摘要:

Fasting hyperglycemia in insulin-dependent diabetic patients (IDDM) treated according to the basal-bolus principle may be due to the fact that currently available neutral protamine Hagedorn (NPH) insulin preparations do not sufficiently meet the increased insulin need in the second part of the night. In the present study, it was investigated whether the amorphous zinc insulin Semilente® can be used to control fasting hyperglycemia in IDDM patients. Ten type 1 diabetic patients with persistent fasting hyperglycemia ( > 10mmol/l) participated in the double-blind randomized cross-over trial with 2 10-day treatment periods. Night profiles of blood glucose and free insulin concentrations were determined at the end of each treatment period. Three doses of regular insulin were given before the meals and NPH insulin and Semilente at 10.00 p.m. Nighttime blood glucose and insulin profiles were different under the treatment with Semilente and NPH insulin. Injection of Semilente at bedtime resulted in higher insulin and lower blood glucose values during the second part of the night (p < 0.001 versus Semilente by ANOVA). Semilente injected at bedtime can prevent the early-morning rise in blood glucose in type I diabetic patients

ISSN:1663-2818    

DOI:10.1159/000182731

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

This retrospective study was carried out to investigate, in a large group of hyperandrogenized women with polycystic ovary syndrome (PCOS) and nonhyperandrogenized control women, the interrelationships between sex steroids and indices of body fat distribution. Moreover, we investigated the relationships between these parameters and insulin blood levels, since obese women with abdominal pattern of fat distribution (A-BFD), as well as those with PCOS (either obese and nonobese) are characterized by moderate to severe hyperinsulinemia. A sample of 100 women with PCOS and that of 138 women without clinical signs of hyperandrogenism, who served as a control group, were investigated. The waist to hip circumference ratio (WHR) which was used to define different patterns of fat topography was significantly (p < 0.05) higher in PCOS (0.84 ± 0.10) than in control women (0.81 ± 0.08). In both groups, women with WHR values lower than or equal to 0.85 were considered as having a peripheral pattern of body fat distribution (P-BFD) whereas those having WHR values higher than 0.85 had A-BFD. Compared to controls, women with PCOS had higher LH, androgen and estrogen concentrations. In both PCOS and controls there were no differences in sex hormone levels between women with different patterns of fat distribution, except androstenedione, which levels were significantly higher in women with A-BFD than with P-BFD. Women with PCOS showed significantly higher insulin levels than controls. Moreover, in both groups fasting and stimulated insulin were significantly higher in women with A-BFD than in those with P-BFD. Significant simple correlation coefficients were found between WHR and androstenedione in PCOS only, and between WHR and insulin in both PCOS and controls. In multiple regression analysis, in which age and body mass index were included as independent variables, a weak but significant correlation between WHR and androstenedione values was found both in PCOS and controls separately, as well as in the whole sample of women considered together. On the contrary, correlation coefficients between WHR and insulin were found in PCOS and controls considered separately and in the whole sample of women, even when the independent effects of androgens had been taken into account in the analysis. These results are consistent with the hypothesis that the degree of androgenization is only weakly correlated with A-BFD in premenopausal women. Hyperinsulinemia, on the contrary, appears to be more consistently correlated with A-BFD, regardless of the presence of PCOS. Whether these associations may have a causal relationship with different patterns of fat distribution remains to be further elucidate

ISSN:1663-2818    

DOI:10.1159/000182732

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

Since normal pulsatile growth-hormone (GH) secretion displays a major and consistent surge during sleep, we studied the effect of timing of GH supplementation on plasma GH-binding protein activity (GH-BP), insulin-like growth factor-I (IGF-I) and growth. 34 prepubertal subjects (28 boys, 6 girls) aged 8-11 years, of short stature ( 10 µg/l and a subnormal 24-hour GH secretion ( < 3 µg/l), were randomly allocated to receive Bio-Tropin (recombinant GH, Bio-Technology, Israel) 0.81 IU/kg/week in 3 equally divided doses. GH was administered either at 8.00-10.00 h (M group), 14.00-16.00 h (AN group) or 19.00-21.00 h (NT group). Height velocity, IGF-I and GHBP were determined prior to and after 6 and 12 months on GH therapy in the three groups. There was no significant difference between the three groups in the growth response, IGF-I and GH-BP increase, all of which increased significantly during GH therapy. Although GH levels after the injection decline to preinjection levels after 10 h, the changes induced by GH therapy, as reflected in IGF-I and GH-BP, last in the circulation long enough to prevent fluctuations in its action. The similarity of IGF-I and of GH-BP levels in the three treatment groups might explain the similar growth effects of the 3 protocol

ISSN:1663-2818    

DOI:10.1159/000182733

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

The changes in body composition evaluated by the mean of bioelectrical impedance analysis (BIA) have been observed in a group of 16 male adolescents at the time of discontinuation of growth hormone (GH) therapy as well as at 6 and 12 weeks later. After reevaluation of their endocrine function, 6 patients (3 craniopharyngioma, 1 irradiation, 1 malformative, 1 idiopathic) had a profound persistent GH deficiency (maximum peak of GH under provocative tests < 5 ng/ml and low IGF-1 levels), while 10 patients had a normal somatotropic function. Both groups were comparable as far as age, weight and body mass index are concerned. Fat weight is significantly higher in the GH-deficient patients (9.9 ± 2.6 kg) than in boys with a normal somatotropic function (6.0 ± 1.1 kg) at the time of the discontinuation of GH therapy (p < 0.01). 3 months later, the increase in fat weight is significant only in the group of patients with severe GH deficiency (+4.1 ± 2.2 kg; p < 0.05), the difference between the 2 groups (14.0 ± 3.5 and 7.3 ± 1.0 kg) becoming highly significant (p < 0.001). Lean body mass is lower in the GH-deficient patients and decreases slightly after GH discontinuation, while no significant variation is observed in the group of non GH-deficient boys. Although BIA assessement of body composition may be discussed when applied to GH-deficient subjects, these results show that such patients should be reevaluated after the discontinuation of GH therapy, including examination of the possible metabolic consequences of GH defici

ISSN:1663-2818    

DOI:10.1159/000182734

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

In 31 children and adolescents with cystic fibrosis (CF), whose bone mineral density (BMD) was determined at the level of the lumbar spine, serum bone γ-carboxyglutamine acid (GLA) protein (BGP) was measured. A standard radioimmunoassay method gave for the studied CF population a median serum BGP concentration of 9 µg/l (range: 0.8-18.6) which corresponds to a median Z-score for age of-1.72 (range: -3.3 to +0.04). Thirteen patients presented a BGP concentration lower than 2 standard deviations (SD) under the mean for age. These patients did not differ from the others by their circulating thyroxine, triiodothyronine, 25-hydroxyvitamin D or parathyroid hormone levels. The lowering of the BGP concentration was neither related to the growth velocity nor to the severity of the lung disease, as assessed by lung scintigraphy. Six patients with a decreased BMD ( < 2 SD under mean for age) were found. Five of them had also a decreased BGP concentration. In conclusion, decreased serum BGP concentration was found in 42% of the studied CF patients and could not be related to hormonal abnormalities. Serum BGP had a low specificity (72%) in predicting osteopenia in young CF patient

ISSN:1663-2818    

DOI:10.1159/000182735

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

Depression is a common, life-threatening complication of Cushing’s syndrome and may occur in several other endocrine disorders. It is not clear, however, whether distinct features pertain to hypercortisohsm. We studied depression in Cushing’s syndrome differentiating pituitary-dependent and pituitary-independent forms, its incidence compared to Graves’ disease, and its appearance in the prodromal phase of both conditions. To 66 consecutive patients with Cushing’s syndrome and 70 with Graves’ disease, after treatment, a semistructured interview for depressive symptoms based on Paykel’s clinical interview for depression was administered. In Cushing’s syndrome, the response of depression to normalization of urinary cortisol levels was evaluated by Kellner’s global rating method. There was a significant difference in the occurrence of depression (p < 0.001) between Cushing’s syndrome (62%) and Graves’ disease (23%). Depression appeared in the prodromal phase in 27% of patients with Cushing’s syndrome and in 14% of those with Graves’ disease, but the difference was not significant. In Cushing’s syndrome, there were no significant differences in depression between patients with pituitary-dependent (n = 41) and pituitary-independent (n = 20) forms, or in their response to treatment. About 70% of patients fully recovered from their depression, whereas there was no substantial change in the others and even worsening in 2. Our findings in Cushing’s syndrome and Graves’ disease are in agreement with previous investigations using specific diagnostic criteria for depression. We found a tendency for this symptom to manifest in the prodromal phase of both illnesses. An endocrine etiology should be, therefore, considered in depressed patients not responding to s

ISSN:1663-2818    

DOI:10.1159/000182736

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

We investigated 2 patients affected with Cushing’s syndrome due to the ectopic production of adrenocorticotropic hormone (ACTH) by a small cell lung carcinoma. In the 2 patients, the long-acting somatostatin analogue octreotide (100 µg, subcutaneously) induced a paradoxical increase in plasma ACTH and cortisol levels. In 1 patient, lanreotide, a new somatostatin analogue in a slow-release formulation (30 mg, intramuscularly), induced a similar rise in ACTH and cortisol secretion. To our knowledge, such a response has not been previously reported. Further use of somatostatin analogues in ectopic ACTH-producing tumors, especially lung tumors, requires preliminary evaluation of their therapeutic efficacy by a short test with somatostatin analog

ISSN:1663-2818    

DOI:10.1159/000182737

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

In order to clarify whether the damage in gonadotropin secretion due to iron overload in patients with β-thalassemia is of pituitary or hypothalamic origin, 14 euthyroid patients (8 females and 6 males, age 15-24 years) affected by β-thalassemia major with hypogonadotropic hypogonadism were studied. Luteinizing-hormone (LH), follicle-stimulating hormone (FSH) and free α-subunit (FAS) were measured during LH-releasing hormone (LH-RH) stimulation test, and thyroid-stimulating hormone (TSH), prolactin (PRL) and FAS during thyrotropin-releasing hormone (TRH) stimulation test. During LH-RH stimulation, the mean basal LH, FSH and FAS levels were similar to those found in normal prepubertal children, but the peak values were lower than those found in such children. Also during TRH stimulation, the mean peak values of FAS were lower than those of normal prepubertal children, but the TSH response was normal. The lack of response of gonadotropins and FAS to LH-RH cannot exclude hypothalamic failure; however, the normal response of TSH to TRH, in spite of the poor response of FAS, indicates that the origin of hypogonadotropic hypogonadism is the pituitary damage concerning not only the gonadotroph but also the thyrotroph cel

ISSN:1663-2818    

DOI:10.1159/000182738

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

CV205-502 is a new non-ergot dopamine agonist currently being studied for the treatment of hyperprolactinaemia. We have assessed the effects of CV205-502 on prolactin secretion and the clinical consequences of hyperprolactinaemia in 16 patients with hyperprolactinaemia who had previously been unsuccessfully treated with bromocriptine. These patients had been either intolerant of and/or resistant to the effects of bromocriptine. Sixteen patients, all women in an age range between 20 and 49 years (mean 31.5 years), were treated for periods of between 8 and 52 weeks with doses of CV205-502 ranging from 0.075 to 0.3 mg taken once daily at night. Seven out of 10 of the patients, who were intolerant of bromocriptine, tolerated CV205-502 better with fewer side effects although the nature of the side effects was similar to that associated with bromocriptine. Only 1 patient from this group stopped taking CV205-502 due to side effects. Six of 11 patients exhibiting bromocriptine resistance showed a significant reduction in the degree of hyperprolactinaemia but normoprolactinaemia was achieved in only 1. Galactorrhoea ceased in 2 of 6 patients, menstruation resumed in 6 of 11 patients presenting with amenorrhoea, and 2 patients conceived. In patients with bromocriptine intolerance and/or resistance, CV205-502 is useful as a second line treatment.

ISSN:1663-2818    

DOI:10.1159/000182739

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

The role of dopaminomimetic drugs on the brain catecholamine metabolism in the neuroendocrine regulation of the polycystic ovary syndrome (PCO) was investigated. We measured, besides peptide hormones and sex steroids, urinary dopamine (DA), norepinephrine, epinephrine, vanillylmandelic acid, homovanillic acid (HVA), 3,4-dihydroxyphenylacetic acid (DOPAC) and total 3-methoxy-4-hydroxyphenylglycol (MHPG) levels by high-performance liquid chromatography with electrochemical detector in 10 women with PCO before and during long-term bromocriptine (BRC) administration. HVA and DOPAC concentrations were significantly lower (p < 0.001) in PCO patients compared with 12 control subjects in the early follicular phase, whereas MHPG concentrations were significantly higher (p < 0.01) in PCO patients. During BRC administration, HVA, DOPAC and MHPG levels increased significantly (p < 0.01 for HVA and DOPAC, and p < 0.05 for MHPG), prolactin levels dropped markedly (p < 0.01), whereas luteinizing hormone levels did not change (p = NS). These data show (1) a reduced DA activity in PCO which may be normalizable under BRC treatment, but also (2) no major effects of DA metabolism on the inappropriate gonadotropin secretion of the syndrome.

ISSN:1663-2818    

DOI:10.1159/000182740

出版商:S. Karger AG    

年代:1993

数据来源: Karger