ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1994.tb02543.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1994.tb02544.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

SummaryBACKGROUND AND OBJECTIVEAmenorrhoea in women of reproductive age causes loss of bone mineral. This study assessed the effect of treatment of amenorrhoea on bone mineral density.DESIGNSerial measurements of bone mineral density were obtained in women receiving treatment for amenorrhoea.PATIENTSEighty‐five women aged 17‐40 with a past or current history of amenorrhoea, from various causes, with median duration of 46.5 months (range 8 months‐21 years).MEASUREMENTSBone mineral density in the lumbar spine was measured by dual‐energy X‐ray absorptlometry. RESULTS initial vertebral bone mineral density was low, mean 0·85 (SD 0·10) g/cm2. After an interval of 19·6 (SD 7·5) months on treatment there was a highly significant increase to 0·89 (SD 0·10) g/cm2(P<0·0005). This was equivalent to a gain in bone mass of 21% per year (95% confidence interval 1·5–2·8%). improvement was seen in ail diagnostic groups (except polycystic ovary syndrome) and with all types of therapy. We observed no difference in the response of previously untreated patients compared with those already on treatment, nor any change in response with increasing duration of treatment. No new fractures were reported during the study. CONCLUSIONS Bone mineral density in young women with amenorrhoea is improved by appropriate treatment, but recovery is not substantial. Hence early diagnosis and therapy is essentlal

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1994.tb02545.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

SummaryOBJECTIVEThe association between thin skin and osteoporosis has been known for some years. We wished to assess a simple measure of skinfold thickness (SFT) as a screening test for osteoporosis and to study the effect of chronological and menopausal age on SFT in a group of osteoporotic women and normal controls.DESIGNA case control study of 225 consecutive women who attended an osteoporosis clinic.PATIENTSWe studied 225 women, 141 with osteoporosis (mean age 61·8 ±10·5 years) and 65 normal controls (mean age 59·9 ± 8·8 years), with 19 exclusions.METHODSEach patient had routine biochemistry, spinal X‐rays and a dual‐energy X‐ray absorptiometry (DEXA) scan of lumbar spine and femoral neck. In addition they had skinfold thickness measured by a single observer using Holtain Tanner Whitehouse callipers over the 4th metacarpal of the right hand.RESULTSMean skinfold thickness was lower in the osteoporotic group, 1·6 ± 0·4 mm compared to normals 1·8 ± 0·3 mm (P<0·0001). SFT did not decline significantly with chronological or menopausal age in the normals (correlation coefficientsr=−0·06,r=−0·09) in contrast to the osteoporotic group (correlation coefficientsr=−0·52, P<0·001;r=−0·27, P<0·0001). Subjects with a SFT of ≤ 1·5 mm had a higher probability of osteoporosis (odds ratio 3·12, 95% confidence Interval 1·58–6·14). Subjects with a SFT of ≥ 2·1 mm had a lower probability of osteoporosis (odds ratio 0·305, 95% confidence interval 0·126–0·740).CONCLUSIONOur results demonstrate a lower mean SFT in osteoporotic compared with normal women, with a negative correlation between SFT and chronological and menopausal age in osteoporotlcs, but not In normal controls. A low skinfold thickness appears to be an indicator of developing osteoporosi

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1994.tb02546.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

SummaryOBJECTIVEReduced bone mass has been reported In adult patients with insulin‐dependent diabetes mellitus but there are few data on bone density in the axial skeleton or on whole body composition In this group. The aim of this study was to determine whether whole body and regional bone mass are normal in middle‐aged women with insulin‐dependent diabetes mellitus.DESIGNTotal and regional bone mass were measured In 24 post‐menopausal women aged 43–69 years (mean 56·3) with insulin‐dependent diabetes, recruited during routine clinic attendance. Results were compared with those obtained from 24 age and weight‐matched community‐based post‐menopausal women.MEASUREMENTSWhole body bone mineral Content and bone mass in the lumbar spine and femoral neck were measured by dual energy X‐ray absorptiometry on a Lunar DPX.RESULTSWhole body bone mineral content was significantly lower in the diabetic women than in community‐based controls (P= 0·02). There was no significant difference between the two groups in whole body bone density or lumbar spine bone density. Mean bone density in the femur was lower in the patient group at all sites assessed (femoral trochanterP= 0·003, femoral neck,P= 0·057). Values for all regional bone density measurements in the diabetic women were within the Lunar reference range (mean ± 2 SD) and at all sites the mean value was close to 100% of the sex and age‐matched reference value. There was no correlation between duration or control of diabetes and bone mass at any site.CONCLUSIONSInsulin‐dependent diabetes mellitus In middle‐aged women is associated with small reductions in total body bone mineral content and in femoral bone density; the clinical Significance of these findings in terms of subsequent fracture risk remains to be established. No evidence was found In this study for a reduction in whole b

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1994.tb02547.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

SummaryOBJECTIVECalcipotriol is a vitamin D analogue which is an effective topical treatment for chronic plaque psoriasis. It has been reported to have no effect on systemic calcium homeostasis provided the manufacturer's guidelines are adhered to (maximum 100 g of calcipotriol ointment (50 μg/g) per week). However, there have been reports of hypercaicaemla in patients using topical caicipotriol even at recommended doses. The purpose of this study was to investigate the effects of topical calcipotriolin vivousing the recently developed ‘intact’ PTH assay as a more sensitive index of systemic calcium homeostasis.DESIGN AND PATIENTSSeven patients with extensive psoriasis were recruited for the study. Each patient was admitted to hospital and applied 200 g 01 calcipotrlol (50 μg/g) ointment over the first week followed by 300 g over the second week. in the third week of treatment, patients were treated with 2% crude coal tar which served as a biochemical washout phase.MEASUREMENTSSerum total adjusted calcium was measured at baseline and three times a week during the study. Twenty‐four‐hour urinary calcium excretion was measured at baseline and twice a week throughout the study. Peak (0400 h) and trough (0900 h) PTH levels were measured at baseline and at the ends of weeks 2 and 3.RESULTSSerum PTH levels were reduced in every patient after 2 weeks' treatment with caicipotriol and rose after withdrawal. Mean 0400 h PTH fell by 2·58pmolli (95% confidence interval 1·45–3·70) from 5·11 to 2·53 pmol/l (P<0·01) and mean 0900h PTH fell by 2·08 pmol/l (0·84–3·36) from 4·04 to 1·96 pmol/l (P<0·01). Mean serum and urine calcium rose during treatment with calcipotriol and fell after withdrawal. Mean adjusted total calcium rose by 0·14mmol/l (95% confidence interval 0·10–0·16) from 2·25 to 2·39 mmol/l (P<0·01). Mean 24 hour urine calcium excretion rose by 2·09 mmol/24h (0·51–3·26) from 3·40 to 5·49 mmol/24h (P<0·05). No patient developed hypercalcaemia at any stage of the study although hypercalciuria was recorded transiently in three patients.CONCLUSIONTopical calcipotriol is likely to have a dose depende

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1994.tb02548.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

SummaryOBJECTIVENo satisfactory treatment for adrenocortical carcinoma (ACC) is available. We investigated the efficacy and toxicity of suramin In the treatment of metastatic ACC since suramin has been recently reported to be active as a single agent therapy for patients with ACC and prostatic carcinoma.DESIGNWe collected data on 9 patients with metastatic ACC treated with suramin in four centres in Germany between 1987 and 1992.PATIENTSNine patients (5 women, 4 men; age range 32–67 years) were included. Biochemical evidence of steroid excess was found in 6/9, in three leading to clinical symptoms (hypertension, hyperglycaemla, hirsutism, gynaecomastia).MEASUREMENTSTumour responses were assessed by radiological and biochemical evaluation. Other investigations included regular measurements of blood cell counts, coagulation, hepatic and renal function parameters, and serum suramin concentrations.RESULTSThe patients received cumulative doses ranging from.2 to 30·2 g suramin over periods of 1–15 months. 3/9 achieved a partial response, 2/9 disease stabilization and 4/9 experienced progressive disease. Tumour responses were transient. Suramin treatment was without direct influence on steroid excess. Serious side‐effects included coagulopathy (6/9), thrombocytopenla (6/9), polyneuropathy (2/9) and allergic skin reactions (4/9); the death of two patients was possibly related to suramin therapy. Both toxicity and tumour response were strongly associated with serum level or cumulative dose of suramin.CONCLUSIONS(1) Suramin is of antineoplastic efficacy in the treatment of metastatic adrenocortical carcinoma. (2) The clinical use of suramln is limited by a narrow therapeutic window with the risk of serious and possibly lethal toxicity at one extreme, and loss of efficacy at the other. Strict monitoring of suramin serum levels is mandatory aiming at levels between 200 and 250mg/l. Suramin should not be considered as first‐line treatment for metastatic adrenocortical carcinoma. (3) To improve treatment options in adrenocortical carcinoma as well as for further investigation on the usefulness of suramin, controlled prospective trials are urgentl

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1994.tb02549.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

SummaryOBJECTIVEThe purpose of this study was to evaluate the postural stimulation test before and after surgical treatment in patients with aldosterone‐producing adenomas.DESIGNThe retrospective study was made on patients with aldosterone producing adenomas.PATIENTSThe postural stimulation test was analysed in 60 patients with surgically proven aldosterone producing adenoma and In 15 healthy volunteers.MEASUREMENTSThe postural stimulation test was based on measurements of plasma aldosterone, cortisol and renin activity (PRA) at 0800 h and at noon after 4 hours ambulation.RESULTSThe patients were divided into two groups according to the individual pattern of plasma aldosterone concentration following the postural test. Plasma aldosterone concentration decreased or did not change after 4 hours of standing in 42 patients (group 1,70% of total) and increased in 18 patients (group 2, 30% of total). Mean plasma aldosterone was significantly higher in group 1 than in group 2 (1325 ± 164 pmol/l (mean ± SE) and 538 ± 53 pmol/l, respectively). Mean plasma cortisol concentration after 4 hours of upright posture in both groups remained low (242 ± 35vs401 ± 63 nmol/l (group 1) and 317 ± 46vs367 ± 43 nmol/l (group 2). Mean PRA In both groups was suppressed after 4 hours of upright posture (0·2 ± 0·04vs0·2 ± 0·04 pmol/l/s and 0·3 ± 0·06vs0·1 ± 0·02 pmol/l/s, respectively).CONCLUSIONDiverse changes In plasma aldosterone and cortisol found in response to the postural test may indicate pathogenetic heterogeneity amongst patients with aldosterone producing adenomas and should be considered during diagnosis of p

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1994.tb02550.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

SummaryOBJECTIVEAdults with long‐standing GH deficiency have a decreased lean body mass and an increased fat mass. We investigated the effects of the abnormal body composition on glucose turnover and fuel metabolism.DESIGNCross‐sectional analysis.PATIENTSTwenty‐four adults with acquired GH deficiency and a wide range of adiposity (body mass index from 18·8 to 42·3 kg/m2).MEASUREMENTSIn the post‐absorptive state glucose turnover was measured following intravenous injection of 3‐3H‐glucose and leucine oxidation was assessed following intravenous injection of 1‐14C‐leuclne. Glucose and fat oxidation were calculated from indirect calorimetry using protein oxidation derived from leucine oxidation.RESULTSTotal glucose turnover was 692 ± 146 μmol/min (mean ± SD) and Increased with height (r= 0·70,P= 0·0003) and with lean body mass (LBM) (r= 0·80,P<0·0001). Glucose turnover expressed per kg LBM was in the published normal range (14·2 ± 2·1 pmol/kg LBM min). Glucose oxidation was 47 ± 27% of glucose turnover and increased with LBM (r= 0·59,P= 0·008) but not with height (r= 0·32, NS). Glucose turnover increased with increasing fat oxidation (r= 0·61,P= 0·006). The non‐oxidative part of glucose turnover was positively correlated with fat oxidation (r= 0·82,P= 0·0001) and inversely with the respiratory quotient (r= ‐0·81,P<0·0001). Ketone body concentration (r= 0·55,P= 0·03), but not free fatty acid levels (r= 0·21, NS), correlated with fat oxidation. Fasting plasma glucagon levels were elevated (35 ± 13vs9 ± 19pmol/l (published controls) and inversely related to lean body mass (r= ‐0·44,P= 0·04).CONCLUSIONSAdults with GH deficiency studied after an overnight fast have changes In glucose and fuel metabolism seen In normal subjects after more prolonged fasting suggesting that adults with h

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1994.tb02551.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

SummaryOBJECTIVEIn active acromegaly body composition is characteristically altered by an increase in lean body mass and a corresponding reduction in fat mass. These changes are induced by an excessive secretion of GH and insulin‐like growth factor I (IGF‐I). Growth hormone is an anabolic hormone and leads to stimulation of protein synthesis and an increased lipolysis in adipose tissue.Treatment with the somatostatin analogue, octreotide, has been shown to reduce GH levels causing reduced hormonal effects on target tissues. We have studied changes in body composition during short‐term reduction in OH level by octreotide in active acromegaly. DESIGN Octreotide was compared to placebo in a double‐blind, cross‐over trial. Dual‐energy X‐ray absorptlometry scanning was employed to calculate body composition. Relations between body composition parameters and clinical signs of acromegaly (finger circumference and foot volume) were studied.PATIENTSTwelve patients with active acromegaly, confirmed by lack of GH suppression during oral glucose loading, were included. All had pituitary adenomas diagnosed by computed tomography.MEASUREMENTSSerum GH and IGF‐I. Lean body mass, fat mass and total weight, foot volume and finger circumference.RESULTSFour weeks of octreotide treatment caused a 75% decrease in GH levels (n= 10), a reduction in IGF‐I from 476 ± 51·9 (mean±SEM) to 233 μg/l ± 46·3 (P<0·005) and a corresponding decrease In both body weight (2·51 kg ± 0·41) (P<0·005) and lean body mass (2·44 kg ± 0·48) (P<0·005). No significant changes in fat mass were observed. These findings were paralleled by significant reductions in foot volume (44·50ml ± 17) (P<0·05) and finger circumference (1·3 mm ± 0·3) (P<0·05).CONCLUSIONSShort‐term octreotide therapy reduces growth hormone levels leading to a significant reduction in lean body mass as assessed by dual‐energy X‐ray absorptiometry. Alterations in lean body mass were positively correlated with reductions in foot volume. Thus, simple clinical tests may be valuable in judging

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1994.tb02552.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY