bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of computerized tomography and magnetic resonance imaging for the examination of the pituitary gland in patients with Cushing's disease
Authors: Escourolle H. , Abecassis J. P. , Bertagna X. , Guilhaume B. , Pariente D. , Derome P. , Bonnin A. , Luton J. P. 
Published: March 2008

SummaryOBJECTIVE The vast majority of patients with Cushing's disease have a corticotroph adenoma, the selective removal of which, through the transsphenoidal route, has the potential to offer a definitive and complete cure. This study was designed to compare the diagnostic accuracy of computerized tomography (CT) and magnetic resonance imaging (MRI) to identify the presence, evaluate the size, and assess the topographic characteristics of pituitary corticotroph adenomas.METHODS Forty‐two patients with Cushing's disease were included in this prospective study, of whom 16 were subsequently explored transsphenoidally. Computerized tomography used a CE12000 CGR apparatus with 1 5‐mm coronal slices and a 2‐mm interslice gap. Magnetic resonance imaging used an MR Max 0 5T GE apparatus; adjacent 3‐mm slices were obtained with a T1‐weighted gradient echo before and after gadolinium injection.RESULTS Lesions compatible with an adenoma were identified in 29 patients by MRI and in 21 patients by CT (69 vs 50%, P < 0 02). Seven macroadenomas were identified as well by the two methods. Eight of the 22 microadenomas detected by MRI were not identified by CT. Evidence for intracavernous tumour extension was found in nine patients: it was more frequently detected by MRI (8 patients) than by CT (4 patients). Fourteen patients with positive MRI had a pituitary examination: in one case the adenoma could not be reached because of purely suprasellar location; of the other 13 all were found by the surgeon and the surgical outcome was successful in 12 cases.CONCLUSION MRI is superior to CTfor the examination of the pituitary gland in patients with Cushing's disease.
Bilateral adrenalectomy: low mortality and morbidity in Cushing's disease
Authors: McCance David R. , Russell Colin F. J. , Kennedy Terence L. , Hadden David R. , Kennedy Laurence , Atkinson A. Brew 
Published: March 2008

SummaryOBJECTIVE We assessed the current role of bilateral adrenalectomy in the overall management strategy of hypercortisolism.DESIGN Retrospective review of case notes.PATIENTS Twenty‐six patients (20F/6M); mean age 46 years (range 15–70 years), median duration of follow‐up 5 25 years (0 6–19 1 years) who had undergone bilateral adrenalectomy at the Royal Victoria Hospital since 1972. Eighteen had had prior transsphenoidal surgery which did not control the hypercortisolism.MEASUREMENTS Morbidity, mortality, incidence of Nelson's syndrome.RESULTS Surgery was performed through bilateral postero‐lateral incisions (20 patients) or a long eplgastric incision (six patients). The mean combined weight of the adrenals at surgery was 11 2 g. Twenty patients received subcutaneous heparin and 18 antibiotic prophylaxis peri and post‐operatively. There was no operative mortality. Minor complications included one post‐operative wound infection and a small pneumothorax requiring drainage. Major complications occurred in two other patients, both with pre‐existing invasive pituitary tumours and considered at high risk because of age and general debility. One patient had a massive pulmonary embolus and the other a subphrenic abscess post‐operatively. This latter patient, the only mortality, died from an unrelated cause three years post‐operatively. Six patients have subsequently undergone pituitary surgery and three have received external pituitary irradiation therapy for expanding tumours.CONCLUSIONS Bilateral adrenalectomy, in experienced hands, is a relatively safe and useful management option in patients with hypercortisolism. Growth of a pituitary adenoma post‐operatively is now the most worrying complication.
The relationship of insulin insensitivity to menstrual pattern in women with hyperandrogenism and polycystic ovaries
Authors: Robinson S. , Kiddy D. , Gelding S. V. , Willis D. , Niththyananthan R. , Bush A. , Johnston D. G. , Franks S. 
Published: March 2008

SummaryOBJECTIVE Insulin insensitivity is a recognized feature of polycystic ovary syndrome (PCOS) but previous studies have suggested that circulating insulin concentrations are normal in hyperandrogenaemic women with regular cycles. The aim of this study was to examine the relationship between insulin sensitivity and menstrual pattern in women with PCO.DESIGN A cross‐sectional study of insulin sensitivity in a cohort of PCO subjects with oligomenorrhoea compared to women with PCO and regular menstrual cycles and a group of normal control subjects.SUBJECTS Seventy‐two women with polycystic ovaries on ultrasonography were studied. PCO subjects had clinical and/or biochemical evidence of hyperandrogenism; 53 had oligo/amenorrhoea (olig) and 19 had regular menses (reg). Results were compared with 31 control subjects. The groups were matched for age, weight and ethnic origin.METHODS Glucose and insulin responses to 75 g oral glucose were measured. Insulin sensitivity was assessed by the decline in plasma glucose following intravenous insulin (0.05 U/kg).RESULTS Glucose area (mean±SEM) after oral glucose was increased slightly in both PCO groups compared with controls (olig 37.6±1.4, reg 36.0±1.8, control 33.7±0.9 mmol/l h, both P < 0.01). Insulin area median (interquartile range) in response to glucose was significantly greater in the oligomenorrhoeic group (346 (239–734) mU/l h), compared with both PCO with regular cycles (246 (148–355), P<0.01) and controls (221 (147–277), P<001). Insulin sensitivity was reduced (P< 0.01) in the oligomenorrhoeic group (147 ±9.2 /imol/l min) compared to controls (185 ±7.4) but was normal in PCO with regular cycles (182 ±12.5). Insulin sensitivity did not correlate significantly with plasma testosterone or with SHBG levels, but plasma insulin concentrations correlated negatively with SHBG levels (fasting insulin vs SHBG, r= ‐0.47, P<0.01; insulin area vs SHBG, r= ‐0.47, P<0.01).CONCLUSIONS Insulin insensitivity in polycystic ovary syndrome occurs when there is oligo/amenorrhoea but not when the menstrual cycle is regular. This is consistent with PCO and insulin insensitivity being separate abnormalities which when combined are associated with anovulation.
Response of sex hormone binding globulin and insulin‐like growth factor binding protein‐1 to an oral glucose tolerance test in obese women with polycystic ovary syndrome before and after calorie restriction
Authors: Hamilton‐Fairley D. , Kiddy D. , Anyaoku V. , Koistinen R. , Seppälä M. , Franks S. 
Published: March 2008

SummaryOBJECTIVE We determined the relationship of short‐term changes in circulating insulin concentrations, resulting from an oral glucose load, to those in both sex hormone binding globulin (SHBG) and insulin‐like growth factor binding protein 1 (IGFBP‐1) and assessed the effect of a short‐term low calorie diet on the levels of SHBG and IGFBP‐1 during an oral glucose tolerance test.DESIGN A within‐group comparison of biochemical indices during an oral glucose tolerance test before and after calorie restriction.PATIENTS AND METHODS Six obese women with polycystic ovary syndrome with mean (SD) BMI 34 2 (3 4) kg/m2 were studied before and after one month on a very low calorie diet (350 kcal/day; Cambridge diet). Each subject was given a 75‐g oral glucose load after an overnight fast and blood samples were taken every 30 minutes for 3 hours. These were analysed for glucose, insulin, SHBG, and IGFBP‐1.RESULTS All the women lost weight (range 1.7–9.5 kg). The SHBG concentrations did not change significantly during the oral glucose tolerance test but there was a highly significant decline in IGFBP‐1 levels both before (0 min, mean (SD) 27 3 (10 6); 180 min, 8.9 (4.2) μg/l) and after (0 min, 28 4 (12 1); 180 min, 6 2 (2 1) μg/l, P< 0 001) dieting. The sum of the SHBG concentrations during the test, however, was significantly lower prior (129 9 (405) nmol/l) to calorie restriction than after (164 3 (70 6) nmol/l), whereas there was no significant effect of dieting on the IGFBP‐1 response to glucose.CONCLUSIONS The changes in insulin and SHBG concentrations found after dieting have been confirmed. SHBG levels, in contrast to IGFBP‐1, do not change in response to a short‐term increase in insulin or glucose concentrations. The difference in the response of the two binding proteins may be explained by differences in their half‐lives in the circulation or the regulation of mRNA for the peptides by insulin. This study confirms that insulin regulates both SHBG and IGFBP‐1 but that there is a difference in the time course of the response of the two proteins to insulin.
Short and long‐term effects of growth hormone treatment on bone turnover and bone mineral content in adult growth hormone‐deficient males*
Authors: Vandeweghe Mark , Taelman Paul , Kaufman Jean‐Marc 
Published: March 2008

SummaryOBJECTIVE In view of the fact that GH‐deficient adults present with pronounced osteopaenia and can be considered at risk for osteoporotic fractures, we wanted to investigate the effects of biosynthetic GH replacement therapy (0.25 IU/kg/week) on biochemical indices of bone turnover and on bone mineral content (BMC) in a group of GH‐deficient adult males.DESIGN We performed a 6‐month randomized, double‐blind, placebo‐controlled study, followed by 12–24 months of GH treatment in all patients.PATIENTS Twenty adult males with GH deficiency of childhood onset were studied.MEASUREMENTS We measured serum IGF‐I, serum phosphate, biochemical indices of bone turnover (serum alkaline phosphatase activity, serum osteocalcin, serum carboxyterminal propeptide of type‐I procollagen, fasting urinary hydroxyproline/creatinine and calcium/creatinine ratios) and bone mineral content, measured at the forearm and the lumbar spine by single and dual‐photon absorptiometry respectively.RESULTS After 3 and 6 months of GH administration, the serum levels of alkaline phosphatase, osteocalcin and carboxyterminal propeptide of type‐I procollagen, and the fasting urinary hydroxyproline/creatinine ratio were significantly increased compared to placebo‐treated patients (P<0.01 to P<0.001). During the open study phase, the values for these indices of bone turnover remained elevated above pretreatment levels (P<0 01 to P<0 001 at 12 months), a downward trend becoming apparent after about one year of GH treatment. BMC values showed an initial decline after 3 months of GH treatment (most likely due to an expansion of the remodelling space), followed by a significant and progressive increase above pretreatment values, reaching 7–8% for total BMC at the lumbar spine (L2‐L4) and 9–9% for total BMC at the forearm, after 30 months of GH administration.CONCLUSIONS The data of our study show that administration of substitutive doses of growth hormone to GH‐deficient adult males activates bone turnover for a period of at least one year and suggests that this may have a beneficial effect on bone mass in these patients.
Plasma IGFBP‐3 and its relationship with quantitative growth hormone secretion in short children*
Authors: Phillip Moshe , Chalew Stuart A. , Kowarski A. Avinoam , Stene Mark A. 
Published: March 2008

SummaryOBJECTIVE We assessed the relationship between serum IGFBP‐3 levels with IGF‐I and quantitative GH secretory status in poorly growing children.DESIGN We studied the relationship between 24‐hour integrated concentration of GH, peak GH to paired sequential stimulation tests, IGF‐I and the IGFBP‐3 serum levels. PATIENTS One hundred and two children (82 males, 20 females, age 11.7±2.7 years) with short stature (height 2.6±0.7 SDS) were studied.MEASUREMENTS Quantitative GH secretory status was assessed by the 24‐hour integrated GH and by response to arginine and insulin stimulation. GH, IGFBP‐3 and IGF‐I were measured by radioimmunoassay. To adjust for age and gender, IGFBP‐3 levels were converted to SD score. RESULTS IGFBP‐3 SDS was strongly correlated with IGF‐I SDS (r= 0 64, P<0.0001), and weakly with peak GH (r= 0.28, P<0 0004), but not with the integrated GH concentration (r= 0 07, P<0 46). IGFBP‐3 SDS increased with pubertal maturation (P< 0 0001). There was no difference in mean IGFBP‐3 SDS in subgroupings of the patients based on the results of their quantitative GH tests. CONCLUSION In short children, IGFBP‐3 levels increase with puberty, are strongly correlated with IGF‐I levels, weakly correlated with peak response to GH stimulation tests, but not correlated with integrated GH. Consequently, diagnostic classifications of patients based on quantitative measurements of GH secretion and IGFBP‐3 differ.
Direct in‐vivo detection of atypical hormonal expression of a Sertoli‐Leydig cell tumour following stimulation with human chorionic gonadotrophin
Authors: Cohen Ilan , Shapira Menahem , Cuperman Solomon , Goldberger Shmuel , Siegal Annette , Altaras Marco , Beyth Yoram 
Published: March 2008

SummaryA 60‐year‐old woman presented with progressive hirsutism and elevated serum testosterone levels. Selective bilateral ovarian and adrenal vein catheterization demonstrated mild elevated testosterone and androstenedione levels in the right ovarian vein, which increased considerably 15 minutes following intravenous injection of 5000 IU human chorionic gonadotrophin. Androgen levels decreased remarkably after administration of gonadotrophin hormone releasing hormone‐agonist (GnRH‐a). On histological examination, diffuse stromal hyperplasia of both ovaries was noted, with a small Sertoli‐Leydig cell tumour in the right ovary. This is the first report of preoperative, direct selective diagnosis of a small Sertoli‐Leydig cell tumour with such a hormonal expression.Ovarian Sertoli‐Leydig cell tumours are rare sex cord stromal tumours that exhibit testicular‐like structure and differentiation. These tumours are potentially malignant, can cause progressive virilization (Young & Scully, 1985), and are often clinically manifested as palpable pelvic masses and virilization (Meldrum & Abraham, 1979; Friedman et al., 1985). We describe a patient with postmenopausal virilization due to Sertoli‐Leydig cell tumour, in whom a remarkable increase in androgens was detected following intravenous human chorionic gonadotrophin injection, during adrenal and ovarian selective vein blood sampling. A remarkable decrease in the serum androgen level was noticed following an injection of gonadotrophin hormone releasing hormone‐agonist (GnRH‐a).
Suppressed TSH levels secondary to thyroxine replacement therapy are not associated with osteoporosis
Authors: Grant David J. , McMurdo Marion E.T. , Mole Patricia A. , Paterson Colin R. , Davies Robert R. 
Published: March 2008

SummaryOBJECTIVE Recent studies have suggested that patients receiving thyroxine are at increased risk of osteoporosis. We set out to measure bone mineral densities in two groups of post‐menopausal women receiving thyroxine replacement therapy (those with serum TSH levels persistently suppressed or non‐suppressed) and to compare the results in both groups with those of the local control population.DESIGN Cross‐sectional study.PATIENTS Seventy‐eight post‐menopausal women who had been treated with thyroxine for primary autoimmune or idiopathic hypothyroidism for a minimum of 5 years, 44 with TSH persistently suppressed and 34 non‐suppressed. One hundred and two control subjects.MEASUREMENTS Forearm bone mineral density at proximal and distal sites as measured by single‐photon absorptiometry.RESULTS Results were expressed as Z‐scores, i.e. number of standard deviations from the mean of a 5‐year age‐band from the local control population. Mean Z‐scores at proximal and distal sites for the non‐suppressed patients were ‐003 and ‐007 and for the suppressed patients were 0 20 and ‐0 25, representing a decrease in bone mineral density of at most 5% in the suppressed patients. The differences between the three groups were not statistically significant.CONCLUSION In this patient population, the reduction in bone mineral density due to thyroxine is small. It is unlikely to be of clinical significance and should not on its own be an indication for reduction of thyroxine dose in patients who are clinically euthyroid.
Effects of different oral oestrogen formulations on insulin‐like growth factor‐I, growth hormone and growth hormone binding protein in post‐menopausal women
Authors: Kelly John J. , Rajkovic Ivan A. , O'Sullivan Anthony J. , Sernia Conrad , Ho Ken K. Y. 
Published: March 2008

SummaryOBJECTIVE Insulin like growth factor‐I (IGF‐I) levels in post‐menopausal women are reduced by oral administration of the synthetic oestrogen ethinyl oestradiol but increased by transdermal delivery of 17 β‐oestradiol. Since these oestrogen types are different, the aim of this study was to clarify whether reduction in IGF‐I is a specific effect of ethinyl oestradiol or common to other oral oestrogen formulations.DESIGN Randomized cross‐over study comparing one month of treatment with ethinyl oestradiol (20 μ g), conjugated equine oestrogen (1 25 mg Premarin) and oestradiol valerate (2 mg).SUBJECTS Six healthy post‐menopausal women, age 60 3 ± 5 6 years.MEASUREMENTS Mean 24 hour GH (from hourly sampling), IGF‐I, GH binding protein (GHBP), pituitary (LH, FSH) and hepatic function (SHBG and angiotensinogen) were measured.RESULTS All three oestrogen formulations resulted in a significant reduction in IGF‐I levels compared to baseline and significant elevations of GH and GHBP (P & lt; 0 05). The percentage increase in GH during oestrogen treatment was significantly related to the percentage decrease in IGF‐I levels (P= 0 04). All three oestrogen formulations resulted in significant suppression of LH and FSH and induction of the hepatic proteins, SHBG and angiotensinogen (P <0 05). GHBP increased in parallel with other hepatic proteins.CONCLUSIONS Reduction in IGF‐I levels is an intrinsic effect of oral oestrogen therapy and increased GH levels may occur as a result of reduced feedback inhibition by IGF‐I. Since GHBP activity is not changed by transdermal oestrogen, we conclude that the liver is a major source of circulating GHBP and that GHBP is an oestrogen sensitive protein.
Effect of oestrogen status on serum levels of growth hormone‐binding protein and insulin‐like growth factor‐I in non‐pregnant and pregnant women
Authors: Massa Guy , Igout Ahmed , Rombauts Luc , Frankenne Francis , Vanderschueren‐Lodeweyckx Magda 
Published: March 2008

SummaryOBJECTIVE Since there appears to be a relationship between circulating oestrogens and growth hormone, we have investigated the effect of the oestrogen status of adult women on serum levels of GHBP and IGF‐I.DESIGN AND patients The investigation was performed on serum samples of 14 spontaneously menstruating women, 10 women taking oral contraceptives containing 20–50 μ g ethinyloestradiol, and 30 pregnant women at different stages of pregnancy.MEASUREMENTS Serum levels of GHBP were measured by HPLC gel filtration and IGF‐I levels were measured by RIA after acid‐ethanol extraction.RESULTS In the spontaneously menstruating women the mean ± SD serum level of GHBP was 34.6 ± 6.7% and of IGF‐I 30 ± 7 nmol/l. Serum GHBP levels were negatively (r=0.67; P<0.01) and IGF‐I levels were positively related (r= 0.69; P< 0.01) to serum oestradiol concentrations. In the women taking oral contraceptives serum levels of GHBP were 470 ±7 4%. This was significantly (P<0.001) higher than in spontaneously menstruating women. In contrast, IGF‐I levels were not different from those obtained in spontaneously menstruating women. In the pregnant women, the mean ± SD serum level of GHBP was not different from that observed in non‐pregnant spontaneously menstruating women. Polynomial regression analysis, however, showed a significant (P= 0.01) second‐order relationship between the duration of pregnancy and serum GHBP levels, with increasing levels during the first half of pregnancy and decreasing levels thereafter. Serum concentrations of IGF‐I increased during the second half of pregnancy and were significantly (P<0.005) elevated in the third trimester.CONCLUSIONS In non‐pregnant women the endogenous oestrogen status seems to modulate negatively GHBP levels and positively IGF‐I levels, whereas oral oestrogen administration, in contrast, increases serum levels of GHBP without modification of IGF‐I levels. During pregnancy serum GHBP levels increase slightly during the first half of pregnancy and decrease thereafter, whereas IGF‐I concentrations increase during the second part of pregnancy. The oestrogen status of women has a complex effect on serum concentrations of GHBP and IGF‐I and has therefore to be taken into account when evaluating serum levels of GHBP and IGF‐I.
Tissue‐specific modulation of insulin receptor mRNA levels in a patient with a phaeochromocytoma
Authors: Leal M. A. , Aller P. , Torres A. , Picardo A. , Calle C. 
Published: March 2008

SummaryWe have observed that the expression of the insulin‐receptor gene is regulated in a tissue‐specific manner in a patient with a phaeochromocytoma. Our results Indicate that insulin receptor mRNA levels are decreased in adipose tissue and increased in both liver and skeletal muscle as compared with the corresponding values in the same tissues of a control patient. These findings provide the first evidence that insulin receptor mRNA levels may be modulated in vivo by high levels of catecholamines.
Differences in testosterone metabolism by beard and scalp hair follicle dermal papilla cells
Authors: Thornton M. J. , Laing I. , Hamada K. , Messenger A. G. , Randall V. A. 
Published: March 2008

SummaryOBJECTIVE Androgens have paradoxically different effects on hair follicles depending on body site, stimulating beard growth while inducing regression in some areas of the scalp. The mesenchyme derived dermal papilla at the base of the hair follicle regulates many aspects of the growth of follicular epithelium, and is probably the site of androgen action. Since 5α‐dihydrotes‐tosterone is considered to be the active intracellular androgen in many target tissues and is required for some androgen‐mediated hair growth, such androgen‐sensitive cells should contain 5α‐reductase. This study was designed to investigate whether cultured human dermal papilla cells contain 5α‐reductase and whether the metabolic capacity varies with the body site of the follicle in line with the clinical picture.DESIGN Testosterone metabolism in cultured dermal papilla cells from androgen sensitive beard follicles was compared with less androgen dependent non‐balding scalp follicles. Primary cell cultures were established from follicles of 11 patients with normal hair growth. The cells were grown to confluence in 10‐cm Petri dishes and incubated with 5 nM 3H‐testosterone in serum‐free medium for 2 hours. The cells and the culture medium were collected separately for individual analysis.MEASUREMENTS Unlabelled carrier and 14C‐marker steroids were added to both the cell and medium extracts before separation by thin‐layer chromatography. The individual steroid identities were confirmed by recrystal‐lizing up to five times to a constant 3H/14C ratio.RESULTS Testosterone was taken up by both cell types; significant amounts of 5α‐dihydrotestosterone were recovered inside beard cells, but not in scalp cells, whereas androstenedione was identified in both. An unidentified compound was present intracellularly in both cell types, but was not present in the culture medium. 5α‐Dihydrotes‐tosterone was present only in the culture medium of beard cells but androstenedione was present in a similar amount in the medium from both cell types. The presence of other steroids could not be confirmed in either the cell extracts or the culture medium.CONCLUSIONS The production of 5α‐dihydrotestosterone by beard cells concurs with the poor beard growth in men with 5α‐reductase deficiency, supporting our hypothesis that androgens mediate their effects on the hair follicle via the mesenchyme‐derived dermal papilla.