bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ovarian morphology and insulin sensitivity in women with bulimia nervosa
Authors: Raphael F. J. , Rodin D. A. , Peattle A. , Bano G. , Kent A. , Nussey S. S. , Lacey J. H. 
Published: March 2008

SummaryOBJECTIVE Hyperinsulinaemia has a role in the development of hyperandrogenism and polycystic ovary syndrome in women of normal weight. Polycystic ovaries are common in women with bulimia nervosa and this study aimed to determine whether women with bulimia nervosa are insulin resistant and to examine the relation between Insulin sensitivity and ovarian morphology.DESIGN A short intravenous insulin tolerance test was used as a direct measure of insulin sensitivity In a group of women with bulimia nervosa and 8 control group.PATIENTS A series of 12 women with bulimia nervosa and normal weight was compared with a control group of 9 healthy women who had no clinical signs of eating disorder or hyperandrogenism and did not have polycystic ovaries.MEASUREMENTS Bulimic behaviour was assessed using the BITE (Bulimia Investigation Test, Edinburgh) questionnaire and clinical interviews. Ovarian morphology was assessed using transabdominal ultrasonography. Insulin sensitivity and serum Insulin, fasting glucose, LH, FSH, prolactin, testosterone, androstenedione and sex hormone binding globulin (SHBG) were measured and compared between the two groups.RESULTS Ten of the 12 women with bulimia nervosa underwent ovarian ultrasound examination and they all had polycystic ovaries. There was no difference in serum LH, FSH, testosterone, androstenedione or SHBG concentrations between the women with bulimia nervosa and the non‐bulimic control group. Fasting blood glucose concentrations were normal in all the women studied and did not differ between the women with bulimia nervosa and the control women. There was also no difference In fasting serum Insulin or Insulin sensitivity between the women with bulimia nervosa and the non‐bulimic women.CONCLUSIONS Bulimia nervosa is not associated with Insulin resistance and chronic hyperinsulinaemia.
Osteomalacia associated with adult Fanconi's syndrome: clinical and diagnostic features*
Authors: Clarke Bart L. , Wynne Alan G. , Wilson David M. , Fitzpatrick Lorraine A. 
Published: March 2008

SummaryOBJECTIVE Osteomalacia associated with adult acquired Fanconi's syndrome is thought to result from hypophosphataemia and relative 1,25‐dihydroxy vitamin D deficiency. We have followed the clinical and diagnostic features of patients with osteomalacia associated with adult Fanconi's syndrome, with particular emphasis on their responses to treatment with calcium, phosphate and vitamin D.DESIGN Retrospective Mayo Clinic case‐note review from 1975 to 1994 and prospective follow‐up study, combined with literature review.PATIENTS Eleven patients (7 male, 4 female) were identified who satisfied criteria for diagnosis of osteomaiacia and adult Fanconi's syndrome. Twenty‐five additional patients were identified in a literature review from 1954 to the present.METHODS Clinical history and physical examination, serum and urine bone and mineral parameters, X‐ray radiography and iliac crest bone histomorphometry.RESULTS All patients presented with typical symptoms of osteomalacia, including lower extremity or low back bone pain, and ail had fractures, pseudofractures, and/or bone demineralization on X‐ray radiography. Osteomalacia and Fanconi's syndrome were diagnosed concurrently in 10 patients, whereas osteomalacia preceded diagnosis of Fanconi's syndrome by 5 years in one patient. Pre‐treatment bone biopsies in 9 of the 11 patients demonstrated increased osteoid surface, volume and width. In the one patient labelled with tetracycline prior to biopsy, mlnerallzation lag time was prolonged at 111 days (normal 19.2±1.0 days). Hypophosphataemia, inappropriately low 1,25‐dihydroxyvltamin D levels, renal insufficiency, and chronic acidosis due to bicarbonate leak and uraemia, contributed to the osteomalacia in these patients. Secondary hyperparathyroidism was present In two patients. Eight of the 11 patients with osteomalacia associated with Fanconi's syndrome had monoclonal disorders, including multiple myeloma or lymphoma, many of them manifest by light‐chain proteinuria. Over a mean patient follow‐up period of 46 months (range 1–239 months), patients responded symptomatically to calcium, phosphate, and vitamin D replacement typically within 1–6 months. In 8 patients in whom follow‐up data were available, post‐treatment serum phosphate and 1,25‐dihydroxyvitamin D levels Improved in the setting of stable mild renal insufficiency; only one patient developed end‐stage renal failure after 20 years, suggesting that these patients do not invariably progress rapidly to renal failure.CONCLUSIONS Regardless of the underlying cause, osteomalacia associated with adult acquired Fanconi's syndrome appears to respond well to calcium, phosphate, and vitamin D replacement. These patients do not appear to necessarily require 1,25‐dihydroxyvitamin D replacement.
Effect of acute desmopressin and of long‐term thyroxine replacement on haemostasis in hypothyroidism
Authors: Erfurth Eva Marie T. , Ericsson Ulla‐Brltt C. , Egervall Karln , Lethagen Stefan R. 
Published: March 2008

SummaryOBJECTIVE Hypothyroidism can be complicated by bleeding symptoms such as easy bruising, menorrhagla and sometimes even a severe bleeding tendency with fatal outcome. Usually there is a prolonged bleeding time, or a low plasma concentration of coagulation factor VIII (FVIII) or von Willebrand factor (vWF). The aim of the present study was to investigate the acute haemostatic effect of desmopressin in hypothyroid patients. Another aim was to study the long‐term effect of thyroxine replacement on the plasma concentrations of coagulation factors and to ascertain the duration of thyroxine treatment needed to restore haemostatic function.DESIGN AND PATIENTS The effects of desmopressin, given intravenously over 10 minutes at a dosage of 0.3 μg/kg, and thyroxine treatment on haemostatic function were studied prospectively In 10 patients with hypothyroidism.RESULTS Before treatment only five of the patients manifested bleeding symptoms; one had prolonged bleeding time, and one had low plasma concentrations of vWF: Ag. Desmopressin virtually immediately reduced bleeding time, enhanced platelet adhesiveness, and significantly increased plasma concentrations of FVIII and vWF.The plasma concentrations of FVIII and vWF showed a significant increase after 4 months, whereas 7 months treatment with thyroxine was needed to reduce bleeding time significantly.CONCLUSION Our results suggest that in hypothyroid patients desmopressin may be of value for the acute treatment of bleeding or as cover for surgery.
Adrenarche does not occur in treated patients with congenital adrenal hyperplasia resulting from 21‐hydroxylase deficiency
Authors: Brunelli Valeria L. , Chlumello Giuseppe , David Michel , Forest Maguelone G. 
Published: March 2008

SummaryOBJECTIVE There have been few studies of adrenarche In patients with congenital adrenal hyperplasia (CAH). We have therefore sought to detect the onset of adrenarche In CAH patients and to investigate whether its evolution was influenced by the severity of the disease, the age at the onset of substitution therapy, or both.DESIGN AND PATIENTS Sixteen female CAH patients were studied longitudinally for 4–11 years. They were all given substitution therapy and treatments were well controlled as judged by repeated hormonal evaluations. The patients were divided into two groups: group A consisted of 10 girls with a severe classic (congenital) form, while group B included 6 girls presenting with a non‐classic form.MEASUREMENTS Circulating levels of dehydroepiandrosterone sulphate (DHEAS), were determined as an indicator of adrenarche. Hormonal assessments Included measurements of 17‐hydroxyprogesterone (17‐OHP), testosterone, ACTH and plasma renin activity. All were estimated by conventional specific assays.RESULTS Mean levels were analysed in consecutive two‐year age periods. In group A, DHEAS levels were significantly lower at any age than in control subjects, and lower than In patients with non‐classic CAH. DHEAS levels showed no increment with age. In group B, plasma DHEAS levels were surprisingly high for the age at the time of diagnosis, declining gradually on substitution therapy, although they remained somewhat higher than in group A.CONCLUSIONS The high DHEAS levels observed In untreated girls of group B are probably the result of chronic hypersecretion of ACTH. Under well controlled, non‐suppressive substitution therapy, patients with congenital adrenal hyperplasia showed no rise in DHEAS levels at the physiological age of adrenarche whatever the degree of the enyzme defect and whatever the age at onset of therapy.
Hypothalamic‐pituitary dysfunction in patients with craniopharyngioma
Authors: Paja M. , Lucas T. , García‐Uria J. , Salamé F. , Barceió B. , Estrada J. 
Published: March 2008

SummaryOBJECTIVE Previous studies of preoperative pituitary function in patients with craniopharyngioma have been limited in scope and have focused on children. We have evaluated the impact of craniopharyngiomas and their surgical treatment on pituitary function In a large group of mostly adult patients.DESIGN We performed a retrospective study of patients treated at our centre between 1980 and 1992.PATIENTS Twenty‐two men and 13 women, most of them adults, treated surgically for craniopharyngioma during the above period.MEASUREMENTS Serum glucose, GH, LH, FSH, TSH and Cortisol were measured both before and after a combined insulin induced hypoglycaemia, GnRH and TRH test. Basal concentrations of thyroid hormones, PRL and gonadal steroids were also measured. Preoperative computed tomographic scan was performed in all patients, and a detailed study of visual function before and after surgery was available for 32 of them. Endocrine function was reevaluated post‐operatively.RESULTS In preoperative studies, 29 patients had some anterior pituitary deficit and 13 had diabetes insipidus. The most common abnormality was gonadotrophin deficiency, followed by GH deficiency. Dynamic studies suggested a hypothalamic origin for these deficits. In post‐surgical evaluation, Impaired pituitary function was observed in most patients. Panhypopituitarism was present in 28 cases and diabetes insipidus in 24.CONCLUSIONS Our report illustrates the high Incidence of endocrine deficits in patients with craniopharyngioma. Additional hypothalamic‐pituitary dysfunction usually occurs following surgical treatment of these tumours.
Familial prolactinoma
Authors: Berezin Meir , Karasik Avraham 
Published: March 2008

SummaryBACKGROUND Apart from the rare association with type I multiple endocrine neoplasia (MEN‐1), familial types of prolactinoma have not been reported.PATIENTS AND MEASUREMENTS Eight hyperprolacti‐naemic patients in four families and 18 of their first and second‐degree relatives (parents, children and grandchildren) were examined. Hormone levels were measured, as well as other biochemical parameters.RESULTS Prolactinoma was diagnosed In more than one member of each of the four families.CONCLUSION Familial prolactinoma Is a distinct entity which Is probably due to a genetic mutation promoting lactotroph proliferation.
Measurement of thyroglobulin in newborn screening specimens from normal and hypothyroid infants
Authors: Mitchell M. L. , Hermos R. J. 
Published: March 2008

SummaryBACKGROUND AND OBJECTIVE Thyroglobulin (Tg) has been found In varying concentrations In Infants and children with congenital hypothyroidism. Our primary goal was to ascertain whether Tg In filter paper blood specimens used for routine newborn screening would be a useful adjunct In the early diagnosis of newborn children with congenital hypothyroidism. Our secondary objective was to correlate the results of the Tg determinations with the results of thyroid scintigraphy in the same cohort of Infants with congenital hypothyroidism.DESIGN An RIA kit with high sensitivity for the measurement of Tg in serum was modified for use with filter paper blood specimens. Results of thyroid scintigraphy were obtained from the family physicians on 10 Infants with ectopic thyroid glands and 18 who were considered to be athyreotic.MEASUREMENTS Determinations of Tg were carried out retrospectively on newborn screening filter paper blood specimens from 61 full‐term normal Infants and 42 newborns with confirmed congenital hypothyroidism.RESULTS Thyroglobulin concentrations during the first week of life in the normal controls ranged between 17 and 160 μg/l, with a median of 66 μg/l. Tg values for Infants with ectopic thyroid glands ranged between 38 and 282 μg/l, with a median of 116 μg/l. In contrast, newborns who were considered athyreotic had Tg values ranging between undetectable and 104 μg/l with a median of 15/ig/l. Fifty per cent of the athyreotic patients and 50% of patients with ectopic thyroid glands had Tg values above or below the normal range and thus fell within the diagnostic category of hypothyroidism on the basis of Tg alone. Fifty per cent of patients who were considered athyreotic by scintigraphy had Tg concentrations ranging from 20 to 104 μg/l.CONCLUSION These studies have shown that thyroglobulin can be measured In the same filter paper blood specimens used for routine newborn screening. Estimation of thyroglobulin In screening specimens from hypothyroid and normal infants indicated that some Infants with congenital hypothyroidism could be Identified solely on the basis of the thyroglobulin concentration. Comparison of the results of scintigraphy with thyroglobulin levels In the same hypothyroid patients suggested that thryoglobulin provided a more reliable marker for the presence or absence of the thyroid gland than did scintigraphy.
Fetal osteocalcin levels are related to placental 11β‐hydroxysteroid dehydrogenase activity in humans
Authors: Benediktsson Rafn , Brennand Janet , Tibi Laila , Calder Andrew A. , Seckl Jonathan R. , Edwards Christopher R. W. 
Published: March 2008

SummaryOBJECTIVE Overexposure to glucocorticoids in utero reduces birth weight and, In animals, leads to persistent hypertension in the offspring. The fetus is normally protected from maternal glucocorticoids by placental 11β‐hydroxysteroid dehydrogenase (11β‐HSD) which catalyses the conversion of Cortisol to Inert cortisone. In adult humans, osteocalcin is a sensitive marker of glucocorticoid exposure. The aim of this study was to determine whether cord blood osteocalcin levels were related to the ability of placental 11β‐HSD to inactivate maternal Cortisol.DESIGN Cross‐sectional study examining the relation between cord blood levels of osteocalcin and placental glucocorticoid metabolism at term.PATIENTS Twenty‐one women attending for delivery at the Simpson Memorial Maternity Pavilion in Edinburgh had cord venous and arterial blood samples collected at delivery.MEASUREMENTS Cord plasma levels of osteocalcin, Cortisol and cortisone were measured by radioimmunoassay and indices of placental 11β‐HSD activity were calculated.RESULTS All indices of placental 11β‐hydroxysteroid dehydrogenase activity correlated directly and significantly with cord blood osteocalcin levels. For cord blood osteocalcin and the placental 11β‐HSD Activity Index, Pearson's r was + 0.58, r2=0.33 and P<0.02.CONCLUSION We conclude that term cord blood osteocalcin level reflects the effectiveness of placental glucocorticoid Inactlvation, and may be a marker for the development of adult hypertension.
Somatostatin receptor scintigraphy and octreotide treatment in patients with thyroid eye disease
Authors: Krassas G. E. , Dumas A. , Pontikldes N. , Kaltsas Th. 
Published: March 2008

SummaryOBJECTIVE Octreotide, a potent long‐acting synthetic somatostatin analogue, has been reported to have a beneficial effect in thyroid eye disease (TED), but the precise mechanism of action remains unexplained. 111 In‐DTPA‐D‐Phe1 ‐octreotide (Octreoscan‐111) has been used to localize a number of endocrine tumours and visualize somatostatin receptors in the retrobulbar tissue of patients with TED. Furthermore, this technique can predict the inhibitory effect of octreotide on hormone secretion by endocrine tumours, as there is a close relation between the clinically observed Inhibition and visualization of the tumour using Octreoscan‐111. The alms of the present study were to confirm the beneficial effect of octreotide in patients with TED, to investigate the presence of somatostatin receptors In the orbital area and also, if possible, to ascertain whether this technique could select those patients with TED who might benefit from treatment with octreotide.DESIGN A prospective study.SETTING An endocrine clinic of a national hospital.PATIENTS Twenty treated thyrotoxic patients with TED, 5 treated thyrotoxic patients without TED and 5 normal Individuals were studied. In 12 patients with TED, 5 without TED and 5 normal individuals, Octreoscan‐111 scintigraphy of the orbits was performed. The remaining 8 patients with ophthalmopathy served as controls. In patients with TED who were Investigated with Octreoscan‐111, 300 μg octreotide dally was given for 12 weeks.RESULTS Six patients In both eyes and one patient In one eye showed an improvement In ocular manifestations as assessed by clinical criteria and changes in the NOSPECS score, while the rest showed no Improvement. The patients who showed an Improvement had a high number of somatostatin receptors and positive orbital scans, while with one exception the patients who did not respond had a low number of receptors and negative orbital scans (P<0.02). None of the 5 patients without TED nor the normal individuals had a positive orbital scan. Seven out of 8 control patients with TED showed no change in the disease during the trial, while 1 deteriorated.CONCLUSIONS We conclude that octreotide has a beneficial effect in thyroid eye disease and that Octreoscan‐111 could predict those patients with thyroid eye disease who might benefit from this treatment.
Urinary pyridinoline and deoxypyridinoline excretion in children
Authors: Shaw N. J. , Dutton J. , Fraser W. D. , Smith C. S. 
Published: March 2008

SummaryOBJECTIVE There are few data on urinary markers of collagen breakdown In children. We have determined a normal range for urinary pyridinoline and deoxypyridinoline In children, assessed the variability in excretion in individual children and examined the effect of GH treatment on the excretion of these collagen cross‐links.DESIGN A cross‐sectional study of a group of healthy children and sequential samples from children receiving GH treatment.PATIENTS One hundred and nine healthy children aged 2–15 years, 8 healthy children aged 4–11 years and 4 children receiving GH treatment.MEASUREMENTS Total pyridinoline and deoxypyridinoline excretion were measured by high performance liquid chromatography after initial acid hydrolysis and cellulose extraction steps. Serum parathyroid hormone was measured using a two‐site immunoradiometric assay and urinary hydroxyproline by Ehrlich's reaction using a colorlmetric assay. Pyridinoline and deoxypyridinoline excretion were expressed as a ratio against urine creatinine.RESULTS High excretion of pyridinoline (Pyr) and deoxypyridinoline (DPyr) was seen at all ages with no apparent relation to age (mean Pyr/Cr 115 nmol/mmol and DPyr/Cr 31 nmol/mmol). No correlation was found with serum parathyroid hormone or urinary hydroxyproline excretion. Marked day to day variation was seen in individual children. A progressive rise in excretion was seen In children receiving GH treatment with no significant correlation to height velocity.CONCLUSIONS There is a high excretion of the pyrldi‐nium cross‐linking amino acids in children of all ages compared to adults. However, a high variability exists In single morning urine samples which will limit the usefulness of these markers in growing children.
Characteristics of adults who wish to enter a trial of growth hormone replacement
Authors: Holmes Sarah J. , Shalet Stephen M. 
Published: March 2008

SummaryOBJECTIVE It Is possible that the degree of perceived well‐being may Influence the decision of an adult with GH deficiency to receive GH replacement. We have therefore sought factors which Influenced whether or not such a patient wished to enter a study of GH replacement.DESIGN Biochemical, anthropometric and demographic characteristics, and well‐being, of patients who chose to enter a 12‐month study of GH replacement at Christie Hospital NHS Trust were compared with those of patients who declined to enter the study.PATIENTS Sixty‐five adults with GH deficiency who entered a study of GH replacement and 33 adults with GH deficiency who were approached but who declined to enter the study.MEASUREMENTS The two groups of patients were compared according to sex, age, height, weight, body mass Index, peak serum GH response to provocative testing, estimated duration of GH deficiency, whether GH deficiency was of childhood or adult onset, presence or absence of additional pituitary hormone deficiencies, aetiology of GH deficiency, previous therapeutic Interventions, employment status, marital status and living arrangement (65 entered vs 33 declined to enter). Well‐being or distress was measured using the Nottingham Health Profile (NHP) (65 entered vs 20 declined to enter) and the Psychological General Well‐being Schedule (PGWBS) (33 entered vs 19 declined to enter).RESULTS Those who entered the study had significantly higher scores on the energy (P= 0.03) and emotional reaction (P= 0.02) subsections and on the total score (P= 0.04) of the NHP, indicating greater distress, and had a significantly lower score (P= 0.009) on the vitality subsection of the PGWBS, again indicating greater distress. Those who entered the study had a significantly lower prevalence of non‐functioning pituitary adenoma (P= 0.02) but there was no other difference in biochemical, anthropometric or demographic characteristics between the two groups.CONCLUSION Adults who enter a study of GH replacement exhibit greater distress on questionnaire assessment than those who decline to enter such a study. This bias must be considered when Interpreting studies of the effect of GH replacement on well‐being in adults.