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PubMedDate not supplied

[Clinical characteristics and course of severe hypercalcemia caused by primary hyperparathyroidism in surgically treated patients].

AIM: To describe presentation, diagnosis, management and outcome of severe hypercalcemia due to primary hyperparathyroidism in a series of patients. METHODS: Clinical characteristics, presentation, diagnosis, acute preoperative medical management, surgical findings and strategy, short outcome and complications of a cohort of 21 patients with primary hyperparathyroidism (HPT) and severe hypercalcemia (serum calcium > or = 14 mg/dL) were analyzed. This group was selected from a total of 118 patients who underwent surgery for HPT in the time period. RESULTS: Mean age was 47 +/- 17 years-old and the male:female ratio was 4:17. A total of 95% of patients presented one or more symptoms related to hypercalcemia while 62% had an abnormal EKG and 76% also had radiological abnormalities. All patients received intense hydration often associated to diuretics. Uniglandular disease was found in 13 patients, multiglandular involvement was identified in 4 and parathyroid carcinoma was documented in other 4. Normalization of the calcemia was achieved in all patients with benign disease. CONCLUSIONS: Severe hypercalcemia was relatively frequent in our patients with HPT. Most patients were symptomatic and presented radiological or cardiac abnormalities. Surgical normalization of the calcemia was achieved in all patients with benign disease.

Adolescent↗
PubMed2001

[Primary hyperparathyroidism in patients treated for non-medullary thyroid carcinoma].

The authors report three cases of primary hyperparathyroidism (HPT) in patients with differentiated thyroid carcinoma (DTC) developed a few years after initial surgical and radiometabolic treatment of DTC. The early diagnosis of HPT in these patients was made possible because of laboratory tests performed during follow-up, including the assay of serum calcium and serum phosphorus levels. Scinti-graphy using 99mTc-MIBI enabled the correct preoperative localisation of a single parathyroid adenoma in two of these patients and multiglandular pathology in the third.

Adenocarcinoma, Follicular↗
PubMed2001

Clinical role of 99mTcO4/MIBI scan, ultrasound and intra-operative gamma probe in the performance of unilateral and minimally invasive surgery in primary hyperparathyroidism.

The main purposes of this study were: (a) to investigate the efficacy of an imaging protocol based on the combination of 99mTcO4/MIBI scintigraphy and neck ultrasound (US) in selecting patients with primary hyperparathyroidism (HPT) for unilateral neck exploration, and (b) to help define the role of the intraoperative MIBI gamma probe (IMGP) technique in the performance of minimally invasive radio-guided surgery (MIRS). One hundred and forty-three consecutive patients with primary HPT were enrolled in the study. We used a modified 99mTcO4/MIBI scintigraphic procedure which included the oral administration of potassium perchlorate to cause rapid 99mTcO4 washout from the thyroid tissue, thereby permitting the acquisition of high-quality early MIBI images. A single-photon emission tomography (SPET) acquisition was also obtained in 21 patients, of whom seven had an enlarged parathyroid gland (EPG) in the mediastinum at planar scintigraphy and 14 had discordant scan/US findings for the presence of a cervical EPG. Neck US was performed in the same session as scintigraphy using a small-parts, high-resolution 10-MHz transducer. All patients were then operated on by the same surgical team. Quick PTH assay (QPTH) was used to measure PTH intraoperatively to confirm successful parathyroidectomy. In patients with scan/US evidence of a solitary EPG and with a normal thyroid gland, limited, unilateral neck surgery or, more recently, MIRS was planned (n=91). In patients with scan/US evidence of multiglandular disease (MGD) (n=21) or concomitant nodular goitre (n=24) or in patients with a negative scan/US evaluation (n=7), extensive bilateral neck exploration was planned (n=52). In 87 of the 91 patients (95.6%) in whom preoperative imaging indicated the presence of a solitary EPG and a normal thyroid gland, a single parathyroid adenoma was found at surgery, and these patients were treated by unilateral neck exploration or MIRS. In the remaining four patients of this group, conversion to bilateral neck exploration was required because parathyroid carcinoma (n=3) or MGD (n=1) was diagnosed at operation. In some cases SPET was helpful in better localising the EPG. In particular, in 5 of the 21 patients evaluated, SPET localised an EPG deep in the neck or mediastinum and at surgery a parathyroid adenoma was found in the paratracheal or para-oesophageal space. In 43 of the 46 patients (93.5%) who were candidates for MIRS, the IMGP technique allowed parathyroidectomy to be performed through a small, 2- to 2.5-cm skin incision with a short duration of intervention (mean 34 min). We conclude that: (a) The integrated scan/US imaging protocol that we used appears to be accurate in selecting patients with primary HPT for unilateral neck exploration. (b) In our series the most prevalent cause of bilateral neck exploration was the co-existence of a nodular goitre; thus accurate preoperative evaluation of the thyroid gland by dual-tracer scintigraphy and US imaging is strongly recommended in all patients with HPT. (c) SPET can provide the surgeon with useful information when an EPG is located deep in the neck or mediastinum. (d) IMGP appears to be a useful intraoperative device in HPT patients with solitary parathyroid adenomas and a normal thyroid gland, since it permits minimally invasive and time-saving surgery.

Adenoma↗
PubMed2001

[Familial and isolated primary hyperparathyroidism. Case report].

Familial hyperparathyroidism can be a part of a type 1 or 2 multiple endocrine neoplasia syndrome, can be associated to mandibular fibromas or can appear as an isolated disease. We report a family with 11 members affected by a primary hyperparathyroidism, all with a history of kidney stones and without evidences of other endocrine tumors. Not knowing the familial history of the disease, only one adenoma was resected in four cases and in all, the disease recidivated. Two were operated again, performing a total parathyroidectomy and heterologous autotransplantation of parathyroid tissue in the forearm. The presentation form of primary hyperparathyroidism in this family, is similar to other reported cases. It is more aggressive, is diagnosed at a lower age has a higher incidence of recurrence and multiglandular involvement than the sporadic disease.

Adult↗
PubMed2002

Multiple endocrine neoplasia 1--current recommendations for diagnosis and treatment.

BACKGROUND: The principally affected glands in the MEN 1 syndrome (parathyroids, pancreas, pituitary and adrenal glands) are often diffusely or multi-centrically involved, making different therapeutic approaches necessary. METHODS: In a retrospective analysis of 10 patients with genetically proven (n = 7) or clinically suspected (n = 3) MEN 1 syndrome, recommendations for diagnosis, timing of interventions and surgical procedures are reviewed. RESULTS: All patients had primary hyperparathyroidism (PHPT). An extended bilateral exploration localized 4 or more enlarged glands in 6 patients and subtotal parathyroidectomy (SPTX) was performed. In 4 patients, only one (n = 2) or two (n = 2) enlarged glands were removed. Two patients were reoperated for persistent PHPT and one patient developed recurrent PHPT. In 3 out of 6 patients, neuroendocrine pancreatic tumors were the first manifestation. 2 patients had solitary, one patient multiple benign and one patient multiple malignant insulinomas. Tumors were removed by enucleation, distal pancreatic resection or a combination of both. Out of the 2 patients with gastrinomas, one underwent partial pancreatoduodenectomy and the other has refused operation up to now. During follow-up, no persistence or recurrence of hormone excess was diagnosed. Three patients had non-functioning bilateral lesions of the adrenal glands, and one of these additionally had a small, clinically insignificant pheochromocytoma. Adrenalectomy was performed during pancreatic surgery in 2 patients, and endoscopically in one patient. Pituitary tumors were treated in 3 patients. CONCLUSION: A high index of clinical suspicion, biochemical screening and menin gene testing, according to current guidelines, is mandatory for early diagnosis of MEN 1. In PHPT with multiglandular involvement and neuroendocrine pancreatic tumors, meticulous surgery can achieve a long-term cure in the majority of patients, with low morbidity.

Adolescent↗
PubMed2002

[Polyadenomatoses: type 2 multiple endocrine neoplasms].

FROM A CLINICAL POINT OF VIEW: Multiple endocrine neoplasia type 2 (MEN2) is an autosomal dominant, inherited multiglandular disease with familial and individual age-related penetration and variable expression. A medullary thyroid carcinoma (MTC) is always concomitant to MEN2 and associated in varying proportion with pheochromocytoma (50%) and hyperparathyroidism (5 to 20%). PROGNOSTIC DATA: The prognosis of MEN2 is related to the carcinological evolution of MTC, which depends mainly on the stage of discovery and the quality of the first surgical treatment, emphasizing the need for early diagnosis. THE IMPORTANCE OF THE ERT GENE: The identification of mutations in proto-oncogene RET, responsible for the various forms of the disease allows subjects at risk in a family circle to be identified and early screening of various endocrine damage, notably MTC, should be performed. Biological explorations in all persons carrying this mutation would permit diagnosis and surgical treatment of the endocrine lesions, before their clinical manifestation.

Adrenal Gland Neoplasms↗
PubMed2003

[Radio-guided surgery in primary hyperparathyroidism: clinical indications and technical procedure].

AIM: The purpose of the present study was to assess the utility of the intraoperative gamma probe technique in a group of 128 patients suffering from primary hyperparathyroidism (PH). METHODS: In view of surgery, these patients were homogeneously subjected to a diagnostic protocol comprising double tracer scintigraphy ((99mTc)-Pertecnetate/(99mTc)-MIBI) and neck echotomography, carried out in a single session. They were then all operated on by the same surgical team. RESULTS: In 97 patients with scintigraphic and echographic evidence of single parathyroid enlargement and normal thyroid gland, mini-invasive radio-guided surgery (MRS) was planned. In 94 of these 97 patients (96%) MRS was carried out successfully by removal of a single parathyroid adenoma (PA) through a small cutaneous incision of 2-2.5 cm; in the remaining 3/97 patients (3.1%), it proved necessary to convert to bilateral surgical exploration of the neck following intraoperative diagnosis of a parathyroid carcinoma in 2 cases and of multiglandular pathology (MGP) suggested by the persistence of elevated values of intraoperative parathormone (PTH) in 1 case. It should be pointed out that the use of IGP enabled us to carry out limited surgical exploration in 18 of 23 patients who had previously undergone operation on the thyroid and/or parathyroids. In a second group of 31 patients with presumed preoperative diagnosis of MGP (5 cases) or nodular goitre concomitant with PH (26 cases), IGP was used in the course of standard bilateral surgical exploration of the neck and enabled us to locate: an ectopic parathyroid gland in the thymus in 1 case of MGP, a PA in the deep levels of the neck in 2 cases with goitre and an ectopic PA at the bifurcation of the carotid in 1 other case with goitre. It should however be specified that in certain other patients with goitre it proved difficult intraoperatively to distinguish thyroid nodes from a PA adhering to the thyroid. CONCLUSIONS: On the basis of the data to emerge from the present study we can conclude that: 1) in patients with PH presenting a scintigraphic and echographic picture indicating single PA and normal thyroid with high probability, the IGP technique proves effective in carrying out an MRS; 2) 37 MBq of (99mTc)-MIBI are an adequate dose for the correct performance of MRS; 3) a rapid intraoperative dose of PTH is to be recommended so as to confirm complete removal of the hyperfunctioning parathyroid tissue; 4) MRS may be employed successfully also in those patients previously subjected to thyroid or parathyroid surgery for the purpose of limiting the surgical trauma connected to reintervention and, therefore, to reducing the risk of complications; 5) IGP would not appear to be recommendable in patients with PH and concomitant goitre, with the possible exception of ectopic PA.

Adenoma↗
PubMed1992

[Primary hyperparathyroidism. Results of a French multicenter study].

The "Association française de Chirurgie" asked to authors an update on primary hyperparathyroidism based on a retrospective multicentric study on 4883 patients operated on by 79 surgeons. Aim of this study was an update on clinic and biologic aspects, localizing studies, and therapeutic aspects with their results. There were 3418 females (70%) and 1465 males (30%) mean age 53 years (9 to 91 years): 3702 solitary adenomas (75.8%), 720 multiglandular lesions (14.7%) 92 multiple endocrine neoplasias (1.9%) and 86 carcinomas (1.8%). None lesion was found in 283 cases (5.8%). To day, diagnosis is most often made on fortuitous hypercalcemia. Localising studies showed sensibility less than 50%. Surgery was successful in 92.7%. Mortality occurred in 0.6%, hypoparathyroidism in 3.8%, laryngeal palsy in 1.5% and hematomas in 0.45%. In conclusion this study shows the changes regarding the diagnosis, the uselessness of localizing studies before first cervicotomy, and the good results of surgery. Autotransplantation and cryopreservation allow reducing of hypoparathyroidism.

Adolescent↗
PubMedDate not supplied

[Video-assisted minimally invasive parathyroidectomy with lateral approach in patients with primary hyperparathyroidism].

INTRODUCTION: Different minimally invasive techniques of parathyroidectomy have been described. We performed a retrospective study to evaluate the indications and results of video-assisted parathyroidectomy (VAP) in the management of patients with primary hyperparathyroidism (PHPT). MATERIALS AND METHODS: Between 1998 and 2002, 528 patients were operated on because PHPT. VAP was proposed for patients with sporadic PHPT, without associated goiter and previous neck surgery, in whom a single adenoma was localized. VAP was performed by lateral approach with insufflation for patients with adenoma located deeply in the neck and by gasless midline approach for anteriorly located adenomas. A quick parathyroid (qPTH) assay was used during the surgical procedure. Calcemia, phosphoremia and PTH were systematically evaluated after surgery. RESULT: Of 528 patients with PHPT, 228 (43%) were not eligible for VAP because associated nodular goiter (99 cases), previous neck surgery (42 cases), suspicion of multiglandular disease (25 cases), lack of preoperative localization (48 cases), and miscellaneous causes (14 cases). VAP was performed in 300 patients with sporadic PHPT: 282 lateral access, 17 midline access and one thoracoscopy. Mean operative time was 50'. Conversion to conventional parathyroidectomy was required in 14% of cases. One patient presented a definitive recurrent nerve palsy. One persistent and one recurrent PHPT were observed. CONCLUSION: VAP can be proposed for patients with PHPT. Immediate results of VAP are similar to those obtained with conventional parathyroidectomy; no conclusions can be drawn in terms of influence of VAP on the outcome of the patients operated for PHPT.

Humans↗
PubMedDate not supplied

Minimally invasive radioguided parathyroidectomy.

In the last years, with the aim of reducing operative time and having better cosmetic results, minimally-invasive parathyroidectomy (MIP) has become to be extensively performed. Several techniques are available, including video-endoscopic techniques, and radioguided parathyroidectomy. In patients undergoing radio-guided parathyroidectomy receive an intravenous injection of 99mTc-sestamibi 60-90 minutes before the operation was scheduled to start. Four early images are obtained 5 minutes after radiopharmaeutical administration, with the aim of confirming the side and site of the enlarged PT gland. Intraoperative nuclear mapping using a hand-held gamma probe and quantitative gamma camera counting in the four quadrants is obtained. A 2-3 cm incision is made, and the enlarged PT gland excision is guided by the probe, resulting in a decline in radioactivity in the corresponding quadrant. Intraoperative quick PTH is routinely assayed. When the PTH levels at 10 min fail to fall to less than 50% of the preoperative levels, a multiglandular disease should be suspected and a bilateral neck exploration is usually required. MIP is a safe, cost-effective alternative to bilateral exploration, and should be considered the procedure of choice in patients with primary HPT, when preoperative imaging tests have suggested the presence of a PT adenoma. Radioguided MIP may improve the success rate of surgery in patients with primary hyperparathyroidism.

Humans↗
PubMedDate not supplied

[Surgical treatment of primary hyperparathyroidism during MEN1 and other genetically determined forms].

In MEN1, HPT manifests precociously and it is almost constant. Whereas in MEN2 it seldom occurs and has been reported in 17 to 40% of the cases, in MEN1 HPT is much more severe, amplifying the secretion of associated gastrinomas. In MEN1, multiglandular involvement is almost constant, and in case of less than subtotal parathyroidectomy, recurrence rate varies from 20 to 40%. Practically, HPT is the first worry of the surgeon in a MEN1 setting, and the last in a MEN2 setting. It is rather important to think to the potential hypoparathyrodism at the time of the cervicotomy for MTC. The operative strategy is to examine all parathyroid glands. In MEN1, it is necessary to be aggressive and perform a subtotal parathyroidectomy, regardless of gland gross appearance. In the MEN2 only the enlarged glands should be removed. In both setting a bilateral cervical thymectomy should be done for removal of a possible supernumerary gland.

Humans↗
PubMed2004

[New surgical approaches to primary hyperparathyroidism].

We have seen recently the appearance of several new techniques for parathyroidectomy: the minimally invasive techniques all have a limited incision when compared to classic transverse cervical incision and are targeted on one specific parathyroid gland. These interventions are today possible for three main reasons: the available imaging techniques permit to locate the diseased gland, the use of rapid intraoperative PTH assay can confirm the successful extirpation, new instrumentation and miniaturised cameras have been adapted for this kind of surgery. Amongst minimally invasive techniques applied to parathyroidectomy, the video-assisted technique has the main advantage to offer a magnified view that permits a precise and careful dissection with minimal risks. Not all patients presenting a primary hyperparathyroidism are candidates for this surgery. Contraindications are mainly due to a large goiter, previous surgery in the parathyroid vicinity, suspicious multiglandular disease and equivocal preoperative localising studies. Currently 60% of patients with primary hyperparathyroidism can benefit of these techniques. Studies comparing conventional parathyroid surgery to endoscopic techniques have shown a diminution of postoperative pain and better cosmetic results with endoscopic techniques. If early results are similar to those obtained with conventional traditional open parathyroidectomies it is still too soon to evaluate what will be the recurrence rate of these new techniques.

Female↗
PubMed2005

Surgeon-performed ultrasound improves localization of abnormal parathyroid glands.

With a secure diagnosis of hyperparathyroidism, preoperative localization of abnormal glands is the initial step toward limited parathyroidectomy (LPX). We investigated whether ultrasonography in the hands of the surgeon (SUS) could improve the localization of abnormal parathyroids when sestamibi scans (MIBI) were negative or equivocal. One hundred eighty patients with sporadic primary hyperparathyroidism (SPHPT) underwent preoperative SUS and MIBI scans before LPX guided by intraoperative parathormone assay. When the sestamibi scans were negative, SUS was used to localize the parathyroid, distinguish parathyroid from thyroid tissue, and to guide the intraoperative jugular venous sampling for differential elevation of parathyroid hormone (PTH). Operative findings, intraoperative hormone dynamics, and postoperative calcium levels determined successful localization. MIBI was negative or equivocal in 36/180 (20%) patients: (1) showed no parathyroid gland in 22 patients, (2) suggested an incorrect location for the abnormal gland in 9, and (3) was insufficient in recognizing multiglandular disease in 5. In these 36 patients, the addition of SUS led to the successful identification of the abnormal tissue in 19/36 (53%). In the remaining 17 patients with negative/equivocal scans, the parathyroid could not be clearly visualized by SUS. In these patients, SUS facilitated LPX by aiding preoperative transcutaneous jugular venous sampling for differentially elevated PTH (n=3) and identifying questionable thyroid nodule versus parathyroid tissue (n=1). Overall, SUS was useful in 23/36 (67%) patients with nonlocalizing MIBI scans, thus improving the rate of localization from 80 per cent to 93 per cent (P < 0.01). Surgeon-performed cervical ultrasonography improved the localization of abnormal parathyroids by MIBI scan, adding to the success of limited parathyroidectomy.

Adolescent↗
PubMed2005

Anesthetic management of autoimmune polyglandular syndrome (Schmidt's syndrome)--a case report-.

BACKGROUND: Autoimmune polyglandular syndromes (APS) are complex diseases with diverse clinical presentations resulting from involvement of multiple endocrine glands. Surgery under anesthetic in these patients is challenging. A case of Schmidt syndrome (autoimmune polyglandular syndrome type 11) that developed adrenocortical insufficiency in the postoperative period is reported. Etiology, pathogenesis, types and anesthetic problems associated with these cases are discussed. CASE REPORT: A 41 yr old female patient, diagnosed to have APS (Schmidt syndrome) presented for uterine surgery. She had autoimmune glandular involvement of pituitary, thyroid, parathyroid, adrenals and melanocytes and was on hormone replacements for the deficiencies incurred, which were continued till the morning of surgery. Surgery was conducted under general anesthetic combined with epidural analgesia. In spite of supplementation of steroid in physiological doses prior to surgery, she developed hemodynamic instability in the early postoperative period, but could be successfully resuscitated with additional steroid dosage and fluids. CONCLUSION: This patient presented with multiglandular endocrine involvement necessitating timely, adequate hormone replacement and appropriate fluid management. These challenges require careful approach to anesthetic management.

Adult↗
PubMed1991

Intraoperative fall in plasma levels of intact parathyroid hormone after removal of one enlarged parathyroid gland in hyperparathyroid patients.

Plasma levels of intact parathyroid hormone (PTH) were measured intraoperatively before and after removal of one enlarged gland in 20 hyperparathyroid patients. In 13 patients with a single parathyroid adenoma, plasma levels of intact PTH-(1-84) had declined at 15 min after removal of the adenoma by 86.5 +/- 4.4% of baseline in the antecubital vein and by 85.6 +/- 4.2% in the ipsilateral internal jugular vein. In seven patients with parathyroid hyperplasia, the corresponding figures for decline at 15 min after removal of one enlarged parathyroid gland were only 26.6 +/- 6.4% and 7.8 +/- 29.4%. The fall in PTH levels was significantly less in hyperplasia than in adenoma (p less than 0.001). Thus 15 min after removal of one enlarged parathyroid gland, the decline in plasma level of intact PTH may distinguish between single adenoma and multiglandular disease as the cause of hyperparathyroidism.

Adenoma↗
PubMed2006

[New horizons for increased sensitivity of radionuclide imaging in primary hyperparathyroidism].

The aim of the study was to evaluate the impact of therapy with biphosphonates in patients with primary hyperparathyroidism and negative result of parathyroid scintigraphic imaging on increase of diagnostic sensitivity in repeated scans. Three female patients with diagnosed primary hyperparathyroidism and negative parathyroid imaging with subtraction 99m-Tc-MIBI scintigraphy were included into this prospective study. Patients had been receiving 70 mg of sodium alendronate orally, once a week for 3 months. After this period they were reevaluated with parathyroid subtraction scintigraphy. In all three patients a solitary area of uptake was found in the repeated scans. Patients were qualified for minimally invasive video-assisted parathyroidectomy. In two of them the repeated scans after treatment with biphosphonates were found to be true positive and in those two patients a solitary parathyroid adenoma was removed with video-assisted technique. In one patient a multiglandular disease was revealed intraoperatively basing on intraoperative iPTH assay and in that patient a subtotal video-assisted parathyroidectomy has been successfully completed. All three patients have been eucalcemic within the 6-months follow-up with iPTH serum values within the reference range. In conclusion, treatment with oral biphosphonates in patients with primary hyperparathyroidism and negative result of radionuclide parathyroid imaging, results in increased diagnostic sensitivity of repeated scans. This allows for successful minimally invasive parathyroid surgery in this group of patients with a predominant solitary parathyroid adenoma.

Adenoma↗
PubMed1991

Preoperative localization of enlarged parathyroid glands with ultrasonically guided fine needle aspiration for parathyroid hormone assay.

For preoperative localization of enlarged parathyroid glands, several imaging techniques have been used. In this study we demonstrate the feasibility of using ultrasonography with fine needle aspiration for parathyroid hormone assay as a preoperative localization procedure in 21 patients with primary hyperparathyroidism. A single adenoma was found in 18 patients while 3 patients had multiglandular disease. Ultrasonically guided fine needle biopsy was possible in 11 cases. In 8 of these aspirates, a high parathyroid hormone content was found. In all 8 cases the localization was confirmed at surgery. We conclude that the efficiency to preoperatively localize enlarged parathyroid glands is enhanced by fine needle aspiration.

Adult↗
PubMed1991

Endocrine complications of AIDS and drug addiction.

The endocrine and metabolic consequences of illicit drug use and HIV disease are extensive and profound. Both narcotic drug use and AIDS have the capacity to cause clinically significant multiglandular derangements. Admittedly, we were not able to focus as much attention on the less frequently occurring disturbances of calcium, phosphorus, or folate metabolism in HIV disease. Similarly, we reported very little information about the endocrinologic significance of the use of classes of narcotics other than opiates and to a far lesser extent cocaine. Even with these limitations, the spectrum of drug abuse and HIV-related endocrine manifestations discussed previously is quite diverse. Given the pervasive effects of drug abuse on other organ systems, it is not surprising to find expanding interest in the endocrine consequences of narcotic drug use. In fact, the use of these drugs is responsible, in part, for the past and continuing interest in identifying receptors for these agents and similarly structured endogenous ligands. As these investigations proceed, we must appreciate the limitations in translating basic and clinical scientific findings to the clinical setting. Much of the current research does not study street-relevant narcotic doses, does not use research designs involving polydrug use, and does not involve the processes or routes of drug administration used by active narcotic addicts. There is a critical need for more research methods with animal models and clinical study settings that more adequately mimic drug use outside of the laboratory. Our ability to develop appropriate psychopharmaceutical agents to respond to the different faces of drug abuse in the United States will depend on continued progress in the area of neuroendocrinology. With respect to the consequences of HIV disease, the clinical findings of elevated hormonal levels in some endocrine systems are amazing given what one would expect if one postulated direct or indirect destruction by HIV or the opportunistic complications that accompany AIDS. In unraveling this puzzle, careful attention must be given to evaluating the degree to which the clinical or biochemical consequences are due to a direct HIV effect, to an effect of a complicating infection or neoplasm, or to an AIDS-related therapeutic intervention. More work is needed also in obtaining histopathologic information to correlate with the biochemical and clinical derangement. In summary, there is a wealth of information demonstrating a wide spectrum of endocrine/metabolic consequences of drug abuse and AIDS. Still, just as many questions remain unanswered. While the exact biologic mechanisms are unclear, many of the biochemical aberrations have clinical relevance.(ABSTRACT TRUNCATED AT 400 WORDS)

Acquired Immunodeficiency Syndrome↗