摘要:

SUMMARYRadioimmunoassays of two unconjugated reduced metabolites of aldosterone were developed. Excretion rates of unconjugated 5β‐dihydroaldosterone (5β‐DHAld) and 3α,5β‐tetrahydroaldosterone (3α,5β‐THAld) were measured in 192 hypertensive patients and 16 normal subjects and results were compared with urinary tetrahydroaldosterone‐glucuronide(TH‐Aldo‐glu), aldosterone‐18‐glucuronide (Aldo‐18‐glu) and ‘free’ aldosterone. Generally, values of unconjugated reduced metabolites correlated with one another but in some cases were exceptionally elevated indicating alteration of urinary bacterial flora or impairment of the enzymatic system regulating the conjugation reaction. We suggest that in those cases of hypertension and suspected primary aldosteronism when aldosterone‐18‐glucuronide and tetrahydroaldosterone glucuronide values remain within normal range, determination of the free metabolite fra

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1985.tb01074.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

SUMMARYA patient is described with malignancy, hypercalcaemia and radiological evidence of severe parathyroid bone disease but undetectable concentrations of circulating immunoreactive PTH. Autopsy showed the tumour to be a metastatic bronchial carcinoid with no evidence of primary parathyroid disease. Extracts of the tumour had no PTH immunoreactivity but had high concentrations of a substance with identical activity to PTH in a cytochemical bioassay. The biological activity of the extract was not inhibited by PTH antibodies but was inhibited by an antagonist to PTH bioactivity.

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1985.tb01075.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

SUMMARYSevere pituitary Cushing's disease of sudden onset after 18 years of unsuccessful treatment for a previously non‐functioning chromophobe adenoma is described in a middle‐aged woman. Initial presentation with symptoms of optic nerve compression had been preceded by two years of amenorrhoea. Transfrontal resection of a chromophobe adenoma followed by radiotherapy, performed both at this time and again after a recurrence eight years later, failed to eradicate the tumour. Ten more years elapsed before she rapidly developed florid features of Cushing's syndrome. Plasma ACTH levels were markedly elevated and were only partially reduced by further transfrontal surgery, complete removal of the tumour proving impossible. Subsequent bilateral adrenalcctomy was performed to control her hypercortisolism and a course of cytotoxic chemotherapy was administered in an attempt to treat the tumour recurrence. Immunocyto‐chemical staining of tumour obtained at surgery demonstrated ACTH immunoreactivity both before and after the development of Cushing's disease. Although silent corticotrophic adenomas of the human pituitary, including chromophobic tumours, have been previously described, this is the first report of such a tumour becoming functional, sufficient to cause clinically evident Cushing's di

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1985.tb01076.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

SUMMARYWe have employed a syngeneic system utilizing thyroid cell monolayers initiated following thyroid surgery co‐cultured with autologous T cells to demonstrate T cell autosensitization in patients with GRAVES' disease. Antigen‐induced blasto‐genesis was monitored using 24 h [3H]thymidine uptake. Control experiments with 5 d cultured normal human thyroid cells from tissue around benign adenomata showed no evidence of syngeneic T cell autosensitization. Human thyroid cells alone were unable to incorporate [3H]thymidine in the presence of bTSH. In three of four experiments with GRAVES' thyroid cells there was significant induction of autologous T cell blastogenesis with a mean stimulation index of 220%. In parallel experiments we explored the non‐specific helper and suppressor T cell function of these and similar patients with GRAVES' disease. In normal controls (n= 6) increasing numbers of T cells added to a constant number of B cells (consisting of a T cell depleted peripheral mononuclear cell preparation) showed a marked helper effect measured as increasing IgG secretion. As the ratio of T:B cells increased above 4:1 there was a suppression of IgG secretion. One of two hyperthyroid GRAVES' patients was observed to have deficient T cell function as demonstrated by lack of IgG suppression. The remaining five patients (all but one of whom were euthyroid at the time of testing) had results similar to the controls indicating normal suppressor T cell function in this disease. Such data showed that patients with GRAVES' disease possessed circulating T cells which exhibited autosensitization to syngeneic thyroid cell surface antigens, a phenomenon not demonstrable in control individuals. Furthermore, this specific T cell autosensitization did not interfere with non‐specific T cell function as judged by its influence on IgG

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1985.tb01077.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

SUMMARYEight patients who had received megavoltage therapy for Cushing's disease 5–12 years previously have been reviewed. The long term response to this therapy was assessed with respect to efficacy of treatment in inducing continued remission and disturbance of hypothalamic‐pituitary function. One patient showed clear evidence of relapse of Cushing's disease. One patient had unequivocal hypopituitarism. Basal levels of growth hormone (GH), TSH, LH, and FSH were not statistically different from controls, but provocative testing revealed significant abnormalities of response of cortisol/ACTH, GH, prolactin and LH. Six out of eight patients had absent diurnal cortisol variation and five patients had elevated serum prolactin levels. Thus, in this group of patients normal pituitary‐adrenal function has not been satisfactorily restored. It is clear that significant disturbances of hypothalamic‐pituitary function follow mega‐voltage therapy and these may progress to overt hypopi

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1985.tb01078.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

SUMMARYA total of 1036 nursing mothers were investigated for their nursing behaviour, status of nutrition and menstrual cycle, serum prolactin and progesterone; 61 in Sweden, 457 in an urban area of Zaïre (Bukavu, Kivu) and 518 in a rural area of the same region (Kabare, Kivu). Lactational hyperprolactinaemia is influenced by the frequency but not by the duration of suckling. The return of luteinization of follicles, but not that of menstrual bleeding, was inversely related to the degree of lactational hyperprolactinaemia. Significant luteinization took place in only some 10% of the mothers during the first three months of lactation in Sweden and within the first year in Zaïre. In these mothers with luteinized follicles the average progesterone was only slightly above 1·0 ng/ml indicating poor luteinization. Lactational hyperprolactinaemia, the return of menstruation and luteinization during lactation were not related to the nutritional status as evaluated by the body weight indices and serum albumin. However, suckling and hyperprolactinaemia do not appear to be the only factors involved in the control of fertility during lactation. When serum prolactin levels were equally low, i.e. below 500 μU/ml, twice the number of lactating mothers with signs of luteinization were found in the urban than in the rural population of Za

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1985.tb01079.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

SUMMARYThe effect of a new dopamine agonist, CU 32‐085 (8α‐amino‐ergoline), on pituitary function in acromegaly was evaluated by a controlled, single blind study of 12 acromegalics. The study included a single dose placebo/drug (0·5 mg CU 32‐085) trial and a long‐term crossover trial with 3 month periods (placebo/CU 32‐085 8 mg daily). The patients were evaluated clinically and biochemically (oral glucose tolerance (OGTT), TRH‐ and LHRH‐tests) before and after each 3 month period. Nine patients completed this long‐term trial; one died from myocardial infarction during the placebo period, and two dropped out because of side effects. The release of GH, judged from more than 9 h suppression of serum GH following the single dose, and from the response to OGTT after the long‐term treatment, was significantly inhibited by CU 32‐085. Serum GH reached normal values in 4 of 9 patients. Serum PRL was also markedly suppressed, to subnormal values after the 3 months in all but one hyperprolactinemic patient. Serum TSH, cortisol, FSH and LH were generally unaffected. Glucose tolerance was not significantly altered, although an improvement was found in six of nine patients. A semiquantitative evaluation of subjective symptoms showed a significant improvement following the long‐term treatment, while objective signs of acromegaly were unaffected. The blood pressure was slightly lowered, both after a single dose and after 3 months' treatment. Seven patients experienced nausea and dizziness, two of them with vomiting, after a single dose of the drug. Four of these had similar symptoms initially during the long‐term treatment, which forced two to interrupt the trial. We conclude that CU 32‐085 caused a marked suppression of the release of GH and PRL and an improvement of the major symptoms of acromegaly, a therapeutic effect that is comparable to the previous

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1985.tb01080.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

SUMMARYAs in laboratory animals, long‐term oestrogen treatment in the human male might induce prolactinomas. We here report on PRL levels in 142 male‐to‐female transsexuals, treated with 100 mg cyproterone acetate and 100 μg ethinyloestradiol per day for 6–108 months (median 52). PRL levels varied markedly between individuals. No relation with age and length of treatment period was found. In 42 subjects in whom PRL levels were followed serially, a slight fall was measured after 12–15 months of treatment. Galactorrhoea, present in 10 of 142 subjects, was unrelated to PRL levels. In 34 subjects in whom PRL levels were measured during treatment and 3 weeks after withdrawal, PRL levels fell significantly. Dopamine in doses of 0·1 μg/kg/min and 1·0 μg/kg/min was administered to six subjects with PRL levels>1000 mU/l and six subjects with PRL levels1000 mU/l than in those with PRL<500 mU/l possibly indicating a loss of control of central dopaminergic regulation. These findings suggest that the risk of inducing prolactinomas through cross‐gender hormone treatment is li

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1985.tb01081.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

SUMMARYThirty‐one patients with active acromegaly were treated with 10–20 mg bromocriptine daily for a period of 6–9 months. The clinical response was evaluated both by a subjective ‘score of symptoms’, and by a combined subjective and objective ‘clinical and metabolic improvement score’(c‐m score). The biochemical response was evaluated both by measurement of the mean of four plasma growth hormone (GH) determinations during the day and by measurement of plasma somatomedin‐C (Sm‐C) concentration. The clinical response as assessed by both methods showed a better correlation with changes in plasma GH levels (respectivelyr= 0·33;r= 0·50) than with changes in Sm‐C levels (r= 0·20;r= 0·36). The study confirms that in some patients clinical improvement is not accompanied by a decrease of plasma GH concentration. However, it is not possible to identify a subgroup of patients who showed clinical improvement with a decrease of Sm‐C levels, but whose plasma GH levels remained constant. It is concluded that measurement of plasma GH levels still appears to be the most useful biochemical assessment of disease activity in bromo

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1985.tb01082.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

SUMMARYThe endocrine effects of low dose (62·5 mg, twice a day) aminoglutethimide (AG), without hydrocortisone (HC), escalating at monthly intervals to a conventional dose of AG (500 mg twice a day) combined with HC, were studied in 33 postmenopausal breast cancer patients. Pretreatment serum concentrations of oestrone (E1) and oestradiol (E2) were significantly suppressed by 62·5 mg of AG twice a day. Although further suppression of E1 appeared to occur with 125 mg of AG twice a day, this was not statistically significant. For E1 and E2, higher doses of AG or combined AG and HC failed to cause further significant suppression compared with that obtained at 125 mg of AG twice a day. Significant rises in serum androstenedione were found with all doses of AG alone, although pretreatment concentrations of androstenedione were not significantly altered by combined AG and HC treatment. Mean pretreatment concentrations of dehydroepiandrosterone sulphate (DHA‐S) were significantly suppressed by 62·5 mg of AG twice a day and further marked suppression occurred on combined AG and HC therapy. Serum cortisol, aldosterone and plasma ACTH concentrations showed no significant alterations throughout treatment. Aminoglutethimide is as effective at 125 mg twice a day without HC in its suppression of oestrogen levels as at 500 mg twice a day with HC, and its use in this form warrants clinical evalua

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1985.tb01083.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY