bluuebunny/crossref_metadata_2025_split huggingface dataset:
Postoperative radiotherapy in acromegaly is effective in reducing GH concentration to safe levels
Authors: Biermasz Nienke R. , Dulken Hans van , Roelfsema Ferdinand 
Published: March 2003

OBJECTIVESeveral studies have established that in treated acromegaly mortality is only normalized in patients achieving a serum GH concentration below 5 mU/l. Few studies however, have addressed results of radiotherapy using this strict criterion. The aim of our study was to assess the efficacy of postoperative radiotherapy in reducing serum GH concentration below 5 mU/l.PATIENTS AND METHODSForty acromegalic patients who underwent radiotherapy for postoperative persistent disease after transsphenoidal surgery were studied. Mean time of follow‐up after radiotherapy was 123 ± 11.1 months. A serum GH concentration of <5 mU/l was used to define remission.RESULTSFollowing surgery mean GH concentration decreased from 120.8 ± 21 mU/l to 24.4 ± 5.2 mU/l and mean GH concentration prior to radiotherapy, administered after a mean of 8.2 ± 2.7 (0.5–96) months postoperatively was 26.0 ± 5.1 mU/l.Using individual regression plots, GH was reduced to 50% by radiotherapy after a mean of 27 ± 5 months (range 3–105 months). The observed mean GH concentration as measured at follow‐up visits was reduced by 55% (−36–95%) after the first year, by 65% (−29–97.3%) after 2 years and by 78% (−29–99%) after 5 years. We could not demonstrate a significant correlation between a normalized GH concentration on the one hand and tumour size, preradiotherapy GH concentration or duration of follow‐up on the other hand. During follow‐up, GH‐suppressive medical therapy was used in 11 patients, five of whom were still using medication at the end of follow‐up. Eight patients had a follow‐up of less than 5 years and three of them had a serum GH concentration of <5 mU/l at their latest follow‐up visit (38%). At 5 years of follow‐up after radiotherapy, 24 out of 32 patients had a GH level of <5 mU/l without medication (75%). At 10 years following irradiation, 16 of 21 patients (76%) had a GH level of <5 mU/l without medical treatment. At 15 years follow‐up, a serum GH concentration of <5 mU/l was observed in 13 out of 15 patients (87%) without GH suppressive medication. At the latest follow‐up visit, serum GH concentration below 5 mU/l was present in 75% of patients (30 out of 40) without medical therapy after a mean of 10.4 ± 0.9 years, but five patients required octreotide up to the end of follow‐up. Twenty‐seven out of 37 patients with available IGF‐I data had normal IGF‐I at the end of follow‐up (73%). Fifty percent of patients needed substitution therapy for (partial) hypopituitarism after 10 years and 75% after 15 years of radiotherapy.CONCLUSIONIn our group of patients who were incompletely cured by surgery, but had a significant postoperative decrease of serum GH concentrations, radiotherapy was able to achieve ‘safe’ serum GH concentrations in the majority in the long term.
Postpartum thyroid dysfunction in women with normal thyroid function during pregnancy
Authors: Sakaihara Mitsuo , Yamada Hideto , Kato Emi Hirayama , Ebina Yasuhiko , Shimada Shigeki , Kobashi Gen , Fukushi Masaru , Fujimoto Seiichiro 
Published: March 2003

OBJECTIVEThe aim of this study was to establish the risk of postpartum thyroid dysfunction (PPTD) in women who had normal thyroid function during pregnancy and no history of thyroid disease.DESIGNFour thousand and twenty‐two consecutive pregnant women were screened for thyroid function and antithyroid antibody. Among women with normal thyroid function during pregnancy and no history of thyroid disease, thyroid function were assessed in 131 of 388 antithyroid antibody positive (Group I) and 1030 of 3503 antibody negative (Group II) women at 1 and 3 months postpartum. In Group I women who experienced PPTD, the frequency of later manifestation of Hashimoto's disease was compared according to titres of antithyroid antibodies.MEASUREMENTSBlood samples in early pregnancy, and at 1 month and 3 months postpartum were obtained using the dried blood spot method. Levels of fT4 were measured by RIA, TSH by fluoroimmunoassay or ELISA, antimicrosome antibody (AMC) and antithyroglobulin antibody (ATG) by indirect agglutination reactions.RESULTSThe prevalence of PPTD at 1 month and 3 months postpartum were found to be 6.9% and 21.3% in Group I, and 5.3% and 4.7% in Group II, respectively. The prevalence of PPTD was significantly higher at 3 months postpartum in Group I (P < 0.05). 27.3% of women with PPTD in Group I were later found to have Hashimoto's disease and 9.1% manifested hypothyroidism without goitre. A high AMC titre (≥ 25 600) at 3 months postpartum in women with PPTD was related to the manifestation of Hashimoto's disease. AMC titres of PPTD women and women who developed Hashimoto's disease were significantly higher than those of control women who did not experience PPTD.CONCLUSIONA high prevalence of PPTD was found in women with antithyroid antibodies who were euthyroid during pregnancy. Prolonged follow‐up of the subsequent thyroid function may be needed in women who experience PPTD and/or show a high titre of antithyroid antibody.
Ectopic ACTH syndrome caused by pulmonary carcinoid tumourlets
Authors: Povedano S. Tofé , Pastor C. Villar , Seoane C. Pérez , Reina L. Jiménez , Moreno M. A. Gálvez , Ortega R. Palomares , López‐Rubio F. , López P. Benito 
Published: March 2003

The differential diagnosis of Cushing's syndrome is a major challenge to clinical endocrinologists, especially those infrequent cases referred to as occult ectopic ACTH syndromes. Although bronchial carcinoids are well known to be a cause of Cushing's syndrome due to ectopic ACTH secretion, very few cases of carcinoid tumourlets causing an ACTH ectopic syndrome have been reported, and their origin remains controversial. For some authors, tumourlets and typical carcinoids represent distinct pathological entities, whilst others hold that tumourlets are merely microscopic carcinoid tumours. We report a patient with an aggressive Cushing's syndrome that required bilateral adrenalectomy, diagnosed 22 years before a 3‐cm lung nodule became apparent on routine chest X‐ray. The biopsy after lung surgery revealed a typical peripheral bronchial carcinoid surrounded by tumourlets. Both tumourlets and carcinoid tumour showed strongly positive ACTH immunostaining. Recently, Arioglu et al. (1998) reported a case of Cushing's syndrome caused by pulmonary carcinoid tumourlets, concluding that this entity should be considered in the differential diagnosis of occult ectopic ACTH syndrome. Furthermore, we consider that the carcinoid tumourlets found in our patient, were the initial source of ACTH, leading to Cushing's syndrome with a rapid onset, and that a loss of cell proliferation control in one of such tumourlets many years later, could have resulted in the development of a typical carcinoid tumour, reinforcing the theory of a common origin of these lesions.
The effect of the menopause on prolactin levels in patients with hyperprolactinaemia
Authors: Karunakaran S. , Page R. C. L. , Wass J. A. H. 
Published: March 2003

Microprolactinomas have been reported to resolve spontaneously after pregnancy and there have been suggestions that oestrogen therapy increases the size of microprolactinomas. Little is known, however, about the effect of the menopause in patients previously known to be hyperpro‐lactinaemic. The aim of this study was to find out if pregnancy or the menopause leads to an alteration in prolactin levels.We conducted a retrospective study of 148 case notes of patients with hyperprolactinaemia and microprolactinomas treated at the Radcliffe Infirmary during the period 1976–96.Sixty‐nine female patients who had not had pituitary surgery as treatment for microprolactinoma were used as a control group. None of this group became pregnant or reached the menopause. They were compared with 25 female patients who became pregnant, 11 who became menopausal and 11 who were male. Subjects were excluded from the analysis if there were no follow‐up data off dopamine agonist treatment or if they were surgically cured. Data were gathered on demographic parameters, treatment given, scan abnormalities, prolactin levels at diagnosis and last follow up, prolactin levels pre‐ and postpregnancy as well as pre‐ and postmenopause. The pregnancy, postmenopausal and male patient groups were compared with the control group and each other to see if they had a higher frequency of normalization of their prolactin levels during follow up. Various factors were examined as possible variables for the normalization of prolactin, including the detection of scan abnormalities at diagnosis, prolactin levels at diagnosis as well as treatment with dopamine agonists and duration of follow up.Forty‐five percent of the menopausal group, 24% of the pregnancy group and 18% of the male group subsequently normalized their prolactin levels during the period of the study in comparison with 7% of the control group. The menopausal groups had a significantly higher chance of normalizing their prolactin compared to the control group (P < 0·005), whilst the pregnancy group showed a non‐significant trend towards normalizing their prolactin (P = 0·06). The detection of scan abnormalities, treatment with dopamine agonist therapy and duration of follow up were not associated with normalization of prolactin levels.Female patients with hyperpro‐lactinaemia who pass through the menopause have a significant chance of normalizing their prolactin levels. Females who pass through pregnancy may have a higher chance of normalizing their prolactin levels. The menopause is an indication for reassess‐ment of the need to continue to treat hyperpro‐lactinaemia and microprolactinoma.
Growth restriction in dexamethasone‐treated preterm infants may be mediated by reduced IGF‐I and IGFBP‐3 plasma concentrations
Authors: Bloomfield Frank H. , Knight David B. , Breier Bernhard H. , Harding Jane E. 
Published: March 2003

OBJECTIVEPreterm infants receiving dexamethasone for respiratory morbidity frequently suffer restricted growth. The aim of this study was to investigate the interactions between dexamethasone treatment regimen and circulating IGFBP‐3 and IGF‐I levels, and the associations between these variables and linear growth rate in preterm babies receiving dexamethasone for chronic lung disease of prematurity.DESIGNA randomised, unblinded, clinical trial of two different courses of dexamethasone: a 42‐day tapering course (the long course) and a repeatable 3 day pulse course.PATIENTSForty preterm infants (19 in the pulse group, 21 in the long group) with a birthweight ≤ 1250 g who were ventilated at 7 days of age.MEASUREMENTSLower leg length was measured thrice weekly by knemometry, and IGFBP‐3 and IGF‐I levels were measured prior to commencing treatment, at 14 and 42 days of treatment and at 36 weeks postmenstrual age (PMA). Interactions between variables were analysed by stepwise regression analysis and analysis of covariance (ancova). Associations between variables were assessed by correlation coefficients.RESULTSIn an ancova, mean daily dose of dexamethasone/kg (MDDD) and treatment group both significantly influenced IGFBP‐3 levels (P = 0·0009 and P = 0·017, respectively), and tended to influence IGF‐I levels similarly (P = 0·098 and P = 0·07). MDDD also significantly influenced mean daily increase in lower leg length (MDILL; P < 0·01). IGFBP‐3 and IGF‐I levels were significantly related to MDILL (ancova: P < 0·01).The correlation coefficients for IGFBP‐3 and IGF‐I levels and MDILL were 0·2 and 0·3 (both P < 0·0001), respectively. IGFBP‐3 and IGF‐I levels were highly correlated (r2 = 0·52, P < 0·0001) and both increased significantly with increasing PMA (P < 0·0001). IGF‐I levels were higher in females (P = 0·036).CONCLUSIONThis study provides evidence that the growth‐restricting effects of dexamethasone may be mediated, at least in part, via suppression of the IGF axis. Both dexamethasone dose and treatment regimen influence circulating IGF‐I and IGFBP‐3 levels, and both are important in inducing growth restriction.
Effect of maternal hyperthyroidism during late pregnancy on the risk of neonatal low birth weight
Authors: Phoojaroenchanachai Meta , Sriussadaporn Sutin , Peerapatdit Thavatchai , Vannasaeng Sathit , Nitiyanant Wannee , Boonnamsiri Vipa , Vichayanrat Apichati 
Published: March 2003

Hyperthyroidism in pregnancy occurs with a prevalence of 0·05–0·2% and has been shown to affect neonatal outcomes. Fetal weight increases markedly during the third trimester of pregnancy. This retrospective study was performed to examine the effect of maternal hyperthyroidism during late pregnancy on neonatal birth weight (NBW).Medical and obstetric records of 293 pregnant women with present and past history of hyperthyroidism were retrospectively reviewed.There were 188 records of 181 patients with adequate data for inclusion in the analysis. The patients were divided into two groups according to the maternal thyroid function during the third trimester of pregnancy: hyperthyroidism (HT; 35 cases) and euthyroidism (ET; 153 cases).Maternal thyroid function tests were periodically evaluated before and during the third trimester of pregnancy. Neonatal thyroid function tests and birth weight of the newborn infants were also assessed.There was no significant difference of maternal age between HT and ET groups mean ± SD (27·6 ± 5·5 vs. 29·2 ± 5·4 years). The NBW of the HT group was not significantly different from that of the ET group (2880 ± 590 vs. 3019 ± 426 g). However, the prevalence of infants with low birth weight (LBW) defined as NBW of lower than 2500 g in HT group was 22·9% which was significantly higher than the 9·8% in the ET group (P = 0·039, OR = 2·7, 95%CI = 1·1–7·1) and 9·7% of infants born to healthy mothers at Siriraj Hospital (control group) between 1991 and 1995 (P = 0·01, OR = 2·7, 95%CI = 1·3–6·1). The 90% CI for the true difference between the prevalence of LBW infants born to ET and HT mothers was 0·7–25·4. There was no significant difference in the prevalence of LBW infants in ET and control groups. Multiple logistic regression analyses showed that maternal hyperthyroidism during the third trimester of pregnancy was an independent factor associated with increased prevalence of LBW infants (P = 0·037, OR = 4·1, 95%CI = 1·1–15·0).Maternal hyperthyroidism during the third trimester of pregnancy independently increases the risk of low birth weight by 4·1‐fold. Appropriate management of hyperthyroidism throughout pregnancy is essential in the prevention of this undesirable neonatal outcome.
Efficacy of single daily dosage of methimazole vs. propylthiouracil in the induction of euthyroidism
Authors: Homsanit Mayuree , Sriussadaporn Sutin , Vannasaeng Sathit , Peerapatdit Thavatchai , Nitiyanant Wannee , Vichayanrat Apichati 
Published: March 2003

Previous studies of the treatment of hyperthyroidism with a single daily dose of antithyroid drugs have demonstrated a favourable result with methimazole (MMI). However, the efficacy of a single daily dose of propylthiouracil (PTU) was inconsistent. The present prospective randomized study was conducted to compare the efficacy of a single daily dose of MMI and PTU in the induction of euthyroidism in patients with Graves' disease.Seventy‐one patients with newly diagnosed Graves' disease were studied.Patients were randomized to two groups to receive once daily dose of either 15 mg MMI or 150 mg PTU for 12 weeks. The therapeutic efficacy was determined biochemically by serum total T3, total T4 and TSH levels at baseline and at 4, 8 and 12 weeks during the study period.There was no significant difference in baseline characteristics. Serum total T3 levels of the MMI group were significantly lower than those of the PTU group after four weeks of the treatment (3·54 ± 0·72 vs. 5·49 ± 2·74 nmol/l, P < 0·05) through the end of the study (2·22 ± 1·42 vs. 4·30 ± 1·78 nmol/l, P < 0·05). The changes in serum total T4 levels occurred in the same direction as serum total T3 levels but a significant difference was observed only after eight weeks of the treatment (MMI vs. PTU; 101·67 ± 54·05 vs. 176·32 ± 66·92 nmol/l, P < 0·05). At the end of the study, more patients in the MMI group had both serum total T3 and T4 levels less than the upper limit of the normal range compared to the PTU group (77·1% vs. 19·4%). Hypothyroidism was observed in 31·4% of the patients in the MMI group but not in the PTU group.During 12‐weeks' treatment of Graves' hyperthyroidism, a single daily dose of 15 mg of MMI was much more effective in the induction of euthyroidism than a single daily dose of 150 mg of PTU. Once daily regimen of MMI not only decreased serum T3 and T4 levels more rapidly but also induced euthyroidism four times more effectively than did the once daily regimen of PTU. In the doses used in this study, MMI is preferable to PTU when a once‐daily regimen of antithyroid drug is considered for the treatment of hyperthyroidism.
Increased serum inhibin B levels after varicocele treatment
Authors: Pierik Frank H. , Abdesselam Salem Aït , Vreeburg Jan T. M. , Dohle G. R. , De Jong Frank H. , Weber Robertus F. A. 
Published: March 2003

OBJECTIVE Inhibin B is secreted by Sertoli cells in response to FSH and is the major feedback regulator of FSH secretion in man. The serum inhibin B level has emerged as a good marker of spermatogenesis and Sertoli cell function. Varicocele has been associated with infertility and disturbed spermatogenesis. We have studied the effect of varicocele treatment on serum inhibin B levels, with the aim of investigating the effect on spermatogenesis and the involvement of the Sertoli cell in varicocele pathophysiology.DESIGN AND PATIENTS In a pre–post test design, the effect of varicocele surgery on inhibin B levels was studied in 30 infertile men.MEASUREMENTS Endocrinology (inhibin B, FSH, LH, SHBG and testosterone) and semen analysis (sperm concentration, motility and morphology).RESULTS In men receiving varicocele treatment, a significant increase in serum inhibin B levels was observed from 133·9 ± 13·4 pretreatment to 167·8 ± 16·1 ng/l after treatment (mean ± SEM, P < 0·0001). No significant changes were observed in serum levels of FSH, LH and testosterone. The serum SHBG level decreased from 32·9 ± 3·5 to 28·6 ± 3·4 nmol/l (mean ± SEM, P = 0·04) and the free androgen index was significantly increased from 66 ± 5·9 pretreatment to 85 ± 6·8 after treatment (P = 0·02, mean ± SEM). Semen analysis showed a significant improvement in sperm concentration, from 6·5 ± 1·9 pretreatment to 19·3 ± 4·9 × 106/ml after treatment (P = 0·003, mean ± SEM), and in sperm motility from the baseline level of 17 ± 3 to 32 ± 4% after treatment (P = 0·001, mean ± SEM).CONCLUSIONS Varicocele treatment can increase serum inhibin B levels, indicating improvement of spermatogenesis and Sertoli cell function. This finding suggests that the pathophysiology of varicocele involves impairment of Sertoli cell function or a different distribution of germ cell stages.
Tissue insulin sensitivity and body weight in polycystic ovary syndrome
Authors: Marsden Philippa J. , Murdoch Alison P. , Taylor Roy 
Published: March 2003

OBJECTIVE Polycystic ovarian syndrome (PCOS) and obesity both affect insulin sensitivity. This study was designed to investigate the biochemical indices of PCOS and tissue insulin sensitivity in groups of lean and obese women with clinically equivalent degrees of the syndrome, relative to control subjects.DESIGN A prospective study of in vivo parameters and in vitro study of adipocytes to assess insulin sensitivity.PATIENTS Six lean and 14 overweight patients fulfilling formal diagnostic criteria for PCOS were studied. The degree of hirsutism and amenorrhoea was similar in each group. Eight control subjects were also studied.MEASUREMENTS Endocrine and metabolic parameters were measured in lean and overweight patients with PCOS and control subjects. In vitro studies of adipocyte insulin receptor binding and adipocyte insulin action were performed.RESULTS The mean plasma LH level was elevated in both groups of PCOS but was significantly higher in the lean group (LH levels were 25·1 ± 3·1 and 14·5 ± 1·6 iu/l in lean PCOS and obese PCOS, respectively (P = 0·01)). There was a strong inverse correlation between BMI and LH levels (R = − 0·70, P = 0·001). Fasting insulin levels were elevated in both lean and obese groups (11·5 ± 2·8 and 26·8 ± 8·1 mU/l, respectively; P = 0·068). Mean serum testosterone and serum androstenedione levels were also elevated in PCOS compared to control subjects but there was no difference between the two groups of PCOS subjects. Insulin receptor binding in amenorrhoeic subjects with PCOS was low in both lean and obese patients with PCOS but was not significantly different between the two groups (0·79 ± 0·17% and 0·66 ± 0·07% per 10 cm2 cell membrane, respectively). Maximally insulin‐stimulated rates of 3‐O‐methylglucose transport were low in both groups compared to previously studied normal subjects (0·96 ± 0·21 and 0·64 ± 0·07 pmol per 10 cm2 membrane in lean and obese PCOS subjects, respectively; P = NS).CONCLUSIONS  Lean subjects with a given phenotypic expression of PCOS have an equivalent degree of tissue insulin resistance compared to obese PCOS subjects. This implies that the insulin resistance may be a primary feature of PCOS. If this is so, a similar clinical degree of the syndrome may be brought about by genetically determined insulin resistance in lean subjects or by insulin resistance which is secondary to obesity.
Gonadotrophin releasing hormone agonist treatment with or without recombinant human GH in adopted children with early puberty
Authors: Mul D. , Oostdijk W. , Waelkens J. J. J. , Schulpen T. W. J. , Drop S. L. S. 
Published: March 2003

BACKGROUND Early onset of puberty is frequently observed in adopted children. During treatment with a gonadotrophin releasing hormone agonist (GnRHa), a decrease in height velocity (HV) precludes height gain.OBJECTIVE AND DESIGN We studied the effect of the addition of GH to GnRHa treatment in a 3‐year prospective randomized trial in 30 adopted children with early puberty.PATIENTS Mean age (SD) at start of treatment was 9·6 (0·9) years in girls and predicted adult height (PAH) using a segmented bone age (BA) assessment method was 148·0 (5·3) cm.RESULTS HV decreased gradually in both groups with a higher HV in the group with GH addition (group B). No significant difference between the rates of bone maturation [change in bone age (ΔBA)/change in chronological age (ΔCA)] of both treatment groups was observed. After 3 years of treatment, PAH increase was 5·7 (3·8) cm in group A (GnRHa alone) and 10·1 (3·8) cm in group B (P < 0·01). IGF‐I levels were higher in group B. HV decreased slowly in both groups during treatment, unlike stabilization of IGF‐I levels.CONCLUSION We conclude that, after 3 years of treatment, the addition of GH to GnRHa results in higher HV and a significant increase in PAH compared to GnRHa alone.