ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1993.tb00337.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1993.tb00338.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryOBJECTIVE Hypothyroidism is a common disorder and while the association of overt hypothyroidism with hyper‐cholesterolaemia is clear, the effect upon lipids of the minor abnormalities of thyroid function often found in those receiving T4 replacement therapy is unclear. The aim of the present studies was to define in those with hypothyroidism the effect upon circulating lipids of subtle changes in thyroid status, indicated by serum TSH values below or above the normal range.DESIGN (i) Prospective study of short‐term T4 treatment of those with subclinical hypothyroidism, (ii) Cross‐sectional study of long‐term T4 treatment, comparing non‐T4 treated controls and T4 treated patients with serum TSH values either below or within the normal range. PATIENTS Short‐term T4 therapy was examined in 11 post‐menopausal females with subclinical hypothyroidism (high TSH, normal free T4) studied before therapy and 6 weeks after T4 at incremental doses (50, 100, 150 μg/ day). Long‐term T4 treatment for hypothyroidism was investigated in 105 females on therapy for at least 1 year compared with 105 controls matched for age and menopausal status.MEASUREMENTS Fasting levels of total cholesterol, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol and HDL subtractions were determined in patients and controls.RESULTS (i) T4 treatment of subjects with subclinical hypothyroidism resulted in reductions in total and LDL cholesterol with increasing T4 dose (P<0 001). Comparison of lipid results pretreatment with those when TSH was restored to normal revealed no significant difference in lipids; in contrast, comparison of lipids in those with normal TSH compared with the same subjects when TSH was suppressed revealed reductions in total and LDL cholesterol, (ii) Long‐term T4 treatment was associated with a reduction in total and LDL cholesterol measurements in those over 55 years receiving suppressive doses of T4 but no significant difference in lipids in those with normal serum TSH compared with non‐T4 treated controls.CONCLUSION Effects of T4 upon lipid measurements suggest that patients with subclinical hypothyroidism should receive replacement therapy. Doses of T4 which suppress TSH to below normal may have a more significant influence upon lipids than doses of T4 which restore TSH

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1993.tb00339.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1993.tb00340.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Summaryobjective We assessed the ability of desmopressin to stimulate the pituitary‐adrenal axis in patients with Cushing's syndrome.DESIGN AND SUBJECTS The Cortisol response to 5 or 10 fig of intravenous desmopressin was evaluated in 31 patients with Cushing's syndrome of several aetiologies and in 15 normal subjects.RESULTS Cortisol responses were observed in 15 out of 16 patients with pituitary dependence and in two patients with adrenal nodular hyperplasia, the increase above baseline ranging from 61 to 379% in the responders. Eight patients with adrenal tumours and one with the ectopic ACTH syndrome did not respond to desmopressin, having shown changes In their Cortisol levels from ‐5 to 42% above baseline. Responses occurred in two out of the 15 normal Individuals, whose Cortisol increased 58 and 69% above baseline, respectively. Stimulation tests with standard agents as lysine vasopressin or ovine corticotrophin‐releasing hormone were performed in the same patients and there was a high degree of concordance. No serious adverse reactions were observed in the tests with desmopressin.CONCLUSIONS Desmopressin was able to stimulate the pituitary‐adrenal axis in patients with Cushing's disease and, like corticotrophin releasing hormone, it may prove useful in the differential diagnosis of Cushing's s

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1993.tb00341.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryOBJECTIVE To induce testicular growth including spermatogenesis, 38 patients with hypogonadotrophic hypogonadism were treated with long‐term pulsatile GnRH administration.PATIENTS The group of patients comprised 17 individuals with idiopathic hypogonadotrophic hypogonadism, 11 with Kallmann's syndrome, four with multiple pituitary hormone deficiencies and six with a secondary hypogonadotrophic hypogonadism due to surgical removal of a brain tumour. Thirteen patients (seven with idiopathic hypogonadotrophic hypogonadism and six with Kalmann's syndrome) had undescended testes, of whom six had undergone surgery on both testes and four on one testis. Sixteen of the 17 had previously received androgen therapy and six others had received gonadotrophin treatment, of whom three had long‐term treatment to induce testicular development, without success.TREATMENT GnRH was administered intravenously in a dose of 2‐20 μg per pulse every 90 minutes. After GnRH discontinuation, hCG treatment was instituted, 1500–3000 III (i.m.) twice weekly.RESULTS During treatment plasma levels of LH, FSH and testosterone increased. In 35 out of the 38 patients plasma testosterone levels increased into the normal adult range. In all patients testicular volume increased. Mean pretreatment testicular volume per patient group ranged from 2 4 to 4.8 ml and increased to 11.5–18.1 ml by the end of treatment. There was a significant difference in the achieved testicular volumes between the patients with Kallmann's syndrome and the brain tumour patients.GnRH treatment mean lasted between 46 and 75 weeks In the different groups. On hCG therapy, testicular development was either maintained or improved. Semen analysis revealed the presence of spermatogenesis in 31 out of the 38 patients (26 patients already on GnRH, and in another five patients on hCG therapy). All three patients pretreated with gonadotrophins as well as three patients with bilateral testicular surgery developed a detectable sperm count. In 19 adolescent patients with growth potential, an adequate height velocity was observed during GnRH treatment.CONCLUSIONS GnRH is a feasible way to induce testicular growth as well as spermatogenesis In hypogonadotrophic male patients, even in patients in whom gonadotrophin treatment has failed. After GnRH treatment, hCG alone can maintain or even improve testicular development, including spermatogenesis. GnRH treatment may also induce a physiological growth spurt In hypogonadotrophic a

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1993.tb00342.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryOBJECTIVE We Investigated the effect of chronic physiological concentrations of oestradiol on the bioactivity (B) and immunoactivity (I) of LH in serum using radioimmunoassay (RIA) and a sensitive Immunoradlometrlc (IRMA) assay.DESIGN Twelve post‐menopausal, hysterectomized women received a 50‐mg subcutaneous E2 Implant, in the absence of progestogen treatment. Pretreatment serum samples were obtained on two occasions for measurement of E2and FSH by radioimmunoassay and for measurement of LH by bioassay (BIO), immunoradio‐metric assay and radioimmunoassay. Further serum samples were obtained monthly for 6 months for assay as above.RESULTS The serum E2level (basal levels<70 pmol/l) rose following implant (P<0.01) peaking at 1 month (mean 454, range 356–580 pmol/l) and remaining within premenopausal physiological levels for 6 months. There were falls in FSH, LH‐RIA, LH‐IRMA and LH‐BIO (P<0.001). There was no change in the B:I ratio for B:I‐RIA or B:I‐IRMA for LH which were 1.8 and 3.3, respectively pretreatment and 1.7 and 2.9 after 1 month's treatment.CONCLUSION The treatment of post‐menopausal women with 50‐mg E2subcutaneous implants produces physiological premenopausal E2levels for at least 6 months. There is no change In the B:I ratio of LH using either the RIA or IRMA during

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1993.tb00343.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryOBJECTIVE We examined the gonadotrophin secretion in patients with increased plasma concentrations of testosterone and oestradiol due to hCG‐producing tumours.DESIGN Comparison of plasma gonadotrophin concentrations before and after stimulation by GnRH, in eight men with hCG‐producing tumours resulting in Increased testosterone and oestradiol plasma levels, and In 29 men with Leydig cell tumours resulting in increased oestradiol and normal to low testosterone plasma levels.PATIENTS Eight men with hCG‐producing tumours (six with testicular tumours, two with extratesticular tumours), 29 men with Leydig cell tumours and 15 normal men. The six men with germinal cell tumours of the testis were studied before and after unilateral orchidectomy.MEASUREMENTS Plasma concentrations of hCG, testosterone and oestradiol were measured before and after intramuscular injection of hCG. LH and FSH were measured before and after intravenous Injection of 100 μg GnRH.RESULTS Plasma LH and FSH concentrations were low In patients with germ cell tumours, who exhibited increased plasma testosterone and oestradiol concentrations, and were normal in patients with Leydig cell tumours, in whom oestradiol only was increased. Plasma LH and FSH were normalized in the five patients with successful (e.g. normal hCG, testosterone and oestradiol) unilateral orchldectomy. Basal plasma testosterone concentrations correlated positively (P<001) with plasma oestradiol concentrations in patients with germ cell tumours and negatively (P<0 01) in patients with Leydig cell tumours.CONCLUSIONS In patients with hCG‐secreting germ cell tumours complete suppression of plasma LH and FSH with increased plasma concentrations of both testosterone and oestradiol are often discovered. No such gonadotrophin suppression is found In patients with Leydig cell tumours, but the negative correlation observed between plasma testosterone and oestradiol in these patients suggests a weak negative feedback effect of oestradiol on LH secretion, which cannot be demonstrated by basal LH measurements i

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1993.tb00344.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryOBJECTIVE We evaluated the presence of anti‐pituitary hormone autoantibodies (APHA) in patients with primary empty sella syndrome and pituitary tumours and examined the correlation of positive antibodies with the hormonal deficiencies.DESIGN Case‐control, retrospective study.PATIENTS Eleven patients were identified with primary empty sella syndrome or a pituitary tumour by magnetic resonance imaging or computed tomography scanning. Six healthy, normal subjects without evidence of a pituitary problem served as the control group.MEASUREMENTS Anti‐pituitary hormone autoantibodies against purified pituitary hormones were measured in ail subjects utilizing an immunoblotting technique. All patients with pituitary disease had their medical records reviewed for any hormonal evaluation.RESULTS All of the normal subjects were negative for antipituitary hormone antibodies. Forty‐five per cent of patients with pituitary disease (pituitary tumours or primary empty sella syndrome) had positive antipituitary hormone antibodies. Of the five patients with positive antipituitary hormone antibodies, anti‐ACTH antibodies were the most common (5/5) followed by anti‐TSH and anti‐GH antibodies (2/5 for each). The hormonal deficiencies failed to correspond with the antipituitary hormone antibodies. Anti‐ACTH antibody had a sensitivity of 50% with a specificity of 56%. The anti‐TSH antibody yielded a sensitivity of 67% with a specificity of 100%. The anti‐FSH/ LH antibody reported a 0% sensitivity.CONCLUSIONS Detection of antipituitary hormone antibody was unable to discriminate between empty sella syndrome and pituitary tumours. The presence of these antipituitary hormone antibodies were neither specific for, nor predictive of, the end

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1993.tb00345.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryOBJECTIVE A number of neoplasms are known to express somatostatin receptors; the use of somatostatin receptor imaging in their localization has recently been described, but the resolution and discrimination of the isotopes used remains sub‐optimal. We have looked at the use of a new” In‐labelled analogue of somatostatin, pentatreotide, in the visualization and functional characterization of a number of neoplastic conditions.PATIENTS Thirteen patients with proven neoplasms were scanned using this agent. Planar and single‐photon‐emission computerized tomographic (SPECT) images of the relevant part of the body were obtained using a gamma‐camera at 10 minutes and 4 and 21 hours after injection of the radiopharmaceutical. In six patients (three carcinoid, three insulinomas) scanning was also performed using123l‐Tyr‐3‐octreotide.RESULTS Primary tumours or metastases were visualized in six of the seven patients with neuroendocrine tumours, and three of six patients with insulinoma. One patient with an insulinoma who had a positive scan showed absent uptake when rescanned after tumour removal. A rise In blood glucose (more than twice basal) in response to octreotide was seen only in those insulinoma patients with positive scans. In cases where both111ln‐pentatreotide and123l‐Tyr‐3‐octreotide scans were performed, both radiopharmaceuticals identified the same 4/ 6 tumours; however, tumour definition (reflecting high tumour to background ratio) was better with pentatreotide on the 21‐hour images with minimum biliary and gut activity, allowing better resolution of the tumour image.CONCLUSION It appears that111ln‐pentatreotide scintigraphy is a rapid and safe procedure for the visualization of neuroendocrine tumours possessing somatostatin binding sites. A positive scan may be predictive of neuroendocrine responsiveness to octreotide therapy. In addition, it also appears that1” In‐pentatreotide has superior kinetics compared to123I‐Tyr‐3‐octreotide, typically achieving more satisfactory tumour to background ratios, and may thus be more useful i

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1993.tb00346.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY