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An adult case of adrenoleukodystrophy with features of olivo-ponto-cerebellar atrophy: I. Clinical and pathological studies.

A male patient was suspected as olivo-ponto-cerebellar atrophy from the clinical and computed tomographic features at 34 years of age. Afterwards, his dysarthria and limb ataxia were slowly and steadily worsened. He was finally bed-ridden and unresponsive, and died of hyperpyrexia and general wasting at 37 years of age. It was noted that laboratory investigation gave lower values of urinary 17-ketosteroids and 17-hydroxycorticosteroids in comparison with those of normal subjects. Pathological investigation in autopsy showed that he had pathological features consistent with adrenoleukodystrophy accompanying the olivo-ponto-cerebellar atrophy; diffuse demyelination in the cerebrocerebellear white matter, distorted architecture and cytoplasmic striations in the adrenal cortex, and in addition, a pseudosystemic degeneration of the olivo-ponto-cerebellar system and subcortical gray matter.

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6 beta-hydroxycortisol in serum and urine as determined by enzyme immunoassay on microtitre plates.

We modified our previous enzyme immunoassay (Clin Chim Acta 1986;157:267-76) for estimating 6 beta-hydroxycortisol (6 beta-OHF) to provide a more routine procedure for measuring it in urine and to increase sensitivity for its measurement in serum. Precision, analytical recovery, specificity, and detection limit are reported. 6 beta-OHF and 17-hydroxycorticosteroids in 24-h and 4-h (08:00-12:00 h) urine collections from healthy volunteers showed no significant day-to-day differences in excretion rate for either collection period. Mean values for 6 beta-OHF in serum of men, women, and women taking oral contraceptives showed no significant differences among these groups.

17-Hydroxycorticosteroids↗

[Influence of the migration of Ascaris suum larvae on blood parameters in the pig].

Biochemical and hematological blood parameters were investigated in pigs experimentally infected with Ascaris suum. The most marked changes were recorded on day 5-8 post inoculation, during fever. In this period there was a marked decrease of concentrations of albumin, iron, thyroxin, A and E vitamins in blood serum, while compared with the control group the contents of A vitamin in liver did not change. Further, the concentrations of nonesterified fatty acid increased, as well as those of inorganic phosphorus and 11-hydroxycorticosteroids. Till day 13 PI the decrease of albumin and iron concentrations intensified and a recession of cholesterol serum binding capacity for iron was also recorded. Our results suggest that the acute phase of pig ascariasis is accompanied by changes in the host metabolism, generally corresponding to findings in fever states of different aetiology.

11-Hydroxycorticosteroids↗

[Changes in collagen metabolism during the chronic electrical stimulation of the midbrain reticular formation].

The content of 11-hydroxycorticosteroids, free and bound hydroxyproline in the peripheral blood, as well as the level of free and net hydroxyproline in the aortic wall and myocardium of rabbits were studied in chronic prolonged electrical stimulation of the mesencephalon reticular system. The experiments have shown that electrical stimulation leads to the activation of adrenal cortex function and is accompanied by alterations in collagen metabolism, accumulation of collagen in the aorta and decreased collagen level in the myocardium.

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Excretion of 3-methylhistidine in nonobese fasting subjects.

The metabolic response to different periods of fasting, ranging from 3 to 7 days, was studied in eight nonobese subjects. Blood ketones rose progressively to 5.07 nmol/l with the prolongation of the fast. The concentrations of glucose and alanine decreased significantly. Valine and leucine rose during fasting but the rise was not statistically significant. Serum triiodothyronine (T3) and insulin decreased, while the urinary excretion of 17-hydroxycorticosteroids (OHCS) doubled. Urea nitrogen decreased in those who fasted 5 to 7 days. Total urinary nitrogen excretion did not change significantly. Excretion of 3-methylhistidine (3-MH) rose during fasting and in some subjects more than doubled when compared with the fed state. The discrepancy between the loss of body protein (calculated by comparing excretion of urinary nitrogen) and the loss of muscle protein (calculated from the excretion of 3-MH) suggests a high rate of recycling of nitrogen during fasting in our subjects.

17-Hydroxycorticosteroids↗

[Characteristics of dyslipidemia in cancer patients].

Blood concentrations of total cholesterol, cholesterol of very high density lipoproteins (alpha-cholesterol), triglycerides, beta-lipoproteins and 11-hydroxycorticosteroids were studied in 560 patients with rectal, colon, lung, ovarian, breast and endometrial cancer as well as in 238 controls. Patients with breast and rectal cancer were examined before and repeatedly after operation (every 6-12 months within 4-5 years). The blood concentration of total cholesterol was found to be elevated in breast cancer patients and controls with fibroadenomatosis and decreased in females with ovarian cancer and males with lung cancer. The level of blood alpha-cholesterol was decreased in males with all tumor localizations under study and in females with ovarian and rectal cancer. The concentration of triglycerides was increased in women patients only. Three possible causes of dyslipidemia in cancer patients are discussed: its development before tumor manifestation, the effect of tumor on the metabolic status of the host and the role of emotional stress in the increase of triglycerides level in the blood of primary cancer patients.

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[Study of protein synthesis regulating hormones in human milk].

A study was made of the content in human milk of hormones which regulate together with their specific function processes of protein assimilation and synthesis. These hormones (thyroxine, triiodothyronine, 17 beta-estradiol, prolactin, 11-hydroxycorticosteroids) were determined in the first days of lactation, in the most important period in the nutrition of a newborn and in the formation of lactation. Chromatography, radioimmunoassay and fluorometry were used. The aim of the study was to determine the levels of exogenous hormones which influence the metabolism of proteins received by a newborn. During the first 10 days of lactation the content of prolactin in human milk was 154.5-546.0 muunits/ml, that of 17 beta-estradiol 34.2-124.4 pg/ml, that of thyroxine 0.5-1.1 micrograms%, that of triiodothyronine 8.6-20.8 ng%. A possible involvement of milk hormones in the regulation of anabolic processes of a newborn as well as changes in the first 3-6 days of lactation of the prolactin and 17 beta-estradiol content in milk in connection with the regulation of the start of lactation are discussed.

11-Hydroxycorticosteroids↗

[Hormonal regulation of anabolic processes and of protein utilization efficiency in the early postnatal period].

The levels of thyroid, pituitary and steroid hormones-thyroxine, triiodothyronine and 11-hydroxycorticosteroids in the blood serum, somatotropin in the pituitary, and processes of protein assimilation were studied in rats in the early postnatal period. The highest endogenous production of thyroxine, triiodothyronine and somatotropin was detected in 15-day-old rats. The highest level of protein utilization was detected in 7 to 15-day-old rats, followed by the lowering of the utilization on changing over to definitive nutrition. Endogenous production of the anabolic hormones thyroxine, triiodothyronine and somatotropin was found to correlate with a high level of protein utilization in rats within the first days of life after birth.

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The effect of indomethacin on the biochemical response to fracture stress in rats.

After acclimatization to metabolic cages, groups of male Wistar rats were pretreated for 48 h with parenteral indomethacin to observe its effect on the biochemical response to femoral fracture stress. This trauma induced an average 2.3-fold rise in fibrinogen levels in all animals, which was maximal 24 h after injury. Indomethacin pretreatment caused a dose-related decrease in the plasma fibrinogen response 24 h after fracture: 1, 2, 10 or 20 mg/kg/day of drug reduced the response by approximately 3, 10, 13 and 23%. Fibrinogen levels in rats treated with high doses (10 and 20 mg/kg) of drug began to rise before fracture owing to intestinal ulceration. Plasma 11-hydroxycorticosteroids and urine total catecholamine levels did not respond to either indomethacin treatment or to fracture but levels of both compounds rose gradually during the experiment. Indomethacin is an inhibitor of prostaglandin synthesis and prostglandins may therefore be involved in the metabolic response to stress.

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[Biochemical indices of the healthy human being in a hermetic chamber with periodically ionized air].

The content of 11-hydroxycorticosteroids, triglycerides and enzyme activity in blood as well as the content of 17-ketosteroids in urine of normal men kept for 16 days in an enclosure ventilated for 24--60 hours with bipolar ionized air (averaged unipolarity factor 1.58, concentration of positive ions 26--35 thous. cm-(3)) were measured. On DD 7--9 concentrations of 11-HOCS, triglycerides and 17-KS increased. This can be attributed to an activation of the hypophyseal-adrenal system in response to the enclosure effect. Further rapid return of the parameters to the normal may be associated with the cumulative effect of air ionization. This ionization at the doses used did not influence activities of creatine phosphokinase, aspartate aminotransferase and alphahydroxybutyrate dehydrogenase.

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[Correction of hypophyseal-adrenal system function in esophageal and stomach cancer patients undergoing combined and surgical treatments].

The paper presents the data on marked dysfunction of hypothalamo-pituitary-adrenal system in patients with esophageal and gastric cancer. Patients revealed lowered levels of 11-hydroxycorticosteroids in blood plasma and 17-corticosteroids and 17-glucocorticosteroids in diurnal urine. It was matched by an elevated threshold of hypothalamic sensitivity to inhibition by glucocorticosteroids. Treatment for these disturbances which brought the function of this system to normal had a beneficial effect on the secretion and excretion of corticosteroids in the course of combined therapy and surgery and was followed by a significant decrease in hemodynamic complication incidence. The favorable clinical effect was in correlation with the decrease in hypothalamic resistance to the inhibitory effect of glucocorticoids.

11-Hydroxycorticosteroids↗

Improved single-dose metyrapone test.

One dose of metyrapone (1.5 g) administered at 6 AM, with subsequent measurement of plasma ACTH, 11-deoxycortisol, or 17-hydroxycorticosteroids (17-OHCS) (cortisol + 11-deoxycortisol) at noon and 2 PM allowed an accurate assessment of the pituitary-adrenal reserve. Eighteen subjects with a normal pituitary-adrenal reserve were studied before and after the administration of this single metyrapone dose. By noon, plasma ACTH rose from a premedication value of 39 +/- 22 (SD) to 193 +/- 104 pg/ml and 11-deoxycortisol, from 0.0 +/- 0.3 (SD) to 9.0 +/- 2.7 microgram/dl. By 2 PM, plasma 17-OHCS had increased from a premedication value of 5.0 +/- 1.5 (SD) to 16.0 +/- 1.8 microgram/dl. The differences between pre- and postmedication values were statistically significant for all indices measured (P less than 0.001). No overlap was found between values before and after metyrapone. This protocol eliminates the need for metyrapone administration every 4 h over a 24-h period. It offers the advantage of low dose and low toxicity. The integrity of the pituitary-adrenal axis can be demonstrated by measuring either plasma ACTH and 11-deoxycortisol or even 17-OHCS 6 to 8 h after the administration of this single metyrapone dose.

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Some genetical aspects on pituitary-adrenal response to stress in mice.

The response of pituitary-adrenal axis (as measured by the estimation of 11-hydroxycorticosteroid level in plasma of decapitated animals) to various kinds of stress (restriction, cold, formalin injection) was studied in eight inbred strains of mice and compared to that found after the injection of epinephrine, isopropyl-norepinephrine or ACTH. It was found that the response to all of the above mentioned influences appears to be genetically determined. A positive correlation was observed between the basal level of corticosteroids in plasma and the effect of adrenomimetics on one hand and the response to cold and restriction on the other, while no correlation was found between the former parameter and the effect of ACTH and formalin injection. It may be concluded that genetically conditioned control and regulatory mechanisms appear to be the most important factor in the response of pituitary-adrenal axis to the emotional and cold stress, while the reactivity of adrenal cortex itself as measured by the effect of ACTH injection appears to be of a minor importance.

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[State of the pituitary-adrenal system of cosmonauts after orbital flights of different duration].

In order to assess the hypophyseal-adrenal system and glucocorticoid activity, excretion of total 17-hydroxycorticosteroids (17-HOCS) was measured before and at R + 1 day after a standard water load (20 ml/kg). Twenty-six cosmonauts were examined after flights of 2--140 days. Although the cosmonauts spent different time in weightlessness, the content and rate of glucocorticoid excretion in the urine during postflight water loads was 1.5--2 times higher than during preflight loads. This increased excretion of 17-HOCS was associated with their decreased reabsorption and/or increased glomerular secretion. The latter may be a manifestation of extrarenal action of ACTH due to its hyperproduction immediately postflight.

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Isolated ACTH deficiency: a heterogeneous disorder. Critical review and report of four new cases.

Isolated adrenocorticotropin (ACTH) deficiency is a rare cause of secondary adrenocortical insufficiency. This review summarizes the clinical and laboratory features of 39 previously reported cases plus 4 new patients. The clinical manifestations of isolated ACTH deficiency are variable, nonspecific and similar to those seen in adrenocortical insufficiency of any cause. The diagnosis of isolated ACTH deficiency due to intrinsic pituitary disease is made unequivocally when all the following criteria are met: 1) low basal urinary 17-hydroxycorticosteroid (17-OHCS) levels with or without low basal plasma cortisol, 2) low or normal basal plasma ACTH, 3) stimulation of cortisol, 17-OHCS or both during prolonged ACTH administration, 4) lack of 17-OHCS elevation in response to metyrapone and 5) normal secretory indices of other pituitary hormones. Isolated ACTH deficiency secondary to suprapituitary (e.g., hypothalamic) dysfunction is also based upon the above criteria, but, in addition, is associated with stimulation of cortisol and ACTH secretion following vasopressin administration.

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[Endocrine and metabolic mechanisms of the pathological syndrome due to antigens of homologous glial tissue in monkeys].

Monkeys (Macaca mulatta) of both sexes repeatedly immunized with a complex of glial antigens of the homologous brain demonstrated abnormalities of hormonal functions after 1 to 5 weeks. These abnormalities were marked by a decrease in the total serum tyroxine (after 1 week) and a rise in the concentration of 11-hydroxycorticosteroids (11-OHCS) that occurred after 5 weeks. The changes in tyroxine level were more stable than those in the concentration of 11-OHCS. The immunized animals manifested changes in the disc electrophoregram of the serum. Application of stress resulted in a consistent elevation of the concentration of 11-OHCS and in temporary changes in the number and intensity of individual fractions of serum proteins. The fractional composition of serum proteins was different in control and experimental monkeys.

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[Relation of the prolongation of life of radically operated lung cancer patients to the state of steroid balance].

An analysis of the rates of steroid hormone excretion and survival time in patients who had undergone radical surgery for lung cancer showed that the said rates may be used as a prognostic variable. Excretion rates of total 17-hydroxycorticosteroids and hydrocortisone proved to be of the highest prognostic value in patients aged 41-50, while in an older age bracket the best results were obtained with androsterone and estrone level measurements.

17-Hydroxycorticosteroids↗

[Enzyme activity of thiamine pyrophosphate in the rat after oxythiamine administration].

Intraperitoneal injection of hydroxythiamine to rats (1 mmol per kg bw) resulted after 2-4 h in a more than 4-fold decrease in the activity of the oxoglutarate dehydrogenase complex, pyruvate dehydrogenase complex and NADP-dependent isocitrate dehydrogenase in adrenal mitochondria. Inhibition of hyaloplasmic transketolase, 6-phosphogluconate dehydrogenase and NADP-dependent malate dehydrogenase occurred later. Based on the correlation of the time course of enzymatic activity in the adrenals and the decreased concentration of 11-hydroxycorticosteroids in the blood the paramount role in the maintenance of the steroidogenesis among thiamine pyrophosphate-containing enzymes is assigned to the oxoglutarate dehydrogenase and pyruvate dehydrogenase complexes.

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