摘要:

Older methods for radioimmunoassay of ACTH in human plasma have detected a high frequency of plasma ACTH elevation in patients with lung cancer, even in the absence of Cushing's syndrome. It now appears evident that these assay systems measure biologically inactive forms and fragments of ACTH. Since ectopic Cushing's syndrome may be clinically atypical, a radioimmunoassay for ACTH that correlates with the clinical state would be of value. Accordingly, circulating plasma corticotropin (ACTH) levels were measured in 39 consecutive patients with biopsy-proven, untreated lung cancer, all without evidence of Cushing's syndrome. In only one instance was ACTH found to be elevated by the method of assay used. Two interpretations are justified: (1) elevated plasma ACTH levels are infrequent in patients with lung cancer, or (2) ACTH measurements vary according to the assay system used.

ISSN:0002-9629    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Thyroid dysfunction is common in older individuals, yet the diagnosis is often complicated by atypical clinical presentations and difficulty in interpretation of laboratory tests. An understanding of the alterations in thyroid function occurring normally as a consequence of the aging process is necessary for correct laboratory diagnosis of thyroid dysfunction in the elderly. There are subtle alterations in hypothalamic and pituitary function but normal feedback control of TSH secretion persists. In the thyroid itself, morphologic changes develop with age, but have little impact on thyroid hormone economy. Thyroidal secretion of thyroxine decreases, but parallels the decrease in thyroxine degradation rate, resulting in unaltered plasma thyroxine levels. Decreased peripheral conversion of thyroxine to triiodothyronine causes a fall in triiodothyronine concentrations. Non-thyroidal illnesses in the elderly may perturb the laboratory assessment of thyroid function by producing isolated high or low thyroxine levels in euthyroid individuals.

ISSN:0002-9629    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Despite the host of complications which may be associated with intravenous sodium bicarbonate infusion, the use of this agent is a frequent necessity in patients with metabolic acidosis. No satisfactory formula for calculating bicarbonate dose has previously been described, although such an approach might be expected to reduce the incidence of these complications. The authors have devised a simple formula for bedside calculation of bicarbonate requirement in metabolic acidosis, designed to elevate the pH to the region about 7.30, and report their experience with the use of this formula in 13 instances. In all but one, the post-infusion pH was between 7.25 and 7.37, with a mean of 7.30 ± 0.04 and no instances of serious overtitration. It is concluded that the formula is useful as a pragmatic aid in the management of patients with metabolic acidosis.

ISSN:0002-9629    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

After receiving a lithogenic regime for 12 weeks (Phase I), 60 hamsters were allocated to groups of 10 animals. During Phase II, except for one group which remained on the lithogenic regime, all groups were switched to a standard diet and chenic acid 20 mg/kg/day or Zanchol 5, 15 or 25 mg/kg/day or no other therapy. Half the animals in each group were sacrificed at 3 weeks and the remainder at 10 weeks. Gallstones were found in all animals except those receiving chenic acid for 10 weeks. At 3 weeks in Phase II, with chenic acid, the bile acid pool size was not significantly decreased and bile remained saturated despite a 38% lower rate of hepatic synthesis of cholesterol (p<0.01), but became unsaturated at 10 weeks at which time the bile acid pool size was increased by 37% (p<0.01). The highest dose of Zanchol increased the bile acid pool size by 74% (p<0.01) while increasing the hepatic synthesis of bile acids by 38% (p<0.01). None of the doses of Zanchol, however, significantly changed biliary cholesterol saturation.In conclusion, chenic acid decreased the hepatic synthesis of cholesterol prior to increasing the bile acid pool, unsaturating bile and dissolving gallstones. Zanchol did not affect the biliary cholesterol saturation or dissolve gallstones despite an increase in the synthesis and pool size of the bile acids.

ISSN:0002-9629    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

A patient is described with Cushingoid features and a tumor of the paranasal sinuses. Laboratory studies revealed hyperglycemia, hypokalemia, alkalosis, hypercortisolemia, and elevated serum ACTH levels. The cortisol level increased briskly in response to parenteral ACTH, but was only partially suppressed by dexamethasone. Microscopically, the tumor was found to be a paraganglioma containing many neurosecretory granules. Treatment with metyrapone, o, p'-DDD, and irradiation of the tumor resulted in a lasting remission. It is concluded that this unique patient suffered from Cushing's syndrome due to ectopic ACTH production by a paraganglioma of the paranasal sinuses.

ISSN:0002-9629    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Growth Hormone (GH) secretion was studied in a 61-year-old woman with idiopathic orthostatic hypotension (IOH) or Shy-Drager Syndrome. The 24-hour pattern of GH secretion showed multiple daytime peaks and little nighttime activity. The largest daytime peak of 35.0 ng/ml is much greater than the levels observed in seven studies using five age-matched normal women. There were few secretory episodes during sleep in the patient and the control subjects. Paradoxical GH responses occurred during oral glucose tolerance tests, despite high blood glucose. GH was also detected in three studies using TRH. These data suggest that our patient with IOH has abnormal regulation of GH secretion. This is a sign of hypothalamic-pituitary dysfunction in a diffuse neurological disease.

ISSN:0002-9629    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

A 78-year-old woman developed spiking fever of obscure etiology while receiving long term therapy with methyldopa and died suddenly seven days after admission to the hospital. Autopsy showed widespread granulomas in the liver, spleen, lymph nodes and bone marrow, interstitial myocarditis with granulomatous features and renovascular vasculitis. Eosinophils were prominent in the granulomas and in the myocardium consistent with a drug-induced cell mediated hypersensitivity reaction presumably triggered by methyldopa. The need for a careful drug history in fever of obscure etiology is emphasized.

ISSN:0002-9629    

出版商:OVID    

年代:1982

数据来源: OVID