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Orphan nuclear receptors: shifting endocrinology into reverse.

Steroid and thyroid hormones and vitamin A metabolites (retinoids) regulate the expression of complex gene programs by binding to members of the nuclear receptor family of ligand-activated transcription factors. The nuclear receptor family also includes many "orphan" members that currently lack known ligands but that represent candidate receptors for new hormones. Recently, natural and synthetic ligands have been identified for several orphan receptors and used to dissect their biological roles. This "reverse endocrinology" strategy has resulted in the discovery of unanticipated nuclear signaling pathways for retinoids, fatty acids, eicosanoids, and steroids with important physiological and pharmacological ramifications.

Animals↗

Advances in endocrinology.

Molecular genetics will continue to help us to make precise diagnoses. At present, the expertise to achieve this for a specific disease is often exclusive to one unit with a research interest. It will be important to establish a coordinated approach at a supraregional level to provide molecular diagnosis for rare disorders as a fast reliable clinical service. In addition understanding the molecular mechanisms of disease is likely to direct a search for new treatments. For instance, calcium channel blockers have been used in nesidoblastosis to reduce the hypersecretion of insulin, as a result of the recognition of the role that calcium has in the function of the beta-cell ATP sensitive K+ channel. Although the potential benefits of hGH are now being clearly defined in a range of growth disorders, the treatment is invasive and expensive. It is likely that future endocrine therapeutic developments could include slow release growth hormone preparations, orally active growth hormone mimetics, or even hormone production from an ectopic viral cDNA vector. The next "advances in endocrinology" will also reveal whether leptin will have a therapeutic role in appetite control or even the modulation of pubertal development.

Endocrine System Diseases↗

Heat treatment for endocrinological investigations on plasma positive for human immunodeficiency virus (HIV).

The effects of heat treatment of serum samples on the hormone analyses used in this laboratory were studied. Total T4, testosterone, progesterone, and growth hormone were not systematically affected by heat treatment over the whole range of analyte concentrations studied; for thyroid stimulating hormone, no effect was noted on serum samples with concentrations of less than 10 mU/l. Significant changes occurred in total T3, cortisol, follicle stimulating hormone, luteinizing hormone, and prolactin. It is suggested that with appropriate preliminary study, heat treated plasma samples may be used in endocrinological investigations without adversely affecting the diagnostic validity of the results.

Acquired Immunodeficiency Syndrome↗

Unusual manifestations of craniofacial fibrous dysplasia: clinical, endocrinological and computed tomographic features.

Clinical, endocrinological and computed tomographic features of three patients with unusual manifestations or complications of craniofacial involvement of fibrous dysplasia are presented. One patient with polyostotic fibrous dysplasia presented in late pregnancy with acute onset of bilateral optic nerve compression and blindness secondary to a rapidly expanding mass of fibrous dysplasia tissue involving the sphenoid, pituitary and optic chiasm regions. A second patient with polyostotic fibrous dysplasia developed thyrotoxicosis and probable gigantism/acromegaly in keeping with a rare form of McCune-Albright syndrome. Extensive bony distortion of the skull and facial bones by fibrous dysplasia made clinical recognition of these complications more difficult. A third patient had monostotic fibrous dysplasia with marked sclerosis of the sphenoid bone on plain radiographs which mimicked appearances of a meningioma and resulted in a negative craniotomy as computed tomography was not yet available at the time of presentation. Each case demonstrated rare complications of craniofacial fibrous dysplasia and highlighted the wide spectrum of appearances in which it may manifest, often resulting in overlap and diagnostic confusion with other disease processes. The value of computed tomography in assessment is emphasized.

Adolescent↗

Endocrinological basis of acupuncture.

The widespread and lasting effect of acupuncture suggests the mediation of humoral factor(s). Controlled clinical and experimental investigations done by Chinese researchers during the past three decades lend support to this assumption. Electrophysiological and histochemical studies denote the involvement of hypothalamus and pituitary in acupuncture. Acupuncture causes the release of some of the anterior pituitary hormones, as assessed by bio-assay methods. Observations from physiological as well as morphological approach showed that acupuncture has significant influences upon thyroid, adrenal gland and gonads. Preliminary results also indicate that pancreatic islets and parathyroid gland are affected by acupuncture. However, much remains to be investigated concerning the endocrinological basis of acupuncture.

Acupuncture Therapy↗

Endocrinological effects of high-dose Hypericum perforatum extract WS 5570 in healthy subjects.

In this single-blind study, the effects of acute oral administration of high-dose Hypericum perforatum extract WS 5570 on the cortisol (COR), adrenocorticotropic hormone (ACTH), growth hormone (GH), and prolactin (PRL) secretions were examined in 12 healthy male volunteers. In a randomized order, the subjects received placebo or WS 5570 at several dosages (600, 900, and 1,200 mg) at 08.00 h on 4 different days. After insertion of an intravenous catheter, blood samples were drawn 1 h prior to administration of placebo or WS 5570 (600, 900, or 1,200 mg), at the time of administration, and during 5 h thereafter at intervals of 30 min. The serum concentrations of COR, GH, and PRL as well as the plasma levels of ACTH were determined in each blood sample by means of double antibody radioimmunoassay, fluoroimmunoassay, and chemiluminescence immunometric assay methods. The area under the curve value was used as parameter for COR, ACTH, GH, and PRL responses. Repeated-measures Anova revealed a significant stimulatory effect of WS 5570 on the ACTH secretion, whereas COR and PRL secretions were not significantly influenced. Moreover, there was a stimulatory peak of GH release 240 min after challenge with WS 5570 in some but not all volunteers, without reaching statistical significance in comparison with placebo. Mean arterial blood pressure and heart rate remained unchanged after administration of WS 5570. Apparently, WS 5570 at the dosages given in this study inconsistently causes endocrinological effects in healthy subjects by influencing central neurotransmitters.

Adrenocorticotropic Hormone↗

Bimodal shape of individual variation in behavior of Wistar rats: the overall outcome of a fundamentally different make-up and reactivity of the brain, the endocrinological and the immunological system.

An overview of the most important features of the two distinct types of individuals which normally co-occur in an unselected population of Wistar rats is given. It reveals that the overall make-up and reactivity of the brain, as well as the endocrinological and immunological systems differ completely between the two types of individuals. Each of these types of individuals has its own individual-specific hardware and software to cope with challenges from the internal or external environment, requires its own optimal niche, and is vulnerable for its own set of stressors.

Animals↗

Pineal region tumors: endocrinological aspects.

The pineal gland and the superior cervical ganglia represent an integration center for hormonal and neural signals, and play an important role in modulating basic hormonal secretions. The prevalence of pineal tumors in the male sex and their frequent association with precocious puberty has been known for a long time. However, the rarity of ascertained cases investigated by means of direct and sensitive methods (RIA; tests applying hypothalamic releasing factors) is still preventing the proper knowledge of the endocrinological aspects of pinealomas. On the basis of the recent literature, the importance of diabetes insipidus as a very early symptom of pineal region tumors should be emphasized; in some cases, it preceded the appearance of precocious puberty of neuro-ophthalmologic signs by some years. A variable pattern of anterior pituitary impairment is also a rather common finding. In rare cases (males, with few exceptions), the precocious puberty may be explained by the presence in the pineal tumor of trophoblastic tissue secreting hCG; some of these tumors produce also alpha-fetoprotein (evidence of a yolk-sac tumor).

Adolescent↗

Suprasellar tuberculoma causing endocrinologic disorders and imitating craniopharyngioma.

A patient is reported with a suprasellar tuberculoma which imitated a craniopharyngioma on computed tomography scan and magnetic resonance imaging of the brain. This lesion developed during irregularly used antituberculous therapy and caused endocrinologic disorders 3 years after the original diagnosis of tuberculous meningitis. Surgery was performed to confirm the diagnosis and also to decompress the optic pathways. Five months later, the lesion disappeared completely after appropriate antituberculous treatment.

Antitubercular Agents↗

Endocrinological meaning of hyperandrogenism in patients with polycystic ovary.

In the light of excessive ovarian androgen hormone production in cases of polycystic ovarian disease (PCO), we have made an endocrinological, symptomatological and morphological study of PCO in women with high serum testosterone levels. The following results were obtained: (1) High serum testosterone levels were found in 18.1% of the infertile women. (2) Morphologically, 44.4% of these women had PCO (the PCO group), and 55.6% did not have PCO (non-PCO group). (3) No significant differences between these groups were found in mean testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), estrone (E1), 17 beta-estradiol (E2) levels, or the E1/E2 ratio, but the LH/FSH ratio was significantly higher in the PCO group. (4) The incidence of menstrual irregularities and hirsutism were significantly higher in the PCO group, but the incidence of obesity did not differ between the groups. (5) No correlation between testosterone and LH or E1 levels was found in the PCO group, but strong positive correlations were found in the non-PCO group. From the above findings it is suggested that in women with high peripheral blood testosterone levels, the presence of morphological abnormalities on the ovaries has effects on gonadotropin production and therefore on the incidence of menstrual irregularities and hirsutism.

Adult↗

Leydig cell tumor of the testis. Morphological and endocrinological investigations in two cases.

Clinical, morphological and endocrine characteristics of 2 patients with Leydig cell tumours (1 benign unilateral and 1 malignant bilateral) are reported. The morphological investigation revealed that the neoplastic cells had the same ultrastructural characteristics as normal Leydig cells. The only ultrastructural difference was the presence of 'membranous whorls' that have never been found in normal human Leydig cells. The patient with benign unilateral Leydig cell tumour appeared to produce no excess of steroid hormones, but rather a substance of FSH-inhibiting activity. The second patient, with the malignant bilateral tumours however, besides producing large amounts of testosterone, oestradiol-17 beta and progesterone, showed typical signs of an ectopic ACTH syndrome. The endocrinological and morphological features are discussed.

Adult↗

Thyrotropin-releasing hormone: differential antidepressant and endocrinological effects.

In a double-blind study, three depressed subjects received thyrotropin-releasing hormone (TRH) on three successive days, and one subject similarly received placebo; all subjects were then given ECT. Two of the patients given TRH responded to ECT. One patient's reaction is of special significance because of her response to ECT, diminished thyroid-stimulating hormone response to TRH, increased growth hormone and prolactin response to stress, and antidepressant effect of TRH. These findings raise the possibility that previous conflicting reports about TRH's antidepressant effects stem from the combined study of endocrinologically distinct depressive subgroups and strongly suggest that there may be a specific subgroup that is responsive to TRH.

Adult↗

Activins, inhibins, and follistatins: from endocrinology to signaling. A paradigm for the new millennium.

It has been 70 years since the name inhibin was used to describe a gonadal factor that negatively regulated pituitary hormone secretion. The majority of this period was required to achieve purification and definitive characterization of inhibin, an event closely followed by identification and characterization of activin and follistatin (FS). In contrast, the last 15-20 years saw a virtual explosion of information regarding the biochemistry, physiology, and biosynthesis of these proteins, as well as identification of activin receptors, and a unique mechanism for FS action-the nearly irreversible binding and neutralization of activin. Many of these discoveries have been previously summarized; therefore, this review will cover the period from the mid 1990s to present, with particular emphasis on emerging themes and recent advances. As the field has matured, recent efforts have focused more on human studies, so the endocrinology of inhibin, activin, and FS in the human is summarized first. Another area receiving significant recent attention is local actions of activin and its regulation by both FS and inhibin. Because activin and FS are produced in many tissues, we chose to focus on a few particular examples with the most extensive experimental support, the pituitary and the developing follicle, although nonreproductive actions of activin and FS are also discussed. At the cellular level, it now seems that activin acts largely as an autocrine and/or paracrine growth factor, similar to other members of the transforming growh factor beta superfamily. As we discuss in the next section, its actions are regulated extracellularly by both inhibin and FS. In the final section, intracellular mediators and modulators of activin signaling are reviewed in detail. Many of these are shared with other transforming growh factor beta superfamily members as well as unrelated molecules, and in a number of cases, their physiological relevance to activin signal propagation remains to be elucidated. Nevertheless, taken together, recent findings suggest that it may be more appropriate to consider a new paradigm for inhibin, activin, and FS in which activin signaling is regulated extracellularly by both inhibin and FS whereas a number of intracellular proteins act to modulate cellular responses to these activin signals. It is therefore the balance between activin and all of its modulators, rather than the actions of any one component, that determines the final biological outcome. As technology and model systems become more sophisticated in the next few years, it should become possible to test this concept directly to more clearly define the role of activin, inhibin, and FS in reproductive physiology.

Activins↗

Endocrinological disturbances in chronic obstructive pulmonary disease.

In this overview, the available literature on endocrinological disturbances in chronic obstructive pulmonary disease (COPD) is reviewed, with stress on growth hormone/insulin-like growth factor I (IGF-I), thyroid hormone and the anabolic steroids. In COPD, little is known about circulating growth hormone or IGF-I concentrations. Some authors find a decrease in growth hormone or IGF-I, others an increase. An increase of growth hormone might reflect a nonspecific response of the body to stress (for instance, hypoxaemia). Until now, only one controlled study on growth hormone supplementation has been published, which however did not reveal any functional benefits. Before growth hormone supplementation can be advised as part of the treatment in COPD, further controlled studies must be performed to investigate its functional efficacy. The prevalence of thyroid dysfunction in COPD and its role in pulmonary cachexia has not been extensively studied. So far, there is no evidence that thyroid function is consistently altered in COPD, except perhaps in a subgroup of patients with severe hypoxaemia. Further research is required to more extensively study the underlying mechanisms and consequences of disturbed thyroid function in this subgroup of COPD patients. A few studies have reported the results of anabolic steroid supplementation in chronic obstructive pulmonary disease. Although some studies have discerned that low circulating levels of testosterone are common in males with chronic obstructive pulmonary disease, little is known about the prevalence, the underlying causes or functional consequences of hypogonadism in these patients. The use of systemic glucocorticosteroids and an influence of the systemic inflammatory response have been suggested as contributing to low testosterone levels. It can be hypothesised that low anabolic hormones will reduce muscle mass and eventually result in a diminished muscle function. Further evidence is required before testosterone replacement can be recommended for males with chronic obstructive pulmonary disease.

Anabolic Agents↗

Haemodynamic and endocrinological effects of noninvasive mechanical ventilation in respiratory failure.

The aim of this study was to investigate the haemodynamic and endocrinological effects of noninvasive positive pressure ventilation (NIPPV). Eleven patients with oedema and recent hypercapnic and hypoxaemic worsening of a chronic respiratory insufficiency were included. Echocardiography, cardiac radionuclide assessment, blood catecholamines, salt and water handling hormones were measured at admission and discharge (long study (LS)). To discriminate between the action of NIPPV and other treatments, measurements were performed on the fourth day, for 4 h without NIPPV and 4 h with NIPPV (short study (SS)). NIPPV entailed a correction of P(a,CO2) and an increase of P(a,O2) in LS and SS. Oedema disappeared. Body weight decreased (from 85+/-42 to 81+/-40 kg) during LS. Systolic and mean pulmonary arterial pressure decreased in LS and SS. Right ventricular ejection fraction increased in LS. Left ventricular ejection fraction did not change. Cardiac index was normal on admission and then decreased. Natriuretic peptides and catecholamines were increased on admission, whereas plasma renin activity, aldosterone and vasopressin were normal. We suggest that in these patients, oedema can occur independently of renin-angiotensin-aldosterone-vasopressin and with a normal cardiac output. Noninvasive positive pressure ventilation allowed a correction of blood gases, associated with the resolution of oedema, a decrease in pulmonary arterial pressures and an increase in right ventricular ejection fraction.

Atrial Natriuretic Factor↗

Introducing a new section to Breast Cancer Research: endocrinology and hormone therapy.

Endocrine therapy is increasingly understood as the conceptual basis for the future treatment and prevention of breast cancer. Endocrine agents have considerably changed the approach to targeted treatment during the past two decades, and select endocrine agents have advanced the goal of preventing breast cancer. Progress has occurred because of a vigorous interaction between laboratory scientists and the clinical trials community. Breast Cancer Research is launching a new section on endocrinology and hormone therapy in order to invigorate this exchange and challenge our readers with novel concepts that might result in enhanced survival in breast cancer.

Antineoplastic Agents, Hormonal↗

Endocrinology of the carbohydrate-deficient glycoprotein syndrome type 1 from birth through adolescence.

The carbohydrate-deficient glycoprotein (CDG) syndrome type 1 is a genetic multisystem disorder, characterized by hypoglycosylation of glycoproteins and presenting with neurologic impairment. In 12 girls and 14 boys, we confirmed the diagnosis of CDG syndrome type 1 by immune-isoelectric focusing of serum sialotransferrins, and we examined the endocrine status singly or sequentially, including a 16-y follow-up of the index cases, a pair of monozygotic girls. Serum FSH levels were normal in newborns and prepubertal children, but elevated in female toddlers and teenagers, as well as in adolescent males. Serum LH concentrations displayed an analogous age-dependent pattern. In adolescent girls, serum estradiol remained low. FSH bioactivity was low normal, as was the bioactive/immunoreactive FSH ratio. However, exogenous gonadotropins evoked an estradiol response and induced ovarian follicular growth. Male patients virilized at puberty; however, testicular volume was subnormal. The thyroid axis was hallmarked by thyroid-binding globin deficiency and, during infancy, increased serum TSH concentrations. A subgroup of female patients presented hypersomatotropism and/or hyperprolactinemia. During adolescence, the index cases responded to glucagon with normal glycemic, but exaggerated insulin and paradoxically augmented growth hormone responses. The hypothalamo-pituitary area appeared intact on magnetic resonance imaging. Circulating IGF-1 levels were in the lower normal range and transcortin concentrations decreased. In conclusion, a study of endocrine aspects of a major glycosylation disorder revealed an age-dependent constellation, including hypergonadotropic hypogonadism with deficient FSH rather than LH action; transient hyperthyrotropinemia; inconsistent hyperprolactinemia; hyperglycemia-induced growth hormone release; deficiencies of hormone-binding glycoproteins and possibly decreased insulin sensitivity, thus pointing to the importance of glycoprotein glycosylation for pediatric endocrinology.

Adolescent↗