Search PubMed⌕ Search

Biomedical subjects

P T Pullan

Publications and source records attributed to P T Pullan.

At least 19 recordsLinked to original sources
PubMed2000

Hypogonadism in patients treated with intrathecal morphine.

OBJECTIVE: The objective of this study was to investigate the hypothalamic-pituitary-gonadal response to intrathecal opioids. PATIENTS: Thirty patients receiving intrathecal morphine for chronic nonmalignant pain were studied for clinical and biochemical evidence of hypogonadism. Ten men and 10 postmenopausal women with chronic pain of similar duration but who were not receiving any form of opioid therapy acted as control subjects. RESULTS: Men and both premenopausal and postmenopausal women had evidence of hypogonadism with low levels of serum testosterone or estrogen coupled with low levels of pituitary gonadotrophins. Control subjects had hormone levels in the expected range for their sex and age. Two men demonstrated recovery after ceasing intrathecal opioid therapy. CONCLUSIONS: Hypogonadotrophic hypogonadism is a common complication of intrathecal opioid therapy in both men and women.

Adult↗
PubMed1997

Hyperprolactinaemia in males: a heterogeneous disorder.

BACKGROUND: The literature suggests that men with prolactinomas typically present with pressure effects of large pituitary tumours and/or the clinical features of hypogonadism. A definitive study of the clinical features of hyperprolactinaemia in males is, however, lacking AIMS: To identity the clinical, biochemical and radiological features of hyperprolactinaemia in males. METHODS: Retrospective review of the case notes of 53 adult males with prolactinoma or idiopathic hyperprolactinaemia diagnosed 1980-1995. RESULTS: The mean age of the patients was 41 years (range 19-75). The presenting symptom was endocrine in nature in 57% of patients (loss of libido/potency 47%, gynaecomastia 6%, galactorrhoea 2%, sparse beard growth 2%), pressure effects of pituitary tumour in 28% (headache 13%, visual loss 13%, diplopia 2%), while 15% of patients presented incidentally. On physical examination, galactorrhoea was present in 8% of patients, gynaecomastia in 23% and abnormally sparse body hair in 21%. Testicular volume was normal (> or = 15 mL) in all but two patients, both of whom had evidence of delayed pubertal development. Visual loss was present in 17% of patients. Serum prolactin ranged from 800 to 1.7 million mU/L (median 20,000 mU/L, reference range < 500), and serum testosterone from 0.7 to 19.3 nmol/L (mean 7.8 nmol/L, reference range ten-35). Pituitary imaging by computed tomography (45%) or magnetic resonance imaging (55%) demonstrated macroadenomas in 70% of patients, microadenomas in 15%, and no detectable tumour in 15% of subjects. On bromocriptine treatment (47 subjects), 89% of patients reported improved sexual function. Follow up imaging in 36 patients with abnormal scans at presentation revealed tumour shrinkage in 89% of cases. CONCLUSIONS: Hyperprolactinaemia in males is a heterogeneous disorder. The majority of patients have prolactin-secreting macroadenomas, but there is wide variation in presenting symptoms, physical signs and results of biochemical and imaging investigations. Bromocriptine treatment is associated with symptomatic improvement and a reduction in tumour size in most cases.

Adult↗
PubMed1996

Predictive diagnosis of multiple endocrine neoplasia (MEN 1) in four Australian kindreds.

BACKGROUND: Multiple endocrine neoplasia type 1 (MEN 1) is a tumour predisposition syndrome that usually manifests in the first four decades of life. It has an autosomal dominant mode of inheritance which means that any new member of a MEN1 kindred has roughly a 50% chance of developing the disorder during their lifetime. The localisation of the MEN1 gene to a small region of chromosome band 11q13 has led to the development of DNA-based predictive diagnosis for this disease. AIMS: To establish a polymerase chain reaction (PCR)-based system, using simple tandem repeat polymorphisms (STRPs), to predict gene carriers in four Australian MEN 1 kindreds. METHODS: Six STRP markers flanking the MEN1 region of chromosome band 11q13 were used to screen individuals for a common haplotype in order to determine carrier status. RESULTS: The accuracy of prediction was calculated to be > 95% in informative individuals. CONCLUSIONS: DNA-based presymptomatic detection of affected members of MEN 1 kindreds could facilitate their care and reduce the inconvenience and expense of repeated testing of unaffected members. However, due to occasional recombination events or uninformativeness of markers in certain individuals, carrier status cannot always be predicted.

Adult↗
PubMed1991

Increased central immunoreactive beta-endorphin content in patients with Wernicke-Korsakoff syndrome and in alcoholics.

beta-endorphin, adrenocorticotrophin, and alpha-melanocyte stimulating hormone were measured by radioimmunoassay in three areas of human brain at necropsy in seven subjects with Wernicke-Korsakoff syndrome and in 52 controls. Thiamin concentration in six brain areas was also measured. Mamillary body beta-endorphin concentrations were significantly increased in those with the syndrome compared with controls, and those controls with high alcohol intake showed increased mamillary body beta-endorphin compared with controls with low alcohol intake. Brain thiamin concentration was similar in both groups, with the exception of the brainstem, where it was reduced in subjects with Wernicke-Korsakoff syndrome. Thalamic beta-endorphin in controls was inversely correlated with thiamin in frontal white matter, frontal cortex, parietal white matter and parietal cortex, while beta-endorphin in the hypothalamus of patients was inversely correlated with thiamin in frontal cortex, parietal white matter, thalamus and brainstem. These results suggest that there is a disturbance of the endorphinergic system in Wernicke-Korsakoff syndrome which may be related to alcohol intake.

Adrenocorticotropic Hormone↗
PubMed1988

Dystonia and intracerebral calcification: pseudohypoparathyroidism presenting in an eleven-year-old girl.

Pseudohypoparathyroidism is an uncommon cause of movement disorders. We describe the case of an otherwise well 11-year-old girl, who presented with dystonia and was subsequently shown to have the classical metabolic abnormalities of pseudohypoparathyroidism. Cranial computerised tomographic scanning (CT scanning) showed intracerebral calcification of the basal ganglia and frontal lobes.

Basal Ganglia Diseases↗
PubMed1987

Fasting calcium excretion and parathyroid hormone together distinguish familial hypocalciuric hypercalcaemia from primary hyperparathyroidism.

Routine estimation of plasma calcium has made the finding of asymptomatic hypercalcaemia a frequent occurrence. A high index of suspicion for familial hypocalciuric hypercalcaemia (FHH) will lead to accurate diagnosis and avoidance of unnecessary parathyroid surgery. Four FHH kindreds with 16 hypercalcaemic members were found in an unselected referral population over 3 years. Differentiation from primary hyperparathyroidism (42 patients in the same period) was facilitated by analysis of fasting blood and urine for renal handling of calcium, phosphate and cyclic AMP. We found that a plot of serum PTH against fasting calcium excretion separated all cases of each disorder. The discriminatory power of these two variables was confirmed by multivariate discriminant function analysis. An elevated plasma chloride was found to be common to both diseases and of no value in differentiation.

Adult↗
PubMed1985

Management of extra-sellar pituitary tumours with bromocriptine: comparison of prolactin secreting and non-functioning tumours using half-field visual evoked potentials and computerised tomography.

To determine whether prolactin secreting and non-functioning pituitary tumours respond differently in terms of shrinkage to bromocriptine, we prospectively studied ten consecutive patients (five with prolactinomas and five with non-functioning tumours) complicated by extra-sellar extensions. No patient had received prior radiotherapy or bromocriptine and the mean dose and duration of bromocriptine treatment were identical in the two groups of patients. Objective evidence of tumour shrinkage was provided by serial half-field visual evoked potentials (VEPs) and computerised tomography (CT). All five prolactinomas were shown to shrink as assessed by improvement in VEP and four of the five as assessed by CT. In contrast, only one of the five patients with non-functioning tumours showed any improvement in VEP or CT. Macroprolactinomas frequently shrink rapidly when treated with bromocriptine, whereas non-functioning tumours seldom show such a dramatic response.

Adult↗