摘要:

Clinical, laboratory and radiological findings were evaluated in twenty‐nine men who had raised serum prolactin concentrations and pituitary tumours. Twenty‐one had functionless pituitary tumours (‘prolactinomas’) and eight had acromegaly. Suprasellar extension was detected in twenty of the twenty‐six men who had lumbar airencephalography. Three patients were studied before, sixteen before and after and ten only after pituitary ablative therapy.Seventeen of these men complained of complete lack of libido and impotence and six had impaired libido and sexual potency; only six patients in this series denied reproductive symptoms. Thirteen of the impotent subjects had small soft testes, ten reduced facial and body hair and three had marked gynaecomastia. No features of hypogonadism were noted in the six patients without reproductive symptoms and none of the patients had galactorrhoea.Serum prolactin concentrations were higher and serum testosterone concentrations lower in the impotent men compared with those with normal sexual potency. Serum LH and FSH (both basal and in response to LHRH), oestradiol and oestrone concentrations were not different between the two groups and, except in those with post‐operative hypopituitarism, were within the normal range. Following successful lowering of prolactin concentrations by surgery or bromocriptine or both, serum testosterone rose and potency returned; by contrast failure to lower prolactin concentrations was associated with persistent impotence and hypogonadism.The endocrine profile of low serum testosterone concentrations with gonado‐ trophins which had not risen into the range usually seen in primary hypogonadism (together with the parallel increase of LH and testosterone in one patient studied sequentially during treatment which suppressed prolactin levels to normal), suggested that the impaired gonadal function was caused by a prolactin‐mediated disturbance of hypothalamic‐p

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1978.tb02770.x

出版商:Blackwell Publishing Ltd    

年代:1978

数据来源: WILEY

摘要:

The effect of somatostatin on the secretion of calcitonin was studied in four patients with medullary carcinoma of the thyroid (MCT). The basal serum calcitonin level was markedly elevated in all cases. A bolus injection (100 μg) of somatostatin followed by an intravenous infusion (5 μg/min) for 60 min suppressed the basal calcitonin level in three of the four patients by 24–42%, while it had no inhibitory effect in one case. In another experiment, the pentagastrin‐stimulated (6 μg/kg s.c.) calcitonin release was partially blocked by a simultaneous i.v. injection of somatostatin (200 μg) in all four patients studied. These experiments add human calcitonin to the list of hormones whose release is inhibited by somat

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1978.tb02771.x

出版商:Blackwell Publishing Ltd    

年代:1978

数据来源: WILEY

摘要:

The aim of this study was to investigate the role of prolactin in the secretion by the adrenal of dehydroepiandrosterone (DHA) and its sulphate (DHA‐S). Therefore prolactin and DHA‐S levels were determined in different groups of subjects under various physiological and pathological conditions. In patients with prolactinomas, or with pharmacologically induced hyperprolactinaemia, plasma DHA‐S and, to lesser extend, DHA concentrations were elevated, and the DHA‐S blood production rate greatly increased. ACTH stimulation which did not influence DHA‐S concentrations in normals, caused a significant increase in patients with prolactinomas; the increase in DHA concentrations was similar in normal subjects and in prolactinoma patients. Bromocriptine treatment of prolactinaemia patients normalized both prolactin and DHA‐S concentrations. Acute elevation of prolactin in normal subjects by TRH stimulation or by short term administration of sulpiride, in contrast to long term treatment, did not influence DHA‐S levels. During pregnancy, notwithstanding high prolactin concentrations, DHA‐S concentrations were lower than during the menstrual cycle. In patients with prolactinomas, given glucocorticoid replacement with cortisol, DHA‐S concentrations were low (normal) notwithstanding persistently high prolactin concentrations. It is concluded that only prolonged elevation of prolactin induces increased DHA‐S secretion by the adrenal cortex and that normal ACTH secretion is a prerequisite for this effect. The absence of elevated DHA‐S concentrations in pregnancy might be explained by the rapid rate of metabolism, as the DHA‐S production rate is increased. The intimate mechanism of prolactin and ACTH interaction at the adrenal cortex

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1978.tb02772.x

出版商:Blackwell Publishing Ltd    

年代:1978

数据来源: WILEY

摘要:

A 16‐year‐old female patient with an adrenal tumour was studied. Clinically she had progressive hirsutism, showed high urinary 17‐oxosteroid excretion with normal plasma cortisol. Plasma C19‐steroids, both unconjugated (including testosterone) and sulphate‐conjugated, were greatly elevated. On surgical exploration an adrenal tumour and the adjoining adrenal were removed; the tumour was histologically an adenoma. On ultrastructural analysis the cells in all zones of the adjoining adrenal were considered normal. Although the tumour cells had the general appearance of a steroid‐secreting cell their structure diverged from the cells of every subzone of the cortex. This was the case particularly with mitochondria and lipid inclusions. The only endogenous unconjugated steroids detected in the adjoining cortex were corticosterone and cortisol while in tumour tissue these were present in lesser amounts. The tumour tissue contained large amounts of C19‐steroids, 11β‐hydroxy‐andro‐stenedione being quantitatively most significant. On the basis of the steroid profile an impaired defect of 21‐hydroxylation in tumour cells leading steroid synthesis from corticosteroidogenesis to the

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1978.tb02773.x

出版商:Blackwell Publishing Ltd    

年代:1978

数据来源: WILEY

摘要:

Eight healthy medical students and four renal transplant patients had blood sampled two or three times hourly throughout EEG monitored nocturnal sleep. This was carried out on the healthy subjects for a total of 12 nights without medication (control nights asleep), a total of 12 nights following 40 mg of flucortolone the previous morning, and a total of 6 nights with similar blood sampling when sleep was prevented (control nights awake). Four renal transplant patients who were receiving long‐term therapy with prednisolone were similarly studied (total of 7 nights asleep). Circulating corticosteroid and growth hormone (GH) levels were determined. A peak of GH was seen during the first 2 h of sleep on the control nights when slow‐wave sleep predominated. The GH peak was absent on the control nights awake. The pattern of plasma corticosteroid levels was identical during control nights asleep and awake. Both single‐dose and chronic corticosteroid administration inhibited the GH peak associated with slow‐wave sleep. Chronic corticosteroid therapy, but not single‐dose administration in the morning, suppressed the circadian rise of plasma corticosteroids which normally occurs late

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1978.tb02774.x

出版商:Blackwell Publishing Ltd    

年代:1978

数据来源: WILEY

摘要:

The thyroid uptake of99m‐technetium after 7 days of triiodothyronine was measured at the end of a course of antithyroid drugs in ninety‐seven patients with thyrotoxicosis who were then followed up for at least 1 year. The relapse rate in sixty‐six patients in whom the uptake was suppressed to less than 4% was 21% whereas it was 90% in those patients in whom the uptake was more than 4%. A prediction of the outcome on the basis of whether the uptake was more or less than 4% would have been correct in 82% of patients. Serial tests during treatment show that a correct prediction could have been made one year after starting treatment in 86% of cases depending on whether the uptake at that time suppressed to more or less than 6%. The initial unsuppressed99m‐technetium successfully predicted the likelihood of relapse after a course of antithyroid drugs in 75% of patients. We recommend that alternative therapy should be advised in those patients whose uptakes fail to suppress below 6% after 1 year of drug

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1978.tb02775.x

出版商:Blackwell Publishing Ltd    

年代:1978

数据来源: WILEY

摘要:

Changes in glucose, phosphate, potassium, non‐esterified fatty acids (NEFA) and insulin in peripheral venous blood were compared in five unrestrained fasted dogs during different rates of insulin infusion by the portal and peripheral circulation. The‘low’rate of insulin infusion was that required to produce a fall in plasma glucose of 0.56–0.83 mmol/l (0.024 u/kg/h ♀, 0.012 u/kg/h ♂). Two‐fold and fourfold higher rates are referred to as‘medium’and‘high’rates, respectively. In all dogs, dose‐related reductions in the glucose concentration of peripheral blood resulted from increasing the rate of insulin by either route. At‘low’and‘high’rates of infusion the net response was independent of the route of administration, but the‘medium’rate of insulin infusion led to a greater degree of hypoglycaemia when given peripherally than intraportally. As expected, insulin infused peripherally resulted in graded increases in peripheral insulin levels as the rate of infusion was increased from low to high while, paradoxically, intraportal administration at low and medium infusion rates resulted in a mean decrease of peripheral insulin levels from control, the low‐dose producing the most consistent fall. The fact that hypoglycaemia accompanied this fall during portal infusion suggests that these low doses of insulin had a direct effect on glucose metabolism in the liver. This hepatic action appears to be overwhelmed by peripheral uptake of glucose at the high rates of insulin infusion. A qualitatively different effect on plasma phosphate resulting from the change in route of administration of insulin (i.e. increase during portal and decrease during peripheral infusion) also suggests a direct hepatic

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1978.tb02776.x

出版商:Blackwell Publishing Ltd    

年代:1978

数据来源: WILEY

摘要:

Linear discriminant analysis, a multivariate statistical procedure, applied to serum calcium, phosphate, alkaline phosphatase, bicarbonate, chloride, creatinine and tubular reabsorption of phosphate, proved to be effective in distinguishing patients with Primary Hyperparathyroidism from other hypercalcaemic patients in eighty‐four retrospective cases. The application of the model to thirty‐four prospective cases enabled us to separate correctly, hyperparathyroid patients from non‐parathyroid hypercalcaemic pat

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1978.tb02777.x

出版商:Blackwell Publishing Ltd    

年代:1978

数据来源: WILEY

摘要:

Radiation‐Associated Thyroid Carcinoma. Ed. by L. J. DE GROOT, L. A. FROHMAN, G. L. KARAN and SAMUEL REFETOFFDiabetes Mellitus: Clinical and Metabolic. By W. P. U. JACKSON and A. I. VINIKRecent Progress in Pediatric Endocrinology. Proceedings of the Serono Symposium, Volume 12. Ed. by G. CHIUMELLO and Z. LAR

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1978.tb02778.x

出版商:Blackwell Publishing Ltd    

年代:1978

数据来源: WILEY