bluuebunny/crossref_metadata_2025_split huggingface dataset:
Low recurrence rate after partial hypophysectomyfor prolactinoma: the predictive value ofdynamic prolactin function tests
Authors: Webster Jonathan , Page Michael D. , Bevan John S. , Richards Stephen H. , Douglas‐Jones Anthony G. , Scanlon Maurice F. 
Published: March 2008

Summary objective To 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. design A retrospective study of patients undergoing surgery for a suspected prolactinoma in Cardiff between 1979 and 1989. patients Eighty‐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. measurements TSH and PRL responses to domperidone (10 mg i.v.) and TRH (200 μg 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. results Forty‐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 rise < 2·0 mU/l) and PRL (> 100% 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 PRL < 1000 mU/l (n= 13) to zero in those with PRL > 10 000 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 (60 vs 94%, P < 0·02) in macroadenoma but not microadenoma patients.Recurrent hyperprolactlnaernia during mean follow‐up of 51·7 months occurred in eight patients (12%), in five cases within 2 months of surgery and in the others at 26, 48 and 50 months. Recurrence could not be predicted from any preoperative parameter, but a serum PRL > 150 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. conclusions In 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 increased risk of late recurrence.
Insulin secretion and insulin‐like growth factor‐I levels in active and controlled acromegaly
Authors: Hopkins K. D. , Holdaway I. M. 
Published: March 2008

Summary objective We examined the contributions of growth hormone (GH) and Insulin‐like growth factor‐I (IGF‐I) to Insulin sensitivity and beta‐cell function in acromegaly. design A cross‐sectional study was used with continuous Infusion of glucose with model assessment todetermine Insulin sensitivity and beta‐cell function. patients Ten patients with active acromegaly, seven with controlled disease and 22 normal Individuals werestudied. measurements Glucose 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. results Patients 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. conclusions Patients 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 elevated but Insulin sensitivity Improves.
The role of thyroid stimulating antibody (TSAb) in the thyroid function of patients with post‐partum hypothyroidism
Authors: Hara Takeshi , Tamai Hajime , Mukuta Toshio , Fukatat Shujl , Kuma Kanji 
Published: March 2008

Summary objective We 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. design A prospective study. patients We studied 25 patients with post‐partum hypothyroidism who visited our thyroid clinic during the period from 1985 to 1990. measurements We 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. results Elevated 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. conclusion The 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 TSBAb activity in some patients.
Nicotinamide and 3‐aminobenzamide inhibit recombinant human interferon‐γ‐induced HLA‐DR antigen expression, but not HLA‐A, B, C antigen expression, on cultured human thyroid cells
Authors: Hiromatsu Yuji , Sato Masayuki , Yamada Kentaro , Nonaka Kyohei 
Published: March 2008

Summary objective We wished to investigate the effects of nicotinamide and 3‐aminobenzamlde, well known as inhibitors of poly(ADP ribose) synthetase, on interferon‐γ‐induced HLA‐DR antigen expression using cultured human thyroid cells from patients with Graves' disease. design and measurements Cultured thyroid cells were Incubated for 3 days with 10–400 U/ml of interferon γ in the presence of nicotinamlde, 3‐amlnobenzamlde, superoxide dismutase or catalase. The surface expression of HLA‐DR and HLA‐A, B, C antigen was measured by flow cytometry. results Nicotinamide and 3‐aminobenzamide dose‐dependently inhibited the induction of HLA‐DR antigen expression by interferon γ, but not HLA‐A, B, C antigen expression on cultured thyroid cells. Neither catalase nor superoxide dismutase, which are free‐radical scavengers, Inhibited the expression of HLA antigens on thyroid cells. conclusions Our data suggest that inhibitors of poly(ADP ribose) synthetase may have differential effects on interferon‐γ‐induced HLA‐DR and HLA‐A, B, C antigen expression, and suppress the autoimmune reactions associated with autoimmune thyroid disorders via the reduction of HLA‐DR antigen expression on thyroid cells. The mechanism of the suppression of HLA‐DR antigen expression is unlikely to be due to the free radical scavenging.
Long‐acting gonadotrophin releasing hormone agonist implant causes variable duration of suppression of ovarian steroid and inhibin secretion
Authors: Fraser H. M. , Hainlng R. , Cowen G. M. , Sandow J. , Smith K. B. , Smith S. K. 
Published: March 2008

Summary objective The duration of action of a gonadotrophin releasing hormone (GnRH) agonist implant designed to be effective for 3 months was investigated in women by monitoring drug release and ovarian hormone secretlon. Serum inhibin secretion was measured to determine whether the secondary rise in serum FSH concentrations observed during long‐term GnRH agonist treatment was attributable to changes in inhibin secretion. design and patients The implants Of Slowly bio‐degradable polylactide/glycolide (molar ratio 75:25) containing 3·3 mg buserelin, d‐Ser (BUt)8‐GnRH (1–9)‐nonapeptide‐ethylamide, in a rod 1 cm long and 0·13 cm diameter were injected s.c. in patients with endometriosis (3·3 mg busereiin in four patients, 6·6 mg busereiin in six patients). measurements Urinary secretion of oestrone, pregnanediol, LH and buserelin were determined in daily samples collected for 2 cycles before treatment, during treatment, and for 2 recovery cycles. Oestradiol, progesterone, inhibin, LH and FSH were measured in serum collected once per week. results in all patients ovarian hormone secretion was suppressed successfully but considerable varlability occurred in the length of time taken for ovarian function to recommence, time to return to ovulation being 100–194 days (median 118 days) (3·3 mg group) and 79–290 (median 178 days) (6·6 mg group). After implant injection, there was a rapid rise in the urinary buserelin excretion followed by an early fast phase of buserelin release, half life (t1/2) = 9 days for 3·3 mg implant and 11 days for 6·6 mg implant. This was followed by a second phase representing a plateau of release, t1/2= 50 days (3·3 mg implant) and 90 days (6·6 mg implant). During this second phase, an excretion rate of > 0·2 nmol buserelin/mol Cr was associated with oestrone excretion at or below early follicular phase values. Once buserelin excretion fell below 0·1 nmol/mol Cr, ovarian function returned in all patients. The period for which buserelin secretion was maintained between 0·1 and 0·2 nmol/mol Cr corresponded to the time taken to recovery of ovulatory cycles in 8/10 of the women. In 9/10 patients serum immunoreactive inhibin concentrations declined at 2 weeks, along with the suppression of oestradiol, and remained suppressed throughout the period of anovulation. Recovery of FSH secretion began after 4–5 weeks. conclusions While this implant should have important clinical application where chronic treatment is indicated, further work is needed on design of long‐term implants so that such preparations can be used when precise return to ovarian activity is required. A fall in inhibin secretion may contribute to the secondary rise in FSH by withdrawal of negative feedback but these events are not closely correlated.
Osteoporosis and Klinefelter's syndrome
Authors: Horowitz M. , Wishart J. M. , O'Loughlin P. D. , Morris H. A. , Needt A. G. , Nordin B. E. C. 
Published: March 2008

Summary objective We wanted to measure forearm mineral density and bone‐related biochemical variables in patients with Klinefelter's syndrome. design Measurements made in patients with Klinefelter's syndrome were compared to those obtained in age‐matched normal male volunteers. patients We studied 22 patients with Klinefelter's syndrome (12 of whom had received sex hormone therapy) and 22 control subjects. measurements We measured forearm mineral density, forearm fat content, fat‐corrected forearm mineral density, plasma calcium and ionized calcium, serum osteocalcin, testosterone and dehydroepiandrosterone sulphate, and urinary hydroxyproline/creatinine ratio. results Forearm mineral density was lower in the Klinefelter's group than in the control sublets (P < 0·05) and below the control range in 5 patients. The fat content of the forearm was greater in the Klinefelter's group (P < 0·002). Serum osteocalcin and testosterone were lower, while ionized calcium and the urinary hydroxyproline/creatinine ratio were higher in the Klinefelter's group (P < 0·002). Serum dehydroeplandrosterone sulphate and testosterone were significantly related in the Klinefelter's group (r= 0·64, P < 0·001), but not in the controls (r= 0·22, NS). Forearm mineral density and fat‐corrected forearm mineral density were significantly related to serum testosterone in the Klinefelter's group (r < 0·63; P < 0·01), but not in the control subjects (r < 0·03, NS). conclusions Decreased bone density occurs in about 25% of patients with Klinefelter's syndrome and probably reflects both decreased bone formation and increased bone resorption.
Thyroxine replacement therapy and circulating lipid concentrations
Authors: Franklyn J. A. , Daykin J. , Betteridge J. , Hughes E. A. , Holder R. , Jones S. R. , Sheppard M. C. 
Published: March 2008

SummaryOBJECTIVE Hypothyroidism is a common disorder and while the association of overt hypothyroidism with hyper‐cholesterolaemia is clear, the effect upon lipids of the minor abnormalities of thyroid function often found in those receiving T4 replacement therapy is unclear. The aim of the present studies was to define in those with hypothyroidism the effect upon circulating lipids of subtle changes in thyroid status, indicated by serum TSH values below or above the normal range.DESIGN (i) Prospective study of short‐term T4 treatment of those with subclinical hypothyroidism, (ii) Cross‐sectional study of long‐term T4 treatment, comparing non‐T4 treated controls and T4 treated patients with serum TSH values either below or within the normal range. PATIENTS Short‐term T4 therapy was examined in 11 post‐menopausal females with subclinical hypothyroidism (high TSH, normal free T4) studied before therapy and 6 weeks after T4 at incremental doses (50, 100, 150 μg/ day). Long‐term T4 treatment for hypothyroidism was investigated in 105 females on therapy for at least 1 year compared with 105 controls matched for age and menopausal status.MEASUREMENTS Fasting levels of total cholesterol, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol and HDL subtractions were determined in patients and controls.RESULTS (i) T4 treatment of subjects with subclinical hypothyroidism resulted in reductions in total and LDL cholesterol with increasing T4 dose (P <0 001). Comparison of lipid results pretreatment with those when TSH was restored to normal revealed no significant difference in lipids; in contrast, comparison of lipids in those with normal TSH compared with the same subjects when TSH was suppressed revealed reductions in total and LDL cholesterol, (ii) Long‐term T4 treatment was associated with a reduction in total and LDL cholesterol measurements in those over 55 years receiving suppressive doses of T4 but no significant difference in lipids in those with normal serum TSH compared with non‐T4 treated controls.CONCLUSION Effects of T4 upon lipid measurements suggest that patients with subclinical hypothyroidism should receive replacement therapy. Doses of T4 which suppress TSH to below normal may have a more significant influence upon lipids than doses of T4 which restore TSH to the normal range.
Induction of testicular growth and spermatogenesis by pulsatile, intravenous administration of gonadotrophin‐releasing hormone in patients with hypogonadotrophic hypogonadism*
Authors: Van de Waal Henrietta A. Delemarre 
Published: March 2008

SummaryOBJECTIVE To induce testicular growth including spermatogenesis, 38 patients with hypogonadotrophic hypogonadism were treated with long‐term pulsatile GnRH administration.PATIENTS The group of patients comprised 17 individuals with idiopathic hypogonadotrophic hypogonadism, 11 with Kallmann's syndrome, four with multiple pituitary hormone deficiencies and six with a secondary hypogonadotrophic hypogonadism due to surgical removal of a brain tumour. Thirteen patients (seven with idiopathic hypogonadotrophic hypogonadism and six with Kalmann's syndrome) had undescended testes, of whom six had undergone surgery on both testes and four on one testis. Sixteen of the 17 had previously received androgen therapy and six others had received gonadotrophin treatment, of whom three had long‐term treatment to induce testicular development, without success.TREATMENT GnRH was administered intravenously in a dose of 2‐20 μg per pulse every 90 minutes. After GnRH discontinuation, hCG treatment was instituted, 1500–3000 III (i.m.) twice weekly.RESULTS During treatment plasma levels of LH, FSH and testosterone increased. In 35 out of the 38 patients plasma testosterone levels increased into the normal adult range. In all patients testicular volume increased. Mean pretreatment testicular volume per patient group ranged from 2 4 to 4.8 ml and increased to 11.5–18.1 ml by the end of treatment. There was a significant difference in the achieved testicular volumes between the patients with Kallmann's syndrome and the brain tumour patients.GnRH treatment mean lasted between 46 and 75 weeks In the different groups. On hCG therapy, testicular development was either maintained or improved. Semen analysis revealed the presence of spermatogenesis in 31 out of the 38 patients (26 patients already on GnRH, and in another five patients on hCG therapy). All three patients pretreated with gonadotrophins as well as three patients with bilateral testicular surgery developed a detectable sperm count. In 19 adolescent patients with growth potential, an adequate height velocity was observed during GnRH treatment.CONCLUSIONS GnRH is a feasible way to induce testicular growth as well as spermatogenesis In hypogonadotrophic male patients, even in patients in whom gonadotrophin treatment has failed. After GnRH treatment, hCG alone can maintain or even improve testicular development, including spermatogenesis. GnRH treatment may also induce a physiological growth spurt In hypogonadotrophic adolescents.
Presence of anti‐pituitary hormone antibodies in patients with empty sella syndrome and pituitary tumours*
Authors: Mau Marjorie , Phillips Terry M. , Ratner Robert E. 
Published: March 2008

SummaryOBJECTIVE We evaluated the presence of anti‐pituitary hormone autoantibodies (APHA) in patients with primary empty sella syndrome and pituitary tumours and examined the correlation of positive antibodies with the hormonal deficiencies.DESIGN Case‐control, retrospective study.PATIENTS Eleven patients were identified with primary empty sella syndrome or a pituitary tumour by magnetic resonance imaging or computed tomography scanning. Six healthy, normal subjects without evidence of a pituitary problem served as the control group.MEASUREMENTS Anti‐pituitary hormone autoantibodies against purified pituitary hormones were measured in ail subjects utilizing an immunoblotting technique. All patients with pituitary disease had their medical records reviewed for any hormonal evaluation.RESULTS All of the normal subjects were negative for antipituitary hormone antibodies. Forty‐five per cent of patients with pituitary disease (pituitary tumours or primary empty sella syndrome) had positive antipituitary hormone antibodies. Of the five patients with positive antipituitary hormone antibodies, anti‐ACTH antibodies were the most common (5/5) followed by anti‐TSH and anti‐GH antibodies (2/5 for each). The hormonal deficiencies failed to correspond with the antipituitary hormone antibodies. Anti‐ACTH antibody had a sensitivity of 50% with a specificity of 56%. The anti‐TSH antibody yielded a sensitivity of 67% with a specificity of 100%. The anti‐FSH/ LH antibody reported a 0% sensitivity.CONCLUSIONS Detection of antipituitary hormone antibody was unable to discriminate between empty sella syndrome and pituitary tumours. The presence of these antipituitary hormone antibodies were neither specific for, nor predictive of, the endocrine deficiencies.
Influence of hyperthyroidism on growth hormone secretion
Authors: Valcavi Roberto , Dieguer Carlos , Zini Michele , Muruais Covadonga , Casanueva Felipe , Portioli Italo 
Published: March 2008

SummaryOBJECTIVE Hyperthyroidism is associated with altered GH secretion. Whether this is due to changes of somatotroph responsiveness or reflects an alteration in negative feedback signals at the hypothalamic level is unknown. We therefore performed a series of studies to shed some light onto this issue.DESIGN Study 1: GHRH (1 μg/kg b.w.) was injected i.v. in 38 hyperthyroid patients and in 30 normal subjects; in 11 of the patients the GHRH test was repeated following methimazole‐induced remission of hyperthyroidism. Study 2: hGH (2 U i.v.) or saline were administered 3 hours prior to GHRH; six hyperthyroid patients and six normal subjects were studied. Study 3: ten normal subjects and ten hyperthyroid patients were given 75 g oral glucose or water 30 minutes before GHRH. Study 4: 11 normal subjects and eight hyperthyroid patients were studied. TRH or vehicle were dissolved in 250 ml of saline solution and infused at a rate of 400 μg/h for 150 minutes. Thirty minutes after the beginning of the infusions, l‐arginine (30 g infused over 45 min i.v.) was administered.PATIENTS Hyperthyroid patients were compared to normal subjects.MEASUREMENTS Growth hormone was measured by RIA at 15‐minute intervals.RESULTS GH responses to GHRH were subnormal in hyperthyroid patients. Following antithyroid drug treatment with methimazole, GH responses to GHRH increased in these patients in comparison to pretreatment values. Serum IGF‐I levels, which were elevated before treatment, decreased after methimazole administration. Exogenous GH administration induced a clear decrease of GH responses to GHRH in both control and hyperthyroid subjects. On the other hand, oral glucose load decreased the GH responses to GHRH in normal but not in hyperthyroid subjects. TRH administration did not modify the GH responses to arginine in either normal subjects or hyper‐thyroid patients.CONCLUSIONS Hyperthyroidism is associated with increased serum IGF‐I levels and marked alterations in the neuroregulation of GH secretion. These changes involve decreased GH responsiveness to GHRH at the pituitary level and, at the hypothalamic level, a lack of suppressive effect of an oral glucose load. The normal inhibitory effect of exogenous GH administration but not of an oral glucose load in hyperthyroid patients suggests that these two feedback signals act through different mechanisms. The lack of effect of a TRH infusion on GH responses to l‐arginine in normal and hyperthyroid patients makes an inhibitory role for TRH in GH secretion unlikely, at least in Caucasian subjects.