摘要:

SUMMARYThe contributions of adrenergic and cholinergic mechanisms to recovery from acute hypoglycaemia induced by insulin (0·15 units/kg i.v.) were examined in eleven normal subjects, six subjects with a pre‐ganglionic sympathectomy (adrenergic denervation) and six sympathectomized subjects given atropine (combined adrenergic denervation and cholinergic blockade).Blood glucose recovery was impaired only in the sympathectomized subjects given atropine. The blood lactate response was reduced and the rise in free fatty acids was delayed in both groups of sympathectomized subjects, in whom the normal rises of plasma cyclic AMP and noradrenaline were absent. The plasma pancreatic glucagon response was appropriate to the prevailing blood glucose concentrations in all three groups. The cortisol response was impaired and the pattern of ACTH secretion was abnormal in sympathectomized subjects given atropine. Growth hormone levels were higher in both sympathectomized groups.Blood glucose homeostasis was impaired during combined adrenergic denervation and cholinergic blockade. Glucagon secretion was activated independently of vagal control. In the sympathectomized group given atropine, the rise in plasma cortisol was blunted despite a greater degree of hypoglycaemia. A blockade of central cholinergic receptors producing impaired activation of ACTH secretion at hypothalamic level may explain, at least in part, this delayed restoration of normoglycaem

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1981.tb00631.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

SUMMARYHypothalamic‐pituitary dysfunction was found in two patients with polyostotic fibrous dysplasia and leontiasis ossea. Both patients probably had McCune‐Albright syndrome with early sexual development, disfiguring craniofacial bone lesions, cutaneous hyperpigmentation and gigantism in childhood. Endocrinological studies revealed measurable plasma growth hormone throughout a 24‐h sampling period with preservation of sleep augmented rises. The mean 24‐h values were 329 and 7 ng/ml, respectively. Both their mean plasma prolactin concentrations, 385 and 45 ng/ml, and the 24‐h secretory patterns of prolactin were abnormal. One patient had an elevated mean plasma cortisol concentration of 8·5 μg/dl but the 24‐h pattern of cortisol secretion was normal. Basal plasma LH, FSH, TSH, T4 and T3 concentrations were normal but neither patient had a TSH response to TRH. Prolactin and growth hormone secretions were, however, increased after TRH. Oral glucose resulted in partial suppression of GH but an exaggerated insulin response in both patients. Post‐mortem in one patient revealed a thick calvarium with bony encasement of the pituitary gland. The pituitary and hypothalamus appeared normal on gross, light microscopic and electronmicroscopic examination. These data strongly suggest the presence of hypothalamic‐pituitary dysfunction in t

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1981.tb00632.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

SUMMARYChanges in plasma cortisol, glucose, cyclic AMP, blood leucocytes, pulse rate and body temperature were measured during and for 24 h after subtotal thyroidectomy in eight propranolol‐treated (120–160 mg per day) mild to moderate thyrotoxic patients and eight patients with a non‐toxic goitre. The results showed a similar metabolic response to surgery in the two groups without any trends towards a hypermetabolic response in the toxic group. The accumulating evidence of the safety of preoperative preparation with propranolol in patients with mild to moderate thyrotoxicosis is thus supported by our re

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1981.tb00633.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

SUMMARYPlasma cortisol and adrenocorticotrophin hormone (ACTH) profiles were estimated in twelve patients with Addison's disease following randomized oral administration of either cortisone acetate (25 mg) or hydrocortisone (20 mg) alternately, at 0900 h on consecutive days. Normal corticosteroid replacement therapy was discontinued from 1200 h on the day prior to the study period.In four patients elevated basal plasma ACTH concentrations were not suppressed to the limit of detection following the administration of either drug, and in three of these no suppression was found following the prolonged administration of pharmacological doses of dexamethasone. Diminished sensitivity of pituitary ACTH secretion to cortisol inhibition may result from chronic loss of negative feedback before and/or after diagnosis and treatment. In three patients elevated basal plasma ACTH concentrations were suppressed adequately during the administration of either drug, but in five, low basal ACTH concentrations following corticosteroid withdrawal suggested chronic inhibition of anterior pituitary corticotrophs by over‐replacement with glucocorticoid. However, further study is necessary to determine whether the estimation of ACTH profiles is a more accurate reflection of the adequacy of corticosteroid replacement than the estimation of cortisol profiles alone, and whether this estimation leads to an improvement in patient management.Hydrocortisone (20 mg) achieved higher mean cortisol levels and lower mean ACTH levels than cortisone acetate (25 mg), but either drug may be suitable for glucocorticoid replacement provided the dose is tailored to the individual need

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1981.tb00634.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

SUMMARYThe 5α‐reductase activity that mediates the transformation of testosterone to dihydrotestosterone in various anatomical sites of human beings, has been studied in different pathological conditions related to 5α‐reductase deficiency. We have studied two patients with male pseudohermaphroditism due to 5α‐reductase deficiency, four patients with the complete form of testicular feminization syndrome and four men with primary hypothyroidism. Results were compared with those obtained in seven normal men.In vivo: radioactive tracers of testosterone were administered to each subject by different routes: intravenous, oral and subcutaneous. The urinary metabolites of these labelled precursors were measured. The 5β: 5α ratios of 17‐ketosteroids (aetiocholanolone: 5α‐androsterone) and androstanediols (5β‐androstane‐3α, 17β‐diol: 5α‐androstane‐3α, 17β‐diol) were calculated in the urine recovered after each mode of administration of radioactive testosterone. When testosterone was administered subcutaneously these ratios were highly increased in one patient with male pseudohermaphroditism due to 5α‐reductase deficiency. In all the other patients, the ratios were found to be in the normal range for men. After oral administration of radioactive testosterone, both 5β: 5α ratios were very high in hypothyroid and in 5α‐reductase deficient patients. These results suggest that the defective 5α‐reductase activity observed in hypothyroid patients is only localized in the hepatic compartment. Conversely, in male pseudohermaphroditism, the 5α‐reductase defect might affect both hepatic and extra‐hepatic compartments.In vitro: the diagnosis of 5α‐reductase deficiency was confirmed in the two male pseudohermaphrodite patients after incubation with3H testosterone of skin homogenates from the external genital area. No 5α‐reduction of testosterone occurred in the two skin specimens studied. In contrast, 5α‐reductase activity was normal in genital skin from hypothyroid and testicular feminization syndrome patients. In pubic skin, 5α‐reductase activity was absent in patients with testicular feminization syndrome. It was in the normal range in homogenates from hypothyroid patients and varied in the 5α‐reductase deficient patients. Based on these data, it may be postulated that the programming of hepatic and extrahepatic 5α‐reductase enzymes is fundamentally different. In addition, the enzyme that mediates the appearance of secondary sex characteristics seems to be androgen dependent, while the 5α‐reductases present

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1981.tb00635.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

SUMMARYThirteen patients with either Addison's disease, or Cushing's disease treated by bilateral adrenalectomy, were infused with the long‐acting met‐enkephalin analogue DAMME. In patients with Addison's disease significant and pronounced falls in ACTH and N‐ and C‐terminal β‐LPH were seen; chromatography suggested that β‐endorphin fell concomitantly. Three out of four patients with Cushing's disease who had not received pituitary irradiation, also showed a decrease in plasma ACTH and N‐ and C‐terminal β‐LPH; however, no change was seen in any of the irradiated patients. The changes were naloxone reversible. The levels of plasma met‐enkephalin were normal and did not change after DAMME in any group of patients. These results are interpreted as suggesting that there are inhibitory opiate receptors controlling the release of ACTH,

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1981.tb00636.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

SUMMARYThe role of dopamine in starvation ketonaemia was investigated in male Wistar rats by administration of a specific dopamine receptor antagonist, metoclopramide (4 mg.kg−1.24h−1), or placebo, intragastrically during a 48‐h fast. Starvation alone caused a fall in blood glucose and gluconeogenic precursor concentrations, which was unaffected by metoclopramide administration. Circulating 3‐hydroxybutyrate and acetoacetate levels rose with fasting alone but metoclopramide impaired this ketonaemic response. After 48‐h starvation, total ketone body concentrations (mean±SEM) were 2·28 ± 0·19 mmol/l with metoclopramide therapy, 3·49 ± 0·21 mmol/l with placebo,P<0·001. Plasma non‐esterified fatty acid levels were similar in metoclopramide‐ and placebo‐treated animals, as were circulating concentrations of insulin, glucagon and growth hormone. Metoclopramide thus decreased the ketonaemic response to starvation without an apparent change in lipolysis or circulating hormone levels, suggesting a direct role for dopamine in production o

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1981.tb00637.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

SUMMARYTwo patients presenting with diabetes mellitus and hypokalaemia resulting from markedly increased ACTH and cortisol secretion are described. Neither patient showed any evidence of a tumour and both responded dramatically to treatment with metyrapone in that all abnormal clinical features disappeared, ACTH concentrations returned to normal and both patients showed prolonged remission after metyrapone treatment was stopped. One patient relapsed after a severe viral illness and the administration of dexamethasone and cortisone. It is suggested that these cases may represent an unusual form of Cushing's syndrome in which ACTH secretion is stimulated by increasing concentrations of cortisol. When these are reduced by metyrapone administration ACTH secretion falls in parallel and prolonged remission of disease may result.

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1981.tb00638.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

SUMMARYSixty‐three male (XY) patients attending a subfertility clinic with average sperm density under 40 million/ml were studied by testicular biopsy and multiple basal estimations of plasma LH, FSH, testosterone as well as LHRH (50 μg i.v.) stimulation. A further forty patients with similar sperm densities also had testicular biopsy but only single estimations of the three hormones. A single basal FSH was found to be the best discriminator of testicular histologies. Patients with testicular biopsies showing germ cell aplasia in some or all seminiferous tubules (grades 3 and 4) had significantly higher basal FSH than those with hypospermatogenesis, germ cell arrest or normal appearance (grades 1 and 2). Basal FSH also showed a linear trend rising with decreasing sperm density but only rose above the normal range when sperm densities fell below 1 million/ml. When basal FSH, testicular histology and sperm density were considered together in the whole group (n= 100), high levels of FSH accurately indicated the presence of germ cell aplasia in some or all seminiferous tubules in azoo‐ and oligospermic men with sperm density under 5 million/ml. Normal FSH and azoospermia is diagnostic of obstruction in the excurrent ducts, and further investigation is undertaken if surgical correction of the obstruction is contemplated. Hormone estimations are not helpful in oligospermic patients with average sperm density over 5 million/ml. On the basis of these findings it is suggested that there is little place for the LHRH test in the routine assessment of male subfertility. Testicular biopsy is indicated only in oligospermic patients with average sperm density under 5 million/ml and normal basal

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1981.tb00639.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

SUMMARYIn a study of fifty‐two patients with Graves' disease followed for 1 year after stopping antithyroid drugs, a strong relationship has been found between serum LATS‐P and relapse. In those with serum LATS‐P activity on stopping therapy, twenty‐one (88%) out of twenty‐four relapsed. In those with no LATS‐P activity on stopping antithyroid drugs only eight (29%) out of twenty‐eight relapsed and in five LATS‐P was detectable at relapse. The overall prevalence of positive assays for LATS‐P at relapse (90%) was similar to that seen in untreate

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1981.tb00640.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY