ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1992.tb02895.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1992.tb02896.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1992.tb02897.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SummaryobjectiveTo evaluate the effect of treatment with TSH suppressive dose of levothyroxine In patients with benig nthyroid nodules.designProspective randomized study. Group A (n= 20) patients received levothyroxine and group B (n= 20) patients did not. The dose of levothyroxine was adjusted to obtain an effective suppression of TSH. A clinical, analytical and morphological (with ultrasound) review was performed every 3 months. The mean ± SD follow‐upperiod was 6·10±2·2 months.patientsForty euthyrold women with solitary thyroid nodule on palpation, cold on sclntlgraphy and cytologically benign without contraindication participated.measurementsAt entry: biochemical and hormonal parameters, thyroid sclntigraphy and thyroid ultrasonography. Every 3 months additional determinations of thyroid hormones and TSH levels were carried out, if necessary, to verify effective TSH suppression. Every 6 months thyroid ultrasound imaging was performed.resultsPatients were euthyroid at entry into the study. The mean dose of levothyroxine necessary to obtain TSH suppression was 2·82±0·6μg/kg/day. No significant modification in the thyroid nodule diameter (mean ± SD 2·6±1·2vs2·5±1·2 cm) or in the thyroid nodule volume(10·3±11·9vs10·1±12·2 ml) were observed in group A. In group B the results were similar (2·8±0·9vs2·7±1·8 cm and 9·2±6·4vs9·2±9·5 ml, respectively). No differences were found in either group in the number of nodules that reduced significantly their volume (four and three, respectively).conclusionsThe suppressive therapy with levothyroxine was not effective In reducing nodule sizes in patients w

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1992.tb02898.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SummaryobjectiveThe aim was to investigate whether a pulsatile discharge of LH from the pituitary Is necessary to achieve the circadian secretion of testosterone.designThe daily rhythm of the androgen has been studied in patients with idiopathic hypogonadotrophic hypogonadism (IHH) both in the absence of therapy and during pulsatile administration of gonadotrophln releasing hormone (GnRH).patientsSix patients with IHH and ten normal subjects were analysed. Blood sampling was performed at 2‐hourly intervals, for 24 hours. The IHH patients then received synthetic GnRH i.v. at the rate of one pulse every 2 hours (10μg/pulse). On day 11 of treatment, blood samples were taken for the rhythm analysis every 2 hours, for 24 hours.measurementsPlasma testosterone and LH were measured in the individual samples by radioimmunoassay. Evaluation of the rhythm was performed by cosinoranalysis.resultsA significant circadian rhythm of plasma testosterone was statistically validated In the normal subjects, whereas no rhythm was detected in the IHH patientsin the absence of therapy. On day 11 of GnRH pulsatile administration the IHH patients showed normal testosterone levels and a statistically indistinguishable from the corresponding values in the normal subjects. Plasma LH did not show statistically significant circadian variations, either In the control group or in the IHH patients before or during therapy.conclusionsWe conclude that a physiological circadian rhythm of plasma testosterone can be obtained, In IHH men, by treatment with GnRH. Since the pulsatile administration of exogenous GnRH at constant dosesinduced a circadian rhythm in testosterone and no dally variations in LH were evident, we suggest that, although a pulsatile secretion of LH is probably necessary for the synchronization of the circadian rhythm with acrophase inthe morning, the testosterone variations might be theresults of a local testicular modulation of LH acti

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1992.tb02899.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SummaryobjectiveTo determine the factors influencing the outcome of transethmoidal partial hypophysectomy for suspected prolactinoma and the predictive value of pre and post‐operative dynamic PRL function tests.designA retrospective study of patients undergoing surgery for a suspected prolactinoma in Cardiff between 1979 and 1989.patientsEighty‐two hyperprolactlnaemlc patients (75 women, seven men) diagnosed as having a prolactinoma on the basis of dynamic PRL function tests, radiological investigation and exclusion of other causes.measurementsTSH and PRL responses to domperidone (10 mg i.v.) and TRH (200μg i.v.) measured preoperatively, 2 months post‐operatively, and annually thereafter. CT scan performed preoperatively in 58 patients. Operative findings, including adenoma size, documented in each case.resultsForty‐two patients (51%) had microadenomas (<10 mm), 37 (46%) had macroadenomas and in three no tumour was found at operation. Preoperatively, normal responses of both TSH (incremental rise100% rise) to domperidone were observed in two patients only: both had an abnormal vascular supply to the pituitary rather than an adenoma. Serum PRL was normalized in the early post‐operative period (<72 h; ‘early cure’) in 65 patients (79%). The highest early cure rate (96%,n= 26) was in patients with adenomas of 5–9 mm, lower rates being achieved for lesions of 10–19 mm (80%,n= 30),<5 mm (63%,n= 19) or ± 20 mm (57%,n= 7). The early cure rate was strongly correlated with preoperative PRL, ranging from 100% in patients with PRL10 000 mU/l. Dopamine agonist therapy of between 5 weeks and 4 years duration prior to surgery was associated with a significantly reduced early cure rate (60vs94%,P150 mU/l 1·3 days following microadenomectomy was associated with early recurrence and probably indicates failed surgery. An abnormal response of TSH to domperidone was documented 2 months post‐operatively in 11/60 patients with normal basal PRL, and preceded all three late recurrences. Of four patients with abnormal responses of both PRL and TSH at this time, two have relapsed to date.conclusionsIn carefully selected patients, partial hypophysectomy is an acceptable alternative to medical treatment for prolactinoma. Preoperatively, dynamic tests accurately identified those patients whose hyperprotactinaemia was non‐adenomatous in origin and, post‐operatively, identified a subgroup of patients at in

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1992.tb02900.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SummaryobjectiveWe aimed to study the effect of biosynthetlc growth hormone (GH) replacement In growth hormone deficient adults.designWe performed a double‐blind placebo‐controlledcross‐over study of 6 months biosynthetic GH, replacement and 6 months placebo separated by a 1‐month'swashout period.patientsFourteen growth hormone deficient adults were studied.measurementsWe measured total body weight, percentage fat mass, lean body mass, muscle volume, exercise capacity, maximum oxygen consumption, muscle strength, bone mineral content, a number of biochemical parameters, IGF‐I, GH antibodies andpsychological well‐being.resultsTotal body weight remained unchanged, but lean body mass increased (before GH mean ± SEM 49·8±5·5, after 53·4±5·6 kg; placebo before 51·2±5·4, after 50·4±5·1 kg;P<0·05 and fat mass decreased (before GH 21·5±4·1, after 19·3±4·3, placebo before 19·3±4·0, after 22·5±4·5 kg;p<0·05). Thigh muscle volume increased: (before GH 94·1±7·7, after 99·5±8·4 ml; placebo before 99·3±8·6, after 95·4±7·8 ml/0·8 mm computerized tomographic slice;P<0·05). Exercise capacity increased (before GH 174·15, after 199·18·9 watts; placebo before 162·5±2·3, after 154·19·8 watts;P<0·05), as did maximum oxygen consumption (before GH 1·93±0·2, after 2·17±0·2 I/m; placebo before 1·92±0·3, after 1·98±0·2 I/m;P<0·05). There was no change in quadriceps muscle strength. Alkaline phosphatase increased (before GH 87·5 (32–158), after 106·0 (49–179) U/l; placebo 98·5 (50–145), after 72·0 (40–111) U/l;P<0·05) without a change in the spinal bone density. IGF‐I increased (before GH 62 (36–97), after 216 (62–362)μg/l; placebo before 59 (52–112), after 60·5 (38–94)μg/l;P<0·05). Carbohydrate tolerance remained unchanged as did fasting lipids, serum sodium, potassium, urea, calcium, phosphate and liver transaminases. Psychological well‐being remained unchanged. No growth hormone antibodies were detected before or after GH treatment.conclusionsGH alters the body composition of growthhormone deficient adults and leads to improved exercisecapacity; alkaline phosphatase act

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1992.tb02901.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SummaryobjectiveWe examined the contributions of growth hormone (GH) and Insulin‐like growth factor‐I (IGF‐I) to Insulin sensitivity and beta‐cell function in acromegaly.designA cross‐sectional study was used with continuous Infusion of glucose with model assessment todetermine Insulin sensitivity and beta‐cell function.patientsTen patients with active acromegaly, seven with controlled disease and 22 normal Individuals werestudied.measurementsGlucose and insulin levels were measured fasting and at the end of the one‐hour glucose Infusion to calculate insulin sensitivity and beta‐cell function. Random GH and IGF‐I were recorded. Most patients had values of GH taken after a 100‐g oral glucose tolerance test and K values from Intravenous glucosetolerance tests.resultsPatients with active acromegaly had significantly decreased Insulin sensitivity compared to thenormal population (P<0·001), while those with controlled disease did not. There was a significant negative correlation between IGF‐I and insulin sensitivity In those with active disease (P<0·05). Beta‐cell function in both active and controlled patient groups was elevated compared tothe normal population (P<0·05,P<0·01 respectively) and this was significantly related to IGF‐I in the active group (P<0·05). GH levels did not correlate with fasting Insulin, glucose, Insulin sensitivity or beta‐cell function In either group.conclusionsPatients with active acromegaly have decreased insulin sensitivity and Increased beta‐cell function that are significantly related to IGF‐I but not GH levels. When the disease is controlled, beta‐cell function remains ele

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1992.tb02902.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SummaryobjectiveWe aimed to Investigate the effect of low dose (1800 cGy) prophylactic cranial Irradiation on physiological growth hormone secretion.designWe performed an analysis of 24‐hour serum GH profiles using 20‐mlnute sampling.patientsForty‐four children were studied, of whom 21 were long‐term survivors of acute lymphoblastlc leukaemia and 23 were normal children. They were further subdivided into prepubertal, pubertal and post‐pubertal groups.measurementsGH profiles were analysed by autocorrelation, Fourier transformation and spectral analysis of stationarlzed data, and peak detection using the Pulsar peak detection program.resultsIn the normal children, there was a significant increase in the median (range) area under the curve (AUC) of the GH profile between the prepubertal and pubertal groups (62 (11–124) and 137 (142–158) IU/l/h respectively, (P<0·01)). There was also a change In the spectral analysis through puberty. The dominant frequencies were spread widely in the prepubertal and post‐pubertal groups but sharply focused in the pubertal group. In the cranlally irradiated children there was no significant increase in AUC between the prepubertal (62(13–110) IU/l/h) and pubertal groups (92 (14–163) IU/l/h). The wide range of dominant frequencies persisted in the pubertal cranially irradiated group due to the presence of additional high frequency pulses. The impression of a disturbance of the periodicity of GH secretion in the cranlally irradiated pubertal group was further supported by the finding that the autocorrelation function in this group alone was not significantly different from that which would arise from random data.conclusionsA novel form of GH Insufficiency has been observed after low dose Irradiation In childhood in which an abnormality of periodicity and a quantitative reduction In GH secretion appears r

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1992.tb02903.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SummaryobjectiveWe investigated the association between thyroid function and the biological activities of thyroid stimulating antibodies (TSAb) and thyroid stimulation blocking antibodies (TSBAb) in patients with post‐partum hypothyroidism.designA prospective study.patientsWe studied 25 patients with post‐partum hypothyroidism who visited our thyroid clinic during the period from 1985 to 1990.measurementsWe measured TSH binding Inhibitory immunoglobulin (TBII) and TSAb activity at the initial presentation of each of the 25 patients. Women found to have elevated TSAb activity were followed up. Upon finding negative TSAb activity along with positive TBII activity In the serum at the initial presentation, we measured TSBAb activity. Women found to have elevated levels of TSBAb at the Initial presentation were also followed up.resultsElevated TBII activity was found in six of the 25 patients, as was high TSAb activity (205–2651 %, normal 55·0–145·0%) in five of these six and in one other patient at the initial presentation. Markedly elevated TSBAb activity (89%) was found in one TBII positive patient. We were able to follow up serially five TSAb positive patients and the TSBAb positive patient over periods ranging from 11·5 to 26·5 months post‐partum. The maximal value of TSAb activity was observed at the initial presentation in all TSAb positive patients, following which the activities gradually decreased.One of these patients developed Graves' hyperthyroidism associated with high TSAb activity (1223%) at 10·5 months post‐partum. One of the other patients was restored to euthyrold with elevated TSAb activity (279%), but thereafter developed hypothyroidism in conjunction with the disappearance of TSAb activity at 26·5 months post‐partum. In the other two patients, normalization of thyroid function was observed with elevated TSAb activity. Thereafter, thyroid function remained within the normal range even with the disappearance of TSAb activity. In the other patient, normalization of thyroid function was observed at 11·5 months post‐partum, 3 months after the disappearance of TSAb activity. In the TSBAb positive patient, TSBAb activity decreased to 21 % by 17·5 months post‐partum associated with normalization of thyroid function.conclusionThe present study demonstrates the presence of elevated levels of TSAb activity in some patients with post‐partum hypothyroidism. In these patients, Graves' hyperthyroldism may be induced by TSAb activity, and hypothyroidism may reoccur with the disappearance of the TSAb activity. Furthermore, post‐partum hypothyroidism may be due to increased TS

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1992.tb02904.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY