摘要:

SUMMARYWe have previously reported thatl‐thyroxine treated patients may often have elevated serum T4 concentrations and yet show no clinical signs of hyperthyroidism. We found that such patients had normal serum T3 concentrations. The present study explored the relationship between serum T3 and T4 and dosage ofl‐thyroxine. Retrospective analysis of 99 patient records was performed. There was an increase of serum T4, serum T3 resin uptake (T3R), and T3 with increasing dose ofl‐thyroxine. The T3/T4 ratio decreased with increasing dose ofl‐thyroxine and with increasing T4. This phenomenon was analysed prospectively by starting 23 individuals onl‐thyroxine and progressively incrementing the dose until either symptoms of hyperthyroidism developed or T4 levels exceeded the upper unit of the normal range. Once again, there was a progressive increase in serum T4, T3R, and T3 with increasing dose ofl‐thyroxine. At even the lowest dose ofl‐thyroxine (0.05 mg), there was a marked fall in T3/T4 ratio as compared to untreated individuals. The T3/T4 ratio fell further with increasing dose but with a fairly weak correlation. The decrease in T3/T4 ratio showed a much stronger correlation with serum T4. Of the 23 individuals, all exceeded the upper limit of the normal range of serum T4. No individual with elevated T4 developed clinical signs of hyperthyroidism unless serum T3 was also elevated beyond the normal range. Of eight individuals who reached elevated T3 levels, six demonstrated clinical signs of hyperthyroidism. We conclude thatl‐thyroxine treated individuals may show elevated T4 levels and yet be clinically euthyroid as a consequence of a relative decrease in T3 levels. Serum T3 appears to be the most reliable indicator of possible hyperthyroidism inl‐thyroxine

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1985.tb00159.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

SUMMARYFour children with 11bT‐hydroxysteroid dehydrogenase deficiency are described. All patients had severe hypertension, hypokalaemia, and low plasma aldosterone and renin activities. Two of the patients were siblings and two were unrelated. The most noticeable biochemical feature of these individuals was the extremely low excretion of cortisol metabolites containing an 11‐carbonyl group compared to the excretion of the 11β‐hydroxyl containing metabolites. Although this condition is readily diagnosed in affected individuals by urinary steroid analysis, carriers of the defect do not differ from normal in their urinary steroids. Both parents of the affected siblings had normal 11‐oxo‐steroid/11bT‐hydroxysteroid ratios under baseline conditions and the lesions could not be revealed by ACTH ad

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1985.tb00160.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

SUMMARYThe obstructive sleep apnoea syndrome occurs predominantly in men. To determine the effect of testosterone on ventilatory function and whether testosterone may play a role in the development of obstructive apnoea, we performed waking ventilatory drive studies and sleep studies in five hypogonadal men. These androgen‐deficient subjects were studied both while receiving no treatment and after six weeks of testosterone replacement therapy (testosterone oenanthate 200 mg i.m. every 2 weeks). Hypoxic ventilatory drive decreased significantly, from 158 · 39 (mean · SEM) off testosterone to 88 · 19 on testosterone therapy (P<0.05). Hypercapnoeic ventilatory drive did not change significantly on testosterone. Obstructive sleep apnoea developed in one man and markedly worsened in another man in association with testosterone administration. Both of these subjects also exhibited marked decreases in oxygen saturation with the development of cardiac dysrhythmias during sleep and large increases in haematocrit. The remaining three hypogonadal men did not demonstrate significant sleep apnoea either on or off testosterone. The percentage of sleep time spent in REM sleep increased from 14 · 3% to 22 · 2% when the men were receiving testosterone (P<0.01), but the episodes of sleep apnoea tended to occur during non‐REM sleep. We conclude that in some hypogonadal men, replacement dosages of testosterone may affect ventilatory drives and induce or worsen obstructive sleep apnoea. The obstructive sleep apnoea syndrome is a potential complication of testosterone therapy. These results suggest that androgen levels present in normal man may play an important role in the pathogenesis of obstructive slee

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1985.tb00161.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

SUMMARYIn an attempt to obtain further information on the aetiology of premenstrual syndrome (PMS), the endocrine changes following enucleation of the corpus luteum in the mid‐luteal phase of the cycle were studied in seven patients with PMS, and the results compared to details of seven control patients undergoing hysterectomy for menstrual problems. In the luteal phase, before surgery, the concentration of progesterone and FSH was lower, while that of oestradiol was slightly higher, in women with PMS. Following enucleation of the corpus luteum, follicular development and ovulation recommenced more slowly in women with PMS compared to controls (time to ovulation: 21 (range 18–24, vs 19(14–20) d,P<0.01). During the follicular phase there was no difference between the two groups in the concentration of oestradiol. The rise in concentration of FSH following enucleation was delayed in patients with PMS, and the serum FSH concentration was significantly lower during the late follicular phase of the cycle, but not during the mid follicular phase. The results suggest that these women with PMS have a more sensitive ‘feed‐back’ than the controls, resulting in a lower preovulatory FSH level even though the oestradiol levels were not different. The results also suggest that the abnormalities described during the preoperative luteal phase are associated with the delay in the initi

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1985.tb00162.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

SUMMARYThe effect of cholinergic blockade on growth hormone (GH) and prolactin (PRL) secretion during insulin‐induced hypoglycaemia was assessed in six normal male volunteers (mean age 23, age range 21–25). Each subject underwent two insulin tolerance tests with and without atropine. GH responses were significantly lower 45 min after insulin administration with atropine (17.5 · 2.5 mU/l (mean · SEM) than with placebo (37.6 · 3.6 mU/l,P<0.0006). In contrast PRL responses were higher (P<0.01) at 45 and 90 min after insulin during treatment with atropine. These data demonstrate that cholinergic mechanisms are involved in stimulatory and inhibitory pathways in the medication of the respective GH and PRL responses to insulin induced hypoglycaemia

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1985.tb00163.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

SUMMARYWe have examined for the presence of subtle hormonal abnormalites in women with long‐standing unexplained infertility. For a full cycle serum LH, FSH, progesterone and oestradiol levels were measured about three times a week, and serial ultrasound scans of the ovaries made until the time of apparent ovulation. The results on 45 cycles in 35 women with unexplained infertility and in three normal volunteers are presented. Normal ovulatory cycles were defined by a length of 26–32 d, and progressive follicular maturation followed by disappearance or abrupt reduction in size of a follicle within 48 h of the recorded LH peak, followed by progressive and sustained rise in serum progesterone levels to more than 25 nmol/l and a luteal phase length of ≥ 13 d. Thirty spontaneous cycles (28 women) were clearly normal while 15 spontaneous cycles (12 women) were abnormal. Abnormalities included luteinization of an unruptured follicle (eight cycles), absence of follicular development (two cycles), poor follicular development (two cycles), persistence of a large ovarian cyst from the preceeding cycle (two cycles) and one aluteal cycle. Six of the abnormal cycles were characterized hormonally by inappropriate elevation of serum LH levels throughout. If this study had been based only on serial ultrasound scans, all results on abnormal cycles might have been misinterpreted. If it had been conducted only with (multiple) progesterone determinations and the level of>25 nmol/l had been taken as indicative of ovulation nine clearly abnormal cycles would have been considered as normal. We conclude that the combination of the hormonal and ultrasound assessment of ovulation increases our confidence for confirmation of normality and reveals various ovulatory disorders which are possibly due to an endocrinological defect or de

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1985.tb00164.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

SUMMARYPubertal development preceding menarche in normal girls having menarche at a relatively early age (11.3–12.9 years) was compared with the development of girls having menarche later (13.0–14.9 years of age). Eighty‐four premenarcheal girls, 7.3–14.3 years old, were examined and their age at menarche was recorded during this longitudinal study. Girls with early menarche had a larger increase in serum oestradiol at about 10 years of chronological age, and after that age the concentrations remained higher than in girls having later menarche. Serum FSH concentrations tended to be slightly higher at the onset of puberty in the former group, even before differences in serum oestradiol concentrations were observed. Pubertal development was faster in girls having early menarche, as indicated by the significantly shorter time from both breast and pubic hair stage 2 to menarche. This rapid sequence can be related to the higher oestradiol levels. A dissociation between gonadarche and adrenarche was evident. The oestradiol/dehydroepiandrosterone (DHEA) ratio was higher in girls developing early menarche. Around the onset of puberty (9.0–11.5 years of age) there was a complete lack of correlation between serum DHEA concentrations and age at menarche, whereas serum FSH and oestradiol concentrations displayed strong correlations with age at menarche. The present data support the view that girls with early menarche have a more profound decrease in the sensitivity of the hypothalamic‐pituitary unit to the negative feed‐back of circula

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1985.tb00165.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

SUMMARYThe ACTH and cortisol responses to an intravenous bolus injection of 100 μg ovine CRF were studied in 19 patients with adrenal failure. In all eight patients with primary adrenal failure, plasma ACTH levels increased from a mean basal level of 1494·431 (SEM) pg/ml to a peak value of 2601±220 pg/ml at 10 min. In comparison with healthy subjects absolute ACTH increments after ovine CRF were significantly augmented in the patients with Addison's disease (P*>0.001), and the absolute ACTH responses after ovine CRF were positively correlated with the basal plasma ACTH levels. The 11 patients with secondary adrenal insufficiency could be subdivided into two groups: (A) those having little or no ACTH and cortisol response to ovine CRF (five patients) and (B) those having prolonged and pronounced ACTH responses with a biphasic pattern and a delayed second peak (six patients), followed in all patients by a marked cortisol increase. These data demonstrate that the CRF‐test can discriminate between hypothalamic and pituitary causes of secondary adrenal fai

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1985.tb00166.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1985.tb00167.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

SUMMARYA family with nine siblings in which three siblings have been shown to have dexamethasone‐suppressible hyperaldosteronism was studied. All three showed no significant changes of plasma aldosterone during angiotensin II infusion at incremental rates under baseline conditions. After dexamethasone administration (2 mg/d for 4 weeks) plasma renin activity (PRA) rose to normal‐supranormal range, while plasma and urinary aldosterone were maintained at low‐normal levels. No restoration of aldosterone response to angiotensin II was observed on dexamethasone. Two other siblings were found to be hypertensive with normal baseline data; however, both showed plasma aldosterone hyperresponsiveness to ACTH. In the four normotensive siblings aldosterone response to ACTH was normal. The family pedigree was consistent with autosomal dominant transmission of the disorder. HLA typing showed haplotype A3 Bw35 in all five hypertensive sibs and in one normotensive. In conclusion, low aldosterone compared to PRA, and plasma aldosterone unresponsiveness to angiotensin II infusion before and during dexamethasone, show functional impairment, at least temporary, of the zona glomerulosa. These findings support the hypothesis that aldosterone may be derived from the zona fasciculata in this dis

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1985.tb00168.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY