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PubMed1976

[An unusual hormone-active avarian tumor in a 3-year-old girl].

A case report on an unusual hormone producing ovarian tumor in a 3 year old girl with sexual precocity is given. The serum values of Estradiol and Progesterone were similar to those of mature women during the luteal phase. The LH values were normal, the 17-Ketosteroids and 17-Hydroxycorticosteroids were near the upper limit of the normal range. At laparotomy a smooth, encapsulated tumor of the left ovary, 12 cm in diameter, was removed by unilateral salpingo-oophorectomy. Hormone analyses of the blood of the ovarian vein as well as of necrotic parts of the tumor showed values of 3450 and 2750 pg/ml Estradiol, and 70 000 and 75 000 pg/ml Progesterone respectively. Histiologically the tumor cells were growing in nests and broad columns, showing bizarre nuclei, abundant pathologic mitoses and patchy calcification. In places the tumor cells were forming follicle-like structures. Both the fat stain and the glycogen stain were positive. Histochemically the tumor showed a strong activity of 3beta-ol-Steroiddehydrogenase. Postoperatively the signs of sexual precocity disappeared soon. The patient is now without complaints for 3 years. The diagnosis of a juvenile granulosa cell tumor (Scully) was given. The endocrine relations between sexual steroids and gonadotropin before and after surgery are discussed.

Child, Preschool↗
PubMedDate not supplied

Secretory function of adrenal cortex in chronic alcoholis.

Three groups of male subjects (healthy subjects, chronic alcoholics with liver cirrhosis and patients with acute viral hepatitis) were included in a 24 hour pattern of excretion of the total and some fractions of 17-ketosteroids (KS), basal concentration of 11-hydroxycorticosteroids (11-OHCS) and dehydroepiandrosterone (DHEA) in plasma, as well as changes of concentration of the same steroids in plasma 15, 30 and 60 minutes after a single i.m. injection of insulin. In regard to healthy subjects and patients with acute viral hepatitis, chronic alcoholics with liver cirrhosis excrete decreased quantities of total and some fractions of 17-KS. In regard to healthy subjects, decreased excretion of the sum androsterone and etiocholanole was established as well as increased DHEA secretion in patients with acute viral hepatitis. In chronic alcoholics with liver cirrhosis basal concentrations of 11-OHCS in plasma and their increase after insulin administration are the same as in healthy subjects, but values of DHEA concentrations in plasma are decreased. It has been pointed to the possibility of damages of the secretory function of adrenal cortex in chronic alcoholics with liver cirrhosis. On the basis of above mentioned results, there is an assumption that adrenal gland primarily provides normal secretion of C21 steroid and thus, satisfying needs for these steroids, increases secretion of DHEA. Follow up of DHEA urinary secretion may provide insight into basal activity of adrenal cortex, whereas the functional state of the liver must be taken into account when interpreting the results.

Acute Disease↗
PubMedDate not supplied

The psychological and physiological effects of an intensive-care unit environment on healthy individuals.

OBJECTIVE: The ideal inpatient environment would be one in which patient stress and anxiety are alleviated, but current inpatient hospital settings often do not seem to take this fact into consideration. To date, the effects of the actual hospital environment itself on patients is poorly understood. The purpose of the present study was to investigate the types of psychological and physiological changes that people undergo in response to being placed in an inpatient setting. DESIGN AND SETTING: Ten healthy volunteers were admitted to an intensive-care unit (ICU) for 4 days and 3 nights. The psychological and physiological changes before and after admission were examined. A qualitative assessment was also performed. RESULTS: Most healthy individuals at times develop feelings of depression, which can be measured by the Profile of Mood States and the Zung Self-Rating Depression Scale (P < .05). In this study, participants' fatigue and confusion increased (P < .05) and vigor decreased (P < .01) as measured by the Profile of Mood States. There was also an increase in the General Health Questionnaire scores (P < .01). However, no significant physiological effects were apparent, as measured by peripheral lymphocyte counts, natural killer cells activity, and urinary 17-kerosteroid and 17-hydroxycorticosteroid levels. Subjects often engaged in introspection during hospitalization and often had a negative attitude towards the hospital environment. CONCLUSIONS: The findings of increased feelings of depression attributable solely to being in an ICU setting are inconsistent with the type of environment generally considered necessary to alleviate patient anxiety and tension in a critical-care-ward environment. The negative perception of this environment strongly suggests room for improvement. Efforts in this regard should focus on improving the five senses, particularly sight, sound, and taste within the ICU.

Critical Care↗
PubMedDate not supplied

Radiogrammetry at four bone sites in normal middle-aged women. their relation to each other, to calcium metabolism and to other biological variables.

In 167 women, ages 41 +/- 3.5 years, who constituted 80 per cent of nuns of this age group in the Omaha area, body dimensions and radiogrammetric indices were determined in (1) radius; (2) femoral shaft; (3) second metacarpal. Calcium, phosphorus and nitrogen balance were measured and calcium kinetics were calculated following oral and intravenous administration of two radioisotopes of calcium. The bone indices were significantly correlated to each other. The femoral diameter was correlated to all the kinetic variables, the radial to many, and the metacarpal to a few. All bone diameters were correlated to height, but only the femoral diameter to body weight. Femoral shaft diameter increased with time after the menopause, but was not correlated to age. There was no correlation between any bone variable and dietary calcium, absorbed calcium, or calcium balance. High dietary calcium was associated with lower bone resorption. There was no correlation between any bone variable and the urinary excretion of estrogens or 17 ketosteroids or 17 hydroxycorticosteroids. Although different bones of the skleton are qualitatively and quantitatively related, in survey work the femoral shaft should be included as a skeletal marker in addition to the second metacarpal. Femoral expansion occurs in women after the menopause. In normal women, dietary calcium is unrelated to skeletal indices.

Adult↗
PubMedDate not supplied

An unusual case of Cushing's syndrome due to ACTH-independent macronodular adrenal hyperplasia.

We report a case of Cushing's syndrome due to ACTH-independent macro-nodular adrenal hyperplasia (AIMAH). The patient, a 51-year-old man, had been suffering from poorly controlled arterial hypertension for the previous 6 years and he complained of progressive weight gain, gynecomastia and impotence. Physical examination revealed classic cushingoid features. Endocrine basal assessment showed increased urinary free cortisol (264-600 micrograms/24 hr). Urinary steroid profile showed an increase of total 17-hydroxycorticosteroids (17-OHCS: 23 mg/24 hr), with a threefold increase of tetrahydrocortisol (THF:9.66 mg/24 hr) and of tetrahydrocorticosterone (THB: 1.35 mg/24 hr). Tetrahydrodesossicortisol was only slightly elevated (THS:0.67 mg/24 hr) and tetrahydrodesossicorticosterone was at the inferior limit of the normal range (THDOC: 0.03 mg/24 hr). Total 17-ketosteroids were decreased (17-KS: 3 mg/24 hr). Plasma cortisol level was elevated and without circadian rhythm (26-29 micrograms/dl in the morning, 26-28 micrograms/dl at 24:00 h). DHEAs and free testosterone levels were significantly reduced (106 ng/dl and 3.9 pg/ml respectively). ACTH was undetectable and unresponsive to CRH. Both dexamethasone and octreotide failed to suppress plasma cortisol levels. Abdomen computed tomography scan demonstrated bilaterally enlarged multinodular adrenal glands. Cerebral magnetic resonance revealed no alteration of the pituitary gland. The patient underwent bilateral adrenalectomy. On macroscopic examination, adrenal glands were occupied by multiple yellow nodules and their compressive weight was 190 g, with left adrenal heavier than the right one (120 g and 70 g respectively). Histologically, nodular lesions were predominantly composed of large clear cells, with small foci of "hybrid" cells and adipose tissue metaplasia. Reticularis zone was atrophic. In the immediate post-operatory course pulmonary embolism occurred, despite prophylaxis with low molecular weight heparin. After having recovered from this complication, the patient showed progressive regression of cushingoid status. The findings of increased THF/THS and THB/THDOC ratios were in agreement with a relative hyperfunction of 11-beta-hydroxylase "in vivo", which might have contributed to the hypercortisolism, in addition to the marked increase of secernent adrenal mass.

Adrenal Gland Diseases↗
PubMed1992

Hypoinsulinemia in a patient with isolated ACTH deficiency.

We report on a patient with isolated ACTH deficiency accompanying deficient insulin response to glucose. The subject is a 59 year-old male. He was admitted to our hospital because of a hypoglycemic attack. Urinary excretion of 17-hydroxycorticosteroid (17-OHCS) and 17-ketosteroid (17-KS) was low. Plasma ACTH levels decreased and serum cortisol levels were undetectable. ACTH did not respond to CRF stimulation for three consecutive days. Antibodies to At-T 20 cells (anterior pituitary cell-derived cell line) were positive in the serum of this patient. Serum immunoreactive insulin (IRI) levels were not detected throughout the day. The urinary excretion of C-peptide decreased to 9.8 micrograms/day. IRI responses on 75 g oral glucose tolerance test (OGTT) were examined at one and two months after the start of cortisol supplementation. No remarkable IRI response was observed, although blood glucose levels were maintained within the normal range. Eight months after the start of cortisol supplementation, the insulin response to 75 g OGTT appeared. The present study suggests that the recovery from hypo-insulinemia may be delayed even after normalization of serum cortisol levels in ACTH deficiency. This may be possibly due to the salutary effects of cortisol in maintaining plasma insulin levels. The time lag may be due to other factors also.

Adrenocorticotropic Hormone↗
PubMed1992

Budesonide in grass pollen rhinitis.

To determine the relative efficacy, to compare the incidence of adverse experiences, and to assess the systemic glucocorticoid effect of nasal preparations of budesonide, 200 micrograms bid, and placebo, 50 adult patients with seasonal allergic rhinitis due to grass pollen were studied in a stratified, double-blind parallel group design. After a 2-week baseline period, budesonide nasal spray, 100 microgram per nostril twice a day, was compared with placebo nasal spray over a 4-week treatment period. Supplementary treatment with chlorpheniramine, 4-mg tablets, was permitted when necessary to control symptoms. Daily symptom and medication diaries were kept by the patients. Investigator assessments of symptoms and side effects were made at clinic visits at 2-week intervals. At baseline and again towards the end of the study, blood samples were drawn for the determination of plasma cortisol levels and 24-hour urine samples collected for the measurement of 17-hydroxycorticosteroid output. Of the 24 men and 26 women entering, 49 completed the study. Symptom scores for sneezing, stuffy nose, and nasal secretion all decreased dramatically from baseline when budesonide treatment was started. The decrease in symptoms was greater for budesonide than for placebo (P < .001). There was no difference between budesonide and placebo with regard to eye itch and rescue medication used. Morning nasal washes were taken during the grass season before treatment was started and 16 to 17 days after. They showed a significant decrease in TAME esterase levels in secretions in the budesonide treated patients (P = .03) but not in the placebo-treated patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Ectopic ACTH-producing adenocarcinoma of the stomach.

A 73-year-old female was admitted to our hospital because of weight loss and pretibial edema. Plasma levels of adenocorticotropic hormone (ACTH) and cortisol were elevated, and neither hormone showed circadian rhythm. Dexamethasone (2 mg for 2 days) failed to reduce the urinary excretion of 17-hydroxycorticosteroids and the plasma cortisol level. The stomach biopsy specimens showed a moderately-differentiated papillo-tubular adenocarcinoma. Computed tomography of the abdomen showed multiple metastases to the liver. Immunohistochemical staining of the autopsy specimens showed immunoreactive ACTH in the primary tumor cells of the stomach as well as the metastatic tumor cells of the liver. On the basis of the clinical, histological and immunohistochemical findings, we diagnosed this patient as having ectopic ACTH syndrome caused by adenocarcinoma of the stomach.

ACTH Syndrome, Ectopic↗
PubMedDate not supplied

[Changes in the activity of the brain renin-angiotensin system and in the functional state of the pituitary-adrenal system of rats under the influence of captopril].

While studying the effect of peroral captopril injections on the activity of renin-angiotensin system (RAS), the activity of angiotensin-converting enzyme (ACE) and angiotensin II content from anterior and mediobasal hypothalamus, medulla and adenohypophysis of intact rats has been established to decrease. Captopril administration decreases ACE activity which increases after hydrocortisone injection in rat medulla and striatum. Captopril results in no potentiation of hormonal effect in hypothalamus and in adenohypophysis where ACE activity decreases following hydrocortisone injection. A decrease in the RAS activity of brain structures and adenohypophysis induced by captopril administration to rats is accompanied by the inhibition of the activity in the pituitary-adrenal system. A decrease in ACTH level and in 11-hydroxycorticosteroids of the rat blood plasma has been determined after single captopril injection in the dosage of 10 and 50 mg/kg of body weight. Duration of the effect depends on the captopril dosage.

Animals↗
PubMed1991

Primary bilateral adrenocortical causes of Cushing's syndrome.

Nontumorous primary adrenal causes of Cushing's syndrome are exceedingly rare. Herein we review our results with seven patients in whom there is biochemical evidence of a primary (adrenocorticotropin independent) bilateral adrenal cause of endogenous hypercortisolism. Each patient had low plasma adrenocorticotropin levels. All patients had elevated 24-hour urinary free cortisol levels and 17-hydroxycorticosteroids that were not suppressed by high-dose dexamethasone. Plasma levels of adrenocorticotropin and cortisol were not elevated by ovine corticotropin-releasing factor. No patient had a gradient between petrosal and peripheral adrenocorticotropin levels. No pituitary tumors were detected by magnetic resonance imaging or computed tomography. Five of six patients who underwent iodocholesterol scanning showed bilateral adrenal activity. Computed tomographic and magnetic resonance imaging of the abdomen demonstrated bilateral small adrenal glands in three patients, an adrenal mass in one patient with Carney's complex, and massively enlarged glands in three patients. Each patient underwent bilateral adrenalectomy and was given glucocorticoid and mineralocorticoid replacement. Pathologic examination of four of these bilateral adrenal specimens revealed primary pigmented micronodular adrenocortical disease, with adrenal gland weights between 2.5 and 13.4 gm (mean 5.2 gm). However, the remaining three patients had primary adrenocorticotropin-independent bilateral macronodular adrenocortical disease with adrenal gland weights between 32 and 81 gm (mean 52 gm). Although each of the patients with primary pigmented micronodular adrenocortical disease was cured by bilateral adrenalectomy through a posterior approach, two of the three patients required an anterior approach. We conclude that Cushing's syndrome can arise through two distinct forms of primary bilateral adrenal cortical disease. Computed tomography is important in evaluation of these patients because the size of the adrenal glands influences the surgical approach.

Adolescent↗
PubMed1977

Ectopic ACTH syndrome due to salivary gland adenoid cystic carcinoma.

A 68-year-old woman developed Cushing syndrome associated with a submaxillary salivary gland adenoid cystic carcinoma. High levels of immunoreactive adrenocorticotrophic hormone (ACTH) were found in the tumor and peripheral blood. Urinary 17-hydroxycorticosteroid levels decreased following administration of dexamethasone, suggesting possible suppression of ectopic ACTH production. however, there was no specific in vitro binding of dexamethasone by tumor cytosol. A trial of metyrapone therapy resulted in control of hypokalemia and hyperglycemia. Both plasma cortisol and 11-deoxycortisol levels decreased with metyrapone administration, suggesting that this agent may inhibit not only 11-beta-hydroxylation, but also possibly earlier steps in glucocorticoid synthesis.

Adrenocorticotropic Hormone↗
PubMedDate not supplied

[Effect of the antioxidant dibunol on the hormonal status of adult and old rats].

The effect of chronic administration of antioxidant dibunol (BHT) on the blood level of thyrotropin, corticotropin, thyroxin, triiodothyronine, 11-hydroxycorticosteroids, immunoreactive insulin and the reactivity of isolated thyroids and adrenals to tropic hormones were studied in adult and old male rats. Chronic administration of BHT was found to inhibit the thyroid functional activity of both animal groups and to reduce the blood insulin level in the old rats. The results obtained suggest that hormonal effects play an essential role in the mechanism of BHT action on the organism.

Adrenal Cortex↗
PubMedDate not supplied

[An experimental and clinical study of the analgesic action of clofelin when administered epidurally].

Clonidine and its Soviet-made analogue clopheline (10 micrograms) after epidural administration to rats equally inhibited nociceptive reactions and changes in arterial blood pressure in the somatic and visceral pain tests. In patients with obliterating atherosclerosis of the lower extremities clopheline (100 and 200 micrograms) relieved the pain syndrome and shifts of II-hydroxycorticosteroids in blood, induced bradycardia and the background arterial blood pressure-dependent antihypertensive effect.

Adult↗
PubMedDate not supplied

[Endogenous ethanol in the blood and tissues of rats with hypobaric hypoxia].

Albino male rats weighing 160-180 g were used to study the effect of short-term hypobaric hypoxia (ascent in an altitude chamber to 2500 m and 5000 m for 1 hr) on endogenous ethanol measured in blood, brain and liver; simultaneously enzymes responsible for ethanol and acetaldehyde metabolism were determined. Endogenous ethanol in blood and tissues was found to be a very sensitive marker of hypoxia which was not correlated with lactate, pyruvate, lipid peroxidation or 11-hydroxycorticosteroids. The latter parameters varied in response to severe hypoxia.

Acetaldehyde↗
PubMed1987

Severe hypertension with absent secondary sex characteristics due to partial deficiency of steroid 17 alpha-hydroxylase activity.

A genotypically female patient with 17 alpha-hydroxylase deficiency, and typical symptoms of hypertension, hypokalaemia and lack of secondary sex characteristics, is described. Plasma 17 alpha-hydroxycorticosteroid levels (cortisol, 11-deoxycortisol) and oestradiol were low. Those of 11-deoxycorticosterone, corticosterone, their 18-hydroxy- derivatives, ACTH and gonadotrophins were high and, with the exception of the gonadotrophins, suppressed to normal with dexamethasone which also corrected blood pressure (BP) and electrolyte abnormalities. Plasma aldosterone levels, initially suppressed, increased during treatment but, at 3 months, showed some signs of subnormal responsiveness. Possible reasons for this are discussed. The patient remains well after 9 years on dexamethasone and oestrogen therapy.

Adrenal Cortex Hormones↗
PubMed1987

[Changes in neurohumoral factors of various tissues in patients with breast cancer].

Such neurohumoral factors of antitumor resistance regulation as catecholamines, corticosteroids and cholinergic mechanisms were studied in tissues of breast cancer patients. Tissue adjacent to tumor revealed elevated concentrations of 11-hydroxycorticosteroids and adrenaline matched by an increased release of norepinephrine which greatly depended on weakened cholinergic influences. These disturbances were pronounced in stages I and II tumors and, particularly, in infiltrating scirrhous cancer. Disbalance in neurohumoral factor distribution between normal and altered tissues may boost tumor recurrence and metastatic spread.

Adult↗
PubMed1988

Predictors of early suicide: identification and appropriate intervention.

The ability to assess the risk of patient suicide and to determine the appropriate and timely intervention is a critical skill for psychiatrists. Data from an ongoing prospective investigation evaluating the suicide risk in patients with major affective disorders have identified several heretofore unrecognized factors as highly correlated with early suicide. The risk factors associated with early suicide--that is, suicide within a year of the diagnosis of major affective disorder--include anhedonia, psychic anxiety (as demonstrated both clinically and by elevated 24-hour 17-hydroxycorticosteroid), panic attacks, depressive turmoil, and moderate alcohol abuse. Recognition and identification of those risk factors, coupled with effective treatment strategies, may help the clinician prevent imminent suicides in high-risk patients.

Depressive Disorder↗
PubMed1988

Pregnancy and Cushing's syndrome: example of endocrine interaction.

Pregnancy rarely occurs in women with Cushing's syndrome, and when it does, fetal mortality and morbidity are very high. We describe a 30-year-old woman who was found to have severe Cushing's syndrome in the 22nd week of her first pregnancy, after a year of unsuccessful attempts to conceive. The patient had the majority of the symptoms and signs characteristic of the syndrome. Laboratory examinations revealed hypokalemia of 2.7 mEq/l, serum cortisol 39.5 micrograms/dl without diurnal variation, free urinary cortisol 1,850 to 3,500 micrograms/24 h, 17-hydroxycorticosteroids (OHCS) 52.5 mg/24 h, 17-ketosteroids (KS) 12 mg/24 h, and ACTH 29 pg/ml. No suppression was observed upon dexamethasone administration (2 and 8 mg). Ultrasound examination of the adrenal glands revealed a left adrenal tumor with a diameter of 4.2 cm. An adrenocortical adenoma was successfully excised in the 24th week of pregnancy. During the 37th week of pregnancy, she delivered a normal baby girl. Postoperatively, the patient was put on maintenance therapy. One year after delivery, mother and child are in perfect health.

Adenoma↗