bluuebunny/crossref_metadata_2025_split huggingface dataset:
Serum FSH bioactivity and response to acute gonadotrophin releasing hormone (GnRH) agonist stimulation in patients with polycystic ovary syndrome (PCOS) as compared to control groups
Authors: Méchain Catherine , Cédrin Isabelle , Pandian Chelvi , Lemay André 
Published: March 2008

SummaryOBJECTIVE We evaluated the biological activity of FSH in the serum of women with polycystic ovary syndrome before and after acute administration of a GnRH agonist as compared to control groups.DESIGN FSH, oestradiol and androstenedione response to buserelin (100 μg s.c.) comparing seven polycystic ovary patients, six idiopathic hirsute women, 11 normal women in the follicular phase and nine normal men.MEASUREMENTS Rat granulosa cell aromatase bioassay in the presence or absence of polyethyleneglycol (PEG) pretreated 2% serum. Serum biological FSH (B‐FSH), immunological FSH (I‐FSH) and B/I ratio at times 0,1, 2, 3, 4, 8, 12 and 24 hours. Serum androstenedione and oestradiol at times 0 and 24 hours.RESULTS Human gonadotrophin‐free (oral contraceptive user and after FSH immunoabsorption) and PEG‐pre‐treated serum increases the aromatase activity in response to increasing doses of purified FSH. The maximum enzymatic activity is however higher with 2% serum than with 4% serum. The amplitude of the B‐FSH response to the GnRH agonist is markedly decreased in the polycystic group as compared to the group of normal women. There is also a small decrease in the l‐FSH response in the polycystic women. When compared to that of normal women, the area under the curve in the polycystic ovary patients is reduced by 71% for B‐FSH (P<001) and by 23% for l‐FSH (P<0.05). The B‐FSH and I‐FSH responses in men are very small. After an initial decrease the B/I ratio returns to baseline level in normal women but remains low in the other groups. At time 24 hours, there is no significant change in the serum concentration of androstenedione but serum oestradiol, the baseline of which is significantly higher in the polycystic patients than in normal women, is also significantly higher at 24 hours (P< 0.05) in response to the pharmacological release of FSH.CONCLUSION The gonadotrophin‐free and PEG‐pre‐treated human serum has an inherent stimulatory effect on the rat granulosa aromatase bioassay with a higher activity at 2% serum. Acute GnRH agonist stimulation reveals a deficiency in the FSH response in polycystic ovary patients. The greater deficit in B‐FSH than in l‐FSH would indicate a possible modification in the FSH isoforms in this syndrome. The meaning of this observation for the understanding of the physiopathology of the polycystic ovary syndrome remains to be evaluated.
The short and long‐term effects of octreotide on calcium homeostasis in patients with acromegaly
Authors: Fredstorp Lennart , Pernow Ylva , Werner Sigbritt 
Published: March 2008

SummaryOBJECTIVE The somatostatin analogue octreotide (Sandostatin, Sandoz) is effective in reducing growth hormone levels in patients with acromegaly. Early and transient gastrointestinal side‐effects are frequent. The aim was to evaluate whether gastrointestinal side‐effects during the initial phase of octreotide treatment affect calcium homeostasis, and whether effects on calcium homeostasis are seen during long‐term treatment with octreotide in patients with optimal effect on GH and subjectively normal gastrointestinal function.DESIGN We first studied short‐term treatment with octreotide during 14 days. From day 15 of the study medication was withdrawn, and on day 20 follow‐up measurements were made. We then observed the effects of long‐term treatment with octreotide. Mean duration of treatment until the day of blood sampling was 32 months (range 9–48 months).PATIENTS Sixteen patients with acromegaly were studied, ten in the short‐term study and ten in the long‐term study; four were included in both.MEASUREMENTS Serum levels of calcium, phosphate, PTH, alkaline phosphatase, 1,25(OH)2 Vit D, vitamin D‐binding protein and sex hormone‐binding globulin (SHBG) were measured before treatment (day 0) and on days 4, 6, 8,14 and 20 during the short‐term study and, except SHBG, before treatment and during therapy in the long‐term study.RESULTS During the short‐term treatment mean (± SEM) serum calcium decreased significantly (on days 6 and 8, 2.21 ±0.08 and 2.15 ± 0.09 mmol/l, respectively vs basal level, 2.38 ± 0.08 mmol/l), whereas significant increments were seen in mean serum PTH (on day 14, 36 ± 4 vs basal, 24 ± 3 ng/l; ng/l ± 9.425 = pmol/l), mean serum 1,25(OH)2 Vit D (on day 8, 112 ± 7 vs basal 96 ± 8 pmol/l), and ‘free 1,25(OH)2 Vit D‐index', i.e. molar ratio of 1,25(OH)2 Vit D and vitamin D‐binding protein (on days 8 and 14, 1.72 ± 0.09 ± 105 and 1 66 ± 0.11 ± 10–5, respectively vs basal, 1.33 ± 0.09 ± 10–5). The changes were within the normal range. No changes were seen in serum phosphate, alkaline phosphatase, or vitamin D‐binding protein.During the long‐term study mean serum calcium and phosphate decreased significantly, 2.32 ± 0.04 vs basal 2.42 ± 0.04 mmol/l and 1.24 ± 0.07 vs basal 1.40 ± 0.09 mmol/l, respectively, whereas mean serum PTH increased significantly, 40 ± 8 vs basal 21 ± 5 ng/l. The changes were within the normal range. No changes were seen in serum alkaline phosphatase, 1,25(OH)2 Vit D, free 1,25(OH)2 Vit D‐index, or vitamin D‐binding protein.CONCLUSION Altered calcium homeostasis during octreotide treatment in acromegaly is not only initial and temporary, but can also be seen after several years of treatment. The clinical relevance of these long‐standing effects needs to be further investigated.
Bone mineral density in patients with endogenous subclinical hyperthyroidism: Is this thyroid status a risk factor for osteoporosis?
Authors: Földes J. , Tarján G. , Szathmari M. , Varga F. , Krasznai I. , Horvath Cs. 
Published: March 2008

SummaryOBJECTIVE The aim of the present study was to elucidate whether endogenous subclinical hyperthyroidism due to a solitary autonomously functioning thyroid nodule affects bone metabolism and is a risk factor for osteoporosis. DESIGN In a cross‐sectional study measurements of bone mineral density were performed in premenopausal and post‐menopausal women. Patients were categorized into non‐toxic nodular goitre (n= 32), subclinical hyperthyroid (n= 37) and toxic solitary autonomous thyroid nodule (n= 22) subgroups and the results were compared with those of sex and age‐matched control reference population (n= 68).MEASUREMENTS Lumbar spine and femoral neck bone mineral densities were measured by dual energy X‐ray absorptiometry. Single‐photon absorptiometry was applied to the measurement of bone mineral content in the midshaft of the radius.RESULTS In the non‐toxic nodular goitre group, bone densities for all the scanned sites did not differ from the sex and age‐matched reference population. At the L2–4 scanning site a significant decrease in the bone mineral density could be observed only in the toxic nodular goitre group and this decrease was more marked in the postmenopausal (P<0 001) than in the premenopausal females (P < 0 05). At the femoral neck and midshaft radius the mean densitometric values were slightly, but significantly, lower only in the post‐menopausal subclinical hyperthyroid group compared with the reference population (P < 0 01). The bone mineral density of the femoral neck, as well as the bone mineral content of the midshaft radius, was significantly decreased in both the premenopausal and post‐menopausal patients with a toxic solitary nodule.CONCLUSION This study indicates that the bone mineral density of the lumbar spine, femoral neck and the midshaft of the radius are not significantly decreased in premenopausal patients with endogenous subclinical hyperthyroidism resulting from a solitary autonomously functioning thyroid nodule. Conversely, findings hint at the possibility that long‐lasting endogenous subclinical hyperthyroidism may be a contributing factor to the development of osteoporosis in some post‐menopausal women, mostly at sites where cortical bone preponderates.
Does acromegaly really predispose to an increased prevalence of gastrointestinal tumours?
Authors: Ladas S. D. , Thaiassinos N. C. , Loannides G. , Raptis S. A. 
Published: March 2008

SummaryOBJECTIVE The few published prospective studies suggest a strong association of colonic tumours with acromegaly, but include small numbers of patients. In addition, the upper gastrointestinal tract of these patients has never been prospectively studied. The aim of the present study was to investigate the incidence of gastric and colonic tumours in a large cohort of acromegalic patients.DESIGN Acromegalic patients consecutively admitted to an Endocrinology Department for diagnosls and follow‐up, were submitted to gastroscopy and colonoscopy, to identify those harbouring gastrointestinal tumours.PATIENTS Over a 5‐year period, 54 out of 61 patients (78% with active disease) received colonoscopy and 42 out of 61 gastroscopy. No patient had a past history of gastrointestinal malignancy.MEASUREMENTS All polypoid lesion8 found at colonoscopy and gastroscopy were separately recorded and biopsled.RESULTS No case of gastrointestinal cancer or gastric polyp was discovered. Nineteen patients (35%) had 1‐8 colonic polyps, including 5 (9·3%) with adenomas. When compared to patients with a normal colon, those with polyps were significantly older (44·±14· vs 52· f 10·9 years, P= 0·47), but the duration of acromegaly (10·±8· vs 10·±7· years, P= 0·9) and the number of patients with active disease were similar in both groups.CONCLUSIONS Acromegalic patients do not have an increased incidence of gastric tumours. The observed significant variation in the prevalence of colonic adenomas (9‐35%, P= 0·03) and cancer (0‐15%, P= 0·017), between our patients and those of the published prospective studies with similar demographic characteristics, suggest that environmental and hereditary factors may be more important than the presence of acromegaly.
Hyperinsulinaemia and Na+, K+ ‐ATPase activity in thyrotoxic periodic paralysis
Authors: Chan A. , Shinde R. , Chow C. C. , Cockram C. S. , Swaminathan R. 
Published: March 2008

SummaryOBJECTIVE Thyrotoxic periodic paralysis (TPP) usually follows a heavy carbohydrate meal and this may be explained by hyperinsulinaemia stimulating Na+, K+ ‐ATPase activity. To clarify this the effect of glucose load on serum insulin concentration and platelet Na+, K+ ‐ATPase activity In thyrotoxic periodic paralysis (TPP) was examined.DESIGN In all subjects a standard 75‐g glucose tolerance test was done and blood samples were taken at 0, 1 and 2 hours.SUBJECTS Twenty‐five healthy controls (8 M and 17 F), 17 uncomplicated thyrotoxic patients (7M and 10 F), 15 TPP patients who presented with paralysis and 4 TPP patients after treatment with antithyrold drugs.MEASUREMENTS Plasma glucose was measured by the glucose oxidase method, serum insulin by radioimmunoassay and platelet Na+, K+ ‐ATPase by the release of phosphate from ATP.RESULTS TPP patients showed glucose intolerance (area under the curve (AUC) 16·5 ± 4·4 (mean ± SD) In TPP compared to 12·9 ± 4·5 In controls (P < 0·01) and hyperinsulinaemia (AUC 189·6 ±100·6 vs 98·5 ±53·4, P < 0·001). In uncomplicated thyrotoxicosis the results were similar to that in healthy controls. Platelet Na+, K+ ‐ATPase were significantly higher in thyrotoxic patients compared to controls and In TPP patients were even higher. Ingestion of glucose increased platelet Na+, K+ ‐ATPase in all groups. AUC for platelet Na+, K+ ‐ATPase in TPP patients were significantly higher than in uncomplicated thyrotoxicosis (601 ±99·3 vs 482 ± 109·4, P < 0·01) or healthy controls (320 ± 107·3). In the 4 TPP patients studied after antithyroid treatment the results were similar to healthy controls.CONCLUSION Patients with thyrotoxic periodic paralysis have hyperinsulinaemia and this is accompanied by higher Na+, K+‐ATPase activity.
Validation of the low dose short insulin tolerance test for evaluation of insulin sensitivity
Authors: Gelding S. V. , Robinson S. , Lowe S. , Niththyananthan R. , Johnston D. G. 
Published: March 2008

OBJECTIVES The assessment of insulin sensitivity requires an accurate and reproducible technique. The short insulin tolerance test is a simple and rapid method for screening large numbers of subjects when the fasting glucose level is normal. Conventionally, an insulin dose of 0·1 units/kg is used, but this may result in symptomatic hypoglycaemia in healthy thin subjects who are insulin sensitive. In order to overcome this problem we have employed a lower dose of insulin and have studied the reproducibility of this modified technique comparing it with the euglycaemic hyperinsulinaemic clamp.DESIGN Subjects were studied on two separate occasions, once by a short insulin tolerance test and on a second occasion by either a euglycaemic hyperinsulinaemic clamp (insulin infusion of 40 mU/m2/min) or a repeat short insulin tolerance test.PATIENTS Eleven healthy subjects were studied twice with a short insulin tolerance test. A further 10 healthy subjects received a short insulin tolerance test on one day and a euglycaemic hyperinsulinaemic clamp study on another occasion.MEASUREMENTS Insulin sensitivity was measured in the short insulin tolerance test using the slope of arterialized blood glucose concentration from 3 to 15 minutes after an intravenous bolus of short‐acting insulin, 0·05 units/kg body weight. In the clamp study, insulin sensitivity was derived from the average amount of glucose infused at steady state (M) and the mean plasma insulin level (l).RESULTS In the short insulin tolerance test no subject developed symptomatic or biochemical hypoglycaemia, defined as a blood glucose < 2·2 mmol/l. The (mean ± SEM) insulin sensitivities for the 11 subjects studied twice were 174±10 and 179±11 μmol/l/min with a coefficient of variation of 6·9±2·6%. There was a close correlation between insulin sensitivity derived from the short insulin tolerance test and that obtained from the euglycaemic clamp studies (so‐called M/l ratio) in the same subjects (r= 0·81; P < 0·005).CONCLUSION The short insulin tolerance test employing 0·05 units/kg insulin is a safe, valid and reproducible method for the assessment of insulin sensitivity.
Primary adrenal and thyroid insufficiencies associated with hypopituitarism: a diagnostic challenge
Authors: Pholsena Maryse , Young Jacques , Couzinet Beatrice , Schaison Gilbert 
Published: March 2008

SUMMARYPolyglandular syndromes have been described for many years but only one case of panhypopituitarism with adrenal and thyroid insufficiencies has been documented. We present a 69‐year‐old woman with the initial diagnosis of idiopathic primary hypopituitarism. An associated primary adrenal disease was suspected on low plasma aldosterone and increased plasma renin values during unjustified withdrawal of treatment. The complete absence of cortisol response to long‐term ACTH administration confirmed the diagnosis. In addition, primary hypothyroidism was demonstrated by the absence of radioiodine uptake by the thyroid gland and the inability to increase T4 secretion after repeated TSH injections. The pattern of hypopituitarism and the coexistence of both adrenal and thyroid deficiencies provide strong evidence for the diagnosis of autoimmune polyglandular syndrome with hypophysitis.
Reduced serum levels of dehydroepiandrosterone sulphate in adrenal incidentalomas: a marker of adrenocortical tumour
Authors: Flecchla D. , Mazza E. , Carllni M. , Blatto A. , Ollvlerl F. , Serra: G. , Camannl F. , Messlna M. 
Published: March 2008

SummaryBACKGROUND AND OBJECTIVE Reduced serum levels of dehydroeplandrosterone sulphate (DHEAS) have been shown In patients with Cushing's syndrome resulting from adrenocortical adenoma, In contrast with normal DHEAS levels In patients with Cushing's disease. The elm of this study was to verify whether patients with incidentally discovered adrenocortical adenomas also have reduced levels of DHEAS.DESIGN Evaluation of serum DHEAS, serum and urinary cortisol, plasma ACTH and low dose dexamethasone suppression test In patients with adrenal Incidentaloma and Cushing's syndrome.PATIENTS Thirty‐two patients with adrenal Incidentaloma and, as controls, 17 patients with overt Cushing's syndrome, were studied.RESULTS Serum DHEAS levels lower than normal were found In 21/24 (81.5 %) patients with adrenocortical Incidentaloma, but In only 1/8 patients with a mass of non‐adrenocortical origin. This patient had massive bilateral metastatic infiltration of both adrenal glands and primary adrenal failure. The prevalence of low DHEAS levels in the two groups was significantly different (P= 00001). In patients with adrenocortical Incidentaloma, the prevalence of low DHEAS levels was significantly higher (P= 00001) than that found for some hormonal alterations Indicating pre‐clinical hypercortlsoilsm (high urinary cortisol, unsuppressed serum cortisol after low dose dexamethasone administration and low plasma ACTH). Low DHEAS levels were found in all patients with Cushing's syndrome due to adrenocortical adenoma but in none of those with Cushing's disease. CONCLUSIONS Our results Indicate that the finding of low DHEAS levels can be considered a marker of the adrenocortical origin of an adrenal Incidentaloma, provided adrenal failure has been excluded.
The effects of prolonged growth hormone replacement on bone metabolism and bone mineral density in hypopituitary adults*
Authors: Beshyah Salem A. , Kyd Patricia , Thomas Elizabeth , Fairney Angela , Johnston Desmond G. 
Published: March 2008

SummaryOBJECTIVE Short‐term GH replacement in hypopituitary adults increases bone turnover; data on the consequences of longer‐term GH treatment are limited. We report on the effects of 12–18 months of GH replacement treatment with biosynthetic human GH on bone metabolism and bone mass in hypopituitary adults.DESIGN Patients were studied before and after GH treatment for 12 months (n= 11) and 18 months (n= 27) respectively in an open trial. GH dose was 0·04±0·01 IU/kg daily.MEASUREMENTS Plasma calcium, phosphate and intact PTH concentrations, 24‐hour urinary calcium excretion, 3 markers of bone formation (total alkaline phosphatase, osteocalcin and procollagen 1 carboxy terminal peptide (P1CP)) and serum concentration of carboxyterminal cross‐linked telopeptide of type 1 collagen (ICTP), as a marker of bone resorption, were measured at 6‐month intervals. Lumbar splne and total body bone mineral mass was measured by dual‐energy X‐ray absorptiometry.RESULTS Small increases were observed in plasma calcium and phosphate concentrations at 12 months of GH therapy but the differences at 18 months were not statistically significant. Serum intact PTH concentration did not change. Plasma total alkaline phosphatase increased significantly on GH from 75 ± 26 to 92 ± 30 (P<0·01) and 85±31 U/I (NS) at 12 and 18 months respectively. Serum osteocalcin increased from 6·5 ± 3·7 to 15·7 ± 6·2 (P<0·0001) and 16·6±5·7 μg/l (P<0·001) at 12 and 18 months respectively and P1CP increased significantly from 106·0 ± 47·3 μ/l to 165·5 ± 95·3 (P< 0·0001) and 177·2 ± 72·2 μg/l (P<0·01) at 12 and 18 months respectively. Plasma ICTP concentration increased also from 3·4 ± 1·8 to 7·3 ± 3·4 (P < 0·0001) and 7·0 ± 2·7 μg/l (P<0·003) at 12 and 18 months of GH therapy respectively. No significant change was observed in total body or lumbar splne bone mass, over the 18 months of GH treatmentCONCLUSIONS Replacement therapy with GH in hypopituitary adults for 6–18 months produced a sustained increase in bone turnover (both formation and resorption). Bone mass was maintained but did not increase over the study period.
Nocturnal breathing abnormalities in acromegaly after adenomectomy
Authors: Pelttari Lisa , Polo Olli , Rauhala Esa , Vuorlluoto Jarkko , Altasalo Kalle , Hyyppä Markku T. , Kronholm Erkkl , Irjala Kerttu , Viikari Jorma 
Published: March 2008

Summaryobjective The Incidence of sleep apnoea Is Increased In acromegaly. The aim of the study was to determine the occurrence of nocturnal breathing abnormalities and upper airway morphology In acromegalic patients some years after adenomectomyDESIGN A case‐control studyPATIENTS Eleven patients with treated acromegaly and two control groups: (1) sleep studies: 197 subjects randomly selected from the population, (2) cephalometry: 27 healthy subjects and 17 patients with obstructive sleep apnoeaMEASUREMENTS Nocturnal breathing was monitored with a static charge‐sensitive bed. The upper airway soft tissues and bone morphology were assessed by cephalometrlc X‐ray photography. The upper airway collapslblllty was Investigated with dynamic nasopharyngoscopy. Endocrinological investigations were also performedRESULTS Nocturnal breathing abnormalities were present In all but one acromegalic patient (91%), which was far more frequent than In the general population (29‐4%, P&lt; 0‐0001). Treated acromegaly was the most powerful predictor of breathing abnormalities, Independent of the other significant predictors, age and body mass Index. The predominant breathing abnormality was periodic breathing with symmetrically waxing and waning respiratory effort without a major body movement component. Episodes of complete obstruction with repetitive arousals were rare. Except for the longer soft palate, the cephalometrlc findings were similar to normal. In comparison to obstructive sleep apnoea, the treated acromegalic patients had rather prognathic than retrognathlc mandibles. Flbreoptlc endoscopy in the acromegalic patients revealed collapsible upper airways at the level of the soft palate, whereas at the base of the tongue little, If any, dynamic narrowing was observed.CONCLUSION Our study confirms that nocturnal breathing abnormalities are common In treated acromegaly, and may persist years after the removal of the G H secreting tumour. The breathing abnormalities and the upper airway morphology in acromegalic patients after adenomectomy are different from those observed In primary obstructive sleep apnoea, suggesting a different pathophysiology of the airway obstruction