bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in growth hormone concentrations during puberty in adolescents with insulin dependent diabetes
Authors: Batch Jennifer A. , Werther George A. 
Published: March 2008

SUMMARY objective To document the changes in pulsatile growth hormone secretion in diabetic adolescents during puberty, and to investigate their relationship to both metabolic control and stature design Auxological parameters, overnight growth hormone secretion, fasting IGF‐I, hourly glucose and metabolic control were assessed in a group of adolescents with diabetes patients Fifty‐two diabetic adolescents (28 males and 24 females) at different pubertal stages and with varying degrees of metabolic control were studied. Ten of those with poor diabetic control were studied on two occasions measurements Height and weight measurements, pubertal staging, growth velocity data and bone age estimation were obtained on all the patients. Overnight growth hormone profiles (Pulsar program analysis), glycosylated haemoglobin and fasting IGF‐I were performed on all the subjects. Hourly overnight glucose measurements were also obtained on the ten subjects who had two overnight growth hormone studies results For the whole diabetic growth, GH area under curve (AUC) was maximal in late puberty (pubertal stage 4), and was paralleled by maximal GH peak amplitude. No relationship between GH‐AUC and metabolic control was demonstrated. No difference in GH parameters was demonstrated between the male and female subgroups. The relationship between growth hormone secretory parameters and stature was not significant. However, GH‐AUC was significantly correlated with growth velocity in the males but not the females conclusions The pattern of GH secretion in adolescents with diabetes parallels that seen in normal adolescents during puberty, with increases in GH concentration associated with increased GH pulse amplitude. The degree of metabolic control had no effect on this pattern and there was no relationship between GH secretory parameters and stature
Mineralocorticoid excess and inhibition of 11 β‐hydroxysteroid dehydrogenase in patients with ectopic ACTH syndrome
Authors: Walker Brian R. , Campbell Jill C. , Fraser R. , Stewart Paul M. , Edwards Christopher R. W. 
Published: March 2008

SummaryOBJECTIVE 11 β‐Hydroxysteroid dehydrogenase protects renal mineralocorticoid receptors from Cortisol by converting Cortisol to inactive cortisone. We hypothesize that 11 β‐dehydrogenase is inhibited by ACTH, providing a mechanism whereby Cortisol induces hypokalemic alkalosis in ectopic ACTH syndrome.DESIGN/MEASUREMENTS The principal sources of plasma cortisone were assessed by selective venous catheterization with measurement of Cortisol and cortisone by radioimmunoassays. The effect of ACTH on peripheral plasma cortisol/cortisone ratio was assessed in healthy volunteers during circadian rhythm, insulin induced hypoglycaemia, and infusions with exogenous ACTH or Cortisol. In patients with Cushing's syndrome plasma cortisol/cortisone ratios were related to plasma potassium, corticosterone, and 11‐deoxycorticosterone concentrations.PATIENTS Catheterization was performed in 24 patients with valvular or ischaemic heart disease. Cushing's syndrome patients included: 15 with pituitary adenoma; two with adrenal adenoma; and nine with ectopic ACTH secretion.RESULTS Plasma cortisol/cortisone ratios were low in renal vein and high in hepatic vein. In healthy volunteers plasma cortisone increased during Cortisol infusion but did not change with increases in endogenous or exogenous ACTH. Plasma cortisol/cortisone ratios were higher in ectopic ACTH syndrome than in other forms of Cushing's syndrome. However, the cortisol/cortisone ratio was no better a predictor of hypokalaemia than the levels of 11‐deoxycorticosterone or corticosterone.CONCLUSIONS Peripheral conversion of Cortisol to cortisone occurs mainly in the kidney and is inhibited by ACTH. In ectopic ACTH syndrome the characteristic mineralocorticoid excess can be accounted for by a combination of increased secretion of Cortisol, corticosterone and of 11‐deoxycorticosterone and decreased inactivation of Cortisol and corticosterone by 11 β‐dehydrogenase.
Administration of human recombinant insulin‐like growth factor‐I to patients following major gastrointestinal surgery
Authors: Miell John P. , Taylor Alastair M. , Jones Jennifer , Buchanan Charles R. , Rennie John , Sherwood Roy , Leicester Roger , Ross Richard J. M. 
Published: March 2008

SummaryOBJECTIVE The aim was to study the pharmacokinetic parameters and biological activity of a single dose of human recombinant IGF‐I (rhIGF‐I) administered to patients following major gastrointestinal surgery.DESIGN A double blind placebo controlled externally randomized study of 30 patients; the study commencing 24 hours after major colonic or gastric surgery.MEASUREMENTS After a baseline blood sampling day, IGF‐I (40 μg/kg by single subcutaneous dose, n= 20) or placebo (n= 10) was administered and serum and urine samples collected over the ensuing 72 hours. Serum IGF‐I, IGF‐II, IGF binding proteins (IGFBP‐1, IGFBP‐3), GH and insulin were measured by radioimmunoassay. Serum IGF bioactivity was assessed using a validated porcine cartilage bioassay. Serum and urinary electrolytes were measured by standard methodology.RESULTS Serum immunoreactive IGF‐I levels peaked at 4hours following injection of IGF‐I (1– 0.9 ± 0.12 U/ml mean ± SEM), remained elevated for 15 hours and returned to basal levels by 24 hours after injection. IGF bioactivity was increased by 57% 6 hours after IGF‐I injection. Mean levels of IGFBP‐1 and IGFBP‐3, IGF‐II and GH were unaffected by IGF‐I administration. Insulin levels were suppressed at 30 minutes following injection of IGF‐I compared with the placebo group (16.9 ± 3.0 mU/l vs 32.3 ± 7.1, P=0.02); thereafter, there were no differences in insulin levels. The mean change in serum creatinine following IGF‐I (‐6.3 ± 3.0 mmol/l) was significantly different from that in the control group (± 7.2 ± 6.2, P= 0.03). Creatinine clearance rose from a mean of 71.6 ± 7.5 ml/ min to 83.2 ± 7.6 ml/min after IGF‐I treatment (P= 0.02). In the IGF treated patients, cholesterol levels consistently fell (‐0.20 ± 0.05 mmol/l); this was not observed in the placebo group (+ 0.20 ± 0.14, P=0.006). Basal serum potassium levels in the IGF treatment group (4.1 ± 0.1 mmol/l) fell to 3.8 ± 0.1 at 4 hours (P= 0.002) and 3.6 ± 0.1 at 10 hours (P= 0.001) returning to a level of 4.0 ± 0.1 (P= 0.293) at 24 hours after injection. There were no other observed differences in serum or urinary electrolytes or serum free fatty acids and triglycerides. Pharmacokinetic parameters derived from baseline adjusted IGF‐I measurements revealed a slow absorption of the administered dose with a Tmax of 5.0 ± 0.43 hours and an elimination half‐life of 10.8 ± 1.2 hours. The computed volume of distribution was 0.33 ± 0.05 l/kg and the clearance on average 25 ml/min.CONCLUSIONS A single subcutaneous dose of IGF‐I normalized circulating IGF‐I levels in post‐operative patients, was well tolerated and without side‐effects. IGF bioactivity was increased and associated with a fall in serum cholesterol, potassium and creatinine levels and a rise in creatinine clearance. Further long‐term studies are now required to assess the anabolic effects of rhIGF‐I in this type of patient group.
Computerized tomography versus magnetic resonance imaging: a comparative study in hypothalamic‐pituitary and parasellar pathology
Authors: Webb S. M. , Ruscalleda J. , Schwarzstein D. , Calaf‐Alsina J. , Rovira A. , Matos G. , Pulg‐Domingo M. , de Leiva A. 
Published: March 2008

OBJECTIVE We wished to analyse the relative value of computerized tomography and magnetic resonance in patients referred for evaluation of pituitary and parasellar lesions.DESIGN We performed a separate evaluation by two independent neuroradiologists of computerized tomography and magnetic resonance images ordered numerically and anonymously, with no clinical data available. PATIENTS We studied 40 patients submitted for hypothalamic‐pituitary study; 31 were carried out preoperatively, of which histological confirmation later became available in 14. The remaining nine patients were evaluated post‐operatively.MEASUREMENTS Over 40 parameters relating to the bony margins, cavernous sinuses, carotid arteries, optic chiasm, suprasellar cisterns, pituitary, pituitary stalk and extension of the lesion were evaluated. These reports were compared with the initial ones offered when the scans were ordered, and with the final diagnosis.RESULTS Concordance between initial computerized tomography and magnetic resonance was observed in 27 cases (67±5%); among the discordant cases computerized tomography showed the lesion in two, magnetic resonance in 10, while in the remaining case reported to harbour a microadenoma on computerized tomography the differential diagnosis between a true TSH‐secreting microadenoma and pituitary resistance to thyroid hormones is still unclear. Both neuroradiologists coincided in their reports in 32 patients (80%); when the initial report was compared with those of the neuroradiologists, concordance was observed with at least one of them in 34 instances (85%). Discordant results were observed principally in microadenomas secreting ACTH or PRL and in delayed puberty. In the eight patients with Cushing's disease (histologically confirmed in six) magnetic resonance was positive in five and computerized tomography in two; the abnormal image correctly identified the side of the lesion at surgery.CONCLUSIONS In patients referred for evaluation of Cushing's syndrome or hyperprolactinaemia (due to microadenomas) or after surgery, magnetic resonance is clearly preferable to computerized tomography. In macroadenomas both scans are equally diagnostic but magnetic resonance offers more information on pituitary morphology and neighbouring structures. Nevertheless, there are cases in which the results of computerized tomography and magnetic resonance will complement each other, since different parameters are analysed with each examination and discordant results are encountered.
Reactivity to stress and psychological adjustment in adults with pituitary insufficiency
Authors: Stabler Brian , Turner J. Rick , Girdler Susan S. , Light Kathleen C. , Underwood Louis E. 
Published: March 2008

OBJECTIVE Hypopituitary adults who were affected during childhood have a below‐average rate of marriage, a rate of unemployment that exceeds national norms, and often indicate dissatisfaction with their life circumstances. We undertook the present study to determine the effects of short stature versus those of pituitary hormone deficiency.DESIGN AND PATIENTS We compared hypopituitary adults (n= 25) with normal short adults (n= 25) who were matched for height, sex, age and socioeconomic status.MEASUREMENTS In these two groups of subjects, we compared the physiological responses to a simulated social stressor, a public speaking task, and we measured the psychometric attributes that are indicators of social assertiveness and extraversion.RESULTS Before, during and after the stress of public speaking, patients with multiple pituitary hormone deficiencies (n= 20) had lower mean systolic and diastolic blood pressures than controls, while patients with isolated growth hormone deficiency (n= 5) were equivalent to controls. The reactivity to stress, assessed using delta scores based on changes in blood pressure and heart rate, was also decreased in multiple hormone deficient patients. Psychometric test results indicated that patients with multiple hormone deficiencies showed lower openness, lower assertiveness, greater neuroticism and a tendency towards less extraversion than did controls. The responses of patients with isolated GH deficiency on the psychometric tests were not statistically different from controls, but the number of subjects in this group (n= 5) was too small to draw conclusions.CONCLUSIONS The impaired cardiovascular responses to stress in patients with multiple hormone deficiencies, compared to short control subjects and to patients with GH deficiency leads us to conclude that factors other than stature and GH are responsible for these observations. The differences might be related to insufficiency of cate‐cholamines or cortisol in the patients with multiple hormone deficiencies. These hormonal deficiencies might also account for the socially inhibited behaviour of these patients. Our results suggest that more attention needs to be directed at preparing hypopituitary patients for the challenges of adulthood. Also, these patients may be helped by more intensive efforts at hormonal replacement in adulthood.
Gonadotrophin secretion in vitro by cells of a pituitary tumour from a patient with multiple endocrine neoplasia type I
Authors: Daniels M. , Newland P. , Dewar J. H. , White M. C. , Kendall‐Taylor P. 
Published: March 2008

OBJECTIVE The aim was to Investigate the hormone secretory products of a pituitary tumour from a patient with multiple endocrine neoplasia type I (MEN I) utilizing cell culture and Immunoassay techniques.DESIGN Adenoma tissue was enzymically dispersed and established In cell culture. Medium was collected for hormone measurement after 2 days, and also after 24‐hour periods during long‐term culture. In addition, tissue fixed at surgery was analysed by Immunocytochemistry and electron microscopy.PATIENT The subject was a 59‐year‐old male with a clinical history characteristic of familial MEN I syndrome. MEASUREMENTS Pituitary hormones in serum and culture medium were measured by fully characterized radiolmmunoassays.RESULTS Preoperative serum LH and FSH levels were normal, or slightly elevated, and there was a progressively blunted gonadotrophin response to GnRH throughout the 8 years prior to adenomectomy. TRH Induced a small, paradoxical Increase In serum gonadotrophin levels 2 weeks preoperatively. Post‐operative pituitary hormone responses to standard stimulation tests showed an active normal pituitary. In vitro, the pituitary tumour cells secreted only gonadotrophins and glycoprotein hormone α‐subunit. The fixed tumour tissue immunostained for α‐subunit alone, and electron microscopy confirmed the presence of secretory granules with diameters of 100–280 nm. Gonadotrophin secretion continued throughout 77 days in long‐term culture, but whilst LH was released at a steady rate, that of FSH transiently increased between days 29 and 48 in vitro.CONCLUSIONS These data demonstrate that a pitultary tumour associated with the MEN I syndrome secreted gonadotrophins in vitro.
Re‐evaluation of the captopril test for the diagnosis of primary hyperaldosteronism
Authors: Hambling C. , Jung R. T. , Gunn A. , Browning M. C. K. , Bartlett W. A. 
Published: March 2008

OBJECTIVE We aimed to re‐evaluate the captopril test in the diagnosis of primary hyperaldosteronism.DESIGN Serum aldosterone and plasma renin activity were measured supine prior to and 60, 90, 120 minutes after oral captopril, 25 mg.PATIENTS We have performed this test in ten patients with primary hyperaldosteronism, two with hypertension and secondary hyperaldosteronism and in ten normokalaemic patients with essential hypertension.MEASUREMENTS Validity was assessed by mathematical prediction methods.RESULTS Using a ratio of aldosterone to plasma renin activity >1400 pmol/l per μg/ml/h as a predictor of primary hyperaldosteronism, the captopril test had a sensitivity of 100%, a specificity of 83% and a predictive value of 82% with a 60‐minute post captopril evaluation being sufficient. Nevertheless, this test was only marginally superior to a careful analysis of the supine values where a similar ratio In the presence of a normal or suppressed plasma renin activity predicted primary hyperaldosteronism with a sensitivity also of 100% but a slightly lower specificity of 75% and predictive value of 77%.CONCLUSION Application of the captopril test to patients identified as abnormal by screening confirms all cases of primary hyperaldosteronism but false positive or equivocal results, necessitating further Investigation, may occur In some patients with esssential hypertension.
Determination of bone mineral density by quantitative computed tomography and single photon absorptiometry in subclinical hyperthyroidism: a risk of early osteopaenia in post‐menopausal women
Authors: Lehmke J. , Bogner U. , Felsenberg D. , Peters H. , Schleusener H. 
Published: March 2008

OBJECTIVE There is evidence that treatment with L‐thyroxine Increases the risk of early osteopaenia. The aim of our study was to Investigate the effect of subclinical hyperthyroidism in patients on TSH‐suppressive L‐thyroxine in view of the increased risk of decalcification.DESIGN Measurements of bone mineral density were performed in patients with subclinical hyperthyroidism at different scanning sites of varying trabecular portion. Bone mineral values as well as biochemical data were compared to those of normal controls.PATIENTS Fifty patients (nine men, 25 premenopausal and 16 post‐menopausal women) on TSH‐suppressive doses of L‐thyroxine were investigated after removal of thyroid cancer.MEASUREMENTS Dual energy quantitative computed tomography was used for osteodensitometry in the lumbar spine. Single photon absorptiometry from a 126I source was applied to the calcaneus, midshaft radius and distal as well as proximal scanning sites of the distal radius. Normal bone mineral values for each measurement site were taken from healthy reference populations.RESULTS A significant decrease of bone mineral density in the calcaneus was found in 26 of 50 patients. Bone mass assessment yielded a 9.1% decrease of mean bone mineral content in all patients compared to controls (P < 0.01). The decrease in post‐menopausal women was 22% (P < 0.001). In premenopausal women bone mineral density changes in the calcaneus were not statistically significant. Cortical measurement sites like the midshaft radlus and the proximal scanning site of the distal forearm showed a 14.8% (P < 0.05) and 10.8% (P= NS) decalcification in post‐menopausal women but normal values at the distal scanning site. The lumbar spine was not affected by subclinical hyperthyroidism in either pre or post‐menopausal women. In hypoparathyroid patients, bone density did not essentially differ from normals. There was no significant correlation between bone mineral values and duration of treatment or osteocalcin values.CONCLUSIONS Our data suggest that TSH suppressive L‐thyroxine treatment has a detrimental effect on the appendicular skeleton in post‐menopausal women. Additional effects of oestrogen deficiency and subclinical hyperthyroidism might lead to accelerated bone loss requiring close supervision to determine the smallest dose needed for suppression of the pituitary‐thyroid axis.
Adrenocortical dysfunction in paracoccidioidomycosis: comparison between plasma β‐lipotrophin/adrenocorticotrophin levels and adrenocortical tests
Authors: Moreira Ayrton C. , Martinez Roberto , Castro Margaret , Ellas Luclla L. K. 
Published: March 2008

OBJECTIVE Paracoccidioidomycosis is an important cause of Addlson's disease in South America. We have carried out an extensive and prospective study on paracoccidioidomycosis comparing glucocorticoid, mineralo‐corticoid and androgen function with adrenal regulators, ACTH/β‐LPH and plasma renin activity (PRA).PATIENTS AND METHODS Forty‐seven male patients with active paracoccidioidomycosis were studied consecutively together with 20 healthy controls. On day 1, plasma aldosterone and PRA levels were measured in blood samples obtained from patients in the supine and erect position. On day 2 at 0900 h, baseline plasma samples were taken for ACTH, β‐lipotrophin (β‐LPH), cortisol, corticosterone, aldosterone, androstenedlone (Δ4‐A) and dehydroeplandrosterone sulphate (DHEA‐S). ACTH 1–24 (250 μg) was given i. v. and blood samples for these steroid assays were taken at 1 and 2 hours.RESULTS Five patients (10%) had Addison's disease with high basal plasma ACTH and β‐LPH, and low cortisol levels after the ACTH test. In the remaining 42 patients, baseline ACTH and β‐LPH levels and plasma cortisol after ACTH were within the normal range. A high percentage of patients presented with reduced corticosterone (21% of patients) and aldosterone (23%) secretion and increased PRA (31%). Plasma Δ4‐A (19%) and DHEA‐S (50%) levels were also reduced.CONCLUSIONS The frequency of Addison's disease among our patients with paracoccidioidomycosis was 10%. In addition, a subset of patients presented with adrenal dysfunction detected by mineralocorticoid or androgen tests. In parallel to pathological lesions a functional adaptation may occur during adrenal involvement in paracoccidioidomycosis.
Increased free testosterone but normal 5α‐reduced testosterone metabolites in obese premenopausal women
Authors: Glagulll V. A. , Pergola G. De , Glorgino F. , Clgnarelll M. , Abbaticchlo G. , Vermeulen A. , Glorgino R. 
Published: March 2008

OBJECTIVE The aim of the study was to investigate whether the absence of increased 5α‐reductase activity explained the absence of hirsutism in premenopausal obese women with increased free testosterone (FT) levels.DESIGN As in hyperandrogenicity there generally exists evidence for increased 5α‐reductase activity, we measured, as parameters of 5α‐reductase activity, plasma levels of 5α‐androstane‐3α,17β‐diol glucuronlde (ADG) and androsterone glucuronlde (ADTG) as well as their precursor levels in obese women without hirsutlsm, obese hirsute women, non‐obese hirsute women, and non‐obese, non‐hirsute women.PATIENTS Eighty‐two premenopausal women (20–45 years old) were studied, in four age matched groups: 39 controls, 18 obese without hirsutism, 11 non‐obese hirsute and 14 obese hirsute women.MEASUREMENTS Blood samples were taken between days 5 and 7 of the menstrual cycle. Steroid hormone levels were measured by radioimmunoassay. Free testosterone levels were measured by equilibrium dialysis.RESULTS Compared to controls, mean free testosterone levels were increased (P <0.01) in obese, obese hirsute and hirsute patients, whereas mean DHEAS levels were increased in hirsute and obese hirsute (P <0.01), but not in obese, women. Mean androstanediol glucuronide levels were markedly increased in hirsute and obese hirsute patients (P <0.01), but not in obese women. Plasma androsterone glucuronide levels were increased in hirsute (P <0.01), in the normal range in obese hirsute, and decreased in obese women (P <0.01).CONCLUSIONS These results show that, despite the presence of higher free testosterone levels, neither 5 α‐reductase activity (as suggested by normal androstanediol glucuronlde levels) nor adrenal androgen precursor levels (DHEAS) are increased in obese women without hirsutism.