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Biomedical subjects

H K Kley

Publications and source records attributed to H K Kley.

At least 19 recordsLinked to original sources
PubMed1992

Testosterone treatment of men with idiopathic hemochromatosis.

Patients with chronic liver disease usually exhibit low plasma levels of testosterone with loss of libido and potency; this is also valid in male patients suffering from idiopathic hemochromatosis (IHC), in whom nowadays the diagnosis is made at an earlier age. Therefore, the effect of testosterone treatment was studied in 10 patients with IHC. After the application of 250 mg testosterone enanthate i.m., the plasma testosterone (from 2.4 +/- 1.9 to 20.1 +/- 7.4 ng/ml) and estradiol (from 17.4 +/- 6.3 to 38.5 +/- 14.2 pg/ml) levels increased significantly. The rise of estradiol was in the range of controls and smaller than reported in other chronic liver diseases. In a long-term study, 250 mg testosterone enanthate was given 4-weekly for 33-96 months to 5 patients with IHC. General well-being, libido, and potency recovered almost immediately. Over a treatment period of 27.3 patient years, symptoms of hyperestrogenism (gynecomastia) or (portal vein) thrombosis were not seen, both of which had been described in patients with alcoholic liver cirrhosis. There was no deterioration of liver function. The effect of testosterone treatment on the patients' well-being and plasma hormone concentrations remained unchanged over the whole period of testosterone treatment. Thus, in male patients with IHC and lowered plasma testosterone, treatment with testosterone enanthate may be instituted. Because of the positive effects on general well-being, liver regeneration capacity, and potency, testosterone should especially be administered to younger subjects suffering from IHC.

Adult↗
PubMed1992

Adrenal incidentaloma and patients with homozygous or heterozygous congenital adrenal hyperplasia.

Adrenal tumors are being detected more frequently in consequence of the wider application of increasingly sensitive radiological investigation techniques. According to the working hypothesis that more silent adenomas could develop from hyperplastic tissue areas under increased stimulation of the adrenal cortex, heterozygous and homozygous patients with congenital adrenal hyperplasia (CAH) were studied. A high incidence of adrenal masses, nearly 82% in homozygous and 45% in heterozygous patients, was found. There was no correlation between tumor size and serum 17-hydroxyprogesterone concentrations. These tumors are, therefore, probably silent adenomas. On the basis of these results, CAH should always be ruled out in the case of incidentally detected adrenal masses. Since CAH is a relatively frequent disease, and the adrenal carcinoma belongs to the rarest malignant tumors, a malignant transformation of these tumors seems to be unlikely.

17-alpha-Hydroxyprogesterone↗
PubMed1991

Age-related changes in 11 beta-hydroxyandrostenedione concentration in normal and osteoporotic women.

The secretion of dehydroepiandrosterone (DHEA) and its sulfate is known to decline gradually with advancing age. Furthermore DHEA is known to be significantly lower in osteoporotic subjects than in normals. Recently 11 beta-hydroxyandrostenedione (11-OHA) has been proposed as an important indicator of the adrenal source of hormone excess in different hyperandrogenic states. In the present study we measured 11-OHA in 224 normal women aged 20-79 yr and 130 osteoporotic women aged 40-79 yr. RIA of 11-OHA was performed with highly specific antiserum raised in rabbits. The mean 11-OHA serum concentration was 2.20 +/- 0.90 ng/ml in normal women and 1.75 +/- 0.58 ng/ml in osteoporotic women. In contrast to DHEA there was no age-related decrease in 11-OHA serum concentrations in normal and osteoporotic women. Osteoporotic subjects showed statistically significantly lower 11-OHA serum concentrations than normal women. Therefore low serum 11-OHA might represent a further risk factor for osteoporosis.

Adrenal Cortex↗
PubMed1990

[Adrenogenital syndrome--today a radiologic diagnosis?].

The following case report shows the course of disease of a 37 year old man, who showed the classical symptoms of an untreated congenital adrenal hyperplasia. But only when an adrenal tumor accidentally was detected, the endocrinological tests and the diagnosis of the congenital adrenal hyperplasia were made. By this diagnosis the planned adrenalectomy could be avoided now.

Adrenal Gland Neoplasms↗
PubMed1979

[Total and free testosterone in the male depending on body weight (author's transl)].

Total testosterone, the fraction of unbound testosterone and free testosterone were measured in 116 males of varying body weight in the range of 80 to 256% of the ideal weight. There are 3 groups for the establishment of normal ranges of testosterone. Testosterone and the fraction of unbound testosterone were fairly constant in group I (80--160% of the ideal weight). In group II (160--200% of ideal weight) there was a tendency towards lower values. The relatively wide normal range for testosterone was not reached in only 5 of these 20 patients. In contrast, in group III (more than 200% of ideal weight) clear-cut changes of total testosterone were demonstable reaching only 38% (P less than 0.001) of control values. Changes were also clear for unbound testosterone which increased from 2.24 to 3.9% (P less than 0.001). The concentration of free testosterone decreased to a lesser extent (P less than 0.01). Despite the low total testosterone hypogaonadism was not demonstable clinically in the extremely obsese patients. According to these results "normal values" for total testosterone, the fraction of unbound testosterone and free testosterone could be established depending on body weight.

Adult↗
PubMed1979

[Diagnostic procedures in diencephalo-hypophyseal insufficiency (author's transl)].

A functional diagnosis of the diencephalohypophyseal system was carried out in patients with Sheehan syndrome, chromophobic adenoma, craniopharyngioma, prolactin-producing pituitary tumours, acromegaly, hypothalamo-pituitary dwarfism and constitutional retardation. A combined insulin hypoglycaemia/LH-RH/TSH test was performed to define frequency and extent of anterior pituitary insufficiency. With these illnesses, almost generally, a somatotropic insufficiency (except in acromegaly) was found. An impairment of gonadotropic function was often present, in general a pathologic LH-RH test correlating with a more or less developed androgen deficiency. An adrenocorticotropic insufficiency was found in most patients with sheehan syndrome, chromophobic adenoma and craniopharyngioma while in acromegaly and hypothalamo-pituitary dwarfism it was present less frequently, necessitating a substitution with corticoids. The TRH test reflects only incompletely a secondary hypothyroidism, and can be normal with organic processes of the diencephalo-hypophyseal region, making a T3 and T4 estimation in the blood decisive for a thyroid hormone substitution. A clear-cut separation of the hypothalamic from the pituitary cause of the insufficiency is neither possible with the LH-RH nor with the TRH test.

Acromegaly↗
PubMed1979

Plasma-estrogens and liver cirrhosis.

The plasma concentrations of estrogens as well as their relationship to testosterone are determined in male patients suffering from fatty liver, chronic hepatitis and cirrhosis of the liver. By stimulation and suppresion tests the contribution of the adrenal gland and the testes to the elevated estrogens are investigated, demonstrating that enhanced peripheral conversion of androgens to estrone rather than to estradiol appears to be more effective in sustaining plasma levels in hepatic cirrhosis. Futhermore, the effect of testosterone application was studied in male patients with alcohol-induced cirrhosis of the liver in order to realize possible side-effects of an androgenic substitution therapy. It is concluded that clinical signs of hyper-estrogensim and hypoandrogenism in male patients with hepatic cirrhosis may in part be attributed to the increase of estrogens and the decrease of total and free testosterone, as is best shown by the ration of the heterosexual hormones which are grossly shifted in favour of the estrogens.

Adrenal Glands↗
PubMed1979

[Effect of cyproheptadine on the regulation of the adrenal system (author's transl)].

The effect of the antiserotoninergic agent cyproheptadine (C) on the adrenal system was studied in male rats, the adrenocorticol function of which was assessed by analysis of the urinary excretion of free corticosterone. After a feeding period with 0.5--0.7 mg C/kg body weight/day for several months significant differences in the urinary excretion of free corticosterone were only found when the rats were exposed to systemic stress stimuli as cold (increase from 118.7 +/- 5.3 to 305.5 +/- 5.1 vs. 417.8 +/- 48.6 ng/d in the controls; p less than 0.001) and hunger (no increase of free corticosterone in treated animals as compared to an increase to 446.0 +/- 53.6 ng/d in the controls). In contrast to these findings no effect of C was seen when studying the neurotropic stress stimuli reserpine and ether. The same was true when measuring free corticosterone under basal conditions and after ACTH- or metyrapone stimulation. It is concluded that serotonin plays a major role as hypothalamic neurotransmitter in systemic but not in the studied neurotropic stress stimuli. The site of serotonin action does not comprise adrenal synthesis of steroids and the hypothalamic-pituitary-adrenal feedback system, as is shown by the ACTH- and metyrapone stimulation tests.

Adrenal Glands↗
PubMed1979

E2/T ratio.

Explore the source record for details and available documents.

Animals↗
PubMed1978

[Differential diagnosis of hypothalamic-hypophyseal Cushing's syndrome and ectopic ACTH syndrome (author's transl)].

Endocrinological symptoms of, on the one hand, hypothalamic-hypophyseal Cushing's syndrome and, on the other, ectopic ACTH syndrome (usually caused by bronchial carcinoma) can often not be distinguished. Reliable differentiation of these two forms of secondary hypercortisolism is necessary, because in hypothalamic-hypophyseal Cushing's syndrome therapy is more and more frequently directed at the anterior pituitary and hypothalamus rather than attempted by bilateral adrenalectomy. The following method was used for distinguishing between the two in six patients: blood was withdrawn by catheter from the jugular vein and the inferior petrosal sinus and the ACTH concentrations measured. Compared with ACTH concentration in a peripheral vein (e.g. cubital vein) that in the jugular vein was higher in five patients by a factor of 1.47 +/- 0.1 and in the inferior petrosal sinus by 2.39 +/- 0.64. A positive diagnosis of hypothalamic-hypophyseal Cushing's syndrome can thus be made. In one patient the diagnosis of ectopic ACTH syndrome could be made from the gradient of ACTH concentration between the cardiac right ventricle and the bronchial artery (1 : 3.75), before there was radiological demonstration of the bronchial carcinoma.

Adrenocorticotropic Hormone↗
PubMed1978

[Cortisol substitution in adrenal insufficiency (author's transl)].

Both in patients with primary (n = 15) and secondary (n = 10) adrenal insufficiency a conventional substitution with 30 mg cortisol daily (3 single doses of 15, 10 and 5 mg) leads to an unsatisfactory adjustment in most cases. Plasma maximal values after the morning dose were obtained only between 9 and 11 a.m. and were 3.5 times higher than cortisol values of healthy probands (n = 35). The half-life of cortisol in plasma (t1/2 = 0.8-3.2 hrs) varied to such an extent that some patients had subnormal values relatively quickly or that concentrations above normal were found permanently. The same also applies to free cortisol in plasma. The amount of free cortisol in urine cannot be used as a parameter of a physiological substitution of cortisol. The individual adjustment of the treatment plan can thus be only established according to cortisol concentrations in plasma.

Adrenal Insufficiency↗