bluuebunny/crossref_metadata_2025_split huggingface dataset:
TREATMENT OF ACROMEGALY BY TRANS‐SPHENOIDAL OPERATION, 90‐YTTRIUM IMPLANTATION AND BROMOCRIPTINE: RESULTS IN 230 PATIENTS
Authors: QUABBE H‐J. 
Published: March 2008

SUMMARYTwo hundred and thirty patients with acromegaly were diagnosed and treated in a prospective cooperative study in twelve university clinics. Primary treatment was: trans‐sphenoidal surgery (152 patients), trans‐sphenoidal surgery with additional cryotherapy (eighteen patients), Yttrium‐90‐implantation (thirty patients), bromocriptine (thirty patients). The results of endocrine assessment before treatment and 6 months after operation, 90‐Y implantation or commencement of bromocriptine therapy are reported.The best results (low GH, no or little deterioration of pituitary function, low complication rate) were achieved by trans‐sphenoidal surgery, especially in patients with intrasellar tumours (basal GH < 5 ng/ml in 59·7%). Results were less good with increasing tumour size. Additional cryosurgery was accompanied by a high rate of anterior pituitary insufficiency and is no longer employed. Yttrium‐90‐implantation resulted in less improvement in GH levels (basal GH < 5 ng/ml in 51·7. of patients with intrasellar tumours), a high rate of pituitary insufficiency and more complications. Bromocriptine treatment was least effective in lowering GH concentrations (basal GH < 5 ng/ml in 33% of patients with intrasellar tumours).Different criteria for treatment success were compared. In the entire group, basal GH concentrations below 5 ng/ml were attained in 51·7. of all patients whose values were higher than this prior to treatment. Suppressibility of GH below 2 ng/ml during glucose loading occurred in only 34·9%. An abnormal GH response to TRH/LHRH was present in 47·2. before and in 43·4% after/during treatment. The prognostic significance of this latter finding must be evaluated by further study.
ADRENOCORTICAL FUNCTION IN CHILDREN WITH PRECOCIOUS SEXUAL DEVELOPMENT DURING TREATMENT WITH CYPROTERONE ACETATE
Authors: STIVEL M. S. , KAULI R. , KAUFMAN H. , LARON Z. 
Published: March 2008

SUMMARYAdrenal function was studied in thirty‐two children with precocious sexual development who were being treated with cyproterone acetate (CPA) at doses ranging from 68 to 175 mg.m2. day for periods lasting from 2 to 79 months. In eighteen children the adrenocortical function evaluation was made before and during CPA treatment. In these eighteen patients, the mean basal plasma cortisol level during the morning hours was 11·2±4·6 μg/dl (m±SD) before treatment and fell significantly to 7·2±4·1 μg/dl (P < 0·02) during therapy. In fifteen patients tested during insulin hypoglycaemia the cortisol peak fell from 21·6±5·5 μg/dl before treatment to 16·7±6·8 μg/dl (P < 0·05) during CPA therapy. There was a significant inverse correlation between this peak and the dose of CPA but no correlation was found between the cortisol response and duration of treatment. In eight of twenty patients tested, urinary free cortisol levels were undetectable during treatment. No change in basal plasma ACTH levels was demonstrated using standard radioimmunoassay techniques. In the patient receiving the highest dose of CPA and showing complete suppression of the adrenal axis, prolonged stimulation with ACTH‐Depot demonstrated a responsive adrenal gland. Addition of a replacement dose of cortisol to the CPA treatment led to the rapid development of the typical signs of Cushing's syndrome. It was concluded that despite the evidence of adrenal suppression by CPA, cortisol supplementation is not necessary and may even be contra‐indicated.
THE PARTICIPATION OF HYPOTHALAMIC DOPAMINE IN MORPHINE‐INDUCED PROLACTIN RELEASE IN MAN
Authors: DELITALA G. , GROSSMAN A. , BESSER G. M. 
Published: March 2008

SUMMARYIn order to assess the role of dopamine in opiate‐induced prolactin secretion, morphine alone or in combination with the dopamine blocker metoclopramide, or the L‐aromatic aminoacid decarboxylase inhibitor benserazide, was administered to a group of normal adult men. Morphine (10 mg) stimulated prolactin release in all subjects; however, the effect was totally abolished when 10 mg metoclopramide or 200 mg benserazide were given before the opiate agonist. The prolactin releasing effect of a sub‐maximal metoclopramide dose (1 mg) was potentiated by morphine. In vitro, benserazide was totally inactive in stimulating prolactin release by isolated anterior pituitary cells. Moreover, benserazide failed to alter the inhibiting action of dopamine on prolactin release.The data suggest that opiates stimulate prolactin release in man by acting through dopaminergic mechanisms.
MALE GONADAL FUNCTION IN COELIAC DISEASE: III. PITUITARY REGULATION
Authors: FARTHING M. J. G. , REES LESLEY H. , DAWSON A. M. 
Published: March 2008

SUMMARYPituitary regulation of gonadal function was investigated in 39 consecutive men with treated and untreated coeliac disease and in an intestinal disease control group of 19 men with Crohn's disease of similar age and general nutritional status. Basal serum FSH concentration was increased in 10 of the coeliacs (26%) compared to only two of 19 men with Crohn's disease (11%). This abnormality was observed with equal frequency in both treated and untreated coeliacs, and was not associated with oligospermia. Serum LH concentration was increased in eight of 15 untreated coeliacs (53%) with sub‐total villous atrophy, an abnormality which unlike the elevation of serum FSH, appears to return towards normal after gluten withdrawal. Serum LH was high in coeliacs despite marked elevation of the free testosterone index. Exaggerated responses of FSH and LH to LHRH were found in 89% and 45% respectively, of coeliacs with sub‐total villous atrophy. However, exaggerated responses of LH alone were found more frequently in coeliacs than in men with Crohn's disease (P <0.02) and unlike the exaggerated FSH responses, LH responses were closely related to jejunal morphology. Exaggerated responses of FSH and LH in coeliacs were commonly found when basal gonadotrophin concentrations were normal. The occurence of exaggerated gonadotrophin responses could not be related to plasma concentration of testosterone, dihydrotestosterone, oestradiol or the free testosterone index. Serum prolactin was modestly raised in 25% of untreated and partially treated coeliacs and in the same proportion of men with Crohn's disease. Elevated serum prolactin concentrations never exceeded 809 mU/1 and were not associated with impotence or infertility. This study provides further evidence that in men with coeliac disease there is a derangement of pituitary regulation of gonadal function. This would seem to be part of a wider disturbance of central regulatory mechanisms of endocrine function in coeliac disease.
INCREASED FREQUENCY OF HLA‐DR3 AND 5 IN THE SYNDROMES OF PAINLESS THYROIDITIS WITH TRANSIENT THYROTOXICOSIS: EVIDENCE FOR AN AUTOIMMUNE AETIOLOGY
Authors: FARID N. R. , HAWE B. S. , WALFISH P. G. 
Published: March 2008

SUMMARYWe studied fifty patients with painless thyroiditis with transient thyrotoxicosis (PTTT) and a low radioiodine thyroidal uptake. In 25 PTTT occurred post‐partum (P) and in the remainder was unrelated to pregnancy (U). Seventeen patients with classical subacute thyroiditis were studied for comparison. All patients were typed for HLA‐A, B, C, DR antigens. Four of the P patients had recurrences with each pregnancy; two had one previous attack of U; three had a maternal history of GRAVES' disease; 76% of the P patients had small to moderate goitres and 76% antimicrosomal antibody titres at > 1:400. HLA‐B35 was found in 24% of P patients compared to 17% of controls; 71% of patients with subacute thyroiditis were, by contrast, B35. Two of P were HLA‐B8 positive (versus 25% of controls); 11 patients were HLA‐DR3 positive and 15 (60%) HLA‐DR5 positive compared to 23% and 27% of controls yielding a relative risk (RR) = 2·50 (P < 0·05) and 3·83 (P < 0·005), respectively. All four P patients with recurrences carried HLA‐DR5. Thirteen of 25 patients in the U subgroup were HLA‐DR3, yielding a RR = 3·38 (P < 0·01); seven were HLA‐DR5, with a non‐significant RR = 1·12; four of U had first degree relatives with either autoimmune thyroid disorders or Type 1 diabetes mellitus. Thus, both P and U are associated with HLA‐DR3, the P subgroup had in addition an increased frequency of DR5. The observed HLA associations for the PTTT syndromes favours an autoimmune rather than viral aetiology.
CHANGING PATTERNS OF SEX DISTRIBUTION IN FAMILIAL MEDULLARY CARCINOMA OF THE THYROID AND ASSOCIATED PHAEOCHROMOCYTOMA
Authors: MINOPOLI MARIAROSARIA , BORDI C. 
Published: March 2008

SUMMARYAnalysis of 49 kindreds with the familial form of medullary thyroid carcinoma (MTC) reported up to 1973 revealed a non‐random sex distribution of 220 affected members, with a predominance of females among patients presenting with MTC and of males among patients presenting only with phaeochromocytoma. This pattern of sex distribution has completely disappeared among 201 patients from 47 kindreds reported in more recent years, MTC now being equally distributed between the two sexes. It is suggested that this change is related to the different diagnostic approach predominant in each period of time and that MTCs discovered at a preclinical stage by calcitonin screening are equally distributed between the sexes, while females predominate when tumours have progressed until they are clinically evident.
SPINAL BONE MINERAL CONTENT IN MYXOEDEMA AND THYROTOXICOSIS. EFFECTS OF THYROID HORMONE(S) AND ANTITHYROID TREATMENT
Authors: KRØLNER B. , JØRGENSEN J. VESTERDAL , NIELSEN S. PORS 
Published: March 2008

SUMMARYThe effects of thyroid hormones and antithyroid treatment upon lumbar spine bone mineral content (lumbar BMC) were studied in a consecutive series of patients with myxoedema and thyrotoxicosis, respectively. All patients were investigated in the untreated state and 3‐monthly during appropriate treatment for 1 year by using dual‐photon [153Gd] absorptiometry. Patients with myxoedema (n= 8) did not differ from normal individuals as regards initial lumbar BMC, but levothyroxine‐treatment caused significant reduction in this variable. The median decrease in lumbar BMC after 1 year was 8·9% (95% confidence limits 1·5–15·4%,P< 0·05). This loss of bone might be attributed to an inappropriate increase in bone turnover in the euthyroid state. It is as yet uncertain whether it predisposes to spinal osteopenia. Median lumbar BMC in patients with thyrotoxicosis (n= 25) was 12·6% (2·0–16·6%,P< 0·05) lower than that of normal individuals before the beginning of treatment. Lumbar BMC increased during antithyroid therapy. The median gain in bone mineral after 1 year was 3·7% (1·6–9·6%,P< 0·01). These findings suggest that excess of thyroid hormones leads to negative spinal bone mineral balance. The revealed bone loss was clinically insignificant, however, and it appeared to be at least partially reversible after antithyroid treatment.
PLASMA AND SALIVARY ANDROSTENEDIONE AND DIHYDROTESTOSTERONE IN WOMEN WITH HYPERANDROGENISM
Authors: BAXENDALE P. M. , JACOBS H. S. , JAMES V. H. T. 
Published: March 2008

SUMMARYSensitive radioimmunoassays (RIA) have been developed to measure salivary and plasma androstenedione and dihydrotestosterone levels in normal women, women with polycystic ovaries (PCO) and idiopathic hirsutism, and patients on antiandrogen therapy. There was a highly significant correlation (r= 0·92, P < 0·001) between the concentration of androstenedione in saliva and the unbound concentration in plasma. The unbound plasma androstenedione was measured in the dialysate by RIA and ranged from 6·0–10·4% of the total concentration. Salivary and plasma androstenedione levels in patients with PCO (185 ± 72 pg/ml (n= 11) and 3262 ± 814 pg/ml (n= 12) respectively) and in those with hirsutism (151 ± 110 pg/ml (n= 25) and 2177 ± 1096 pg/ml (n= 25)) were significantly higher than levels in normal women (78 ± 30 pg/ml (n= 18) and 787 ± 355 pg/ml (n= 18)). A good correlation (r= 0·82, P < 0·001) was also found between salivary and unbound plasma dihydrotestosterone concentrations. Salivary and plasma dihydrotestosterone levels in patients with PCO (8·2 ± 3·3 pg/ml (n= 9) and 167 ± 45 pg/ml (n= 11) respectively and hirsutism (6·0 ± 2·1 pg/ml (n= 14) and 176 ± 69 pg/ml (n= 17)) were significantly higher than levels in normal women (4·5 ± 1·3 pg/ml (n= 17) and 90 ± 44 pg/ml (n= 16)), although there was a large overlap between groups. A similar decrease was observed in salivary and plasma androstenedione levels after treatment with cyproterone acetate (CA) and ethinyl oestradiol (EE) for 3 months. Plasma dihydrotestosterone levels remained elevated in 47% of treated women whereas only 21% of cases had raised salivary dihydrotestosterone levels. It is concluded that, as with testosterone salivary androstenedione and dihydrotestosterone measurements give a good reflection of their biologically active levels in normal, hyperandrogenic and CA + EE treated women.
RADIOIMMUNOASSAY OF 1,25‐DIHYDROXY VITAMIN D2: STUDIES ON THE METABOLISM OF VITAMIN D2 IN MAN
Authors: FRAHER L. J. , ADAMI S. , CLEMENS T. L. , JONES G. , O'RIORDAN J. L. H. 
Published: March 2008

SUMMARYA sensitive radioimmunoassay for 1,25‐dihydroxy vitamin D2 was developed using a sheep antiserum which preferentially reacts with 1‐hydroxylated forms of vitamin D. An improved isolation procedure was also developed using acetonitrile for the initial extraction of serum followed by chromatography on cartridges of C18 silica and high pressure liquid chromatography eluted with a ternary solvent system to separate 1,25‐dihydroxy vitamin D2 and 1,25‐dihydroxy vitamin D3. 25‐hydroxy vitamin D2 and 25‐hydroxy vitamin D3 were separated by further reverse phase high pressure liquid chromatography prior to competitive protein binding assay. The limits of detection were 4.3 pmol/l (2.0 pg/ml) for the 1,25‐dihydroxy metabolites and 1.25 nmol/l (0.5 ng/ml) for both 25‐hydroxy vitamin D2 and 25‐hydroxy vitamin D3. 25‐hydroxy vitamin D2 ranged from 2.0 to 11.3 nmol/l (0.8–4.5 ng/ml) with a mean of 4.75 nmol/l (1.9 ng/ml) in thirteen healthy British adults and this accounted for 9.0% of the mean total 25‐hydroxy vitamin D. 1,25‐dihydroxy vitamin D2 was detected in the sera of only one of these subjects whereas 1,25‐dihydroxy vitamin D3 was present in all ranging from 48 to 163 pmol/l (20–65 pg/ml) with a mean of 100 pmol/l (42 pg/ml).Both 1,25‐dihydroxy vitamin D2 and 1,25‐dihydroxy vitamin D3 were detected in the sera of hypoparathyroid patients treated with vitamin D2 but the relationship between 25‐hydroxy vitamin D and 1,25‐dihydroxy vitamin D was complex. For example, when an excess of 25‐hydroxy vitamin D2 was present the serum concentration of 1,25‐dihydroxy vitamin D3 was disproportionately high. Conversely, in patients who had previously been treated with vitamin D2 but were receiving only vitamin D3 at the time of study, the major 25‐hydroxy metabolite was in the vitamin D3 form and there was a disproportionately high amount of 1,25‐dihydroxy vitamin D2. Total 1,25‐dihydroxy vitamin D ranged from 110 to 400 pmol/l (45–165 pg/ml) and was above the upper limit of normal for 1,25‐dihydroxy vitamin D3 in half of these hypoparathyroid patients treated with pharmacological doses of vitamin D.
SERUM THYROGLOBULIN IN ACUTE AND CHRONIC LIVER DISEASE
Authors: HEGEDÜS L. , KASTRUP J. , FELDT‐RASMUSSEN ULLA , PETERSEN P. HYLTOFT 
Published: March 2008

SUMMARYIn view of the widespread use of serum thyroglobulin determination in the follow‐up of patients with differentiated thyroid carcinoma, the influence of acute and chronic liver disease on serum thyroglobulin concentration was investigated in thirty‐seven consecutive patients with histologically proven alcoholic liver cirrhosis and twenty‐three patients with acute non‐alcoholic hepatitis. Seventy‐four healthy volunteers served as controls.Serum thyroglobulin concentration was significantly elevated in cirrhosis: median 29·5 μg/l, (range 4·3‐94·0 μg/l) compared to controls: median 16·0 μg/l, (range 4·8‐89·6 μg/l), (P< 0·001). Serum thyroglobulin concentration in patients with acute hepatitis: median 16·2 μg/l, (range 7·9‐70·0 μg/l) was not significantly different from controls. The level of free‐T3‐index was significantly reduced and the level of free‐T4‐index was significantly elevated in both cirrhosis and hepatitis compared to controls. Serum TSH concentration was significantly elevated in cirrhosis compared to hepatitis and controls. Serum thyroglobulin levels were positively correlated to levels of free‐T3‐index (r= 0·35,P< 0·05) and T3/T4‐ratio (r= 0·40,P< 0·05) but not to levels of serum TSH or free‐T4‐index or any of the liver function tests in any of the groups.In conclusion, our results do not clearly indicate whether the elevated serum thyroglobulin level in cirrhosis was caused by an impaired elimination and/or an increased secretion from the thyroid gland. The increase in serum thyroglobulin concentration in chronic alcoholic liver disease was not of a magnitude likely to cause misinterpretation of results obtained during the follow‐up of patients with differentiated thyroid carcinoma.
INFLUENCE OF 1α‐(OH)D3 ADMINISTRATION ON BONE AND BONE MINERAL METABOLISM IN PATIENTS ON CHRONIC GLUCOCORTICOID TREATMENT; A DOUBLE BLIND CONTROLLED STUDY
Authors: BRAUN J. J. , BIRKENHÄGER‐FRENKEL D. H. , RIETVELD A. H. , JUTTMANN J. R. , VISSER T. J. , BIRKENHÄGER J. C. 
Published: March 2008

SUMMARYWe have performed a double‐blind placebo controlled study of 1α‐hydroxyvita‐min D3 (1α‐(OH)D3) 2 μg daily for 6 months, in 14 patients receiving long‐term glucocorticoid treatment. Patients were matched for age, sex, underlying disease and dose of glucocorticoid.Initial values for serum calcium, phosphorus and alkaline phosphatase were in the normal range. Two of the 14 patients showed an increased serum immunoreactive parathyroid hormone (iPTH) concentration. Serum 25‐hyd‐roxyvitamin D and 1,25‐dihydroxyvitamin D (l,25‐(OH)2D) were normal but the average 24,25‐dihydroxyvitamin D (24,25‐(OH)2D) was low.The histomorphometrically determined trabecular bone volume of an iliac crest biopsy appeared to be low in 6 patients. The average active bone resorption and osteoid seams were increased, while the average osteoblast seams were within the normal range. Treatment with 1α‐(OH)D3 raised 47Ca2+ intestinal absorption and 24 h urinary Ca2+ excretion significantly at 3 and 6 months and at 6 months serum iPTH concentration and 24 h urinary hydroxyproline excretion had fallen significantly in the treated group. During treatment with 1α‐(OH)D3 the serum 1,25‐(OH)2D and 24,25‐(OH)2D levels increased significantly.In all cases of the 1α‐(OH)D3‐group, the second bone biopsy, taken at the end of the treatment period, showed a decrease of active resorption and a more positive course of trabecular bone volume than the biopsy of the placebo‐treated counterpart: trabecular bone volume remained constant or even increased in the 1α‐(OH)D3‐group. In both groups osteoid seams and osteoblast seams did not change significantly. We conclude that treatment with 1α‐(OH)D3 during 6 months inhibits the increased bone resorption seen in glucocorticoid‐induced bone disease, while bone formation is not suppressed by this therapy.
PHAEOCHROMOCYTOMA AND DIABETES MELLITUS: FURTHER EVIDENCE THAT α2 RECEPTORS INHIBIT INSULIN RELEASE IN MAN
Authors: ISLES C. G. , JOHNSON J. K. 
Published: March 2008

SUMMARYAn insulin‐dependent diabetic presenting with thirst, polyuria and weight loss was noted to be hypertensive and shown subsequently to have a right adrenal phaeochromocytoma. Pre‐operative control of both diabetes and hypertension was achieved with propranolol and phenoxybenzamine, but not with propranolol alone. Full recovery with restoration of normal glucose tolerance and blood pressure followed successful surgery. Analysis of this patient's response to medical therapy provides further evidence that α2 receptors inhibit insulin release in man. Since as many as one‐third of phaeochromocytomas are not detected during life, this diagnosis should be considered as an uncommon cause of carbohydrate intolerance in patients with diabetes mellitus, especially if accompanied by continuous or paroxysmal hypertension.
NEGATIVE FEEDBACK EFFECTS ON ACTH SECRETION BY CORTISOL IN CUSHING'S DISEASE
Authors: READER S. C. J. , DALY J. R. , ALAGHBAND‐ZADEH J. , ROBERTSON W. R. 
Published: March 2008

SUMMARYBioassayable plasma ACTH and corticosteroid levels were measured during constant infusions of low doses of cortisol (3–15 mg/h) into normal subjects and into two patients with Cushing's disease. Plasma ACTH levels decreased significantly in all subjects within 60 min from the start of the infusion. The rate of rise of plasma corticosteroid levels concomitant with this feedback suppression were considerably higher in the patients with Cushing's disease (> 13 nmol/l/min) than in normal subjects (3–6 nmol/l/min). In one of the Cushing's patients, ACTH secretion resumed in spite of the corticosteroid levels rising at a rate of > 20 nmol/l/min. It is concluded that cortisol‐induced suppression of ACTH secretion may be operational in Cushing's disease but that the mechanism is less sensitive than in normal subjects.
TESTOSTERONE AND Δ4‐ANDROSTENEDIONE IN THE SALIVA OF PATIENTS WITH KLINEFELTER'S SYNDROME
Authors: WELLEN J. J. , SMALS A. G. H. , RIJKEN J. C. W. , KLOPPENBORG P. W. C. , BENRAAD Th. J. 
Published: March 2008

SUMMARYThis study compares salivary and total plasma levels of testosterone and androstenedione in healthy controls and chromatin positive patients with Klinefelter's syndrome. The mean plasma testosterone level in fifteen Klinefelter patients was significantly lower than in ten control subjects, but the mean androstenedione levels were similar. Saliva of the normal men and patients with Klinefelter's syndrome did not differ significantly in binding potency for testosterone or androstenedione. The mean salivary testosterone level in the Klinefelter patients was significantly lower than in the controls but again salivary androstenedione levels were similar. Although testosterone as well as androstenedione showed a fair correlation between the salivary and plasma concentrations, preliminary data suggested that salivary testosterone levels better characterize the clinical state of androgenicity than do plasma levels. When salivary testosterone and androstenedione were expressed as a percentage of total steroid levels in plasma, the ratios for both steroids were similar in Klinefelter patients and healthy controls and closely approximated to the reported percentages of free steroid levels in plasma. The absolute salivary testosterone concentrations also were almost identical to the reported free plasma hormone levels.Together the data provide indirect evidence that in Klinefelter patients testosterone and androstenedione binding in plasma and saliva does not differ from that in normal men, and measurement of salivary steroids, by reflecting their free hormone concentration in plasma, may be useful in evaluating endocrine function in both health and disease.