bluuebunny/crossref_metadata_2025_split huggingface dataset:
Insulin sensitivity and insulin clearance in cystic fibrosis patients with normal and diabetic glucose tolerance
Authors: Lanng Susanne , Thorsteinsson Birger , Rsder Michael E. , Nerup Jern , Koch Christian 
Published: March 2008

SummaryOBJECTIVE We studied glucose metabolism and insulin kinetics in cystic fibrosis patients with diabetic and normal glucose tolerance.DESIGN Measurements of blood glucose and serum free insulin concentrations during hyperinsulinaemic normo‐glycaemic clamp and post‐clamp insulin decay, followed by the calculation of insulin sensitivity (M‐value and M/1 ratio), insulin clearance rate, serum half‐life and apparent distribution space for insulin.SUBJECTS Cystic fibrosis patients, age range 20–29 years, with diabetes mellitus (n= 10) and normal glucose tolerance (n= 10), and 10 age‐matched control subjects.RESULTS During the glucose clamp, diabetic cystic fibrosis patients needed less glucose than cystic fibrosis patients with normal glucose tolerance and control subjects (M‐value), and steady‐state serum insulin concentrations were lower in cystic fibrosis patients with diabetic and normal glucose tolerance than in control subjects. The quantity of glucose metabolized per unit of serum insulin concentration (M/l ratio) was similar in the three study groups (median ∼ 145 (μmol/kg/min)/(nmol/l); range 70–252).insulin clearance rates were higher in cystic fibrosis patients with diabetic (24·4 (19·3–29·9) mi/kg/min) and normal (22·6 (14·9–28·4) mi/kg/min) glucose tolerance than in control subjects (17·5 (15·9–24·2) ml/kg/min). Although Insulin clearance rates were inversely related to body mass index (R(S)=−0·59, P < 0·001), the higher insulin clearance rates in CF patients cannot be accounted for solely by differences in body mass index since the insulin clearance rates were similarly increased in patients with body mass index above and below 20kg/m2(22·7 (14·9–28·4) and 24·4 (19·3–29·9) ml/kg/min, respectively). Serum half‐lives for Insulin were shorter in cystic fibrosis patients (∼4·3 (3·2–7·2) min) than In control subjects (5·9 (3·8–12·5) min), whereas the apparent distribution spaces for Insulin were similar in the three study groups (∼150 (88–391) ml/kg).CONCLUSIONS Insulin sensitivity, calculated as the quantity of glucose metabolized per kg body weight per unit of serum insulin concentration, is normal in cystic fibrosis patients with normal glucose tolerance and with well controlled diabetes mellitus. The insulin clearance rate is increased in cystic fibrosis patients with diabetic and normal glucose tolerance, owing to a shorter serum half‐life of insulin, whereas the apparent distribution space for insulin is normal.
Insulin‐like growth factor binding protein 1 response to acute insulin induced hypoglycaemia in Type 1 diabetes
Authors: Quin J. D. , Fisher B. M. , MacCulsh A. C. , Beastall G. H. , Small M. , Holly J. M. P. , Cotterill A. M. 
Published: March 2008

SummaryOBJECTIVES Insulin Is believed to be the prime regulator of Insulin‐like growth factor binding protein 1 (IGFBP‐1) secretion, and In normal subjects acute insulin Induced hypoglycaemla exerts a rapid effect on concentrations of IGFBP‐1, and may also Influence Insulin‐like growth factor I (IGF‐I) concentrations. The rise In IGFBP‐1 concentrations in normal subjects following hypoglycaemia has been suggested to be due to suppression of endogenous insulin secretion. We have examined this further by studying diabetics with no endogenous Insulin secretion.DESIGN We have compared the IGFBP‐1 response to acute insulin Induced hypoglycaemia in normal subjects and patients with Type 1 (insulin dependent) diabetes mellitus.METHODS Insulin tolerance test8 were performed using a bolus of Insulin (0·15 U/kg), in six control subjects and six patients with Type 1 diabetes.MEASUREMENTS Serum levels of IGFBP‐1, insulin, glucose, and IGF‐I were measured at regular Intervals during the insulin tolerance test.RESULTS Blood glucose fell to a nadir which coincided with the onset of the acute autonomic reaction ‘R’ In both groups. The basal concentration of IGF‐I was significantly lower In the diabetic group at 0·4 ± 0·1 kU/l, compared to 0·9 ± 0·1 kU/l In the control group, but there was no significant change In IGF‐I concentrations In response to hypoglycaemia In either group. Hypoglycaemia provoked a fall In IGFBP‐1 In patients with Type 1 diabetes, from 38 ± 9 μg/l basally to 17 ± 3 μg/l at R + 120 minutes, with a return to basal values of 45 ± 11 μg/l at R + 180 minutes. In the control subjects there was no fall In IGFBP‐1, but a significant Increase to 71 ± 14 μg/l at R + 180 minutes.CONCLUSION This difference In the IGFBP‐1 response In the presence of a similar glucose response suggests that In Type 1 diabetes there may be different sensitivities to the actions of exogenous Insulin on IGFBP‐1 regulation.
A prospective study of the prevalence of clear‐cut endocrine disorders and polycystic ovaries in 350 patients presenting with hirsutism or androgenic alopecia
Authors: O'Driscoll J. B. , Mamtora H. , Higginson J. , Pollock A. , Kane J. , Anderson D. C. 
Published: March 2008

SummaryOBJECTIVE To determine the frequency of polycystic ovaries (PCO) on ultrasound and the incidence of clear‐cut endocrine disorders leading to virilization in patients complaining of hirsutism or androgenic alopecia. The major purpose was to determine a coherent policy for the routine biochemical assessment of such women. DESIGN A prospective study of women attending a joint skin/endocrine clinic complaining of these problems. PATIENTS Three hundred and fifty consecutive women with hirsutism and/or androgenic alopecia were assessed. MEASUREMENTS Baseline endocrine screens were conducted on two occasions and included measurement of serum testosterone, androstenedione, dehydroepiandrosterone sulphate, sex hormone binding globulin, LH, FSH, 17‐hydroxyprogesterone and PRL. The ovarles were visualized by high‐resolution pelvic ultrasound scanning. RESULTS Eight women were identified with relevant endocrine disorders; of these, one was acromegalic and one had a microprolactinoma—In both cases the association may have been fortuitous. Three had clear‐cut 21‐hydroxylase deficiency, one a rare hepatic enzyme deficiency (11‐reductase), one a virilizing adrenal carclnoma and one a Leydig cell tumour. The latter six cases all had persistently elevated levels of serum testosterone (>5nmol/l). In ail, 13 women had baseline testosterone levels in excess of 5nmol/l. Polycystic ovaries were present in 81 % of the cases who had erratic cycles and 52% of those with regular cycles; PCO were present In two of the women with 21‐hydroxylase deficiency and In the woman with 11‐oxoreductase deficiency. The Leydig cell tumour (1.2 cm diameter) was not detected on ultrasound or CT scan.CONCLUSIONS For the exclusion of enzyme deficiencies and virllizing tumours clinical assessment and a single serum testosterone measurement will suffice.
Malignancy‐associated hypercalcaemia: resolution of controversies over vitamin D metabolism by a pathophysiological approach to the syndrome
Authors: Schweitzer Dave H. , Hamdy Neveen A. T. , Frölich Marijke , Zwinderman Aellko H. , Papapoulos Socrates E. 
Published: March 2008

SummaryOBJECTIVE Parathyroid hormone‐related protein (PTHrP) is recognized as a major pathogenetic factor of humoral hypercalcaemia of malignancy but Its action on vitamin D metabolism is controversial. Our aim was to study the relation between serum 1,25‐dihydroxyvitamin D and humoral activity in malignancy‐associated hypercalcaemia.DESIGN Prospective, cross‐sectional, single‐centre study of patients with documented solid malignancles, hypercalcaemia and suppressed plasma PTH concentrations.PATIENTS AND METHODS Vitamin D metabolites, PTH, nephrogenous cyclic AMP (N‐CAMP), PTHrP and biochemical parameters of calcium and bone metabolism were measured in 39 patients with solid mallgnancles and hypercalcaemia and bone scans were performed.RESULTS In 27 patients plasma PTHrP levels were elevated (69%) and in 9 patients (23%) serum 1,25‐(OH)2D concentrations were not appropriately suppressed (>92pmol/l). Patients with plasma PTHrP levels below the upper limit of normal (< 1·6 pmol/l) had lower serum 1,25‐(OH)2,D concentrations than those with elevated levels (>1 6 pmol/l) (47±6 vs 70± 7 pmol/l, respectively; P < 0·04). Serum 1,25‐(OH)2D concentrations were higher in patients with negative bone scans than In those with metastatic bone disease (80 ± 9 vs 50 ± 5 pmol/l; P < 0·01) and similar levels of plasma PTHrP. In the patients with negative bone scans there was a significant relation between plasma PTHrP and serum 1,25(OH)2,D (r= 0·51; P < 0·03) whereas there was no such correlation in those with a positive scan.CONCLUSION Contrary to current belief, serum 1,25‐(OH)2D concentrations are not generally suppressed in humoral hypercalcaemia of malignancy and PTHrP is a determinant of these levels in the absence of demonstrable bone metastases. These findings provide further Insights into the pathophysiology of malignancy‐associated hypercalcaemia and may help in the clinical management of these patients.
Calcitonin‐producing insulinoma: clinical, immunocytochemical and cytogenetical study
Authors: Bugalho Maria João G. M. , Roque Lúcia , Sobrinho Luís G. , Hoog Anders , Nunes José F. Moura , Aimeida José M. Mendes , Leltão C. Nobre , Santos Jorge R. , Pereira Maria Conceičão , Santos Maria Amparo , Soares Jorge 
Published: March 2008

SummaryThe case of a patient with a large goitre associated with hypercaicitoninaemia and fasting hypoglycaemia is reported. Pentagastrin (PG) test was negative. Repeated measurements of fasting glycaemia, insulin and C peptide established the diagnosis of insulinoma. After localization by endoscopic ultrasonography, a distal pancreatectomy was performed and a small insulinoma was recovered. Glycaemia and calcitonin (cT) became normal. The tumour cells a a strong immunoreactivity for insulin and CT. Cytogenetical evaluation of the tumour revealed a translocation t(1;9) (pl3;p22).
Secondary hypoadrenalism presenting with hypercalcaemia
Authors: Vasikaran S. D. , Tallis G. A. , Braund W. J. 
Published: March 2008

SummaryWe describe a young woman with lymphocytic hypophysitis presenting In the early post‐partum period. She had selective corticotroph failure causing secondary adrenal Insufficiency. At the time of presentation she had transient hyperthyroidism due to thyroiditis, and hypercalcaemia. This is the third case to be described of hypercalcaemia occurring in association with lymphocytic hypophysitis. Hypercalcaemia is not a recognized complication of other forms of pituitary failure. The two previously described cases also had selective corticotroph failure and hyperthyroidism due to thyroiditis. This pattern of presentation supports the concept that thyroid hormone action In the presence of glucocorticoid deficiency is responsible for the increased calcium efflux from bone into the circulation. Reduced renal excretion of calcium due to a reduction in calcium delivery to the glomeruius and increased proximal tubular reabsorption are also implicated in the aetiology of hypercalcaemia associated with adrenal failure.
Is a low skinfold thickness an indicator of osteoporosis?
Authors: Orme S. M. , Belchetz P. E. 
Published: March 2008

SummaryOBJECTIVE The association between thin skin and osteoporosis has been known for some years. We wished to assess a simple measure of skinfold thickness (SFT) as a screening test for osteoporosis and to study the effect of chronological and menopausal age on SFT in a group of osteoporotic women and normal controls.DESIGN A case control study of 225 consecutive women who attended an osteoporosis clinic.PATIENTS We studied 225 women, 141 with osteoporosis (mean age 61·8 ±10·5 years) and 65 normal controls (mean age 59·9 ± 8·8 years), with 19 exclusions.METHODS Each patient had routine biochemistry, spinal X‐rays and a dual‐energy X‐ray absorptiometry (DEXA) scan of lumbar spine and femoral neck. In addition they had skinfold thickness measured by a single observer using Holtain Tanner Whitehouse callipers over the 4th metacarpal of the right hand.RESULTS Mean skinfold thickness was lower in the osteoporotic group, 1·6 ± 0·4 mm compared to normals 1·8 ± 0·3 mm (P < 0·0001). SFT did not decline significantly with chronological or menopausal age in the normals (correlation coefficients r=−0·06, r=−0·09) in contrast to the osteoporotic group (correlation coefficients r=−0·52, P < 0·001; r=−0·27, P < 0·0001). Subjects with a SFT of ≤ 1·5 mm had a higher probability of osteoporosis (odds ratio 3·12, 95% confidence Interval 1·58–6·14). Subjects with a SFT of ≥ 2·1 mm had a lower probability of osteoporosis (odds ratio 0·305, 95% confidence interval 0·126–0·740).CONCLUSION Our results demonstrate a lower mean SFT in osteoporotic compared with normal women, with a negative correlation between SFT and chronological and menopausal age in osteoporotlcs, but not In normal controls. A low skinfold thickness appears to be an indicator of developing osteoporosis and a high SFT may indicate a normal bone mass.
Whole body composition and regional bone mass in women with insulin‐dependent diabetes mellitus
Authors: Compston J. E. , Smith E. M. , Matthews C. , Schofield P. 
Published: March 2008

SummaryOBJECTIVE Reduced bone mass has been reported In adult patients with insulin‐dependent diabetes mellitus but there are few data on bone density in the axial skeleton or on whole body composition In this group. The aim of this study was to determine whether whole body and regional bone mass are normal in middle‐aged women with insulin‐dependent diabetes mellitus.DESIGN Total and regional bone mass were measured In 24 post‐menopausal women aged 43–69 years (mean 56·3) with insulin‐dependent diabetes, recruited during routine clinic attendance. Results were compared with those obtained from 24 age and weight‐matched community‐based post‐menopausal women.MEASUREMENTS Whole body bone mineral Content and bone mass in the lumbar spine and femoral neck were measured by dual energy X‐ray absorptiometry on a Lunar DPX.RESULTS Whole body bone mineral content was significantly lower in the diabetic women than in community‐based controls (P= 0·02). There was no significant difference between the two groups in whole body bone density or lumbar spine bone density. Mean bone density in the femur was lower in the patient group at all sites assessed (femoral trochanter P= 0·003, femoral neck, P= 0·057). Values for all regional bone density measurements in the diabetic women were within the Lunar reference range (mean ± 2 SD) and at all sites the mean value was close to 100% of the sex and age‐matched reference value. There was no correlation between duration or control of diabetes and bone mass at any site.CONCLUSIONS Insulin‐dependent diabetes mellitus In middle‐aged women is associated with small reductions in total body bone mineral content and in femoral bone density; the clinical Significance of these findings in terms of subsequent fracture risk remains to be established. No evidence was found In this study for a reduction in whole body or lumbar spine bone density.
High dose topical calcipotriol consistently reduces serum parathyroid hormone levels
Authors: Bourke J. F. , Berth‐Jones J. , Mumford R. , Iqbal S. J. , Hutchinson P. E. 
Published: March 2008

SummaryOBJECTIVE Calcipotriol is a vitamin D analogue which is an effective topical treatment for chronic plaque psoriasis. It has been reported to have no effect on systemic calcium homeostasis provided the manufacturer's guidelines are adhered to (maximum 100 g of calcipotriol ointment (50 μg/g) per week). However, there have been reports of hypercaicaemla in patients using topical caicipotriol even at recommended doses. The purpose of this study was to investigate the effects of topical calcipotriol in vivo using the recently developed ‘intact’ PTH assay as a more sensitive index of systemic calcium homeostasis.DESIGN AND PATIENTS Seven patients with extensive psoriasis were recruited for the study. Each patient was admitted to hospital and applied 200 g 01 calcipotrlol (50 μg/g) ointment over the first week followed by 300 g over the second week. in the third week of treatment, patients were treated with 2% crude coal tar which served as a biochemical washout phase.MEASUREMENTS Serum total adjusted calcium was measured at baseline and three times a week during the study. Twenty‐four‐hour urinary calcium excretion was measured at baseline and twice a week throughout the study. Peak (0400 h) and trough (0900 h) PTH levels were measured at baseline and at the ends of weeks 2 and 3.RESULTS Serum PTH levels were reduced in every patient after 2 weeks' treatment with caicipotriol and rose after withdrawal. Mean 0400 h PTH fell by 2·58pmolli (95% confidence interval 1·45–3·70) from 5·11 to 2·53 pmol/l (P < 0·01) and mean 0900h PTH fell by 2·08 pmol/l (0·84–3·36) from 4·04 to 1·96 pmol/l (P < 0·01). Mean serum and urine calcium rose during treatment with calcipotriol and fell after withdrawal. Mean adjusted total calcium rose by 0·14mmol/l (95% confidence interval 0·10–0·16) from 2·25 to 2·39 mmol/l (P < 0·01). Mean 24 hour urine calcium excretion rose by 2·09 mmol/24h (0·51–3·26) from 3·40 to 5·49 mmol/24h (P < 0·05). No patient developed hypercalcaemia at any stage of the study although hypercalciuria was recorded transiently in three patients.CONCLUSION Topical calcipotriol is likely to have a dose dependent effect on systemic calcium homeostasis.
Postural stimulation test in patients with aldosterone producing adenomas
Authors: Feltynowski T. , Ignatowska‐Switaiska H. , Woclal B. , Lewandowski J. , Chodakowska J. , Januszewicz W. 
Published: March 2008

SummaryOBJECTIVE The purpose of this study was to evaluate the postural stimulation test before and after surgical treatment in patients with aldosterone‐producing adenomas.DESIGN The retrospective study was made on patients with aldosterone producing adenomas.PATIENTS The postural stimulation test was analysed in 60 patients with surgically proven aldosterone producing adenoma and In 15 healthy volunteers.MEASUREMENTS The postural stimulation test was based on measurements of plasma aldosterone, cortisol and renin activity (PRA) at 0800 h and at noon after 4 hours ambulation.RESULTS The patients were divided into two groups according to the individual pattern of plasma aldosterone concentration following the postural test. Plasma aldosterone concentration decreased or did not change after 4 hours of standing in 42 patients (group 1,70% of total) and increased in 18 patients (group 2, 30% of total). Mean plasma aldosterone was significantly higher in group 1 than in group 2 (1325 ± 164 pmol/l (mean ± SE) and 538 ± 53 pmol/l, respectively). Mean plasma cortisol concentration after 4 hours of upright posture in both groups remained low (242 ± 35 vs 401 ± 63 nmol/l (group 1) and 317 ± 46 vs 367 ± 43 nmol/l (group 2). Mean PRA In both groups was suppressed after 4 hours of upright posture (0·2 ± 0·04 vs 0·2 ± 0·04 pmol/l/s and 0·3 ± 0·06 vs 0·1 ± 0·02 pmol/l/s, respectively).CONCLUSION Diverse changes In plasma aldosterone and cortisol found in response to the postural test may indicate pathogenetic heterogeneity amongst patients with aldosterone producing adenomas and should be considered during diagnosis of primary aldosteronlsm.
Body composition in active acromegaly during treatment with octreotide: a double‐blind, placebo‐controlled cross‐over study
Authors: Hansen T. B. , Gram J. , Bjerre P. , Hagen C. , Bollerslev J. 
Published: March 2008

SummaryOBJECTIVE In active acromegaly body composition is characteristically altered by an increase in lean body mass and a corresponding reduction in fat mass. These changes are induced by an excessive secretion of GH and insulin‐like growth factor I (IGF‐I). Growth hormone is an anabolic hormone and leads to stimulation of protein synthesis and an increased lipolysis in adipose tissue.Treatment with the somatostatin analogue, octreotide, has been shown to reduce GH levels causing reduced hormonal effects on target tissues. We have studied changes in body composition during short‐term reduction in OH level by octreotide in active acromegaly. DESIGN Octreotide was compared to placebo in a double‐blind, cross‐over trial. Dual‐energy X‐ray absorptlometry scanning was employed to calculate body composition. Relations between body composition parameters and clinical signs of acromegaly (finger circumference and foot volume) were studied.PATIENTS Twelve patients with active acromegaly, confirmed by lack of GH suppression during oral glucose loading, were included. All had pituitary adenomas diagnosed by computed tomography.MEASUREMENTS Serum GH and IGF‐I. Lean body mass, fat mass and total weight, foot volume and finger circumference.RESULTS Four weeks of octreotide treatment caused a 75% decrease in GH levels (n= 10), a reduction in IGF‐I from 476 ± 51·9 (mean±SEM) to 233 μg/l ± 46·3 (P < 0·005) and a corresponding decrease In both body weight (2·51 kg ± 0·41) (P <0·005) and lean body mass (2·44 kg ± 0·48) (P < 0·005). No significant changes in fat mass were observed. These findings were paralleled by significant reductions in foot volume (44·50ml ± 17) (P < 0·05) and finger circumference (1·3 mm ± 0·3) (P < 0·05).CONCLUSIONS Short‐term octreotide therapy reduces growth hormone levels leading to a significant reduction in lean body mass as assessed by dual‐energy X‐ray absorptiometry. Alterations in lean body mass were positively correlated with reductions in foot volume. Thus, simple clinical tests may be valuable in judging the effects of treatment in active acromegaly.
Age as a determinant of the impact of growth hormone therapy on predicted adult height
Authors: Hochberg Zeev , Leiberman Esther , Landau Heddy , Koren Ronit , Zadik Zvl 
Published: March 2008

SummaryOBJECTIVE Final adult height is determined by both childhood and pubertal growth. The later is a function of growth velocity and bone maturation, and both are regulated by growth hormone. In a study of the safety and efficacy of GH therapy, we analysed the Impact of age on bone maturation and predicted adult height.PATIENTS AND METHODS The subjects were 65 male patients with GH deficiency, as diagnosed by pharmacological or physiological tests, who participated in a multi‐centre trial and completed 3 years of hGH therapy. The age range at initiation of therapy was 3·1–15·7 years. Subcutaneous injections of hGH were given in a dose of 0·3 mg/kg/week, in thrice‐weekly doses. Calculation of the adult height prediction was performed on annual growth parameters using the Bailey‐Pinneau, TW‐II and Roche methods.RESULTS The rate of pubertal advancement correlated positively with the child's age at initiation of therapy. The bone age advanced in positive correlation with chronological age, and by the end of 3 years of hGH therapy the δ‐bone age/δchronological age ratio increased to 1·5 for children with an age at start of therapy of 10·7 years. During the adolescent years, the predicted gained height over 3 years of therapy declined, in correlation with age, and became negative at a therapy‐initiation age of 12·9 years.CONCLUSIONS In a retrospective analysis of a group of children with heterogeneous GH secretory ability, GH induced acceleration of growth, around the age of normal puberty, advanced the age of pubertal onset and accelerated pubertal progression which, in turn, expedited bone maturation and thereby restricted predicted adult height gain from hGH therapy.