摘要:

Growth hormone has several insulin antagonistic effects. To determine the time course of these effects in growth-hormone-treated children, the frequently sampled intravenous glucose tolerance test was used to measure insulin sensitivity (SI) and glucose effectiveness (Sg) before, and 1 week, 1 month and 6 months after beginning growth hormone therapy in 3 patients with growth hormone deficiency (GHD), 3 patients with non-growth-hormone-deficient short stature (NGHD) and 3 with Turner syndrome (TS). Pretreatment SI was lower in TS than in the other two groups (p < 0.05), but Sgdid not differ between groups. Mean SIlevels 1 week and 1 month after starting growth hormone therapy were not different from before growth hormone [1.6 7 ± 0.26 × 10∼4 (pmol/l-1 min-1]6 months of growth hormone [0.67 ± 0.15 × 10-4(pmol/l)-1 m-1] was lower than before and 1 week after growth hormone (p < 0.005). SI responses did not differ between groups. Sg, glucose tolerance, blood pressure, triglyceride, and cholesterol levels did not change, but the incremental insulin response increased with growth hormone therapy. Thus, in this small study 6 months of growth hormone therapy decreased SI, but did not affect other cardiovascular risk fa

ISSN:1663-2818    

DOI:10.1159/000184625

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

In 34 children with idiopathic short stature (ISS) we studied parameters of humoral and cellular immunity before and during growth hormone (GH) therapy. The patients were treated with recombinant human GH 3.0 or 4.5 IU/m2 body surface/day, 6 times/week. Leucocyte and lymphocyte counts, percentages of neutrophils, eosinophils, basophils and monocytes were available up to 4 years of therapy (n = 34) and lymphocyte subsets and serum immunoglobulins during the first year of treatment (n = 16). Differences between the measurements at the start and during therapy were tested by a mixed model ANOVA to repeated measurements. Before the start of GH therapy all parameters of immunity were within the normal range in these children. During the first months of treatment the leucocyte and lymphocyte counts decreased and at 6 months were significantly lower than at the start (p = 0.003 and p = 0.006, respectively). Thereafter leucocyte numbers no longer differed from baseline. Lymphocytes were again lower at 36 months (p = 0.001). The percentages of neutrophils, eosinophils, basophils, monocytes and lymphocyte subsets did not change during therapy. Serum IgA concentrations showed a transient decrease at 3 and 6 months of GH therapy (p = 0.01 and p = 0.02). The observed changes were not related to GH dosage or height velocity. We conclude that GH treatment in children with ISS induced a small decrease in leucocyte and lymphocyte counts and serum IgA concentrations.

ISSN:1663-2818    

DOI:10.1159/000184626

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

We previously found that, following intravenous administration of ovine corticotropin-releasing hormone (CRH), the plasma ACTH concentrations of Black women were approximately twice as high as those of White women; however, there were no corresponding differences in cortisol response. To determine whether this difference in ACTH secretion is also present in men, we studied the hypothalamic-pituitary-adrenal axis of 10 Black and 10 White weight-, age-, and education-matched men. Waist-to-hip ratio, 24-hour urine free cortisol excretion, and ACTH and cortisol responses to 1 μg/kg ovine CRH were determined. There were no racial differences in waist-to-hip ratio, 24-hour urine free cortisol excretion, baseline free or total plasma cortisol and ACTH concentrations, or plasma cortisol response to CRH. However, CRH-stimulated plasma ACTH concentrations, measured in an extraction polyclonal radioimmunoassay, were significantly greater in Blacks than in Whites at all time points between 30 and 180 min after administration of CRH (area under curve (AUC) 1,796 ± 245 pmol/l·min in Blacks vs. 1,278 ± 121 pmol/ l·min in Whites, p < 0.001). Neither cortisol nor ACTH AUCs were significantly correlated with Body Mass Index in Black or White men. We conclude that there are differences in the HPA axis of Black and White men similar to those found previously in women. The physiology underlying these differences remains to be unders

ISSN:1663-2818    

DOI:10.1159/000184627

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

In 35 young children, circadian rhythms of salivary cortisol levels were determined by ELISA using a commercially available kit with a minor modification. The concentration of labeled cortisol in the serum kit was reduced in order to measure cortisol in 10 μl of saliva. Intra- and interassay coefficients of variation for salivary cortisol ranged from 2.4 to 9.9 and 3.2 to 8.9%, respectively. Recovery of salivary cortisol was 82.9-107.0%. There was a highly significant correlation between cortisol levels in saliva and serum in adults (r = 0.857). Salivary cortisol levels ranged from 0.01 to 2.252 μg/l00 ml and showed significant diurnal variation in the children. Our ELISA is a precise, simple, noninvasive and useful method for clinical practice and study in infants and childre

ISSN:1663-2818    

DOI:10.1159/000184628

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Blood concentration of corticosteroid-binding globulin (CBG) was measured in 85 preterm (24-36 weeks of gestational age) infants over the first 6 weeks of postnatal life. CBG concentrations directly correlated to gestational age and postnatal age in the first week of life. There was a significant increase in CBG values over the first 6 weeks such that mean values at weeks 4 through 6 were significantly greater than values at weeks 1 and 2. Postnatal CBG values were significantly lower in infants who had pulmonary disease during week 1 (p = 0.001). In summary, CBG values were directly correlated to gestational and postnatal age, and negatively correlated to acute illness. We speculate that the lower CBG values with lung disease may reflect an ongoing inflammatory response.

ISSN:1663-2818    

DOI:10.1159/000184629

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Background: In the last decade, the treatment of macroprolactinomas has been significantly improved by the introduction in the clinical practice of new drugs with dopamine-agonist properties. In particular, the availability of different forms of bromocriptine (BRC) with long duration of action and slow absorption, suitable for injectable (BRC-LAR) or oral (BRC-SRO) administration, has allowed one to obtain a more constant bromocriptinemia than with standard BRC, thus reducing adverse reactions. Moreover, a selective action on dopamine D2 receptors has been achieved using a new non-ergot derivative: the quinagolide (CV 205-502). The aim of this study was to evaluate the effects of BRC-LAR, BRC-SRO and CV 205-502 in 34 patients with macroprolactinoma. Protocol of the study: BRC-LAR was given at the monthly dose of 50-100 mg for 6-24 months to 8 patients whose PRL levels were 150 – 700 μg/l. BRC-SRO was given at the daily dose of 5-20 mg for 1-24 months to 10 patients whose PRL levels were 120-900 μg/l. CV 205-502 was given at the daily dose of 0.075-0.6 mg for 6-12 months to 16 patients whose PRL levels were 250-2,050 μg/l. CT and/or MRI scans were performed before and during treatment to evaluate tumor shrinkage. Data are presented as Mean ± SD. Results: Serum PRL levels normalized in 8/8 with BRC-LAR, 7/10 with BRC-SRO and 12/16 patients with CV 205-502. A significant shrinkage of tumor mass was obtained in 7/8 with BRC-LAR, 9/10 with BRC-SRO and 16/16 patients with CV 205-502, with consequent improvement of visual-field defects. Overall, the drugs were rather well tolerated: no patient stopped BRC-LAR or BRC-SRO and only 2 stopped CV 205-502. In particular, nausea, vomiting, headache, hypotension that disappeared spontaneously were observed in 5/8 with BRC-LAR, 4/10 with BRC-SRO and 4/16 with CV 205-502. Conclusions: The medical approach with long-acting BRC preparations and CV 205-502 which selectively binds D2 receptors allows one to obtain rapid normalization of PRL levels and shrinkage of macroprolactinomas in a large series of patients. These drugs are rather well tolerated also by patients proven to be untolerant to standar

ISSN:1663-2818    

DOI:10.1159/000184630

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Thyroxine intoxication is a benign, nonfatal condition, relatively common in the pediatric age group. We present here a detailed laboratory follow-up of all thyroidal hormones in 2 healthy girls who inadvertently ingested 2,500 μg of L-thyroxine. The two girls were hospitalized and treated with ipecac, gastric lavage, propranolol, prednisone, cholestyramin and propyl-thiouracil. All physical signs were normal and no symptoms were reported. All thyroidal hormones were measured 12 times from 2 h to 20 days after the ingestion. For T4, T3, rT3 and thyroglobulin (Tg) a one-compartment kinetic model was formulated and fitted to the empirical data. The kinetic data constants of production and elimination were calculated, as well as the metabolic clearance rate. All laboratory values were similar in both girls. T4 serum levels were already high 2 h after the intoxication and returned to normal values only after 13 days. Fitting the T4 serum levels with a one-compartment model resulted in absorption and degradation constants similar to those in normal adult subjects. Thyroid-stimulating hormone (TSH) levels decreased reaching their lowest concentration 14 h after the intoxication. They remained low till the 4th day, after which they rose gradually. Twenty days after the intoxication, TSH levels were still below their initial values. T3 reached its peak levels 11 h after the ingestion and decreased to normal values after 3 days. Both T3 production constants and T3 degradation constants were significantly increased. rT3 reached its peak level on the 2nd day after the intoxication and decreased to normal values on the 4th day. Its production and degradation constants were somewhat below normal levels. The T3/rT3 ratio decreased from a normal level of around 3 to as low as 1 and rose again after 13 days to extremely high levels (as high as 8). Tg serum levels dropped continuously with a half-life of 1-5 days and started rising again after 2-13 days. In conclusion, T4 intoxication in the child is combated primarily by a significant increase in T3 production and degradation, while meticulously maintaining relatively low T3 levels

ISSN:1663-2818    

DOI:10.1159/000184631

出版商:S. Karger AG    

年代:1995

数据来源: Karger

ISSN:1663-2818    

DOI:10.1159/000184632

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

An 11.5-year-old boy presented with recurrent attacks of hypoglycaemic coma. Endocrine investigations indicated adrenocortical insufficiency secondary to isolated ACTH deficiency, low ACTH and cortisol plasma levels with normal secretory reserve of other anterior pituitary hormones. The absence of ACTH response after corticotropin releasing factor and insulin-induced hypoglycaemia suggested a failure of primary pituitary ACTH-secreting cells. Among other hormone-secreting cells, pituitary cell circulating antibodies were negative. CT scan and MRI failed to reveal any anatomical abnormality of the sella or suprasellar area.

ISSN:1663-2818    

DOI:10.1159/000184633

出版商:S. Karger AG    

年代:1995

数据来源: Karger