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Biomedical subjects

R M Jordan

Publications and source records attributed to R M Jordan.

At least 55 records · Page 3Linked to original sources
PubMed1977

The primary empty sella syndrome: analysis of the clinical characteristics, radiographic features, pituitary function and cerebrospinal fluid adenohypophysial hormone concentrations.

Twelve cases of the primary empty sella syndrome were analyzed in regard to clinical findings, roentgenographic features, pituitary function and cerebrospinal fluid adenohypophysial hormone concentration. The findings were compared with those in 247 cases of the primary empty sella syndrome reviewed from the literature in order to determine the major characteristics of this disorder. The majority of patients are obese, multiparous women with normal pituitary reserve, normal visual fields and undetectable adenohypophysiol hormone concentrations in cerebrospinal fluid. In addition occasional patients witll have hypertension, pseudotumor cerebri and cerebrospinal fluid rhinorrhea. Patients who present with the typical features of the primary empty sella syndrome should be evaluated periodically with pituitary function testing, visual field examinations and cerebrospinal fluid adenohypophysial hormone determinations. If these parameters remain normal during careful follow-up studies, the patient is likely to have an empty sella, and pneumoencephalographic and angiographic studies can be avoided.

Adult↗
PubMed1977

Sulfonylurea-induced factitious hypoglycemia. A growing problem.

Two patients had sulfonylurea-induced factitious hypoglycemia. Both patients demonstrated hyperinsulinism during hypoglycemia suggesting the presence of an insulin-secreting tumor. One patient underwent an exploratory laparotomy with subtotal pancreatectomy before the etiology of the hypoglycemia was discovered. Inboth patients, the diagnosis was made by detecting sulfonylurea agents in blood. A survey of Portland, Ore metropolitan hospitals suggests that factitious hypoglycemia occurs with a frequency similar to the insulinoma syndrome. The biochemical similarity of these disorders and the apparent increasing incidence of factitious hypoglycemia suggests that blood determinations of sulfonylurea agents should be performed prior to exploratory laparotomy for an insulinoma.

Adenoma, Islet Cell↗
PubMed1976

Rapid appearance of transient secondary adrenocortical insufficiency after alpha-particle radiation therapy for Cushing's disease.

A 17-year-old women received 12,000 rads of alpha-particle radiation for the treatment of Cushing's disease. One day after the completion of therapy, the patient developed nausea, vomiting, headache, and postural hypotension. Laboratory evaluation demonstrated a marked fall of the previously elevated urinary 17-hydroxycorticosteroids (17-OHCS) and undetectable plasma cortisols. The urinary 17-OHCS transiently returned to supranormal levels but over a 2 1/2-week period decreased and then remained low. The patient also demonstrated a subnormal urinary aldosterone excretion in relation to plasma renin activity (PRA) during 10 mEq/24 h sodium restriction. The remainder of the endocrine evaluation was normal, suggesting that pituitary function otherwise remained intact. One and one-half years after alpha-particle therapy, the patients's urinary 17-OHCS were normal and responded normally to metyrapone. The relationship between urinary aldosterone excretion and PRA also was normal. It is postulated that there was an infarction of an ACTH secreting pituitary tumor leaving the remainder of the pituitary intact. Achronically elevated circulating level of ACTH with sudden loss of ACTH secretion appeared to have been responsible for the initial low urinary aldosterone as well as the low urinary 17-OHCS. This is the first reported case of a presumed pituitary tumor infarction in association with alpha-particle pituitary radiation.

17-Hydroxycorticosteroids↗
PubMed1976

Cerebrospinal fluid hormone concentration in the evaluation of pituitary tumors.

Cerebrospinal fluid (CSF) concentrations of corticotropin, growth hormone, thyrotropin, prolactin, luteinizing hormone, and follicle stimulating hormone were measured in 28 patients with various neurologic disorders, in 49 patients with pituitary tumors of whom 22 had suprasellar extension, and in 6 patients with craniopharyngiomas. With the exception of 1 patient with pseudotumor cerebri, CSF adenohypophyseal hormone concentrations were low in patients with neurologic disease and in patients with pituitary tumor without suprasellar extension. In marked contrast, 21 to 22 patients with suprasellar extension of a pituitary tumor and 2 of 6 patients with a craniopharyngioma had elevations of one or more CSF adenohypophyseal hormones. Posttreatment CSF adenohypophyseal hormone levels fell from previously elevated levels in 4 of 5 patients. These data suggest that an elevated CSF adenohypophyseal hormone concentration is a sensitive indicator of suprasellar extension of a pituitary tumor, and posttreatment measurements are useful in determining efficacy of therapy.

Adenoma, Acidophil↗
PubMed1976

Helen C. Cousland.

Explore the source record for details and available documents.

History of Medicine↗
PubMedDate not supplied

An insulinoma without fasting hypoglycemia.

A patient with a 25-year history of episodic irritability, confusion, and unconsciousness was suspected of having organic hypoglycemia. He was fasted for a 72-hour period without developing symptoms. At the end of the fast his blood sugar was 85 mg/100 ml and the immunoreactive insulin (IRI) concentraion was elevated to 350 microunits/ml. Surgical exploration demonstrated a 4 x 3 centimeter insulinoma in the tail of the pancreas. Since proinsulin-like components (PLC) are known to be elevated in patients with islet cell tumors and have only 5 to 10 per cent of the biologic activity of insulin, it is suggested that a major portion of the IRI was PLC. This case demonstrates that the inability to withstand prolonged fasting does not exclude the diagnosis of an insulinoma and suggests a mechanism whereby such patients can tolerate fasting.

Adenoma, Islet Cell↗
PubMedDate not supplied

Urine cortisol/creatinine ratio in controlled insulin-induced hypoglycemia.

An elevated urine cortisol/creatinine ratio has been presented as a simple laboratory method to detect nocturnal hypoglycemia. The present study examines the time course of the rise and fall of the urine cortisol/creatinine ratio in 11 patients following insulin-induced hypoglycemia. The mean urine cortisol/creatinine ratios at 1 and 3 h after the onset of symptomatic hypoglycemia were 170 +/- 103 and 62 +/- 23, respectively. These were significantly greater (P less than 0.01) than the basal ratio of 13 +/- 7. By 5 h, the ratio had fallen to 19 +/- 11, which was similar to basal values. The study documents the sensitivity of the urine cortisol/creatinine ratio in detecting hypoglycemia but indicates that after 3 h, the ratio may return to normal despite a previous hypoglycemic episode.

Creatinine↗