A 59-year-old woman with metastatic breast carcinoma presented with weight loss, vomiting, and polyuria. Basal endocrine testing revealed low levels of thyroxine, cortisol, and gonadotropins, and the presence of diabetes insipidus. Direct stimulation of the pituitary with hypophysiotropic hormones indicated intact pituitary reserve. Insulin-induced hypoglycemia, however, failed to increase plasma cortisol or growth hormone levels significantly. On computed tomographic scanning, a lesion was found in the area of the hypothalamus. Thus, a functional abnormality of the hypothalamic-pituitary axis causing clinically significant hypothalamic hypopituitarism was not clearly apparent following administration of hypothalamic releasing factors but was demonstrable with indirect stimulation via insulin-induced hypoglycemia. Insulin-induced hypoglycemia remains an important diagnostic test in the evaluation of hypopituitarism.

Female↗

PubMed1986

Electrocardiographic abnormalities in diabetes mellitus: association between T-wave changes and nephropathy.

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Adult↗

PubMed1984

Development of diabetic complications despite the absence of growth hormone in a patient with post-pancreatectomy diabetes.

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Adult↗

PubMed1984

Elevated hemoglobin A1c and low-density lipoprotein cholesterol levels in thiazide-treated diabetic patients.

Despite the well-known hyperglycemic effect of thiazide diuretics, these agents are often administered to diabetic patients. This study compared 89 insulin-treated diabetic patients receiving hydrochlorothiazide, 57 receiving furosemide, and 255 receiving no diuretic. Hemoglobin A1c level was 7.2 +/- 1.8 percent (mean +/- SD) with hydrochlorothiazide, significantly higher than the levels of 5.9 +/- 2.3 percent with furosemide and 6.4 +/- 2.0 percent with no diuretic. Low-density lipoprotein cholesterol level was 154 +/- 43 mg/dl with hydrochlorothiazide, but 134 +/- 42 mg/dl with furosemide and 130 +/- 42 mg/dl with no diuretic. Multivariate analysis showed that the associations remained significant after adjustment for age, sex, race, type and duration of diabetes, body mass index, blood pressure, serum potassium level, insulin dose, and treatment with other medications. These findings suggest that treatment with thiazide diuretics in the diabetic population may increase low-density lipoprotein cholesterol and hemoglobin A1c levels.

Cholesterol↗

PubMed1983

Histamine release from a gastric carcinoid: provocation by pentagastrin and inhibition by somatostatin.

We have previously reported that flushing associated with a gastric carcinoid tumor can be provoked by pentagastrin and inhibited by either somatostatin or combined histamine H1- and H2-receptor blockade. In this report, the effects of pentagastrin and somatostatin on histamine release in a patient with a metastatic gastric carcinoid tumor were examined. Small doses of intravenous pentagastrin (0.1-0.4 micrograms) produced a dose-dependent increase in the level of circulating plasma histamine. Graded infusions of somatostatin suppressed both basal and pentagastrin-stimulated plasma histamine levels in a dose-dependent fashion. A close correlation was found between circulating plasma histamine levels and attendant changes in blood pressure and pulse rate. This study documents that pentagastrin directly evokes the release of histamine from this patient's gastric carcinoid tumor and that the release of histamine is inhibited by somatostatin. In addition, this study provides additional evidence that the primary mediator of the flushing in this patient with foregut carcinoid syndrome is histamine.

Blood Pressure↗

PubMed1981

Amino acid disposition by liver and gastrointestinal tract after protein and glucose ingestion.

Hepatic uptake and gut and splanchnic output of amino acids were determined after administration of protein and glucose loads in conscious dogs with indwelling catheters in the femoral artery and portal and hepatic veins. Oral or parenteral glucose given with a beef meal blunted the rise in arterial amino acids relative to that seen with ingestion of beef alone. Gut amino acid output was considerably delayed with oral hypertonic glucose, but was unchanged with parenteral glucose and with oral isotonic glucose. Ingestion of beef with oral hypertonic mannitol, a nonabsorbable sugar alcohol, delayed the rise in gut amino acid output in a manner similar to that seen with beef plus oral hypertonic glucose. We have evaluated the relationship between circulating amino acids, circulating hormone concentrations, and amino acid metabolism. Significant correlations with hepatic amino acid uptake were found for insulin, for arterial and portal amino acid levels, and for gut amino acid output. Partial correlation analysis suggests that gut amino acid output is the major determinant of hepatic amino acid uptake.

Amino Acids↗