摘要:

SUMMARYTwo patients with Cushing's disease first presented with amenorrhoea, hyperprolactinaemia, and normal tomograms of the sella turcica. Both women underwent trans‐sphenoidal removal of a pituitary microadenoma resulting in a decreased serum prolactin concentration in both, and cessation of galactorr‐hoea and return of menses in one of them. One woman became ACTH deficient while the other has persistent Cushing's disease. A survey of the literature on Cushing's disease and prolactinomas shows the association to be uncommon. A likely mechanism is secretion of both hormones by the microadenomas. These two patients illustrate the need for screening other pituitary hormone function in patients with hyperprolactinae

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1981.tb02963.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

SUMMARYThe value of plasma 17α‐hydroxyprogesterone (17α‐OHP) concentration in monitoring the treatment of congenital adrenal hyperplasia (CAH) was studied by using a capillary blood micromethod. The blood‐spot 17‐OHP radioim‐ munoassay method involves serial sampling throughout the day and sending the samples into a centre by mail. Follow‐up of seven children treated for CAH due to 21‐hydroxylase deficiency showed that a single measurement of plasma 17‐OHP concentration cannot be relied upon to determine adequacy of control, since circadian variation and timing of the sample in relation to the last dose of glucocorticoid may influence the plasma level of 17α‐OHP. Our data confirm the value of sequential 17α‐OHP assays throughout the day in the follow‐up of CAH. With the blood‐spot method the 17α‐OHP determinations can be used on a wid

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1981.tb02964.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

SUMMARYThe outcome of a standardized carbimazole (CMI) regimen was evaluated in fifty‐four patients with Graves' disease. Triiodothyronine (T3) and thyroxine (T4) serum values were determined before and throughout the first 6–8 months of therapy. Before therapy, decreasing T4/T3 ratios were found with increasing T3 levels, reflecting a relative increase in T3 production compared with T4 in thyrotoxicosis. High pretreatment T3 values were comparatively common among patients in whom a fixed CMI dosage had an insufficient effect. T4 levels were less informative in this respect. Serum levels of methimazole (MMI), the active metabolite of CMI, were dose‐dependent. A 50% reduction in dosage resulted in a similar decrease in the serum values. For a given dose, the MMI levels differed considerably among individuals. The variation was not related to thyroid hormone values. It appears that the response to the anti‐thyroid drug is primarily dependent upon the severity of the disease, which is clearly reflected in serum T3 levels, rather than individual differences in drug handling. A routine CMI regimen for the treatment of thyrotoxicosis is su

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1981.tb02965.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

SUMMARYFive patients with hereditary angiooedema were treated with Danazol for periods up to 10 months. This therapy resulted in normalization of serum levels of the inhibitor of the first complement component and disappearance of clinical disease symptoms in all patients. Although a variety of hormones were measured, only those of the pituitary‐gonadal axis altered during treatment: a moderate decrease in leuteinizing hormone levels and a sharp fall of testosterone in adult men were observed. In all patients, however, both sex hormone binding globulin and thyroxine binding globulin concentrations were considerably suppressed during Danazol therapy. However, levels of corticosterone binding globulin remained unchanged. The fraction of endogenous testosterone not bound to sex hormone binding globulin invariably increased. The possible relevance of these findings to the understanding of the mode of action of Danazol both in these patients and in general, are discusse

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1981.tb02966.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

SUMMARYWe have studied a patient who was azoospermic and infertile. The cause of his infertility was unusual and curable: untreated congenital adrenal hyperplasia resulting from a partial 21‐hydroxylase deficiency. The diagnosis was suggested by the combination of small testes, elevated levels of testosterone and suppressed levels of gonadotrophin

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1981.tb02967.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

SUMMARYThyroid‐stimulating antibodies (TSAb) were studied in patients with Graves' disease using a method based on cAMP production in isolated human thyroid membranes. Stimulation was detected in forty‐one (82%) of fifty patients with untreated Graves' disease. In these subjects, the TSAb levels were correlated with the thyroid hormone levels. Among twenty patients treated for 1–2 months with carbimazole, 16 (80%) had positive TSAb. During prolonged treatment TSAb gradually diminished and finally normalized. In fifteen patients, it was possible to compare TSAb levels after cessation of previous medical therapy with TSAb levels at relapse. In nine of these patients, an increase of the TSAb level within the normal range at the time of relapse was found, in four the litres were positive.The results indicate that positive TSAb litres are markers of active Graves' disease and suggest that in such patients antithyroid therapy should be continued. A normal TSAb titre after anti‐thyroid therapy does not exclude the possibility of

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1981.tb02968.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

SUMMARYTwenty‐seven out of thirty craniopharyngioma patients treated with human growth hormone (hGH) for 2 years or more (average 4·5 years) reached final adult heights above the population third centile, though none was above the fiftieth centile. However, only twelve of twenty‐eight patients had final heights above the lower limits to be expected from their parents' heights. All patients eventually had long legs relative to sitting height (final mean subischial leg length SDS =+ 0·2, final mean sitting height SDS = ‐3·0).Twenty‐nine patients were TSH‐deficient, twenty‐two were ACTH‐deficient, thirteen were deficient in ADH and all had total (85%) or partial (15%) gonado‐trophin deficiency. Following the administration of testosterone or hCG the boys had, on average, only half the normal adolescent growth spurt. This may have been due to the lateness of starting androgens in these patients and we recommend, when considering height, that testosterone or hCG should be started when a bone age of 13·0 ‘years’ is reached or when a lower bone age has remained unchanged for a year. The girls showed no adolescent height spurt; the average increase after oestrogen treatme

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1981.tb02969.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

SUMMARYThe endocrine response to partial thyroidectomy in a group of twenty hyperthyroid patients prepared with propranolol alone was compared to that of a matched control group of ten euthyroid patients. In propranolol‐prepared patients the glucose response to surgery was reduced (P<0·05) for up to 4 h post‐operatively and biochemical hypoglycaemia was noted in one patient. Both thyroxine and triiodothyronine (T3) fell significantly, associated with a marked rise in reverse T3. Growth hormone levels were higher (P<0·05) both pre‐and post‐operatively in propranolol‐prepared patients, whereas prolactin levels, although similar pre‐operatively, were lower (P<0·05) in these patients post‐operatively. Cortisol and ACTH levels were lower (P<0·05) both before and following thyroidectomy in propranolol‐prepared patients. These results suggest that the endocrine response to surgical stress is markedly altered in propranolol‐prepared

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1981.tb02970.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

SUMMARYTwo women had acromegaly due to a pituitary adenoma associated with phaeochromocytoma. Eight additional patients with this combination of tumours have been described by others. Our first patient had sustained hypertension, mild hypercalcaemia, and elevated basal levels of parathyroid hormone and calcitonin associated with malignant phaeochromocytoma and parathyroid hyperplasia. The second patient had episodic hypertension and normal basal serum calcium, parathyroid hormone, and calcitonin levels with a benign cystic phaeochromocytoma. Four of the ten patients died from causes related to the phaeochromocytoma. Three patients had parathyroid hyperplasia. A separate group of four patients with phaeochromocytoma and pituitary adenoma without acromegaly has also been reported. These fourteen patients probably represent a non‐familial variant of the multiple endocrine neoplasia syndrome. Our findings suggest that acromegalic patients with hypertension should be screened for phaeochromocytom

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1981.tb02971.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

SUMMARYWe observed that change in body posture from the supine to the erect position in normal volunteers was associated with a rise in circulating potassium and a fall in sodium concentrations, irrespective of whether the electrolytes were measured in serum or plasma, or whether head‐up tilt or ambulation was used. In patients with primary aldosteronism, the fall in serum sodium and rise in serum potassium with ambulation tended to obscure the characteristic electrolyte abnormalities of that syndrome. These changes in potassium and sodium could contribute to the rise in aldosterone secretion on orthostasis. The body posture of patients should be considered in the interpretation of plasma and serum electrolyte level

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1981.tb02972.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY