摘要:

Diurnal variations and temporal coupling in the circulating levels of immunoactive and bioactive luteinizing hormone (LH) and prolactin (PRL), testosterone (T) and 17-beta-estradiol (E2) in plasma of 6 healthy men (mean age 33 years) were studied. Each hormonal profile was analyzed for circadian amplitude, acrophase and nadir. Acrophases for immunoactive LH and T were coincident and ranged between clock hours 1 and 5. Acrophase for bioactive LH ranged between 9 and 12 h and was coincident with nadir for T. Acrophase for E2 ranged between 15 and 18 h and was coincident with nadir for immunoactive LH (15–17 h). Acrophase for bioactive PRL and immunoactive PRL ranged between 20–23 and 23–4 h, respectively. The circadian amplitude for T showed a negative correlation coefficient with circadian amplitude of bioactive LH (alpha = -0.86) and positive correlation coefficient with circadian amplitude of immunoactive LH (alpha = 0.94). It is inferred that immunoactive LH may be a sensor of T concentration while bioactive LH may be actually involved in the feedback regulation of T secretion. It is suggested that PRL may have a key role in the regulation of LH secr

ISSN:1663-2818    

DOI:10.1159/000181880

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Short children who respond normally to growth hormone (GH) stimulation, but have a subnormal spontaneous secretion of GH (neurosecretory GH dysfunction, NSD) are treated with exogenous GH which might suppress their endogenous GH secretion. The effect of chronic administration of GH (8–24 months) on plasma GH responses to GHRH, clonidine and spontaneous GH secretion were studied in 17 NSD patients. The diagnosis of NSD was based on a normal GH response to clonidine ( > 10 µg/l) and an integrated concentration of (IC-GH) GH < 3.2 µg/l. The GH dose used in this study was 0.25 IU/kg three times a week in 10 patients and 0.05 IU/kg daily in 7 patients. Insulin-like growth factor I levels (nmol) increased significantly on therapy from 9.3 ± 3.8 to 24.4 ± 22.4 (p < 0.001). The GH response (µg/l) to GHRH was 20.4 ± 5.5 before treatment and 22.4 ± 6.2 on GH. Peak GH after clonidine was 22.4 ± 8.9 and 22.8 ± 8.1, respectively. There was no significant decrease in the number of GH spontaneous peaks (1.8 ± 0.7 vs. 2.0 ± 0.7, respectively) or in the area under the curve. A subcutaneous GH bolus of 0.25 IU/kg in 4 patients resulted in a GH peak of 55–82 µg/l at 3–5 h and a gradual return to basal levels at 15–20 h after GH administration. The first spontaneous GH peak appeared 26–28 h after GH injection, peak amplitude was 10–15 µg/l. Administration of a smaller subcutaneous dose 0.05 IU/kg to 7 patients resulted in a GH peak of 40 ± 10 µg/l at 4–5 h and a gradual return to basal levels at 10–12 h after GH administration. The first spontaneous GH surge was then noted within 4–7 h of GH return to basal levels. The amplitude of the first spontaneous peak was 30.5–13.0 µg/l. In conclusion, GH therapy in NSD patients on either alternate day or daily basis does not inhibit GH secretion. Four to nine h after GH disappearance, GH secretion reco

ISSN:1663-2818    

DOI:10.1159/000181881

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Subjects with Cushing’s disease have diminished growth hormone (GH) response to growth hormone-releasing hormone (GHRH). The aim of our study was to investigate the underlying mechanism of this diminished GH response in these patients using pyridostigmine (PD), an acetylcholinesterase inhibitor, which is reported to increase GH secretion by reducing somatostatin tone. Eight subjects with untreated Cushing’s disease (caused by a pituitary adenoma) and 6 control subjects received GHRH 100 µg in 1 ml of saline, as intravenous bolus injection 60 min after (1) placebo (2 tablets, p.o.) or (2) PD (120 mg, p.o.). After GHRH plus placebo, the GH peak (mean ± SEM) was significantly lower in subjects with Cushing’s disease (2.4 ± 0.5 µg/l) compared to control subjects (25.1 ± 1.8 µg/l, p < 0.05). After GHRH plus PD, the GH peak was significantly enhanced both in subjects with Cushing’s disease (7.1 ± 2.3 µg/l, p < 0.05) and in control subjects (42.3 ± 4.3 µg/l, p < 0.05). In patients with Cushing’s disease, the GH response to GHRH plus PD was lower with respect to the GH response to GHRH alone in normal subjects. We conclude that hypercortisolism may cause a decrease in central cholinergic tone which is in turn hypothesized to be responsible of an enhanced somatostatin release from the hypothalamus. However, other metabolic or central nervous system alterations may act synergistically with hypercortisolism in causing GH inhibition in patients wit

ISSN:1663-2818    

DOI:10.1159/000181882

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Thirty-seven patients with idiopathic hypopituitarism, of whom 12 had multiple pituitary hormone deficiencies (MPHD) and 25 isolated growth hormone deficiency (IGHD), were evaluated by magnetic resonance imaging (MRI). Twenty-two of the 37 showed congenital anterior pituitary hypoplasia, stalk agenesis and ectopic posterior pituitary gland at the infundibular recess (group A), while the remaining 15 presented isolated anterior pituitary hypoplasia (group B). Perinatal histories obtained from all patients demonstrated that 18/22 children of group A (81.81 %) had histories of adverse perinatal events, with breech presentation in 15 (68.18%). Twelve of 12 children of group A born by breech delivery developed MPHD; 3 born by cesarean section for breech presentation had only IGHD. Patients of group B had also a high incidence of perinatal insults (12/15, 80%), but breech delivery was markedly less frequent (13.33 vs. 68.18% of group A) and responsible for only IGHD. Group B had also higher percentages of maternal spontaneous abortion and low birth weight. Our study suggests that several factors may play a role in the development of growth hormone deficiency. Some patients had severe perinatal insults apparently leading to hypopituitarism. We were able to define by MRI a group of patients with congenital abnormalities, such as anterior pituitary hypoplasia, stalk agenesis and posterior pituitary ectopia, among whom breech presentation was very common. In this group, breech delivery was always followed by MPHD while cesarean or normal delivery in such patients was followed by IGHD only.

ISSN:1663-2818    

DOI:10.1159/000181883

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Tubular bone length of the left middle finger was determined by analysis of 259 hand radiographs of 118 patients with Turner syndrome (TS). Specific standards for TS children were developed and compared with those of normal children. The results show that in TS the growth pattern of the tubular bones of the left middle finger parallels statural growth and is not disproportional to height. In 14 patients with TS the length of the tubular finger bones was determined before and after a 1-year treatment with recombinant human growth hormone (rhGH) (mean dose 2.8 IU/m2 BSA/day). No disproportionate increment in the length of these bones compared to the respective height change was observed. The data suggest that over a short period of time the relatively high doses of growth hormone given in TS are unlikely to induce acromegaloid hand growth. The derived standards may serve to monitor hand growth in relation to height in TS during treatment in long-term trials with rhGH.

ISSN:1663-2818    

DOI:10.1159/000181884

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

The long-term results of transsphenoidal adenomectomy and the incidence of possible recurrences were studied in 61 patients who had normal basal serum growth hormone (GH) levels 1 week after surgery. The patients were followed up for an average of 6.0 years (range: 1.5–14.0 years) by repeated measurements of GH, oral glucose tolerance testing (OGTT) and at the last follow-up visit also by assaying somatomedin C levels. In 4 of the patients, the basal GH levels had increased to values above 5 ng/ml. In 43 patients, a normal suppression of GH during an oral glucose load was observed shortly after surgery. In only 2 of these cases did a transiently inadequate suppression develop during the follow-up period, although clinical acromegaly did not recur and the somatomedin C levels remained normal. It is concluded that recurrence of active acromegaly is unlikely to occur in patients who achieve a normal glucose-induced suppression of GH levels shortly after adenomectomy. As such, an OGTT provides better prognostic information than basal human GH level measurements and may give a clearer and earlier indication of surgical succes

ISSN:1663-2818    

DOI:10.1159/000181885

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Oxytocin (OT) administration has been shown to inhibit adrenocorticotropic hormone (ACTH)&slash;cortisol secretion in several experimental conditions. In the present study, the plasma OT responses to suckling in 7 lactating women or to mechanical breast stimulation in 6 normally menstruating women (experimental tests) or to sham stimuli in the same subjects (control tests) were measured and correlated with the simultaneous changes in plasma ACTH/cortisol levels. All women showed similar basal levels of OT, ACTH and cortisol, which remained unmodified after sham stimulation. In contrast, both suckling and breast stimulation produced a significant increase in plasma OT levels and a significant decrease in plasma ACTH concentrations. When OT and ACTH data were considered together, a significant negative correlation was found between the OT increase and the simultaneous ACTH decline. Plasma cortisol levels were lower during suckling or breast stimulation than in control conditions. These data show an inverse relationship between plasma OT and ACTH levels during suckling and breast stimulation in humans, suggesting an inhibitory influence of OT on ACTH/cortisol secretion in a physiological condition.

ISSN:1663-2818    

DOI:10.1159/000181886

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

A full-term 46, XY female newborn presented with respiratory failure due to a right-sided diaphragmatic hernia. During surgical repair, exploration revealed isolated dextrocardia and hypoplasia of the right lung. Neither gonads nor wolffian or müllerian structures could be palpated. Cardiac catheterization demonstrated defects of the ventricular septum, hypoplasia of the right pulmonary artery, persistence of the left vena cava superior and a patent ductus arteriosus. Anthropometric data were normal at birth, but fell below the 3rd percentile during follow-up. Body proportions displayed a predominance of the upper compared to the lower segment. Endocrine studies indicated no defect of steroid biosynthesis and no functional gonadal tissue. Using genetic analyses of various loci within the testis-determining region of the Y chromosome, a mutation could not be detected. The patient died from pneumonia at the age of 19 months. Postmortem examination confirmed the diagnosis of gonadal agenesis

ISSN:1663-2818    

DOI:10.1159/000181887

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Severe adverse reactions to propylthiouracil occur in 1–5% of patients. Three major side effects, namely agranulocytosis, hepatotoxicity and drug-induced hypersensitivity, have been described though these syndromes are not distinct entities and there can be overlaps in the clinical manifestations. The drug-induced hypersensitivity may be an immune-mediated reaction with multiorgan involvement in which a combination of polyarthritis, cutaneous vasculitis and fever is common. We report a patient with propylthiouracil-induced hypersensitivity with an unusual combination of high spiking fever, migratory polyarthritis, reversible sensorineural deafness, normochromic normocytic anaemia, leucocytosis and hepatotoxicity associated with polyclonal activation of multiple autoantibodies. This case illustrates the highly variable clinical manifestations of the syndrome. The prompt recovery upon withdrawal of the drug indicates the importance of early diagnosi

ISSN:1663-2818    

DOI:10.1159/000181888

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

The efficacy and tolerability of a slow-release preparation of bromocriptine (Parlodel SRO) were compared to those of conventional bromocriptine (Parlodel R) in a double blind, double dummy study of 12 hyperprolactinemic women (plasma PRL 81.3 ± 4.73, ng/ml mean ± SEM). For 2 weeks, the patients received 2.5 mg b.i.d. Parlodel R or 5 mg once daily Parlodel SRO; for the following 2 weeks, the dose of the drugs was doubled. The patients were then treated, in an open study, with 2.5–10 mg daily Parlodel SRO for 6 months. Both preparations caused a prompt and sharp PRL fall. Hormone levels remained inhibited over the whole month of observation with both preparations. Daily PRL profiles were very close with either drug although morning PRl levels were slightly higher during Parlodel SRO than during Parlodel R administration. Doubling the doses of the two drugs did not result in further significant lowering of PRL values. During the 6-month study with Parlodel SRO, plasma PRL further decreased and normalized in 11 of 12 patients. Clinical improvement occurred in the majority of cases. Tolerability of Parlodel SRO appeared to be better, though without statistically significant differences, than that of Parlodel R. Side effects were less important with the former compound in their number, severity and duration. In conclusion, thanks to its favourable pharmacological profile, Parlodel SRO appears to be a valuable alternative to regular bromocriptine in the management of hyperprolactine

ISSN:1663-2818    

DOI:10.1159/000181889

出版商:S. Karger AG    

年代:1991

数据来源: Karger