bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of treatment variables on mood and social adjustment in adult patients with pituitary disease
Authors: Peace K. A. , Orme S. M. , Sebastian J. P. , Thompson A. R. , Barnes S. , Ellis A. , Belchetz P. E. 
Published: November 2003

OBJECTIVE Studies of mood in hypopituitary adults have yielded inconsistent results. This investigation was carried out to investigate whether treatment characteristics may be responsible for the inconsistent results.DESIGN AND MEASUREMENTS We compared three groups of patients with a group of matched healthy controls on self‐report measures of mood and social adjustment (Beck depression inventory, State‐trait anxiety inventory, Social adjustment scale (modified)) and a measure of quality of life (Nottingham health profile, NHP).PATIENTS The patient groups were those treated with transfrontal surgery (n=23), transsphenoidal surgery (n=23) or medication only (n=23). In addition, a close informant of each subject was asked to complete a social adjustment measure about the subject’s level of adjustment.RESULTS On the self‐report mood and social adjustment measures and the emotion sub‐scale of the NHP, the transsphenoidal and medication patient groups rated themselves as being more depressed, anxious and having poorer social adjustment than the transfrontal or control groups. The close informants, however, rated all three patient groups as having poorer social adjustment than the controls. Patients treated with surgery and without radiotherapy reported fewer symptoms of depression than those treated with radiotherapy. Realistic self‐appraisal of social adjustment in surgical patients was found only in those treated with transsphenoidal surgery without radiotherapy.CONCLUSIONS Patients treated for pituitary tumour, excepting those treated with transfrontal surgery and to a lesser extent those treated with radiotherapy, suffer from mild mood disturbance and self‐perceived decreased social adjustment. All patient groups are seen by others as having decreased social adjustment, raising the possibility that the transfrontal patients and possibly those who have had radiotherapy, lack insight. This may explain some of the discrepancies in the previous literature and needs to be taken into account when using self‐report measures with these patients.
Growth response and levels of growth factors after two years growth hormone treatment are similar for a once and twice daily injection regimen in girls with Turner syndrome
Authors: Van Teunenbroek A. , De Muinck Keizer‐Schrama S. , Stijnen T. , Waelkens J. , Wit J. M. , Vulsma T. , Gerver W. J. , Reeser H. , Delemarre‐van de Waal H. , Jansen M. , Drop S. 
Published: November 2003

GH is known to improve height velocity in girls with Turner syndrome (TS) but the optimal dosage regimen has yet to be defined.OBJECTIVE We attempted to improve the growth response by trying to mimic normal pulsatile GH secretion more closely.DESIGN In a 2‐year study the effect of fractionated twice daily (BID) was compared with once daily (OD) s.c. injections of a total GH dose of 6 IU/m2/day. BID injections were administered as two‐thirds at bedtime and one‐third in the morning. The subjects concurrently received low dose ethinyl oestradiol (0.05 mg/kg/day, orally).SUBJECTS Nineteen girls with TS aged 11 years or over, who were previously involved in a 10‐week GH cross‐over study.MEASUREMENTS Height and bone age were evaluated in relation to untreated Turner reference data. Final height (FH) was predicted using the Bayley and Pinneau (BP) method, the modified Index of Potential Height (mIPHRUS), and a recently developed Turner‐specific method (PTSRUS) based on regression coefficients for height (H), chronological age (CA) and bone age (BA). Plasma levels of GH, GHBP, IGF‐I, and IGFBP‐3 were determined by RIA.RESULTS After 2 years treatment the growth response expressed as HV, HVSDS, the change in HSDSCA, the gain in height over estimated untreated values and in FH prediction all showed significant improvements. Although mean values tended to be higher with OD injections, significant differences between groups were not found. Bone maturation was similar between groups and compared with untreated estimated values. Independent of treatment group, the change in HSDSCA after 2 years of GH treatment was related negatively to the baseline CA and HSDSCA, and positively to BA delay at baseline. After 18 months of GH treatment the significant decrease in GHBP plasma levels observed after 6 months was no longer significant. In contrast, IGF‐I and IGFBP‐3 plasma levels and the IGF‐I to IGFBP‐3 ratio increased significantly during 18 months GH therapy. None of these growth related factors showed a difference between groups in their 18 months change. Relevant side‐effects were not observed during the first 2 years of GH treatment.CONCLUSIONS The present growth data are in conformity with the data of the earlier 24‐hour GH profiles. The growth response and plasma levels of growth related factors after 2 years GH on a total dose of 6 IU/m2/day in combination with low‐dose oestrogens were not significantly different between the once daily and the twice daily GH injection regimen.
Hypothalamic‐pituitary‐adrenal axis in abdominal obesity: effects of dexfenfluramine
Authors: Boushaki F. Z. , Rasio E. , Serri O. 
Published: November 2003

OBJECTIVE Hyperactivity of the HPA axis is a possible mechanism underlying abdominal obesity. We aimed to evaluate in premenopausal women with abdominal obesity, (i) the hypothalamic‐pituitary‐adrenal (HPA) axis responses to direct pituitary stimulation with corticotrophin releasing hormone (CRH) and to opioid blockade with naloxone, and (ii) the interaction between short‐term serotoninergic activation with dexfenfluramine (dF), a serotonin‐release agonist, and these responses.DESIGN AND SUBJECTS Eight obese women (mean BMI, 35 kg/m2) with waist to hip ratio (WHR) > 0.85 were tested with CRH (1 μg/kg i.v.) and naloxone (125 μg/kg i.v.) before and at the end of two treatment periods with dF (15 mg twice daily for 7 days) and placebo (washout 7 days) in a cross‐over design. Eight normal weight control women were tested with CRH and naloxone.RESULTS Prior to treatment, ACTH and cortisol responses to naloxone (areas under the curve) were significantly higher in obese women then in control women (P=0.027 and P=0.035 respectively). dF treatment resulted in significant (P<0.05) reduction of ACTH and cortisol increments. In contrast, ACTH and cortisol responses to CRH were not significantly different in obese and control subjects and were unaffected by dF treatment.CONCLUSION We conclude that women with abdominal obesity have hyperreactivity of the HPA axis to opiod blockage and that dexfenfluramine treatment reduces this hyperreactivity.
High Incidence of Positive Autoantibodies against Thyroid Peroxidase and Thyroglobulin in Patients with Sarcoidosis
Authors: Nakamura Hirotoshi , Genma Rieko , Mikami Tomoko , Kitahara Akira , Natsume Hiroko , Andoh Shinichiro , Nagasawa Shinsuke , Nishiyama Kozo , Chida Kingo , Sato Atsuhiko , Yoshimi Teruya 
Published: November 2003

OBJECTIVE Although abnormalities of the humoral immune system, such as increased immunoglobulin production, are known in sarcoidosis, the relationship between sarcoidosis and autoimmune disorders is uncertain. We studied the incidence of thyroid autoantibodies and the prevalence of Hashimoto’s thyroiditis in patients with sarcoidosis.PATIENTS AND MEASUREMENTS Sixty‐two patients with pulmonary sarcoidosis, diagnosed by a combination of clinical, radiographic and histological findings, were studied. As controls, three groups of subjects aged 40 and over without a known history of thyroid disease (60 patients with pulmonary diseases other than sarcoidosis, 88 hospital employees and 82 company workers), were also analysed. Antibodies against thyroid peroxidase (TPO‐Ab) and purified thyroglobulin (Tg‐Ab) were measured by radioimmunoassay and antibodies against microsomal antigen (MCHA) and thyroglobulin (TGHA), by haemagglutination.RESULTS Seventeen of 62 patients (27.4%) had either positive TPO‐Ab or Tg‐Ab or both. All the patients with positive thyroid autoantibodies were of middle or advanced age, and the incidence of positive TPO‐Ab/Tg‐Ab in patients with sarcoidosis aged 40 and over was 54.5% in males, 32.4% in females and 37.8% overall. The prevalence was significantly higher in males compared to age‐matched control males (0–7.7% in the controls), and in female patients was twice that found in controls (11.8–16.3%). Seven patients had Hashimoto's thyroiditis, indicating that the prevalence was 11.3%, and much higher than that previously reported.CONCLUSIONS The data show a remarkably high incidence of thyroid autoantibodies in patients of middle or advanced age with sarcoidosis, especially in males, and a higher prevalence of Hashimoto's thyroiditis than in previous reports.
Absence of desensitization by hexarelin to subsequent GH releasing hormone‐mediated GH secretion in patients with anorexia nervosa
Authors: Popovic V. , Micic D. , Djurovic M. , Obradovic S. , Casanueva F. F. , Dieguez C. 
Published: November 2003

OBJECTIVEBoth the basal levels and the neuroregulation of GH secretion are perturbed in patients with anorexia nervosa. It is unknown if these alterations are due to severe undernutrition or if they reflect basic neurotransmitter alterations of the patient’s neural pathways. On the other hand, prior administration of the GH secretagogue hexarelin in normal subjects blocks the GH‐releasing capability of GH releasing hormone (GHRH) administered 2 hours later. In the present work a sequential test was performed using the administration of hexarelin as first stimulus followed 120 minutes later by GHRH. The two aims of the study were: (a) to evaluate the interaction of GHRH and hexarelin, and (b) to further understand the alterations in GH neuroregulation in patients with anorexia nervosa.DESIGNThe GH stimuli used were hexarelin (1 μg/kg i.v.), a GH stimulus whose main action is hypothalamic, followed 120 minutes later by GHRH (1 μg/kg i.v.) as a pituitary stimulus. Each woman was tested once.PATIENTSThirty‐two women matched for age participated in the study: six normal‐weight women as controls, 14 women with anorexia nervosa, seven women with secondary amenorrhoea due to voluntary weight loss for aesthetic reasons, and five normal‐weight women after 72 hours of a controlled hypocaloric diet (800 cal/day).MEASUREMENTSPlasma GH levels were measured by time‐resolved fluoroimmunosasay, each value shown is the mean±SE in mU/l.RESULTSThe administration of hexarelin to the normal‐weight women induced a clear‐cut GH secretion (expressed as mean±SE of GH peak in mU/l of 77.5±21.8, but blocked the GH‐releasing capability of GHRH administered 120 minutes later (6.6±2.8, P<0.05). In contrast, the women with anorexia nervosa showed a normal GH response after the two stimuli: hexarelin 64.8±9.2. GHRH 71.1±14.2. The absence of heterologous desensitization was specific to anorexia nervosa, because the women with amenorrhoea due to voluntary weight loss but with a normal energy intake showed a pattern similar to the controls (GH after hexarelin 60.3±9.5 and to GHRH 120 minutes later 6.2±1.0 (P<0.05)). Similarly, the women after the short‐term hypocaloric diet showed a hexarelin‐mediated GH secretion of 99.6±17.8, which blunted the subsequent administration of GHRH (GH mean peak of 9.9±2.9, P<0.05 vs hexarelin).CONCLUSIONSIn the normal subjects, the administration of hexarelin induced clear‐cut GH secretion, but inhibited the action of GHRH when administered 120 min later, while this heterologous desensitization was not observed in the patients with anorexia nervosa. This sequentially delayed test may be of some value in the clinical setting for assessing the status of patients with anorexia nervosa.
The safety profile of GH replacement therapy in adults
Authors: Chipman J. J. , Attanasio A. F. , Birkett M. A. , Bates P. C. , Webb S. , Lamberts S. W. J. 
Published: November 2003

OBJECTIVE The benefits of GH replacement in GH‐deficient adult patients are becoming accepted but the safety profile continues to be defined. The GH deficiency in adults may have arisen in either childhood or during adult life and these two groups differ with regard to history of disease. The aim of the present report was to study differences in safety profile between these two groups during long‐term replacement therapy with recombinant human GH (hGH). Possible factors which placed a patient at risk of experiencing an adverse event were also examined.PATIENTS AND DESIGN GH‐deficient adult patients were randomized into two study protocols, differing only in age of onset of the GH deficiency syndrome. There were 98 patients with adult‐onset and 67 patients with childhood‐onset GH deficiency. Each study consisted of a 6‐month double‐blind placebo‐controlled phase followed by an open‐label hGH treatment phase. Glucose tolerance, incidence of treatment‐emergent adverse events and relationship to IGF status were studied throughout the 36 months of treatment.RESULTS Human growth hormone‐related adverse events were reported less commonly in childhood‐onset patients compared with adult‐onset patients. Adult‐onset patients who continued into the open‐label therapy phase reported an increased incidence of arthralgia, myalgia and paraesthesia. There were significant increases in fasting glucose with hGH therapy but values remained within the normal range. Hypertension was reported in 7.7% of adult‐onset patients at 18 months of hGH, which was within the expected prevalence for the number of patients, but was not reported for any childhood‐onset patients. Only in adult‐onset patients were sufficient adverse events reported to enable analysis of risk factors. Patients reporting hGH‐related adverse events were significantly heavier and, therefore, received more hGH. There was a significantly greater increase in IGF‐I and IGFBP‐3 in the first month in patients who experienced hGH‐related adverse events compared with those who did not.CONCLUSION The risks of replacement therapy with hGH in GH‐deficient adults varied with pathogenesis of disease; hGH‐related adverse events occurred more frequently in patients with adult‐onset compared with those with childhood‐onset GH deficiency. In the adult‐onset patients there was an increased risk of adverse events in heavier patients and those who had the greatest increases in IGF‐I and IGFBP‐3 at 1 month of therapy.
The thyroid gland in acromegaly: an ultrasonographic study
Authors: Cheung N. W. , Boyages S. C. 
Published: November 2003

OBJECTIVEAn association between acromegaly and goitre is well recognized. We have studied the incidence and morphology of goitre in acromegaly, and examined the role of IGF‐I and TSH in goitre pathogenesis.DESIGN AND SUBJECTSThirty‐seven subjects with acromegaly, active or in remission, were assessed by ultrasound to determine thyroid volume (TV) and morphology, and compared with normal controls. Nine subjects with acromegaly were also studied again following treatment with octreotide for 1 year.RESULTSCompared with controls, TV was greater (28.7±18.3 ml vs 5.4±2.6 ml, P<0.001) and IGF‐I levels were higher (62.0±34.8 nmvs 28.9±10.9 nmP<0.001) in subjects with acromegaly. Those with active disease tended to have larger glands (30.0±17.2 ml vs 22.2±16.7 ml, P=0.18). The overall incidence of goitre was 92%. Twenty‐seven subjects (73%) had nodules or heterogeneous thyroid echotexture. Subjects with nodular goitre had a longer duration of acromegaly than those with homogeneous glands (12.1±5.7 vs 7.6±4.0 years, P=0.032). Those with nodular glands also had larger goitres than those with homogeneous glands (35.2±18.8 ml vs 19.5±11.9 ml, P=0.032). Thyroid volume correlated with IGF‐I levels (r2=0.38, P=0.002) and body mass index (r2=0.24, P<0.001), and there was an inverse relationship with TSH levels (r2=0.46, P=0.032). Patients studied again after treatment with octreotide for 1 year had a reduction in TV from 32.6±16.1 to 27.6±17.0 ml (P=0.041).CONCLUSIONSThis study confirms that goitre is a common finding in acromegaly. Our findings suggest that early in the course of the disease, diffuse goitre occurs. Subsequently, thyroid autonomy and nodule formation develop, and further growth may occur independent of TSH. With control of GH hypersecretion, a reduction in thyroid size occurs, but this may be limited by the extent of thyroid nodularity.
A CTLA‐4 gene polymorphism is associated with both Graves' disease and autoimmune hypothyroidism
Authors: Kotsa K. , Watson P. F. , Weetman A. P. 
Published: November 2003

OBJECTIVEThe autoimmune thyroid diseases, Graves' disease and autoimmune hypothyroidism, result from a complex interaction between genetic, environmental and endogenous factors. The genetic loci conferring susceptibility remain unclear. A recent report has demonstrated an association between a microsatellite polymorphism of the CTLA‐4 gene (allele 106) on chromosome 2q33 and Graves' disease in Caucasian patients in the USA. The aim of the present study was to confirm this association in UK patients and to determine whether this polymorphism is also associated with autoimmune hypothyroidism.DESIGNAnalysis of Caucasian patients with autoimmune thyroid disease from a single clinic, compared to local Caucasian controls.PATIENTSWe studied 112 patients with Graves' disease, 44 with autoimmune hypothyroidism and 91 controls.MEASUREMENTSCTLA‐4 microsatellite gene polymorphisms were determined by polymerase chain reaction amplification of genomic DNA and resolution of the products on sequencing gels.RESULTSAs in previous studies, 21 alleles of the CTLA‐4 microsatellite region were detected. Allele 106 was significantly increased in patients with Graves' disease (P=0.006) and in those with autoimmune hypothyroidism (P=0.02) when compared to controls. There was no significant difference between the groups in the distribution of the other alleles and no association between allele 106 and sex, HLA‐DR or ‐DQ specificities or the presence of ophthalmopathy in the Graves' patients.CONCLUSIONSThese results confirm that the CTLA‐4 gene, or one closely associated with it, confers susceptibility to Grave's disease but is not specific as the CTLA‐4 106 allele is also associated with autoimmune hypothyroidism. This association seems to be with autoimmune thyroid disease in general.
Combined βFSH and βLH response to TRH in patients with clinically non‐functioning pituitary adenomas
Authors: Somjen D. , Tordjman K. , Kohen F. , Baz M. , Razon N. , Ouaknine G. , Stern N. 
Published: November 2003

OBJECTIVE‘Paradoxical’ responses of LH, FSH, α‐subunits and βLH to TRH have previously been reported in individuals with clinically non‐functioning pituitary tumours (NFT). The present study was designed to assess the in vivoin vitro responses of βFSH to TRH in NFT. We further examined the possibility that a TRH challenge with combined measurement of βFSH and βLH will identify a common anomalous secretory pattern in patients with NFT.DESIGN, PATIENTS AND MEASUREMENTSForty patients with NFT underwent a standard TRH test (400 μg intravenously). Blood samples for the determination of βFSH, βLH, FSH and LH were collected prior to TRH as well as 15, 30, 45, 60 and 90 minutes following injection. Additionally, cultured adenomatous cells from eight of these patients were exposed to TRH in the absence and presence of octreotide and gonadotropin subunits were determined.RESULTSTRH elicited a marked rise in circulating βFSH in 29 of 40 individuals and in βLH in 28 of 36 patients with NFT. In a subgroup of eight individuals whose tumours were harvested during surgery and cultured for 7–21 days, TRH increased βFSH or βLH and α‐subunit release in cultured adenomatous cells in all cases, including tumours from subjects not responding to TRH in vivo. In this subgroup of patients octreotide inhibited basal βFSH secretion but not basal βLH secretion both in vivo and in primary cultures of NFT cells. Both the in vivoin vitroβFSH, βLH and α‐subunit responses to TRH were entirely inhibited by octreotide. In all, 38 of the 40 subjects could be identified by either elevated basal βFSH or βLH levels and/or an abnormal rise in either βFSH or βLH in response to TRH.CONCLUSIONThe measurement of basal and TRH‐stimulated β‐FSH and β‐LH levels identifies an abnormal hormonal secretory pattern in the vast majority (>90%) of patients with clinically nonfunctioning pituitary tumours.
Thyroid volume and function after 131I treatment of diffuse non‐toxic goitre
Authors: Nygaard B. , Faber J. , Veje A. , Hansen J. E. M. 
Published: November 2003

OBJECTIVE Traditional treatment modalities of diffuse non‐toxic goitre are thyroid hormone suppression or surgery. When treating nodular non‐toxic goitre with 131I treatment a reduction in thyroid volume to about 50% has been observed. In the present study we evaluated the effect of 131I treatment of diffuse non‐toxic goitre.DESIGN Retrospective study of patients treated for a diffuse non‐toxic goitre and followed by evaluation of thyroid volume measured by ultrasound.PATIENTS Ten selected patients from our out‐patient clinic with diffuse non‐toxic goitre.MEASUREMENTS Thyroid volume was measured by ultrasound and thyroid function by serum values of T4, T3, T3 uptake ratio, TSH, TSH receptor antibodies and thyroid peroxidase antibodies (anti‐TPO). Measurements were performed before and 1, 3, 6 and 12 months (and 18 months (n=7), thyroid volume measured in six patients)) after 131I treatment.RESULTS Thyroid volume declined in all patients from median 41 (range 27–160) ml to 20 (range 9–108) ml over 1 year, a reduction of 47%. One patient developed transient and one persistent hypothyroidism in the follow‐up period. Both had elevated anti‐TPO levels before treatment (331 and 9185 U/ml) and demonstrated titre increases of 2.5 and 30 times after 3 and 6 months, respectively. Pretreatment values were reached after 1 year. The other eight patients had normal anti‐TPO levels and free T4 and T3 indices did not change during follow‐up, whereas serum TSH levels demonstrated upward trends within the normal range (P<0.05). TSH receptor antibodies were normal and remained so in all patients.CONCLUSION S131I treatment of diffuse non‐toxic goitre reduces thyroid volume by approximately 50% within 12–18 months. Hypothyroidism, during a limited follow‐up period, developed only in patients with positive anti‐TPO levels before treatment.