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The endocrine abnormalities associated with the development of androgen-dependent hirsutism have been presented and discussed in the light of the frequent finding of ultrasonographic abnormalities suggestive of polycystic ovary syndrome. A simple protocol of investigation, which should ideally include pelvic ultrasonography, has been presented. The treatment of hirsutism by combined anti-androgen and oestrogen therapy has been detailed and other approaches discussed.
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Altogether 23 patients were examined to assess the value of echography in the diagnosis of aldosteromas. Tumors were diagnosed at operation in 21 (2 malignant tumors) and adrenal hyperplasia in 2. The accuracy of diagnosis with regard to the presence or absence of aldosteromas was 82.6%. An analysis of the causes of erroneous results showed that they were noted in small size formations less than 2 cm in diameter, in corpulent patients and in the left-side tumor site due to more complicated anatomotopographic interrelationships of the organs in this area.
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Analysis of 2 of our own cases of cutaneous alternariosis (CA) and 31 reported cases showed this mycosis to be nosologically heterogeneous. CA may present as an endogenous, multilocular form or as an exogenous, usually localized form. In the endogenous form of CA (11 cases), infection most probably occurs via the lung by inhalation. The highly dermatotropic organisms spread hematogenically to the skin where they cause the typical verruciform or granulomatous lesions. In the exogenous form (8 cases), the organisms are inoculated at the site of a trauma ("traumatogenic CA"). In both forms, the underlying pathogenic disorders are of a non-mycotic nature, and hypercorticism plays the most important role. In the third form ("dermatopathic CA", 14 cases), Alternaria alternata secondarily colonizes, in a non-parasitic fashion, in preexisting lesions, which are predominantly steroid-treated eczema of the face. This form represents nosoparasitism of A. alternata rather than genuine mycosis. With regard to the pathogenesis of alternariosis, the predisposing factors mentioned are more important than the relatively weak pathogenicity of the organisms. Elimination of the predisposing factors usually cures the disease. If this fails, surgical excision of the lesions is required since an effective systemic anti-mycotic drug for CA is not yet available.
A study was made of the absorption of exogenous hydrocortisone and formation of its metabolites in isolated liver of intact and exposed rats in conditions of recirculating perfusion. It was shown that the absorption of the hormone by the liver of irradiated rats was greatly lowered but the content of most metabolites found in the perfused medium of irradiated liver increased as compared to the control. It is suggested that irradiation inhibits subsequent transformations of the hydrocortisone metabolism products.
Epidermophyton floccosum was isolated from a lesion of dermatophytosis on a dog with hyperadrenocorticism. This report is, to our knowledge, the first unequivocally documented case of canine infection in the United States.
Nodules commonly occur in the human adrenal gland. They are best regarded as part of the ageing process, produced in response to adrenal vascular changes. Nodules exhibit a wide diversity of size and distribution and are seen not only in subjects with normal adrenal function but also in patients with hypercorticalism (Cushing's and Conn's syndromes). In these disorders, the nodules appear to be a consequence of the diseases, rather than being aetiological.
A 5-year-old female dog with hyperadrenocorticism was determined to have pituitary-dependent hyperadrenocorticism even though plasma cortisol concentrations were not suppressed after high-dosage dexamethasone administration. The diagnosis was based on a supranormal response of plasma cortisol to ACTH administration and a lack of suppression of plasma cortisol concentration after administration of 0.1 mg of dexamethasone/kg. Although a higher dosage of dexamethasone (1 mg/kg) did not cause suppression of plasma cortisol, plasma ACTH concentrations in the dog were increased above those in clinically normal dogs, supporting a diagnosis of pituitary-dependent hyperadrenocorticism. During treatment with mitotane, the dog became unconscious and died. Necropsy revealed a pituitary tumor that had compressed and displaced the hypothalamus. Although high-dosage dexamethasone suppression tests often are useful in the differential diagnosis of hyperadrenocorticism, a lack of suppression of plasma cortisol does not necessarily exclude pituitary-dependent hyperadrenocorticism.
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Bone death is always due to a disparity between the oxygen need of the bone cell and the ability of the local circulation to supply that need. As with infarction anywhere else, this can be brought about either by interruption of the arterial supply or by occlusion of the venous drainage, resulting in stasis and gradual oxygen starvation. In this article, these mechanisms and the events surrounding them are discussed, and the pathogenetic pathways linking the various clinical disorders with osteonecrosis are explored.
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