[ACTH-dependency of hirsutism; significance and critical aspects of function tests].
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Biomedical subjects
Publications and source records attributed to A Tache.
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Starting from the interference between the renin-angiotensin-aldosterone (RAA) system and cardiovascular pathology in arterial hypertension (AH) we have made a correlative study of the cardiovascular system and plasmatic aldosterone in normal and hypertensive subjects under conditions of stimulation (ACTH) and inhibition (propranolol). After administration of ACTH (one of the physiologic mediators of stress) increased values for plasmatic aldosterone were found. Negative cardiovascular effect: arrhthmia, angor, AH, cardiac asthma, under the condition of preexisting cardiovascular pathology or altered steroidogensis, were also noticed. Inhibition with propranolol does not have conclusive effects in AH with normal aldosterone. The best effect were noticed in that hypertension which implies the RAA pressor system in its pathogeny, irrespective of etiology, the reduction AT occurring in parallel with decline in plasmatic aldosterone values and total peripheral resistance (RPT). Administration of propranolol in AH with activated RAA system irrespective of etiology represents a pathogenic treatment able to prevent efficiently the major complications of AH.
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A 27-yr female patient was admitted to the hospital because of secondary amenorrhea and a severe and complex virilization syndrome. The urinary 17-Ks, 17 OHCS and testosterone glucuronide values were greatly increased. The plasma testosterone through very high, was within the normal limits in males (3.52 ng/ml). Urography, echography and CT scan revealed a large right adrenal tumor. Removal of the tumor brought about a considerable clinical improvement: reoccurrence of the menstrual cycle, a progressive decrease in the virilization syndrome and normalization of the urinary 17-Ks, 17-OHCS and of the plasma testosterone.
Basal and post-suppressive dexamethasone (dxm) levels of some urinary androgen metabolites, plasma testosterone (T), 17 hydroxyprogesterone (17 OHP) and of basal serum prolactin were determined in 34 hirsute amenorrheic adolescents aged 13-17 in whom a five day course of bovine pineal extract (4 ml a day i.m.) was instituted. No convincing effect of pineal extract administration on plasma T and 17 OHP and on serum prolactin was detectable in most of pineal-treated patients. Suppressibility to dxm of plasma T and 17 OHP was not a relevant index of both the origin of androgens or the clinical course of the patients.
Eighty obese children and adolescents (41 males) aged 4-18 were screened for urinary adrenergic derivatives (NA, A, AVM, MN, MHPG) and the results compared with age- and sex-matched controls. Significantly higher amounts of A (8.1 +/- 0.38 micrograms/24 h), MN (0.327 +/- 0.032 mg/24 h) and MHPG (2.74 +/- 0.192 mg/24 h) were found and significantly linear regression curves of MHPG were plotted against urinary creatinine and NA but not against age, weight and Quettelet index. A subgroup of 26 obese having urinary MHPG over 3 mg/24 h ("high MHPG excretors") revealed significantly greater means of weight Quettelet index, A and NA than the remaining 54--member subgroup ("low MHPG excretors"). It was concluded that in randomly selected obese children and adolescents there are obvious humoral signs of sympathetic nervous system overactivity and, possibly, of adrenomedullary increased tonus and that these manifestations may be due, at least in part, to increased central (encephalic) noradrenergic activity, especially in more overweight patients.
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Cyclofenil 600 mg/day was given to 10 women with excessive skin hair and marked excretion of urinary androgens. The urinary values of androgenic metabolites as well as the plasmatic values of radioimmunoassayable testosterone remained unaltered. A significant increase was noticed in the radioimmunoassayable plasma estradiol. Urinary total estrogens could not be assayed in the women under cyclofenil because of a non-specific color reaction. It was concluded that the estrogenic effects of cyclofenil are mediated, at least partly, by release of gonadotropins from the hypophysis.
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The authors have studied on 25 cases of hypercorticism, one of the mechanisms of producing arterial hypertension, the renin-angiotensin system. The study showed that in only 20% of the cases plasma renin activity was high whereas in the remaining 80% other mechanisms were responsible for the hypertension. In the cases in which the plasma activity of renin was high, by studying the changes in the value of electrolytes we were able to derive some understanding of the mechanism of action of the RA2A system. Thus, the literature data show that sometimes the excess of glucocorticoids causes hypertension by activating directly the RA2A system and concomitently inhibiting the renin-kalikrein system (RKKS) and PgS; at other times, the excess of glucocorticoids is exerted on the same renin-angiotensin system, but via ACTH and ADH, the electrolytes values being those that demonstrate the borrowed mechanism.
The authors have studied on 50 patients hospitalized in the Adrenal Pathology unit of the Institute of Endocrinology, the etiopathogeny of arterial hypertension (AH) in hypercorticism and the therapeutic implications, arriving at the conclusion that in 20% of the cases AH was probably due to an increased activity of renin-angiotensin and in 47% to elevated levels of aldosterone. The authors hypothesize that AH in the remaining 30% of the hypercorticism cases in this study is due to other mineralocorticoids in excess and suggest that the treatment should be pathogenic and strictly individualized.
The investigation was carried out on 66 patients with hypo- or hyperfunctional syndromes of adrenocorticism, hospitalized and treated by our team. The patients were grouped into 5 lots according to their diseases. Lot one consisted of 34 female patients with Cushing's syndrome, lot two of 10 males with Cushing's syndrome, lot three of 10 males with Addison's disease and lot four, of 6 females with androgenic hypercorticism. The morphofunctional disorders of reproduction were followed up clinically and by complex hormone assays, before and after treatment. The incidence of these disorders is very high, and the results of clinical observations and of laboratory data demonstrate that both the excess of adrenocortical hormones and the decrease in their circulating level have a negative influence on the reproduction function or represent a risk factor in cases of pregnancy. By the curative treatment of the adrenal cortex a preventive treatment of abortion and/or sterility is achieved.
The present work has attempted an analysis of the role hypercorticism as a risk factor in arterial hypertension and atherosclerosis. Our series consisted of 149 male and female patients of various ages. The incidence of cardiovascular disorders in relation to age and the glucidic lipidic metabolic disorders were also investigated. The results showed that hypercorticism may trigger in very young patients as well arterial hypertension (AH) and glucidic-lipid metabolic disorders both incriminated as risk factors in including atherosclerosis. Hypercorticism was proved to be an aggravating factor of pre-existing cardiopathy. Efficient management of adrenocortical hormones excess brings complete resolution of arterial hypertension and glucidic lipid metabolic disorders in young patients and most adult patients who had no cardiovascular complaints prior to the endocrine syndrome.