摘要:

SUMMARYTwo hundred and thirty patients with acromegaly were diagnosed and treated in a prospective cooperative study in twelve university clinics. Primary treatment was: trans‐sphenoidal surgery (152 patients), trans‐sphenoidal surgery with additional cryotherapy (eighteen patients), Yttrium‐90‐implantation (thirty patients), bromocriptine (thirty patients). The results of endocrine assessment before treatment and 6 months after operation, 90‐Y implantation or commencement of bromocriptine therapy are reported.The best results (low GH, no or little deterioration of pituitary function, low complication rate) were achieved by trans‐sphenoidal surgery, especially in patients with intrasellar tumours (basal GH<5 ng/ml in 59·7%). Results were less good with increasing tumour size. Additional cryosurgery was accompanied by a high rate of anterior pituitary insufficiency and is no longer employed. Yttrium‐90‐implantation resulted in less improvement in GH levels (basal GH<5 ng/ml in 51·7. of patients with intrasellar tumours), a high rate of pituitary insufficiency and more complications. Bromocriptine treatment was least effective in lowering GH concentrations (basal GH<5 ng/ml in 33% of patients with intrasellar tumours).Different criteria for treatment success were compared. In the entire group, basal GH concentrations below 5 ng/ml were attained in 51·7. of all patients whose values were higher than this prior to treatment. Suppressibility of GH below 2 ng/ml during glucose loading occurred in only 34·9%. An abnormal GH response to TRH/LHRH was present in 47·2. before and in 43·4% after/during treatment. The prognostic significance of this latter finding must be evalu

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1982.tb03154.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

SUMMARYThe authors present an unusual case of T3 hyperthyroidism caused by a well‐differentiated thyroid follicular carcinoma and its large skull metastasis. They suggest iodine deficiency as being the single major factor in the aetiology of both disorder

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1982.tb03155.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

SUMMARYHypothalamic–pituitary–gonadal function was assessed in forty‐seven patients with cystic fibrosis (CF) by the 3‐h infusion of 100 μg of synthetic gonadotrophin‐releasing factor, LHRH and the results compared with a group of children being evaluated for short stature and delayed puberty (‘controls’). Levels of gonadotrophins and sex steroids were measured prior to and during the infusion. In prepubertal boys, LH and FSH release evoked by LHRH was significantly greater (P<0·001) in ‘control’subjects than in CF patients. In pubertal boys, LH and FSH release was also greater in ‘controls’than in CF, though to a lesser degree (P<0·05). In pubertal girls, responses to LHRH were comparable for LH and slightly greater (P<0·05) in ‘controls’for FSH. In the earliest pubertal groups of both sexes (male‐Tanner genitalia stage 2; females‐Tanner breast stage 2), LH secretion was similar in patients with CF and ‘control’subjects. Significant increments of testosterone and oestradiol in pubertal CF patients do not occur until 6 h after the LHRH infusion begins, in contrast to a rise at 3 h in ‘control’subjects. These data suggest that prepubertal boys with CF, who are the most impaired in height, weight and skeletal maturation, also have measurable abnormalities of LHRH‐releasable gonadotrophin secretion. Despite continued impaired weight growth, pubertal patients do attain essentially normal gonadotrophin secretory responses to LHRH administration and are similar to subjects with constitutional delayed adolescent devel

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1982.tb03156.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

SUMMARYPatients with primary testicular failure have increased basal TSH levels and an exaggerated TSH response to TRH in the presence of normal circulating levels of thyroid hormones. In order to evaluate if this TSH profile is an oestrogenrelated phenomenon, sixteen patients with primary testicular failure were challenged with 200 μg TRH prior to and after the administration of clomiphene citrate. The latter was given in a dose of 100 mg/day for 4 weeks to ten patients; 200 mg/day for 4 weeks to three patients and 100 mg/day for 2 months to the final three patients.The patients demonstrated increased mean basal TSH levels with an exaggerated TSH response to TRH. Following the administration of clomiphene citrate, there were no changes in T4, T3 sephadex or total T3 levels and in basal or stimulated TSH levels. Clomiphene did produce an increase in oestradiol, testosterone, basal gonadotrophins and LH response to LHRH. Since the oestrogen antagonist, clomiphene citrate, had no effect on TSH secretion, it is unlikely that the exaggerated TSH response to TRH is mediated by oestrogens

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1982.tb03157.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

SUMMARYAn oestrogen provocation test was performed in five healthy women during chronic intranasal treatment with 400 or 600 μg of the superactive LHRH agonist D‐Ser(TBU)6‐EA10‐LHRH daily. Oestradiol benzoate 2±5 mg was administered intramuscularly after at least 3 months of LHRH agonist treatment. The serum levels of FSH and LH were not affected by the oestrogen injection. Failure of positive feedback of oestradiol may be one explanation for the inhibition of ovulation which occurs during chronic LHRH agonist tr

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1982.tb03158.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

SUMMARYSerum gonadotrophin concentrations were measured every 15 min for 8 h in six patients before and at weekly intervals during initiation of bromocriptine treatment of hyperprolactinaemic amenorrhoea. Before treatment mean gonadotrophin levels were similar to those found in the normal follicular phase, but LH secretion was characterized by infrequent pulses of large amplitude. In three subjects the patterns of LH pulsatility and serum oestradiol levels returned to normal within 7 days of starting bromocriptine. The other three subjects responded with an increase in the frequency of LH pulses and mean LH levels, but little rise in oestradiol. Thus some hyperprolactinaemic subjects have a defect in the ovarian response to endogenous gonadotrophin stimulation, which may persist for a few weeks after return of prolactin levels to normal. The restoration of a normal rate of LH pulsatility with bromocriptine can occur without any change in serum oestradiol concentration.

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1982.tb03159.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

SUMMARYAdrenal function was studied in thirty‐two children with precocious sexual development who were being treated with cyproterone acetate (CPA) at doses ranging from 68 to 175 mg.m2. day for periods lasting from 2 to 79 months. In eighteen children the adrenocortical function evaluation was made before and during CPA treatment. In these eighteen patients, the mean basal plasma cortisol level during the morning hours was 11·2±4·6 μg/dl (m±SD) before treatment and fell significantly to 7·2±4·1 μg/dl (P<0·02) during therapy. In fifteen patients tested during insulin hypoglycaemia the cortisol peak fell from 21·6±5·5 μg/dl before treatment to 16·7±6·8 μg/dl (P<0·05) during CPA therapy. There was a significant inverse correlation between this peak and the dose of CPA but no correlation was found between the cortisol response and duration of treatment. In eight of twenty patients tested, urinary free cortisol levels were undetectable during treatment. No change in basal plasma ACTH levels was demonstrated using standard radioimmunoassay techniques. In the patient receiving the highest dose of CPA and showing complete suppression of the adrenal axis, prolonged stimulation with ACTH‐Depot demonstrated a responsive adrenal gland. Addition of a replacement dose of cortisol to the CPA treatment led to the rapid development of the typical signs of Cushing's syndrome. It was concluded that despite the evidence of adrenal suppression by CPA, cortisol supplementation is not necessary and may ev

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1982.tb03160.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

SUMMARYA rapid (3‐h) radioimmunoassay of plasma progesterone has been developed and used successfully to predict the time of ovulation in women undergoing artificial insemination. The results obtained using progesterone levels to date the stage of the cycle were analysed retrospectively by (1) estimation of the length of the ensuing luteal phases and comparison of these with luteal phase lengths of a control group (2) comparison of the dating using progesterone levels with retrospective determination of LH values and (3) by analysis of the dating in cycles in which conception occurre

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1982.tb03161.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

SUMMARYWe measured urine flow and the renal excretion of total solute, sodium, potassium and calcium in eleven patients with hyperthyroidism before and after treatment. Mean nocturnal sodium excretion was significantly greater (P<0·05) during hyperthyroidism and was unaccompanied by any significant alterations in day time or 24‐h values. As a result of this nocturnal natriuresis in hyperthyroidism significant changes were noted in the ratios of day/night sodium excretion (P<0·005) and urinary flow (P<0·05). The change in ratio of day/night sodium excretion resulting from treatment of hyperthyroidism was shown to correlate significantly with the change in plasma total triiodothyronine (r=0·73,P<0·01). Twenty‐four hour urinary calcium output was significantly greater (P<0·02) in hyperthyroidism but there was no significant alteration in the day/night pattern of

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1982.tb03162.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

SUMMARYWe have examined the combined usefulness of TSH‐receptor antibody detection and HLA status on the therapeutic response to standard doses of radioactive iodine (RAI) in forty‐three hyperthryoid Graves’patients. Twenty‐three patients had detectable TSH‐receptor antibodies as measured by125I‐TSH binding‐inhibition (TBI) prior to administration of 7 mCi RAI. Eighteen (78%) of these patients were rendered euthyroid within 3 months. In contrast, twenty patients were TBI negative prior to RAI and sixteen (80%) of these individuals remained hyperthyroid at 3 months and required two, or more, doses of RAI to control their thyroid function. DR3 status alone was not strongly associated with resistance to RAI. However, of sixteen patients without detectable TBI activity and who required two or more doses of RAI, ten patients were DR3 positive (62%) compared with 25% in a control population. Only one patient who was both TBI and DR3 negative required more than one dose of RAI.These data indicate that TBI may be an accurate predictor of the therapeutic response to RAI in patients with hyperthyroid Graves’disease. Investigation of HLA status alone was of limited value, although it appeared that the combination of TBI and DR3 may be of additional help in developing an overall strategy for the treatment of hyperthyroid

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1982.tb03163.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY