Biomedical subjects
Publications and source records attributed to C Lucke.
A 68-year-old man developed severe swallowing difficulties after a cerebrovascular accident: he was unable to take food. Nutrition was assured via a gastrostomy ( Witzel fistula). Nonetheless there was steady weight loss. A cricopharyngeal achalasia was finally discovered to be the cause of the swallowing problem. Myotomy of the cricopharyngeal muscle completely abolished it.
Clinical symptoms in elderly patients with hyperthyroidism are atypical and uncharacteristic. In 13 patients with overt hyperthyroidism a goiter was found in only half the patients, eye signs in just three of them. Tachycardias, sometimes even paroxysmal tachycardias, predominate. In old people the diagnosis of hyperthyroidism is frequently missed, in 11 of 13 patients the disease was diagnosed following transfer to the rehabilitation center. About 50% of patients were iodine contaminated and this may have contributed to the disease. Data are presented to demonstrate that hyperthyroidism in old age may be a life threatening disease.
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To evaluate the existence of circadian variations in thyroid hormone and TSH levels, blood was drawn every 20 min for 24 h in four and for 14 h in one volunteer. Hormones were measured by sensitive radioimmunoassays. TSH: A diurnal rhythmicity could be demonstrated with peaks from 8 p.m. to 2 a.m and a nadir from 7 a.m. to 2 p.m. Superimposed on the diurnal rhythm multiple shortlived fluctuations were observed. Thyroxine: Pooled data showed peak values from 8 a.m. to 12 a.m. and lowest levels from 11 p.m. to 3 a.m. Again, shortlived fluctuations were superimposed on the diurnal rhythm in all instances. Triiodothyronine: Hormone levels were highest from 7 a.m. to 1 p.m. and lowest from 11 p.m. to 3 a.m. Fluctuations in T3 levels were less marked than those of T4. Diurnal variations in hormone levels can be demonstrated in most, but not in all instances. Fluctuations are minor and do not exceed the normal range. Therefore these changes are of no relevance in routine testing of these hormones.
Somatostatin, a peptide isolated from ovine hypothalami, prevents growth hormone secretion in vivo and in vitro. Moreover, somatostatin interferes with the secretion of various other hormones: TSH insulin, glucagon, gastrin, VIP and GIP. Under certain conditions a blunting effect on the secretion of prolactin and ACTH can be demonstrated.
It is well known and also confirmed in this study that somatostatin (growth hormone inhibiting factor, GHIF) prevents the noctural GH secretion, as long as the peptide is infused. Following the infusion a rapid rise in GH levels is seen in sleeping subjects with peak values of 26.8 +/- 9.7 ng/ml compared to 31.7 +/- 4.7 ng/ml (+/- SEM) in control nights. Delayed GH peaks were seen even in the absence of slow wave sleep. No postponed GH rise was observed when subjects fell asleep again. These data demonstrate that the postponed nocturnal GH peak does not represent a rebound phenomenon to a previous trigger mechanism but is acutely sleep induced.
Somatostatin, a growth hormone inhibiting factor (GHIF), was infused into 8 patients with primary hypothyroidism at a dosage of 1000 mug for 105 min. GHIF caused a suppression of TSH levels from 42.6 to 76.9% of preinfusion levels with a mean nadir of 65.0 +/- 4.0%;(mean +/- SEM).
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