摘要:

SUMMARYThe present study investigated the possible effect of somatostatin and oxytocin on the basal and stress‐induced rise of beta‐endorphin (β‐END), beta‐lipotrophin (β‐LPH) and cortisol in the human. For this purpose somatostatin (4.1 μg/min for 120 min or oxytocin (0·4 μg/min for 120 min) was infused into two different groups of seven healthy subjects; 30 min after the start of the infusion, placebo or insulin (0·1 IU/kg body weight, B.W.) was injected on two different days. In a third experimental step, an insulin tolerance test was performed during saline infusion to evaluate stress‐related effects on the different hormonal secretions under basal conditions. Plasma levels of β‐END, β‐LPH and cortisol were measured by radioimmunoassay. Extraction and chromatographic procedures preceded the assay for β‐END and β‐LPH. Neither somatostatin nor oxytocin significantly modified basal plasma levels of β‐END, β‐LPH and cortisol. However these treatments blunted the rise of the three hormones seen at 45 and 60 min during insulin‐induced hypoglycaemia (P>0·01). These results indicate that somatostatin and oxytocin may influence the β‐END, β‐LPH and cortisol increase induced by stress in hum

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1986.tb01656.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

SUMMARYEleven patients, five males, six females, aged 14–20 years with hepatosplenic schistosomiasis (HSS), growth failure and delayed puberty were submitted to endocrine evaluation. All patients had well preserved parenchymal liver function although several changes were present in the portal system, showing a poorly vascularized liver. Bone age was retarded, thyroid function was normal, the human growth hormone response to hypoglycaemia was within the normal limits and the prolactin response to TRH was normal. LH and FSH basal levels were normal and a normal rise was observed after a provocative test with LHRH. Gonadal function, expressed as serum testosterone or oestradiol levels, was abnormally low for the chronological age. Serum somatomedin‐C levels were also low (range 0·11–2·10 U/ml) for the respective Tanner stage or bone age of each individual patient. One year after a splenorenal shunting in the three patients that returned for follow‐up, it was observed that sexual maturation reached Tanner stage III, linear growth increment ranged from 9·0 to 11·5 cm and serum somatomedin‐C levels increased to 4·3–5·6 U/ml. We concluded that a combination of undernutrition and marked vascular changes in the liver, present in HSS, are associated with decreased serum sex steroids and somatomedin‐C concentrations, resulting in growth failure and delayed pubert

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1986.tb01657.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

SUMMARYAmiodarone, an iodine containing drug, may induce thyrotoxicosis by an uncertain mechanism. In this study the role of thyroid autoimmunity was evaluated in 28 consecutive patients referred to us because they had become hyperthyroid during long‐term amiodarone administration. Titres of thyroglobulin and thyroid microsomal antibodies, TSH binding‐inhibitory and thyroid stimulating antibodies were evaluated. Underlying thyroid disorders were demonstrated in 20 patients (9 of them had toxic diffuse goitre, seven toxic multinodular goitre and four toxic adenoma), while eight patients did not show any apparent thyroid gland abnormality. Circulating thyroid autoantibodies could be found in all amiodarone iodine‐induced hyperthyroid patients with toxic diffuse goitre and in one with toxic multinodular goitre, whilst they were absent in the other patients. These studies suggest that thyroid autoimmunity has little if any role in the development of thyrotoxicosis in amiodarone treated patients without underlying thyroid disorders. Furthermore, in amiodarone‐iodine‐induced thyrotoxicosis associated with various thyroid diseases, the humoral markers of thyroid autoimmunity show an incidence similar to that observed in spontaneous hypert

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1986.tb01658.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

SUMMARYSerum thyroglobulin (Tg) response to bovine TSH (bTSH) was evaluated in 44 goitrous patients (grades III and IV) living in conditions of chronic iodine (I) deficiency (iodine urinary excretion>40 μg I/g) and in 26 normal subjects. After the initial clinical evaluation and laboratory tests (bTSH test, T4, T3, anti‐Tg and anti‐microsomal antibodies) all goitrous patients received 1 ml i.m. of iodized oil (I‐oil) and were followed up for 30 months. The bTSH test was repeated at 6, 12, 20 and 30 months after I‐oil in 21 subjects. A marked reduction in goitre size was observed in 85% of the patients with a concomitant significant increase in the mean serum T4 and T3 concentrations, a significant fall in the mean serum TSH level and a significant decrease in the T3/T4 ratio. Goitrous patients had elevated serum basal Tg levels (55 ± 8 SEM μg/l) and a significantly mean higher peak Tg value after bTSH (200 ± 65 μg/l) as compared with normal subjects (respectively, 11 ± 1·4 and 32 ± 3·4 μg/l). Larger goitres (grade IV) had a significantly higher mean peak Tg response as compared with grade III goitres. Treatment with I‐oil significantly reduced the mean peak Tg response to bTSH after 6 months (59 ± 10 μg/l) but at 12 and 20 months the peak Tg response after the injection rose, respectively, to 110 ± 19 μg/l and 92 ± 14 μg/l (P>0·02 as compared with 6 months), returning to the normal range only at 30 months. (55 ± 10 μg/l). The absolute increment (ΔTg) was also reduced significantly at 6 and 30 months but not at 12 and 20 months after I‐oil. We conclude that two major factors may be involved in the increased secretion or release of Tg from the goitrous tissue: increased thyrotrophic stimulation and follicular derangement and necrosis. Both events seemed to be corrected wit

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1986.tb01659.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

SUMMARYEight patients, one male and seven females, with no pre‐existing hypothalamic‐pituitary disease, who developed symptoms of hypopituitarism following cranial irradiation for nasopharyngeal carcinoma were studied 5 years or more after radiotherapy. All were GH deficient. Four of the patients with no GH response during insulin tolerance tests (ITT) showed increased GH in response to synthetic human growth hormone releasing factor (GRF‐44). Four patients had impaired cortisol responses to ITT, and gradual but diminished cortisol responses to ovine corticotrophin releasing factor (CRF‐41). There was no significant difference between mean peak increments in response to ITT and those in response to CRF‐41. TSH responses to TRH were delayed in five and absent in two patients; four of these had low free T4 index. Prolactin was raised in all seven women and increased further in response to TRH. Two patients had impaired gonadotrophin responses to LHRH. None of the patients had clinical or biochemical evidence of diabetes insipidus. These data suggest that post‐irradiation hypopituitarism in these patients results from radiation damage to the hypothalamus leading to varying degrees of deficiency of the hypothalamic releasing or inhibit

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1986.tb01660.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

SUMMARYAn attempt was made to correlate the serum concentration of PRL, GH and cortisol with anxiety experienced before elective surgery. A significant direct correlation was observed between cortisol and anxiety (P= 0·028), and between GH and anxiety (P= 0·001) although the latter correlation may have reflected the confounding effects of sex and age on GH levels. No correlation was observed between anxiety and PRL and we conclude that psychosocial stress cannot be invoked as an occasional cause of hyperprolactinaemi

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1986.tb01661.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

SUMMARYIn vitro, ketoconazole has been shown to block testicular and adrenal 17,20‐lyase, which converts progestins to androgens. At higher concentrations, it also inhibits 11β‐hydroxylase, 20,22‐desmolase and 17α‐hydroxylase. To determine the differential hormonal effects of a 2‐week ketoconazole high‐dose therapy, the plasma levels of 10 major androgens, gluco‐ and mineralocorticoids were measured in 14 previously untreated patients with metastatic prostate cancer. Within 24 h, plasma testosterone fell from 14·6 ± 1·4 nmol/l (mean ± SEM) to 3·7 ± 0·7 nmol/l. Thereafter, it decreased to about 2·5 nmol/l and remained at that level. Plasma androstenedione and dehydroepiandrosterone decreased more gradually, respectively from 3·1 ± 0·4 nmol/l to 0·64 ± 0·17 nmol/l and from 6·6 ± 1·0 nmol/l to 2·82 ± 0·55 nmol/l (on day 14). In contrast, 17α‐hydroxyprogesterone and progesterone rose respectively 2‐ and 5‐fold. Plasma cortisol and aldosterone levels remained unchanged whereas 11‐deoxycorticosterone and 11‐deoxycortisol rose by factors of 14 and 6·7 respectively. Plasma corticosterone also increased, but to a much lesser extent (3‐fold). These results demonstrate that ketoconazole high dose therapy blocks mainly the 17,20‐lyase of both adrenal and testis. In addition it inhibits mitochondrial 11β‐hydroxylase to a lesser extent. The inhibition of 20,22‐desmolase also seems to be of little clinical relevance. However, since clinical or laboratory symptoms suggestive of hypo‐adrenalism have been reported in a small minority of patien

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1986.tb01662.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

SUMMARYLong‐acting somatostatin analogues may be of benefit in certain hypersecretory endocrine and gastrointestinal disorders. The 24 h hormonal and metabolic profiles of six normal male subjects receiving a twice daily subcutaneous injection of one such analogue SMS 201–995, 50 μg, has been compared to that obtained following placebo injection. Spontaneous daytime peaks of GH secretion were delayed until 1400 h following SMS 201–995 but nocturnal and total 24 h GH secretion were unaffected. The nocturnal rise in thyrotrophin was abolished by SMS 201–995 but thyroid function was unaffected. Insulin levels were suppressed following SMS 201–995 and the response to meals was inhibited. Glucose intolerance followed main meals. Glucagon levels were suppressed for up to 6 h. Circulating alanine levels were raised between 1200 h and 0600 h and there were intermittent elevations in lactate, pyruvate, glycerol and 3‐hydroxybutyrate. Amino acid levels, including branched chain amino acids, were also increased. All six subjects suffered gastrointestinal side‐effects. SMS 201–995, 50 μg, given twice daily shortly before meals does not suppress 24 h GH secretion, but demonstrates significant effects on metabolism and causes side effects i

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1986.tb01663.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

SUMMARYThe long‐term sequelae of external pituitary irradiation alone or in combination with surgery and/or bromocriptine therapy have been studied in 14 patients with large prolactinomas over an observation period of 6–22 years (mean 13 years). Galactorrhoea was abolished in four of the five females with this symptom, but menstrual disturbance persisted in five of six patients. Sexual function was normal without sex hormone replacement in only one of the eight males after treatment. Neurological deficits were abolished or improved by treatment in all 9 patients with this presentation. Serum prolactin levels declined after treatment (P>0·001) and fell to within the normal range off bromocriptine therapy in six of the 14 patients at a mean of 9 years (range 5–17 years) after radiotherapy. All patients had anterior pituitary deficiency of some degree at reassessment, and 13 required replacement treatment. Serial skull radiographs revealed remineralization of the fossa floor in five patients and a decrease in fossa size in three. All five patients who did not also have surgery had evidence of tumour shrinkage without bromocriptine treatment (on CT scan or metrizamide cisternography). Fourth generation CT scans on completion of the study revealed a decrease in tumour mass in all patients, with varying degrees of empty sella in 13 and a cystic intrasellar tumour in the remaining one. Residual tumour was demonstrated in 10 patients, three of whom had normal serum prolactin levels, while one patient without visible tumour had persistent hyperprolactinaemia. Radiotherapy, alone or in combination with surgery and bromocriptine, effectively decreases prolactin secretion and tumour size in patients with large prolactinomas at the expense of other anterior pituitary function. Circulating prolactin levels are a poor marker of residual tumour

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1986.tb01664.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

SUMMARYTo assess the effect of cholinergic blockade on the ACTH, β‐endorphin and cortisol responses to insulin‐induced hypoglycaemia, six healthy male volunteers each underwent two insulin tolerance tests in random order, separated by at least 1 week with and without atropine. ACTH levels were significantly greater at + 45 min (mean ± SEM, 223 ± 21 pg/ml vs 148 ± 15 pg/ml,P>0·01) and at + 120 min (54 ± 11 pg/ml vs 29 ± 10 pg/ml,P>0·05). β‐endorphin levels were significantly greater at + 30 min (170 ± 45 pg/ml vs 96 ± 32 pg/ml,P>0·05) and at + 105 min (81 ± 14 pg/ml vs 54 ± 7 pg/ml,P>0·01). Cholinergic blockade had no effect on plasma glucose or cortisol concentrations. This study demonstrates that cholinergic blockade with atropine facilitates the ACTH and β‐endorphin responses to insulin‐induced hypoglycaemia without alteri

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1986.tb01665.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY