摘要:

Serum thyroxine was consistently immeasurable by radioimmunoassay in an elderly patient with myxoedema after successful treatment with oral thyroxine. Abnormal binding of thyroxine was suspected and shown to be due to the presence in serum of antibodies of the IgG variety. The characteristics of these antibodies with respect to their binding of thyroxine (T4), triiodothyronine (T3), reverse triiodothyronine (rT3) and human thyroglobulin (Tg) were systematically studied. Three preparations of Tg, and T4, T3 and rT3 were examined for their ability to compete with125I‐Tg,125I‐T4,125I‐T3 and125I‐rT3 for binding to the antibodies. For each tracer used the order of competitive efficiency was Tg>T4>T3>rT3. This provides for the first time direct evidence that iodothyronine reacting antibodies occurring in man are generated against Tg. All three iodothyronines were able to inhibit tracer binding of labelled iodothyronines completely, the order of effectiveness being T4>T3>rT3, suggesting antibodies with one type of binding site and that these were probably raised against a Tg sequence incorporating T4, although there was some evidence for the existence of a minor subpopulation of antibodies with higher specificity for T3. Complete displacement of labelled Tg by cold iodothyronines, however, was not possible. The experimental evidence suggests two classes of Tg antibodies, 70% of which were directed towards the T4 containing region, and 30% directed against other part(s) of the Tg molecule. Despite the presence of such Tg antibodies conventional haemagglutination tests of the patient's serum for Tg antibodies were n

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1981.tb02741.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

An heterologous radioimmunoassay for measurement of 3′‐monoiodothyronine (3′T1) has been developed using pure 3′T1 as standard, (125I) DL3′T1 and an anti 3,3′L‐diiodothyronine antiserum. The assay utilizes Sephadex G25F minicolumns to separate 3′T1 from other endogenous iodothyronines. 8‐ani‐lino‐1‐naphthalene sulphonic acid was used to inhibit binding of 3′T1 to serum binding proteins. Sensitivity was approximately 3·2 pmol/l. The mean serum 3′T1 concentration was 7·4 pmol/l in normal subjects, 30·8 pmol/l in thyrotoxic patients, 4·1 pmol/l in hypothyroid patients, 23·2 pmol/l in patients with severe non‐thyroidal illness and 109·8 pmol/l in cord blood. Increased levels of 3′T1 were found in two normal volunteers who were injected with 3,3′T2, demonstrating that 3′T1 is derived from 3,3′T2 in extrathyroidal tissues. These studies suggest that 3′T1 is a minor iodothyronine metabolite in the human. It is unli

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1981.tb02742.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

The results of quantitative adrenal imaging using75Se selenomethylcholesterol in sixty‐two subjects are analysed. The adrenal area was localized by a renal scan, lateral views of which enabled adrenal depth to be estimated. The first nineteen cases were scanned with a rectilinear scanner and the remaining forty‐three cases imaged with a gamma camera. Quantitation of adrenal uptake was performed on computer‐stored static images obtained 7 and 14 days post‐injection of75Se selenomethylcholesterol (3 and 6 days in the first ten cases studied). Normal uptake was found to be 0·07–0·30% of the administered dose. Overall predictive accuracy of the type of adrenal disorder of thirty‐two patients with Cushing's syndrome was 90·6%, this included twelve cases of Cushing's disease (mean uptake 0·58%), seven ectopic ACTH syndromes (mean uptake 0·69%), five unilateral adenomata (mean uptake 0·93%), three post adrenalectomy regrowths (mean uptake 1·37%), three adrenal carcinomas (mean uptake 0·01%), one congenital hyperplasia (mean uptake 3·4%) and one unilateral nodular hyperplasia. Overall predictive accuracy of the cause of Conn's syndrome in twenty‐two cases was 86·4%; this included thirteen cases of bilateral hyperplasia (mean uptake 0·34%), eight unilateral adenomata (mean uptake 0·47%) and one patient with mineralocorticoid excess in whom the cause has not been confirmed. The mean uptake in the normal adrenal in cases of unilateral adenoma was 0·19% (range 0·07–0·30%). Causes of unsatisfactory adrenal imaging are examined. The procedure is recommended as the localizing and lateralizing technique of choice in Cushing's syndrome except where due to adrenal carcinoma, and as an important non‐invasive technique in Conn's syndrome f

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1981.tb02743.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

The renin‐angiotensin‐aldosterone system was studied in fifty healthy children aged 4–16 years under normal sodium and potassium intake. The plasma renin activity (PRA) and plasma aldosterone (PA) decreased with age: r =−0·30,P<0·05 for plasma renin activity and r =−0·33,P<0·05 for plasma aldosterone. Significant negative correlation was obtained between plasma renin activity and the 24‐h urinary sodium excretion; r =−0·40,P<0·01. This relationship remained significant when the daily urinary sodium excretion was corrected for 1·73 m2body surface area (BSA); r =−0·40,P0·05). This finding suggests that during childhood, sodium rather than age has a major modulatory role on plasma renin activity. With advancing age the plasma aldosterone showed a significant positive correlation coefficient with plasma renin activity (r = 0·29,P<0·05). Multivariance analysis between plasma aldosterone and the two combined parameters, plasma renin activity and age, significantly improved the correlation coefficient (r = 0·42,P<0·05) suggesting that both plasma renin activity and age play a dominant modulatory role in the control of plasma aldosterone during childhood. Neither 24‐h urinary sodium excretion, nor 24‐h urinary potassium excretion, improved the multiple correlation coefficient with plasma aldosterone when ad

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1981.tb02744.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

A large cystic adrenal carcinoma was removedin totofrom a 6½‐year‐old girl with isosexual precocious puberty treated with cyproterone‐acetate. Immediately following surgery, severe galactorrhoea developed, but was successfully treated with bromocriptine. The tumour fluid and pre‐operative plasma samples contained highly elevated levels of both oestrogens and androgens. In addition prolactin values were high. One year after adrenalectomy all plasma hormonal values were normal for age, but galactorrhoea could still be elicited. The prolonged galactorrhoea is most likely the result of excessive oestrogen‘priming’, whereas the hyperprolactinaemic effect of cyproterone acetate therapy remai

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1981.tb02745.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

Evidence for a role of dopamine and endogenous opioids in the control of the secretion of renin and adrenal steroids was sought in man. The effects ofl‐dopa,l‐dopa plus carbidopa, dopamine, domperidone and naloxone were studied on the renin and aldosterone responses to head‐up tilt.l‐dopa diminished the rise in renin following tilt and this effect ofl‐dopa was abolished by carbidopa. Aldosterone was not significantly affected by any of the compounds. Cortisol secretion was stimulated by carbidopa plusl‐dopa more thanl‐dopa alone, and was also increased by both dopamine and naloxone. The significance of these findings

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1981.tb02746.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

A 57‐year‐old woman who presented with depression and hypertension for which she had received anti hypertensive therapy including diuretics was found to have Cushingoid features. All medication was stopped and subsequent investigation demonstrated markedly elevated urinary free cortisol (UFC) levels. An increase in UFC occurred in response to the low dose dexamethasone suppression test and a further increase was noted during the high dose test. Plasma cortisol levels did not change significantly. Detailed examination of the data revealed that over the 6‐day testing period the plasma creatinine had fallen from 1·4 mg/dl to 0·7 mg/dl while the creatinine clearance had doubled—presumably due to withdrawal of the diuretic. When the UFC was expressed per 100 ml of plasma filtered, there was no difference between any of the daily excretions. We conclude that a concurrent increase in glomerular filtration rate is one mechanism by which a‘paradoxical’increase in UFC in response to dexamethasone suppress

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1981.tb02747.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

The case history of a patient with basal ganglia calcifications found by computerised tomography is presented. Calcium and phosphorus metabolism showed a pattern suggesting lack of parathyroid hormone (PTH). Further studies revealed increased endogenous PTH levels and urinary cAMP excretion. However, endogenous and exogenous PTH could not elicit the cAMP‐mediated phosphaturic response, indicating pseudohypoparathyroidism type II. The responses of prolactin to TRH and chlorpromazine was impaired. Basal ganglia calcification in pseudohypoparathyroidism type II may represent the only somatic abnormality in this disease apart from the biochemical abnormalitie

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1981.tb02748.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

We measured urinary cyclic AMP (UcAMP) excretion after parathyroidectomy in order to assess postoperative parathyroid function. Patients undergoing successful treatment for primary hyperparathyroidism were divided into three groups based on therapy required to correct postoperative hypocalcaemia: 1 (n= 44) vitamin D not required; 2 (n= 17) vitamin D required temporarily (1 year).Patients in group 1 experienced only brief (<7 days) hypocalcaemia. UcAMP fell immediately postoperatively and returned to the normal range (in the majority) within 7 days. Group 2 showed the most severe hyperparathyroidism as judged by preoperative serum calcium, alkaline phosphatase and UcAMP and eight of seventeen showed radiographic evidence of osteitis fibrosa cystica (OFC). Patients in this group developed severe hypocalcaemia postoperatively, but in the majority UcAMP was elevated in proportion to the degree of hypocalcaemia and could be suppressed by raising serum calcium. Hypocalcaemia in these patients was presumably due to calcium entry into bone associated with healing of skeletal disease. Group 3 patients also developed severe postoperative hypocalcaemia but showed significantly lower UcAMP excretion than groups 1 or 2.We conclude that measurement of UcAMP excretion is helpful in the diagnosis and management of postparathyroidectomy hypocalcaemia. The combination of low UcAMP and hypocalcaemia more than 7 days after parathyroidectomy indicates hypoparathyroidism that will usually but not always require permanent therapy with vitamin D. Postoperative hypocalcaemia accompanied by increased UcAMP indicates that parathyroid gland function persists and that lifelong treatment with vitamin D will generally not be required.

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1981.tb02749.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

After a single dose of 2 g metyrapone given with a snack at 2300 h, blood was taken for estimation of plasma adrenocorticotrophin hormone (ACTH) concentrations at 0800 h the next morning from normal individuals and from patients with pituitary disease. Plasma ACTH concentrations following metyrapone were significantly lower in patients with pituitary disease with no evidence of anterior pituitary hormone deficiency (mean 90·0±SD 63·9 ng/l) when compared with normal individuals (mean 182·5±SD 14·1 ng/l,P<0·01) but significantly greater than in patients with pituitary disease in whom a deficiency of one or more anterior pituitary hormones was demonstrated (mean 50·8±SD 14·1 ng/l,P<0·01). It is concluded that the short metyrapone test is a sensitive method of detecting minor degrees of impairment of the negative feedback control of ACTH secretion that would be unrecognized by conventional assessment by insulin‐induced hypoglycaemia. The clinical relevance of impaired ACTH release in response to a single dose of metyrapone in patients with pituitary tumours, in whom pituitary function is otherwise shown to be adequate, needs to b

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1981.tb02750.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY