摘要:

SUMMARYThe effects of loperamide, an opiate analogue of the piperidine class on pituitary hormone secretion were evaluated in eight patients with Addison's disease. In all patients loperamide administration (16 mg orally) induced a marked fall in plasma ACTH levels (P<0.01), without affecting GH, PRL and LH levels. Plasma ACTH concentration fell significantly from 854±167 pg/ml (mean±SEM) to 460±123 pg/ml at 60 min (P±0.01). The inhibition persisted throughout the whole test period, the nadir being reached at 300 min. Low dose naloxone infusion 180 min after loperamide administration caused plasma ACTH to rise from 181±61 pg/ml to 539±99 pg/ml (P±0.01). The present data suggest that the opiate analogue loperamide is a potent inhibitor of ACTH secretion in patients with Addison's disease, which may be acting on μ receptors, since its effect is blocked by low doses of n

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1986.tb03276.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

SUMMARYUrinary 3,5‐diiodotyrosine (DIT) and thyronine (T0) excretion was investigated in 18 patients with chronic renal disease. In accord with previous findings serum T4 and thyroid hormone binding proteins measured in 17 patients were in the low or normal range. Urinary albumin excretion was elevated in all 18 and T4 binding prealbumin (TBPA) in 15 of the 18. Urinary T0 excretion measured in 12 patients was also significantly lower than normal (mean±SD 4.4±2.6 vs 15.8±5.8 nmol/24 h renal vs normal 2P<0.001). In contrast urinary DIT excretion was significantly elevated in renal patients compared with normal subjects (2.0±1.5 vs 0.75±0.41 nmol/24 h, respectively). Possible sources of the increased DIT are dis

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1986.tb03277.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

SUMMARYThe interactions of ovarian steroids with PRL secretion in women are still controversial. Ten healthy postmenopausal women, on no medication, received during the first period or 2 months later in a cross‐over design study, i.m. injections of 0.625 mg of oestradiol benzoate (EB) alone for 10 d or in combination with 750 μg/d of a pure progestin promegestone for 10 d. A TRH (200 μgi.v.) stimulation test was performed before the start and at the completion of each treatment period. Basal plasma gonadotrophins, PRL and oestradiol were measured every day by radioimmunoassay. The EB‐induced rise in oestradiol levels was similar during the two periods. In response to EB treatment serum PRL levels increased from 6·1±0·9 ng/ml to 22·9±3·4 ng/ml. With the addition of promegestone, the increase in PRL, from 6·7±1·3 ng/ml to 13·8±2·5 ng/ml, was significantly diminished (P<0.001). The PRL release induced by TRH was significantly greater with EB treatment than was the response with the combined treatment (P<0·05, Wilcoxon test to compare the areas under the curves). These data suggest that in postmenopausal women (1) oestrogens act as stimulators of PRL release and (2) promegestone is able to partially counteract the stimulatory effect of oestradiol benzoate upon basal and TRH‐stim

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1986.tb03278.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

SUMMARYEleven patients with PRL and three with GH‐secreting pituitary adenomas were treated with a single intramuscular injection of 50 mg of bromocriptine retard (Parlodel, LA (long‐acting)). There was a marked PRL suppression in 9 prolactinoma patients, in four for a period of at least 6 weeks. In one patient with acromegaly GH plasma levels decreased into the normal range. The size of the pituitary adenoma diminished considerably, as shown by CT scan, in three out of the 9 responding patients with prolactinoma and in the above acromegalic patient. Visual fields normalized within 14 d in one patient with a PRL‐secreting macroadenoma and bitemporal hemianopsia who also had CT scan‐documented shrinkage of the tumour. There were no side‐effects except slight hypotension in two and local tenderness at the injection site in one patient; these symptoms disappeared without treatment. It is concluded that bromocriptine retard is a safe and effective therapeutic tool for shrinking hormonally active pituitary tumours in selected patients. Due to its good tolerance and the rapid hormonal and clinical improvement it may be also considered as the best therapeutic approach to initiate the treatment of PRL‐ and/or GH‐secreting pitu

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1986.tb03279.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

SUMMARYIn order to throw further light on the role of androgens in the aetiology of the polycystic ovary syndrome (PCO) we have examined the effect of artificially increasing serum testosterone levels on menstrual function in a group of ovulating women. Six women were studied who had either severe premenstrual syndrome or loss of libido for which they were treated with 100 mg testosterone by s.c. implantation. All had regular menstrual cycles. For 1 month before implantation serum LH, FSH, oestradiol (E2), progesterone and testosterone were measured three times per week. All women showed normal cyclical variation of LH, FSH, E2and progesterone. Following implantation, three times weekly blood samples were taken during the first and third cycles. No patient had any disturbance of menstrual pattern. All continued to show cyclical changes of LH, FSH, E2and progesterone. Serum E2and progesterone were lower but not significantly so in the luteal phase of the treated cycles. This was despite a mean serum testosterone which rose from 1.3 to 7.1 nmol/1 at the end of the third week following implantation and to 4.1 nmol/1 at the end of the third month. Sex hormone binding globulin levels fell as expected by 18.5% during the first cycle. The lack of significant effect of a markedly elevated serum testosterone level on cyclical hormone changes is indirect evidence that in PCO the primary cause of the menstrual disturbance is not excessive production of ovarian or adrenal testosterone.

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1986.tb03280.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

SUMMARYA young female patient, with clinical and biochemical manifestations of severe hypercorticism and with the presence of a pituitary adenoma shown by computerized tomography, was thought to have Cushing's syndrome of hypophysial origin. However, the surgically‐removed pituitary adenoma contained no ACTH, by immunocytology, and hypercorticism persisted after transsphenoidal adenomectomy. The patient died and autopsy demonstrated an ACTH and corticotrophin releasing factor (CRF)‐containing bronchial carcinoid. It can be concluded that bronchial carcinoids can produce ACTH and CRF and can mimic the clinical and biochemical manifestations of pituitary Cushing's syndrome. Thus, the localization of the primary site of hypercorticism can be extremely difficult in patients who have an insidious, occult extrapituitary tumour. Further work is required to establish whether CRF plays a role in the causation of Cushing's syndrome and whether the simultaneous secretion of this peptide can modify the clinical and biochemical manifestations of the ectopic ACTH syndr

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1986.tb03281.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

SUMMARYFive patients with hyperprolactinaemic amenorrhoea who had been resistant to, or intolerant of bromocriptine were treated with pulsatile LHRH therapy. Ovulation was induced in 9 of 12 treatment cycles. In one patient hyperstimulation occured in the first cycle of treatment but subsequently she ovulated normally on a reduced dose of LHRH. The gonadotrophin and ovarian responses to treatment in ovulatory cycles were normal despite prolactin concentrations that remained elevated throughout treatment and rose still further with resumption of ovarian activity. The length of the luteal phase and the mid‐luteal serum progesterone concentrations were also normal. Pulsatile secretion of progesterone in response to LHRH pulses was observed. These data show that ovulation and normal luteal function can be induced by physiological LHRH replacement in women with persistent hyperprolactinaemia. This confirms that the mechanism of anovulation in hyperprolactinaemic amenorrhoea is disordered LHRH secretio

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1986.tb03282.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

SUMMARYIn a double‐blind placebo‐controlled study in 49 boys with cryptorchidism the effect of intranasal synthetic LHRH was studied. After 8 weeks improvement in testicular location was found in 13 testes (37%), but this improvement was considered sufficient of only six testes. Placebo resulted in an improved location in 18% of the testes. The mean change in testicular position (expressed in cm) after LHRH therapy was slightly greater than after placebo but only in the squatting position did this difference reach significance. Aggressive behaviour was reported in 23% of the children treated with LHRH. A second LHRH course did not result in significant improvement in any of the patients. At follow‐up reascent was frequently seen. The final results in unilateral cryptorchidism are poorer than those in bilateral cryptorchidism. LHRH therapy leads to higher plasma LH levels and a lower FSH in response to an intravenous LHRH test. In 15 boys plasma testosterone levels rose above 0.4 nmol/1. We conclude that intranasal LHRH application has a limited value for the treatment of cryptorchidism but may be suitable as a diagnostic

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1986.tb03283.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

SUMMARYThe biological response, as measured in the cytochemical bioassay, to the high circulating levels of immunoreactive parathyroid hormone (iPTH) in patients with pseudohypoparathyroidism type I (PSPI) is affected by the presence of an endogenous inhibitor. This is evidenced by the reduced recovery of the biological activity of PTH added to the plasma. Here we have used i.v. calcium infusion to inhibit the release of PTH and studied endogenous PTH bioactivity and immunoreactivity as well as the recovery of the bioactivity of added PTH in a normal subject and two patients with PSPI. In the control subject both bioactive PTH (bioPTH) and iPTH fell in response to the increased levels of plasma calcium and the recovery of the biological activity of PTH added to the plasma remained unchanged. In the PSPI patients, although the level of iPTH fell, the level of bioPTH remained unchanged. However, the level of inhibitory activity of the plasma, as determined by the recovery of added PTH, was transiently normalized in response to the rise in plasma calcium. Thus i.v. calcium infusions not only suppress the release of endogenous iPTH but also the inhibitory activity present in the plasma of PSPI patients.

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1986.tb03284.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

SUMMARYDanazol and gestrinone are both effective agents in the treatment of endometriosis. Their mechanism of action is unknown but may be related to their androgenic activity, which is at least partly dependent on increases in the proportion of testosterone which circulates unbound to plasma protein. We have quantified these increases in patients on treatment, and by experimentationin vitrohave demonstrated the relative importance of (i) the reduction of sex hormone binding globulin (SHBG) binding capacity and (ii) competition with testosterone for SHBG binding sites by the drugs and some of their metabolites. The mean SHBG binding capacity in patients treated with danazol (400 mg/d,n =7) and gestrinone (5 mg/week,n =7) fell from 66.9 and 56.4 nmol/1 to 36.1 and 28.1 nmol/1, after 1 week's treatment and to 11.1 and 7.1 nmol/1 after 4 weeks respectively. Despite the similarity between the falls in SHBG binding capacity there was a significantly greater increase in % free testosterone in plasma samples from patients treated with danazol than in those from patients treated with gestrinone at 1 week. Experimentsin vitrosuggest that this was largely due to ethisterone (a major metabolite of danazol) competing with testosterone for SHBG binding sites. After 4 weeks on treatment there was a similar, near maximal reduction in SHBG binding of testosterone in both treatment groups. At the low levels of SHBG binding capacity reached by this time the extra effect of any competition for binding sites was much reduced.

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1986.tb03285.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY