with regular ovule‐tory menses (8.0± 1.1 vs 3.1 ± 1.5 mU/I,P<0.01) despite similarly raised androgen levels. Both basal Insulin and sumINS correlated with BMI In women with PCO (r=0.37,P<0.05 andr= 0.64,P<0.01 respectively) but not in controls. There was no significant correlation between insulin or IGF‐I levels and T, A or AG despite a positive correlation of AG (but no other androgen) with BMI. SHBG showed an Inverse correlation and I T correlated positively with sumINS (r= ‐0.51,P<0.01;r=0.39,P<0.05). Regression analysis of each of the androgens on the other variables demonstrated no significant relationship between insulin and androgens.conclusionsThese data suggest that,in vivo, the major effect of insulin on androgen secretion is mediated by changes In SHBG rather than by direct stimulation of ovarian androgen production. Higher Insulin concentrations In anovulatory compared with ovulatory women with hyperandrogenaemia may indicate that Insulin resistance In the ovary contributes to the mechani

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1991.tb03531.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY