bluuebunny/crossref_metadata_2025_split huggingface dataset:
The development of transient hypothyroidism after iodine‐131 treatment in hyperthyroid patients with Graves' disease: prevalence, mechanism and prognosis
Authors: Aizawa Yoshihiko , Yoshida Katsumi , Kaise Nobuko , Fukazawa Hiroshi , Kiso Yoshinori , Sayama Noriyo , Hori Hironobu , Abe Keishi 
Published: November 2003

OBJECTIVE Recovery of thyroid function in patients following hypothyroidism induced by 131I therapy for Graves' disease has been described, but only a few detailed clinical and biochemical studies of this phenomenon (transient hypothyroidism) have been published. The prevalence, mechanism, and final outcome of transient hypothyroidism in 260 patients with Graves’ disease treated with 131I was studied. DESIGN A retrospective study. PATIENTS Two hundred sixty patients with Graves' disease, treated with 131I between 1 and 15 years previously, were categorized into 4 groups according to their thyroid function during and 1 year after therapy (Group 1: permanent hypothyroidism, 28 patients; Group 2: transient hypothyroidism, 39 patients; Group 3: euthyroidism without transient hypothyroidism, 83 patients; Group 4: hyperthyroidism, 110 patients). MEASUREMENTS We compared total T4, total T3, TSH, anti‐thyroglobulin (TGHA) and anti‐microsomal (MCHA) antibodies, the TSH‐binding inhibitory immunoglobulin (TBII) index, thyroid weight, dose of 131I, and 24‐hour 131I uptake as pretreatment variables. The mean time for permanent hypothyroidism to develop was estimated by the Kaplan–Meier product limit method. The TBII index and thyroid stimulating antibody (TSAb) activity were measured in seven patients from Group 1 and in nine patients from Group 2 at the time that they became hypothyroid. RESULTS Hypothyroidism developing within 12 months of therapy was transient in 58% (39/67) of patients. No pretreatment variables were found to differ between patients with and without transient hypothyroidism. The mean estimated time between therapy and the development of permanent hypothyroidism was 96 months in Group 2; this time interval was significantly shorter than 126 months in Group 3 and 129 months in Group 4 (P<0.05, P<0.01, respectively). TSAb activity was > 500% in 78% (7/9) of patients from Group 2, which was significantly higher than that found (14%, 1/7) in Group 1. CONCLUSIONS These results indicate that (1) more than half the patients who developed hypothyroidism within 6 months after 131I treatment for Graves' disease recovered spontaneously, (2) TSAb activity might play some role in the recovery of transient hypothyroidism, and (3) the development of transient hypothyroidism may influence long‐term thyroid function.
Octreotide scintigraphy and catecholamine response to an octreotide challenge in malignant phaeochromocytoma
Authors: Kopf D. , Bockisch A. , Steinert H. , Hahn K. , Beyer J. , Neumann H. P. H. , Hensen J. , Lehnert H. 
Published: November 2003

OBJECTIVE Octreotide scintigraphy has been reported to visualize chromaffine tumours. This study in patients with malignant phaeochromocytoma was designed to assess octreotide in comparison with standard m‐iodobenzylguanidine (MIBG) scintigraphy and to study functional activity of somatostatin receptors. Finally, two cases of octreotide treatment are reported. DESIGN Open, prospective clinical trial. PATIENTS In 12 patients with histologically proven malignant phaeochromocytoma, 111In‐octreotide scintigraphy, 123I‐MIBG scintigraphy and computed tomography were performed. In ten patients plasma catecholamine response to a single dose of octreotide (200 μg i.v.) was monitored up to 5 hours after injection. Two patients were treated with octreotide over several months. MEASUREMENTS Plasma catecholamines were measured by high performance liquid chromatography (HPLC). Scintigraphy was performed using a large field gamma camera and SPECT technique where appropriate. RESULTS At least one metastatic lesion was visualized by octreotide scintigraphy in eight patients while the remaining four patients had negative findings. In total, 43 out of 54 known metastases (79.6%) were detected by MIBG, 24 (44.4%) by octreotide. Nevertheless, octreotide scintigraphy detected six metastases that were negative by MIBG. There was no correlation between the results of octreotide scintigraphy and catecholamine suppression after i.v. octreotide. In two patients on octreotide treatment, symptomatic improvement, but not mass reduction, could be documented. CONCLUSIONS Octreotide scintigraphy behaves in part complementary to MIBG, thus increasing diagnostic sensitivity. Presence of somatostatin receptors, as demonstrated by octreotide scintigraphy, does not necessarily predict functional activity or therapeutic response.
Diurnal variation in serum insulin‐like growth factor (IGF)‐I and IGF binding protein‐3 concentrations during daily subcutaneous injections of recombinant human growth hormone in GH‐deficient adults
Authors: Oscarsson Jan , Johannsson Gudmundur , Johansson Jan‐Ove , Lundberg Per‐Arne , Lindstedt Go¨ran , Bengtsson Bengt‐Åke 
Published: November 2003

OBJECTIVE Whereas there seems to be little, if any, circadian variation in circulating concentrations of IGF‐I and IGFBP‐3 in healthy subjects, there are conflicting reports on this issue in GH‐deficient patients treated with GH as a daily subcutaneous injection. We have therefore investigated the 24‐hour serum profiles of IGF‐I and IGFBP‐3 concentrations after one week and more than one year of GH treatment. PATIENTS Eleven subjects, with adult onset GH deficiency mainly caused by pituitary adenomas were included in the study. DESIGN AND MEASUREMENTS In an open study, six subjects (three women and three men; age (±SEM) 41.2±3.9 years) were investigated after one week of GH therapy and five subjects (three women and two men; age (±SEM) 61.4±3.3 years) were investigated after 13–40 months of GH therapy. The GH injections were given at 2000 h. The subjects were hospitalized for 24‐hour blood sampling at 1‐hour intervals and serum concentrations of GH, IGF‐I and IGFBP‐3 were determined. RESULTS There was a significant diurnal variation in serum IGF‐I and IGFBP‐3 concentrations both in the subjects who had received GH for one week and in those who had received GH treatment for more than one year. The serum concentrations of IGF‐I and IGFBP‐3 were highest in the morning and lowest during night‐time and early morning. The molar IGF‐I/IGFBP‐3 ratio varied significantly with time in both groups of patients in a similar way as IGF‐I and IGFBP‐3 indicating a more pronounced variation in IGF‐I compared with IGFBP‐3 in response to the GH therapy. CONCLUSION Significant diurnal variations in serum IGF‐I and IGFBP‐3 concentrations occur after one week and more than one year of GH treatment with daily subcutaneous injections. The results indicate that the free fraction of IGF‐I may exhibit a diurnal variation.
Elevated fibrinogen levels decrease following treatment of acromegaly
Authors: Landin‐Wilhelmsen Kerstin , Tengborn Lilian , Wilhelmsen Lars , Bengtsson Bengt‐Åke 
Published: November 2003

OBJECTIVE Acromegaly is associated with increased morbidity and mortality from cardiovascular disease and from stroke in particular. Fibrinogen is an established risk factor for stroke and myocardial infarction and high levels of plasminogen activator inhibitor‐1 (PAl‐1) activity were predictive of a recurrent myocardial infarction. The aim of this study was to analyse fibrinogen and PAI‐1 activity in patients with acromegaly before and after treatment. PATIENTS Twenty patients with acromegaly were compared with healthy controls matched for sex (12 men, 8 women), age (mean 53±7 years), body mass index (mean 26.5±2.5kg/m2) and smoking. Fibrinogen was also compared with a random population sample of men and women (n=392), aged 25–64 years, from the WHO's MONICA Project, Go¨teborg, Sweden. RESULTS The acromegalic patients had a higher lean body mass of 65±11 vs 59±11 kg (P<0.05), lower body fat of 17±8 vs 25±10kg (P<0.01), higher plasma fibrinogen of 4.0±0.9 vs 2.4±0.5g/l (P<0.001) and plasma insulin of 15±14 vs 7±2mU/l (P<0.01), serum triglycerides of 1.5±0.5 vs 1.2±0.5mmol/l (P<0.05), as well as serum insulin‐like growth factor‐I (IGF‐I) levels of 742±271 vs 168±51μg/l (P<0.001) compared with the matched controls. PAI‐1 activity was similar, as was total cholesterol, high‐density lipoprotein cholesterol, low‐density lipoprotein cholesterol, fasting blood glucose and blood pressure for acromegalic patients compared with controls. All the acromegalic patients had higher fibrinogen levels (P<0.001) than the population mean. Plasma fibrinogen correlated positively with serum IGF‐I in acromegaly (r=0.55, P<0.05). Fibrinogen decreased to a mean value of 3.2±0.3 g/l on treatment. CONCLUSION Acromegaly is associated with high fibrinogen levels which may be one explanation for the increased risk of cardiovascular events, and stroke in particular, in this disease. Fibrinogen levels decreased following treatment of acromegaly.
Involvement of nitric oxide in arginine, but not glucose, induced insulin secretion in normal men
Authors: Coiro V. , Volpi R. , Capretti L. , Speroni G. , Caffarri G. , Chiodera P. 
Published: November 2003

OBJECTIVE At present, there are no reports in the literature of studies in humans concerning a possible role of nitric oxide (NO) in the regulation of pancreatic endocrine secretions, whereas studies in the rat provided discrepant results. The aim of this study was to clarify whether NO is involved in the control of insulin and/or glucagon secretion in basal conditions and/or in response to arginine or glucose administration in normal male subjects. DESIGN We investigated whether an intravenous infusion of the NO synthase (NOS) inhibitor L‐NAME, at a dose previously demonstrated not to produce blood pressure alterations or untoward side‐effects, modifies insulin and/or glucagon secretory patterns. SUBJECTS Fourteen healthy male volunteers aged 24–35 years, within 10–13% of their ideal body weight and without family history of diabetes mellitus or other endocrine diseases. METHODS Seven normal men were treated intravenously with L‐arginine (30g in 50ml of normal saline over 30 minutes) or glucose (0.33g/kg body weight in a bolus) with or without the concomitant infusion of L‐NAME (90μg/kg in 50 ml of normal saline). L‐NAME was infused for 30 minutes before and during arginine infusion and over 30 minutes before and 30 minutes after glucose injection. Another group of 7 men was infused over 60 minutes with L‐NAME (90μg/kg in 50 ml of normal saline) alone or saline alone. RESULTS Basal and L‐arginine or glucose induced glucagon secretions and basal and glucose stimulated insulin secretions were not altered by L‐NAME administration. In contrast, the drug produced a partial but significant decrease in the insulin response to L‐arginine. In fact, the mean peak insulin response to L‐arginine was 5.3 times (53±5mU/l (mean±SE)) higher than basal value (10±2) in the absence of L‐NAME, but only 3.33 times (40±4) higher than baseline (12±3) during the infusion of the NOS‐inhibitor. CONCLUSION These data suggest that NO at least partially mediates the stimulatory action of L‐arginine on insulin secretion in normal human subjects.
Treatment of post‐menopausal osteoporosis with recombinant human growth hormone and salmon calcitonin: a placebo controlled study
Authors: Gonnelli Stefano , Cepollaro Chiara , Montomoli Marcello , Gennari Luigi , Montagnani Andrea , Palmieri Rossella , Gennari Carlo 
Published: November 2003

OBJECTIVE The usefulness of GH in the treatment of post‐menopausal osteoporosis (PMO) is still debated. We have studied the effects of recombinant human GH (rhGH) given alone or in combination with salmon calcitonin (sCT) in the treatment of PMO. PATIENTS Thirty women with established PMO (aged 61.1±4.4 years) were divided into 3 groups of 10 and randomly assigned to 3 treatment sequences: rhGH (12 IU/day) s.c. for 7 days, followed by sCT (50 IU/day) s.c. for 21 days and by 61 days without treatment (group 1); placebo for 7 days, followed by sCT for 21 days and by 61 days without treatment (group 2); rhGH for 7 days, followed by placebo for 21 days, and by 61 days without treatment (group 3). Each cycle was repeated 8 times (24 months). MEASUREMENTS At days 0, 8, 29 and 90 of each cycle, serum IGF‐I, calcium, phosphate, osteocalcin, alkaline phosphatase and urinary excretion of calcium, hydroxyproline and pyridinoline cross‐links (Pyr) were measured. At months 0, 6, 12, 18 and 24, bone mineral density (BMD) was measured by dual‐photon absorptiometry (DPA), at lumbar spine (LS), femoral shaft (F) and distal radius (DR). RESULTS A significant increase in serum osteocalcin and urinary calcium, hydroxyproline and Pyr was detected after each rhGH period. In group 1, BMD at lumbar spine increased by 2.5% at year 2; in contrast, significant (P<0.05) decreases in BMD‐LS values were found in patients treated with CT and placebo (group 2) and with GH and placebo (group 3). BMD‐F did not show any significant change in patients of group 2, but a significant (P<0.05) decrease was found in groups 1 and 3. BMD‐DR did not show any significant change with respect to baseline in any of the three groups. No significant difference between the three groups was found in bone mass at the three different regions. CONCLUSIONS Our study demonstrates that treatment with rhGH increases bone turnover in post‐menopausal osteoporotic women. Combined treatment with rhGH and CT over a period of 24 months is able to maintain bone mass at lumbar spine and distal radius, but induces a decline at femoral shaft; therefore, it does not seem particularly useful in the therapy of post‐menopausal osteoporosis.
Incidentally discovered adrenal mass (incidentaloma): investigation and management of 208 patients
Authors: Kasperlik‐Załuska A. A. , Rosłonowska E. , Słowińska‐Srzednicka J. , Migdalska B. , Jeske W. , Makowska A. , Snochowska H. 
Published: November 2003

OBJECTIVE Incidentally discovered adrenal masses are fairly common, although there are some controversies concerning the results of hormonal investigation (especially DHEAS values) and the methods of management. We summarize our experience in diagnosis, pathological findings and treatment of a large group of patients with incidentally found adrenal tumours. DESIGN AND PATIENTS Our study included patients referred to the Department of Endocrinology of the Centre of Post‐graduate Medical Education (Warsaw, Poland) during the last 10 years because of an adrenal tumour incidentally found on ultrasound scan. In all cases this was confirmed by computed tomography. There were 208 patients (148 female and 60 male), 14–76 years old. Unilateral adrenal masses were found in 172 patients (right 106, left 66), while bilateral masses were demonstrated in 36 patients. The size of the tumours ranged between 0.8 and 21.0cm. The most common clinical abnormalities were hypertension (36 cases), obesity (23 cases), diabetes (8 cases), Addison's disease (6 cases). MEASUREMENTS Endocrine tests evaluating pituitary‐adrenal function (urinary excretion of 17‐hydroxycorticosteroids, 17‐ ketosteroids and catecholamines, plasma concentrations of ACTH, cortisol, DHEAS, androstendione and testosterone, dexamethasone suppression test and corticotrophin‐releasing hormone stimulation test). RESULTS Cortisol hypersecretion was noted in two patients with coexisting Cushing’s disease and high normal 17‐OHCS values with lack of dexamethasone suppressibility were found in six other patients with pre‐clinical Cushing's syndrome. More common were subtle hormonal abnormalities: low ACTH levels (in 33 out of 98 investigated patients), diminished dexamethasone suppressibility and lack of ACTH response in the CRH test (in two out of 12 patients). Urinary catecholamine excretion was elevated in nine patients. In the group of 85 patients treated by surgery the most frequent pathological findings were: adrenocortical adenoma (21), carcinoma (17), phaeochromocytoma (13), metastatic masses (12) and myelolipoma (10). The size of carcinomas ranged from 3.2 to 20.0 cm, while the size of non‐malignant tumours ranged from 1.5 to 21.0 cm. CONCLUSIONS Every patient with an incidentally discovered adrenal mass has to be investigated to detect malignancy and subtle hormonal overproduction, to select the cases for surgical treatment. Most of the adrenocortical carcinomas were >7.0 cm in diameter. For prophylactic purposes, adrenal incidentalomas >4.0 cm should be treated by surgery, while the smaller ones could be followed‐up (with especial care for those between 3.0 and 4.0 cm).
The effect of the treatment of hypothyroidism and hyperthyroidism on plasma lipids and apolipoproteins AI, AII and E
Authors: O'Brien T. , Katz K. , Hodge D. , Nguyen T. T. , Kottke B. A. , Hay I. D. 
Published: November 2003

OBJECTIVE Although lipid abnormalities are well described in hypothyroidism, effects on apolipoproteins are less well understood. The aim of this study was to examine the effects of thyroid dysfunction on plasma lipids and apolipoproteins. DESIGN A prospective study of lipids and apolipoproteins before and after treatment of hypothyroidism and hyperthyroidism. PATIENTS Eighteen patients with hypothyroidism and 5 patients with hyperthyroidism were included. MEASUREMENTS Plasma cholesterol, triglycerides, HDL cholesterol, apo AI, apo AII, and apo E were measured before and after treatment of the thyroid abnormality. RESULTS Total and HDL cholesterol, apo AI and apo E decreased with treatment of hypothyroidism, while triglycerides and apo AII levels were unchanged. The total/HDL cholesterol and LDL/HDL cholesterol ratios also decreased with treatment of hypothyroidism. In contrast, treatment of hyperthyroidism was associated with an increase in total and HDL cholesterol, and apo AI. Triglycerides, apo AII and Apo E were unchanged by treatment of hyperthyroidism. The total/HDL cholesterol and the LDL/HDL cholesterol ratios increased with treatment of hyperthyroidism. CONCLUSIONS Hypothyroidism and hyperthyroidism have opposite effects on plasma lipids and apolipoproteins. In hypothyroidism, total and HDL cholesterol, total/HDL cholesterol ratio, apo AI and apo E are elevated. The increase in apo AI without a concomitant increase in apo AII suggests selective elevation of HDL2. In contrast, hyperthyroidism is associated with decreased total and HDL cholesterol, total/HDL cholesterol ratio, and apo AI levels. These effects are reversible with treatment of the underlying thyroid disorder.
Effect of low dose oxandrolone and testosterone treatment on the pituitary‐testicular and GH axes in boys with constitutional delay of growth and puberty
Authors: Crowne E. C. , Wallace W. H. B. , Moore C. , Mitchell R. , Robertson W. H. , Holly J. M. P. , Shalet S. M. 
Published: November 2003

OBJECTIVE To investigate the effect of low dose oxandrolone and testosterone on the pituitary‐ testicular and GH‐IGF‐I axes.DESIGN Prospective double‐blind placebo‐controlled trial.PATIENTS Sixteen boys with constitutional delay of growth and puberty (CDGP) with testicular volumes 4–6 ml were randomized to 3 months treatment: Group 1 (n = 5), daily placebo: Group 2 (n = 5), 2.5 mg oxandrolone daily or Group 3 (n = 6), 50 mg testosterone monthly intramuscular injections with assessment (growth, pubertal development and overnight hormone profiles) at 0, 3, 6 and 12 months.MAIN OUTCOME MEASURES  LH and GH profiles (15‐minute samples) were analysed by peak detection (Pulsar), Fourier transformation and autocorrelation. Testosterone levels were measured hourly and insulin, SHBG, IGF‐I, and IGFBP‐3 levels at 0800 h. Statistical analysis was by multivariate analysis of variance for repeated measures.RESULTS  LH and testosterone parameters increased significantly with time in all 16 (LH AUC, P < 0.0001; peak amplitude, P = 0.02; number of peaks, P = 0.02; testosterone AUC, P = 0.02; morning testosterone, P = 0.002). In Group 2, however, LH and testosterone parameters decreased at 3 months followed by a rebound increase at 6 and 12 months. SHBG levels were markedly reduced at 3 months (P = 0.006) and a wider range of dominant GH frequencies was present although GH AUC was not increased until 6 months, with an increase in GH pulse frequency but not amplitude. IGF‐I levels were increased at both 3 and 12 months. In Group 3, pituitary‐testicular suppression was not apparent, but GH levels increased with an increase in GH amplitude at 3 and 12 months.CONCLUSION Oxandrolone transiently suppressed the pituitary‐testicular axis and altered GH pulsatility. Testosterone increased GH via amplitude modulation.
Audit of 6 years' experience of breast fine needle aspiration (FNA) cytology using the cytospin method; improvement through multidisciplinary clinical audit
Authors: DUNDAS S. A. C. , MANSOUR P. , ZEIDERMAN M. , HARRISON I. , SKIPWORTH P. , DUTTON J. 
Published: November 2003

Audit of 6 years' experience of breast fine needle aspiration (FNA) cytology using the cytospin method; improvement through multidisciplinary clinical auditA breast FNA cytology service for palpable breast lumps was commenced in 1989 using the cytospin method. Over the following 6 years 2314 aspirates were received. The results were audited in detail in 1990, 1991/1992 and 1994. Multidisciplinary clinical audit meetings followed each audit cycle. Practice change was agreed after each audit. Each audit cycle was followed by demonstrable improvement in the complete sensitivity of the technique, being respectively 79%, 88% and 96%. The cytospin method is a viable alternative to the conventional smear method.
Immunocytochemical staining of effusions; an external quality control study in The Netherlands
Authors: KUENEN‐BOUMEESTER V. , DE BRUIJN E. M. C. A. , HENZEN‐LOGMANS S. C. 
Published: November 2003

Immunocytochemical staining of effusions; an external quality control study in The NetherlandsIn The Netherlands an external quality control study of immunocytochemical (IC) staining of effusions was initiated, consisting of three test rounds. The 12 participating laboratories received samples of malignant effusions (runs 1, 2 and 3), and five unstained control specimens prepared from the same material in runs 2 and 3. The laboratories used their own protocols to prepare and stain the samples (‘in‐house’ specimens). Two persons viewed and scored the slides following preset criteria concerning number and morphology of diagnostic cells, background staining and staining specificity. Better scoring results were found for control specimens, compared with ‘in‐house’ specimens, primarily caused by cell loss in the latter. This finding underlines the view that high quality IC needs well organized processing and staining procedures, and warrants external quality control systems.