Endocrinological Findings Research Articles

Clinical and Endocrinological Evaluation of Patients with Congenital Microphallus

Eight patients with congenital microphallus were investigated. Plasma luteinizing hormone, follicle-stimulating hormone, testosterone and androstenedione levels were obtained in all cases. In addition, the response to the administration of human chorionic gonadotropin, luteinizing hormone-releasing hormone and adrenocorticotropic hormone, the assessment of testicular histology by electron microscopy and the measurement of dihydrotestosterone formation by preputial skin were determined in some patients. The results of these studies were compared to similar studies in 6 normal prepubertal boys, 4 boys with bilateral cryptorchidism, 1 male infant with anorchia and 1 adult with hypogonadotropic hypogonadism.The clinical and endocrinological findings in the 8 patients with microphallus can be divided into 2 distinct categories. In 5 patients the disorder is familial, gonadotropin levels are low and there is a normal response to stimulation with chorionic gonadotropin. The data are compatible with the possibility that 3 (possibly 5) of the 8 patients with microphallus have hypogonadotropic hypogonadism. In the other group the cases are sporadic, serum luteinizing hormone and folliclestimulating hormone levels are elevated and plasma testosterone failed to increase after shortterm treatment with chorionic gonadotropin. In these patients a primary testicular disorder appears to be responsible. Experimental and clinical evidence suggests that microphallus results from defective testicular function during the second and third trimesters of pregnancy, either as the result of defective gonadotropin secretion or defective androgen synthesis.

Treatment of Cushing's disease by transsphenoidal microsurgery (author's transl)

Six patients of ACTH dependant Cushing's disease were treated by transsphenoidal resection of pituitary adenomas. Preoperative endocrinological results showed that both plasma ACTH and cortisol were maintained at higher levels and their normal diurnal rhythms were lost. Urinary 17-OHCS excretion was partially suppressed by larger doses of dexamethasone (8 mg). These data was suggestive of pituitary dependent Cushing's disease, rather than ectopic ACTH-producing tumors. The sella volume was measured by Di Chiro's method and in 3 cases it exceeded minimally above the upper limit of the normal value, but the other 3 showed completely normal sella. Localized bulging of the sella floor was found in 2 cases by midline lateral tomography. In the A-P tomogram asymmetry of the sella floor was found in one case and localized bulging in other 2 cases. Minimal suprasellar expansion of the tumor was found only in one case by midline pneumotomography. Magnified cerebral angiography with subtraction method or computed tomography was not diagnostic to verify pituitary microadenomas. The indication of pituitary surgery had to be decided mainly by endocrinological findings. In only one case the adenoma occupied most of the intrasellar space, but in the other 5 they were microadenomas and 3 of them were buried in the normal glands. Complete resection of the adenoma was attempted, but macroscopically normal tissue was tried to be left as much as possible. Typical Crooke's hyaline changes were found in the normal adenohypophysis in one case and immunohistochemical studies using anti-ACTH serum revealed that the Crooke's cells are still reactive. After surgery most patients showed decreased plasma ACTH and cortisol levels and substitution therapy of adrenocortical hormones was necessary for the first one or two months. Rapid clinical remission of Cushing's syndrome was observed in all but one, who might have residual tumor cells due to technical incompleteness. Successive endocrinological reevaluation showed that pituitary-adrenal function has been normal or subnormal in 5 cases. One showed no significant improvement. None had pan-hypopituitarism nor any serious side effects, such as liquorrhea and continuous diabetes insipidus. Overall results suggest that transsphenoidal resection of pituitary adenomas in Cushing's disease should be located in the center of the treatment.

Transsphenoidal microneurosurgery.--Part 1. Operative technique and results of 150 cases (author's transl)

The purpose of this study is to evaluate the results of 150 transsphenoidal pituitary operations in light of the clinical, endocrinological and neuroradiological findings obtained preoperatively in these patients. There were 63 cases of pituitary adenomas, 68 cases of hypophysectomies, 9 arachnoid cysts (“empty sella”) and 10 other cases in this series. The mortality was 2 percent, occurring only in patients undergoing transsphenoidal hypophysectomies for metastatic breast cancer. The cumulative morbidity, including three cases each of CSF rhinorrhea and meningitis, two cases of rhinorrhagia and a single case of a temporary sixth nerve palsy, was 6 percent. The combined recurrence rate for both nonfunctioning and functioning adenomas was 9.5 percent. Improvement of visual field defects was observed in 92.3 percent of cases who preoperatively exhibited visual field loss. Improvement of endocrinological findings in functioning adenomas was also discussed. Postoperative change of water and sodium metabolism were carefully studied in 49 patients harboring pituitary adenomas and in 36 patients undergoing transsphenoidal hypophysectomy. Diabetes insipidus was seen more frequently following transsphenoidal hypophysectomies than after removal of pituitary tumors. In 85 cases of transsphenoidal pituitary operations studied in relationship to the developement of diabetes insipidus, a permanent diabetes insipidus lasting over a month (Grade III) occurred only in 8 patients following transsphenoidal hypophysectomy. Temporary diabetes insipidus, on the other hand, lasting less than a month (Grade II and I) could be observed following 20 operations for a pituitary tumor and in 17 hypophysectomized patients. Recurrence of the pituitary adenoma was observed in 6 out of 63 cases. All cases had large mass radiologically demonstrating destruction of the sella turcica and suprasellar extension of the tumor. Operative results by transcranical operation were also discussed reviewing literatures. The attempt will be made to define the indications for transsphenoidal approach in the light of the neuroradiological findings and to summarize our experiences with the postoperative management of these patient in part—2 and 3.

The Posteromedial Hypothalamus and Pain, Behavior, with Special Reference to Endocrinological Findings

Stereotactic intervention into the posterior hypothalamus gives satisfactory results for controlling both aggressive, violent behavioral disorders and intractable pain. From the endocrinological point of view, this procedure activates the hypothalamic-hypophyseal axis only temporarily, without causing any serious dysfunctions.

Psychosomatic and endocrinologic findings in secondary amenorrhea (proceedings)

Psychosomatic and endocrinologic findings in secondary amenorrhea (proceedings)

ENDOCRINOLOGICAL FINDINGS IN TWO PATIENTS WITH PREMATURE OVARIAN FAILURE

ENDOCRINOLOGICAL FINDINGS IN TWO PATIENTS WITH PREMATURE OVARIAN FAILURE

Observations on the role of the fetal adrenal gland in steroidogenesis during diabetic pregnancy.

SummaryClinical and endocrinological findings are reported in a patient with diabetes mellitus who was subjected to bilateral adrenalectomy for adrenal hyperplasia and to removal of 80 per cent of the pancreas on account of an islet cell tumour. The patient subsequently became pregnant as a result of treatment with Pergonal (Serono) and human chorionic gonadotrophin (HCG).During the gestation period levels of HCG did not differ from normal while values for oestrogens and pregnanediol were at the lower end of or below the normal range.Levels of urinary testosterone and epitestosterone during the pregnancy were considerably higher than in an adrenalectomized subject previously studied, suggesting that, in the presence of maternal diabetes, the main site of elaboration of precursors of these hormones was the fetal adrenal gland.

Endocrine studies in a quintuplet pregnancy.

This communication describes a 21 year old patient who developed secondary amenorrhea following the administration of an oral contraceptive Orthe-Novum 2 mg (2 mg norethindrone plus .1 mg mestranol) for 10 months. For the 10 months of administration the patient noted a marked diminution in menstrual flow. After the last cycle of treatment slight bleeding occurred for 2 days and during the next 7 months menstruation did not occur. Tests showed she was not pregnant and bleeding did not occur after giving 10 mg 6-dehydroretroprogesterone per day for 5 days. Admitted to the hospital an attempt was made to induce ovulation by administration of human menopausal gonadotrophin (HMG) (Pergonal) followed by human chorionic gonadotrophin (HCG). This treatment resulted in a quintuplet pregnancy. Clinical and endocrinological findings are reported. Urinary excretion values for estrogens pregnanediol and HCG were abnormally high for the last 5 weeks of pregnancy which terminated at 24 weeks. Placental histology and fetal blood group determinations were conducted in an attempt to establish the zygosity of the fetuses but a definite conclusion on this point could not be drawn.

Pituitary-adrenocortical function of women following Gestagen administration

Investigation on the effect of Gestagens on the Pituitary-Adrenocortical function has been undertaken in women who have received long-term administration.The studies were made in two groups of women : (1) The one group was orally administered Gestagens, i.e., a compound of Norethindrone-Mestranol (norethindrone 5 mg., with mestranol 0.05 mg. per tablet), for a cyclic period of eight to twelve months. (2) While, to study the effect of larger dosage administration, the other group received Norethindrone-Mestranol for a period of three months in connection with pseudopregnancy. The following conclusions were obtained based on various endocrinological findings : 1. No precise conclusion could be drawn from the findings of urinary 17-OHCS, 17-KS evaluations and Thorn test.2. It was found, however, that there were significant decreases of urinary 17-OHCS, 17-KS, Pregnane-diol and Pregnane-triol, accompanied by a slight increase of plasma 11-OHCS during the period of administration as compared with the pre-treatment values, when the estimation was carried out in more precisely adjusted conditions as regards individual difference and diurnal change.3. During the period of administration, the effects of ACTH, Su-4885 and dexamethasone tests were studied. It was observed that the excretory patterns of urinary 17-OHCS, 17-KS, Pregnane-diol, Pregnane-triol and plasma 11-OHCS revealed no abnormal depression as compared with the pre-treatment pattern.4. These results reasonably indicate that the basic function of the pituitary-adreno-cortical system was not basically disturbed during the oral administration of the contraceptive agent.5. Similar patterns of urinary and plasma steroids under ACTH, Su-4885 and dexamethasone tests were observed in women who were treated with pseudopregnancy type of Gestagens administration. These results clearly point out the evidences that even massive administration of Gestagens has no particular effect on the basic function of pituitary-adrenocortical system.6. It was assumed that the changes in steroid metabolism of the liver seemed to have occurred during the treatment compared with a pre-treatment period in view of lowered metabolic rate of urinary 17-KS of testosterone in addition to elevated value of serum transaminase and delayed secretory phase of BSP.7. An attempt was made to explain a mechanism of decreased urinary steroid upon the findings of changed steroid metabolism in the liver and by the increasing trend of plasma 11-OHCS which possibly heighten the plasma protein bound cortisol.8. It was interpreted that variations of steroid values in blood and urine upon the administration of combined norethindrone-mestranol was not due to an action of estrogen but by a combination of the two, namely, norethindrone and mestranol.9. From the findings of the tolerance tests, it is proposed that the urinary Pregnanediol, Pregnane-triol, 17-OHCS, 17-KS could equally be applied for the functional test of the pituitary-adrenocortical system of normal women (uncastrated) with a prerequiste of making a fixed environmental condition for estimation.

PLASMA AND URINARY 17-OHCS RESPONSES TO MOTION PICTURES.

A serious limitation in efforts to study emotional processes in normal human subjects has been the lack of experimental methods for eliciting emotional responses in a predictable or systematic manner. While studies of persons undergoing naturally occurring stressful life experiences have been relatively numerous and fruitful, deliberate attempts to produce acute emotional responses in the laboratory have met with much difficulty in the way of supplying standard techniques for psychophysiological studies. The present study represents an exploration of the practicability of using motion pictures as a relatively standard means of stimulus presentation which, hopefully, might produce changes in emotional state, as reflected both by psychological and physiological responses, particularly by changes in plasma and urinary 17-hydroxycorticosteroid (17-OHCS) levels. Some of the psychological aspects of this study are reported elsewhere in detail.^1,2This report deals primarily with the detailed endocrinological findings and is especially concerned with the crucial problems