Biomedical subjects

A L Hulting

Publications and source records attributed to A L Hulting.

At least 19 recordsLinked to original sources

PubMed2001

[Antipsychotic drugs can affect hormone balance. Weight gain, blood lipid disturbances and diabetes are important].

Hormonally related side effects of antipsychotic drugs, e.g. weight gain, hyperlipidemia and diabetes have come to the forefront in that the use of clozapine and new antipsychotics have increased. Hormones involved are prolactin, growth hormone (GH), insulin-like growth factor I (IGF-I), insulin and leptin. Patients treated with clozapine had lower levels of GH-dependent IGF-I than patients receiving classical antipsychotics. Patients treated with olanzapine had higher serum insulin levels than those receiving classical antipsychotics, indicating a probable influence of olanzapine on insulin secretion. In clozapine-treated patients the insulin levels correlated to the clozapine serum concentration, indicating a likely influence also of clozapine on insulin secretion. The gender difference, i.e. that women normally have higher leptin levels than men, was found in patients receiving classical antipsychotics, but not in patients treated with clozapine or olanzapine.

Antipsychotic Agents↗

PubMed2001

Insulin and leptin levels in patients with schizophrenia or related psychoses--a comparison between different antipsychotic agents.

RATIONALE: Conventional as well as newer antipsychotics cause weight gain, and, in the regulation of body weight, both insulin and leptin are hormones involved. OBJECTIVE: The aim of the present study was to compare these hormonal levels in patients on treatment with different antipsychotics. METHODS: Nineteen patients receiving conventional antipsychotics, 14 patients receiving clozapine and 14 patients receiving olanzapine, were studied. Fasting blood samples for insulin, leptin, glucose, and drug serum concentrations were analyzed. In addition, body mass index (BMI) was calculated. RESULTS: The median insulin level was significantly higher in the patients receiving olanzapine than in those receiving conventional agents, whereas there was no significant difference in insulin between the clozapine and the other two groups. However, in the clozapine group, insulin levels were positively correlated to the drug serum concentration. BMI was elevated in about half of the patients, with no difference being found between the groups. The leptin level was significantly higher in the women than in the men in the conventional agent group, but not in the olanzapine or clozapine groups. CONCLUSIONS: The higher insulin level in the patients receiving olanzapine than in those receiving conventional antipsychotics, despite similar BMI, points to a probable influence of olanzapine on insulin secretion. The correlation between the insulin levels and the clozapine concentration indicates, in addition, an influence of clozapine on insulin secretion. The gender difference in leptin, i.e. females normally having higher leptin levels than males, was found in the conventional agent group, but not in the olanzapine or clozapine groups, suggesting that also leptin regulation is altered during olanzapine or clozapine treatments. Moreover, it was mainly due to an increase of leptin in the males that leptin levels were equalized between sexes in the olanzapine group. We conclude that the influence of olanzapine and clozapine on both insulin and leptin levels might be associated with their weight-gain-inducing ability, while other mechanisms may be involved in the weight gain caused by conventional antipsychotics.

Adult↗

PubMed2001

Different effects of antipsychotic drugs on insulin release in vitro.

The aim of this study was to examine the influence of antipsychotic drugs on insulin release from pancreatic beta cells in vitro. The effect of seven antipsychotics (i.e. chlorpromazine, haloperidol, perphenazine, zuclopenthixol, clozapine, olanzapine and risperidone) in a concentration of 10(-6) M was investigated on basal and glucose-stimulated insulin release. Clozapine increased basal insulin release, whereas haloperidol inhibited glucose-stimulated release and the other five antipsychotics had no significant effects. A possible stimulatory effect of clozapine on insulin release may explain its ability to increase appetite and induce weight gain.

Animals↗

PubMed2001

The role of gamma knife radiosurgery in the management of pituitary adenomas.

No treatment modality has been entirely successful in the management of pituitary adenomas. Although most patients with pituitary microadenomas can be cured by transsphenoidal surgery, the results are less satisfactory in macroadenomas in particular with suprasellar and/or parasellar extension. Additional treatment is then called for. Conventional fractional radiotherapy can often control tumour growth but is limited to 45-50 Gy with a very slow reduction in elevated pituitary hormones and a high incidence of pituitary insufficiency. Stereotactic radiosurgery allows the delivery of radiation with high precision to the target with low doses to the surrounding tissues permitting higher radiation doses. Gamma knife radiosurgery using photon energy with gamma beams from multiple cobalt 60 radiation sources is now used in many centers. It can be carried out in an outpatient setting with one single treatment. A more rapid normalization of pituitary hormone hypersecretion than with conventional radiation can be achieved as well as arrest of tumour growth and reduction of tumour mass. We therefore consider gamma knife radiosurgery as a valuable compliment to pituitary surgery. Long-term prospective studies are needed to evaluate the frequency of pituitary insufficiency in patients where the target area is determined with stereotactic magnetic resonance imaging (MRI).

Adenoma↗

PubMed2001

Dose requirement and prolactin elevation of antipsychotics in male and female patients with schizophrenia or related psychoses.

AIMS: The aim of this study was to investigate the prolactin (PRL) secretion and the growth hormone (GH)-insulin-like growth factor I (IGF-I) axis in relation to gender and side-effects and dose of antipsychotic drugs during long-term treatment. METHODS: Forty-seven patients (21 men and 26 women), diagnosed with schizophrenia or related psychoses according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria and treated with different classical antipsychotics, were studied. Prolactin, GH and IGF-I were measured, as well as the serum concentration of the antipsychotics. In addition, body mass index (BMI) was calculated. RESULTS: The median daily, as well as the median body weight, adjusted daily dose of antipsychotic drugs was twofold higher in male compared with female patients. Antipsychotic-induced hyperprolactinaemia was more frequent and occurred at a lower daily dose of antipsychotics in women. Irrespective of sex, more than half of the patients had elevated BMI. Two patients had a slight increment in IGF-I levels, whereas the GH concentration, as assessed on a single occasion, was normal in all patients. CONCLUSIONS: Patients on long-term antipsychotic therapy, with doses adjusted according to therapeutic efficiency, exhibited hyperprolactinaemia and elevated BMI, but no obvious influence on the GH-IGF-I axis. Furthermore, it appeared that the males required twice the dose of antipsychotic compared with females.

Adult↗

PubMed2001

Adrenocorticotropic hormone-producing pituitary tumors: 12- to 22-year follow-up after treatment with stereotactic radiosurgery.

OBJECTIVE: To study retrospectively long-term outcomes of patients with adrenocorticotropic hormone-producing pituitary tumors that were treated with stereotactic Leksell gamma knife unit radiosurgery. METHODS: Eighty-nine patients aged 5 to 67 years were treated between 1976 and 1985. Eighteen patients aged 18 to 68 years (mean age, 41 yr) were followed in detail. Fifteen patients were women. None had previously received conventional radiotherapy, but pituitary microsurgery had been performed in two patients, and one patient had had an adrenalectomy. In the remaining 15 patients, radiosurgery was the primary therapy. RESULTS: Sixty-four patients had one stereotactic treatment, and 25 patients had two or more treatments. No complications were observed during treatment and the immediate follow-up period. At follow-up, 17 patients had died 1 to 20 years after the first treatment. No deaths were related to the treatment. In our 18 patients, the follow-up time after the first radiosurgical treatment was 12 to 22 years (mean follow-up period, 17 yr). Urinary cortisol levels gradually normalized in 83% of the patients. No recurrences were observed. Pituitary hormone insufficiencies developed in about two of every three patients and occurred even more than 10 years after treatment. Eight patients had transient hyperprolactinemia. The patients' vision and visual fields were unaffected, and none of them had signs of radiation-induced side effects such as brain tumors or brain necrosis. CONCLUSION: Stereotactic radiosurgery is a safe and effective method in the treatment of patients with adrenocorticotropic hormone-producing pituitary tumors, and the effect of treatment is long-lasting. Stereotactic radiosurgery is mainly a complement to microsurgery because of its gradually appearing effect and the occurrence of pituitary insufficiency. New pituitary deficiencies may be found more than 10 years after treatment.

Adolescent↗

PubMed2000

Prolactin-secreting pituitary adenoma in neuroleptic treated patients with psychotic disorder.

Three patients with psychoses and concomitant prolactin-secreting pituitary tumours are described. Patients A and B had bipolar and schizoaffective disorders, respectively. They had both been treated with neuroleptics for 20 years before the prolactinomas were revealed. Patient C developed a paranoid psychosis after two years of continuous bromocriptine treatment for a pituitary tumour. In patient A the prolactin level was successfully normalized and a good antipsychotic effect was maintained by combined therapy with haloperidol and quinagolide but not bromocriptine. In patient B the prolactinoma was removed by surgery, in view of the serious nature of the psychotic disorder, to avoid psychotic relapse by treatment with a dopamine agonist. In patient C a good result was obtained with the combination of clozapine and bromocriptine. These case reports support the view that neuroleptics being dopamine antagonists and dopamine agonistic agents which are the primary treatment of prolactinomas can cancel out each other's effects. The combination of clozapine and quinagolide is recommended as the treatment of choice for most patients.

Adult↗

PubMed2000

Elevated levels of insulin, leptin, and blood lipids in olanzapine-treated patients with schizophrenia or related psychoses.

BACKGROUND: The aim of this study was to investigate the influence of the antipsychotic agent olanzapine on glucose-insulin homeostasis to explain possible mechanisms behind olanzapine-associated weight gain. METHOD: Fourteen patients on treatment with olanzapine (all meeting DSM-IV criteria for schizophrenia or related psychoses) were studied. Fasting blood samples for glucose, insulin, the growth hormone (GH)-dependent insulin-like growth factor I, and the insulin-dependent insulin-like growth factor binding protein-1 (IGFBP-1) were analyzed, as well as GH, leptin, and blood lipid levels and the serum concentrations of olanzapine and its metabolite N-desmethylolanzapine. In addition, body mass index (BMI) was calculated. Moreover, weight change during olanzapine treatment was determined. RESULTS: Twelve of the 14 patients reported weight gain between 1 and 10 kg during a median olanzapine treatment time of 5 months, whereas data were not available for the other 2 patients. Eight patients (57%) had BMI above the normal limit. Eleven patients were normoglycemic, and 3 showed increased blood glucose values. Most patients (10/14; 71%) had elevated insulin levels (i.e., above the normal limit). Accordingly, the median value of IGFBP-1 was significantly lower for the patients in comparison with healthy subjects. Moreover, 8 (57%) of 14 patients had hyperleptinemia, 62% (8/13) had hypertriglyceridemia, and 85% (11/13) hypercholesterolemia. Weight change correlated positively to blood glucose levels and inversely to the serum concentration level of N-desmethylolanzapine. Additionally, the levels of blood glucose, triglycerides, and cholesterol correlated inversely to the serum concentration of N-desmethylolanzapine. CONCLUSION: Olanzapine treatment was associated with weight gain and elevated levels of insulin, leptin, and blood lipids as well as insulin resistance, with 3 patients diagnosed to have diabetes mellitus. Both increased insulin secretion and hyprleptinemia may be mechanisms behind olanzapine-induced weight gain. Moreover, it is suggested that the metabolite N-desmethylolanzapine, but not olanzapine, has a normalizing effect on the metabolic abnormalities.

Adult↗

PubMed1999

Oxytocin causes a sustained decrease in plasma levels of corticosterone in rats.

The aim of this study was to investigate how oxytocin (OXT) influences plasma levels of ACTH and corticosterone in rats. A single injection of OXT (1 mg/kg s.c.) caused a transient increase in ACTH and corticosterone. In contrast, 1 mg/kg OXT (but not 10-100 microg/kg) decreased corticosterone, but not ACTH levels, 6 h after the injection. OXT (1 mg/kg s.c.) administered once a day for 5 days, decreased cortiocosterone for 10 days after the last injection. An acute challenge with ACTH increased corticosterone to the same level in rats pretreated with OXT and controls. Dexamethasone decreased corticosterone to equal levels in both groups. Thus, OXT seems to be able to stimulate as well as to inhibit the activity within the HPA-axis within a short- and a long-term perspective, respectively.

Adrenocorticotropic Hormone↗

PubMed1999

Paradoxical GH response to TRH during status epilepticus in man.

Information on GH in relation to epilepsy is sparse, and to our knowledge there is no information on GH levels during status epilepticus in man. We studied GH in serum in six patients during status epilepticus, and in a control group of six seizure-free patients with epilepsy, before and after injection of TRH. The baseline GH values before TRH administration were within the normal range in all patients. After injection of TRH all patients with status epilepticus showed a paradoxical peak-shaped increase of GH to at least twice their baseline levels within 45 min after the injection (median basal GH value 1.5 mU/l and median peak GH value 6. 5 mU/l, mean increase 330%). No uniform reaction to TRH was observed in the control group (median basal GH value 2.7 U/l and median of the highest value within 45 min 5.2mU/l). A paradoxical peak reaction of GH to TRH was significantly more frequent in the status epilepticus group compared with the control group (P=0.008, Fisher exact probability test). TRH is not considered a GH-releasing hormone in humans during normal conditions, but a paradoxical response of GH to TRH, similar to that observed during status epilepticus, has been reported in various other pathological conditions, such as acromegaly, liver cirrhosis, mental depression and hypothyroidism. Our results of GH release after TRH administration in patients with status epilepticus suggest an altered regulation of GH as a result of the long-standing epileptic activity.

Adult↗

PubMed1999

Different influences of classical antipsychotics and clozapine on glucose-insulin homeostasis in patients with schizophrenia or related psychoses.

BACKGROUND: The aim of this study was to investigate the influence of classical antipsychotics and the atypical antipsychotic agent clozapine on glucose-insulin homeostasis to explain possible mechanisms behind weight gain associated with antipsychotic treatment. METHOD: Twenty-eight patients on therapy with classical antipsychotics and 13 patients treated with clozapine (all meeting DSM-III-R criteria for schizophrenia or related psychoses) were studied. Fasting blood samples for glucose and insulin, as well as for 2 markers of the glucose-insulin homeostasis, i.e., the growth hormone (GH)-dependent insulin-like growth factor I (IGF-I) and the insulin-dependent insulin-like growth factor binding protein-1, were analyzed. Body mass index (BMI) was calculated and serum concentrations of the different antipsychotic drugs were measured. In addition, the relationship between the endocrine parameters and drug serum concentrations was examined. RESULTS: The insulin levels were positively correlated to the serum concentration of clozapine, whereas no correlations were found between insulin and the serum concentrations of perphenazine (N = 12) or zuclopenthixol (N = 9). Insulin elevation was seen in the patients receiving clozapine more frequently than in the patients receiving classical antipsychotics. In addition, the median level of IGF-I was significantly lower in the patients receiving clozapine than in the patients receiving classical antipsychotics. No significant difference in BMI was found between the 2 patient groups, and all patients but 1 were normoglycemic. CONCLUSION: The correlation between insulin and the clozapine concentration indicates a probable influence of clozapine on insulin secretion. The normal blood glucose levels in the clozapine group support the theory that clozapine induces concentration-dependent insulin resistance with secondary increased insulin secretion. In addition, lower median level of IGF-I in patients receiving clozapine compared with patients receiving classical antipsychotics points to a lower GH secretion in the clozapine group. This impaired GH secretion together with the clozapine-induced insulin resistance might be mechanisms behind weight gain during clozapine therapy.

Adult↗

PubMed1998

Pituitary autoantibodies in patients with hypopituitarism and their relatives.

Autoantibodies to human pituitary cytosol proteins were determined by immunoblotting in sera from patients with hypopituitarism and their relatives. Reactivity to an M(r) 49,000 protein was significantly more frequent in patients (6/21 (28%) P < 0.05) as well as in relatives (10/35 (28%) P < 0.02) compared with controls (3/44 (6.8%)). Autoantibodies to this particular protein have previously been detected in sera from 70% of patients with biopsy-proven lymphocytic hypophysitis. Unlike patients with biopsy-proven lymphocytic hypophysitis, none of the patients in this study presented with a suspected pituitary adenoma or showed an enlarged sella turcica. Cisternal herniation was seen in 6/21 patients and this may very well represent the end stage of lymphocytic hypophysitis. Since organ specific autoantibodies are frequent in patients with autoimmune endocrine disease as well as in their unaffected relatives, autoantibodies to this M(r) 49,000 pituitary cytosolic protein may represent markers for an immunological process affecting the pituitary gland.

Aged↗

PubMed1997

Botulinum neurotoxin F, a VAMP-specific endopeptidase, inhibits Ca(2+)-stimulated GH secretion from rat pituitary cells.

Botulinum neurotoxin F (BoNTx F) is a zinc-dependent endopeptidase that causes proteolytic cleavage of the vesicle protein VAMP (vesicle-associated membrane protein). VAMP is an important component of the molecular machinery regulating docking and fusion of secretory vesicles with the target membrane. We have investigated presence of VAMP protein in cultured rat anterior pituitary cells. Confocal laser microscopy revealed presence of VAMP-like immunoreactivity in secretory granules of GH-containing cultured rat anterior pituitary cells. Using BoNTx F, we have investigated whether VAMP is involved in growth hormone (GH) secretion. Treatment of streptolysin-O permeabilized GH-secreting cells with BoNTx F (2.0 and 20 nM) significantly inhibited Ca(2+)-induced GH release. The results show that the secretory granules of rat anterior pituitary cell contain VAMP protein and suggest that VAMP is of importance in regulating Ca(2+)-mediated GH secretion.

Animals↗

PubMed1997

Evidence for a dual function of oxytocin in the control of growth hormone secretion in rats.

The aim of the present study was to investigate the role of oxytocin (Oxy) in the control of growth hormone (GH) release. Oxy was administered subcutaneously (s.c.) or intracerebroventricularly (i.c.v.) to male rats. The animals were decapitated and trunk blood was collected at 30 and 120 min after Oxy administration. GH levels were analyzed by radioimmunoassay. Oxy (100 microg, s.c) increased plasma levels of GH significantly 30 min after administration. Oxy (2 ng, i.c.v.) caused a significant rise of GH after 120 min. This effect was completely abolished by previous administration of the Oxy antagonist 1-deamino-2-D-Tyr-(OEt)-4-Thr-8-Orn-oxytocin. When 5 microg of Oxy were given i.c.v. or 1 mg s.c., an inhibition of GH secretion was seen after 120 min. This effect was also abolished by the Oxy antagonist. Thus Oxy may influence GH in opposite directions depending on the doses given.

Animals↗

PubMed1997

High-molecular weight IGF-2 expression in a haemangiopericytoma associated with hypoglycaemia.

Spontaneous hypoglycaemia is usually caused by an insulin-producing islet-cell tumour of the pancreas. Rarely, it can be caused by non-islet cell tumours. Most of the tumours are of mesenchymal type, large, and slowly growing. One representative is haemangiopericytoma (HAP). The present report describes a case of a large recurrent retroperitoneal HAP associated with severe hypoglycaemia. Blood serum insulin and proinsulin concentrations were low. By means of acid-gel chromatography and dot-blot techniques, an increased amount of a high-molecular-weight IGF-2 peptide was found. By using antigen retrieval procedures, IGF-2-immunoreactive tumour cells were found in specimens of the recent tumour recurrence-but not in the original. When the in situ hybridization technique was used it could be shown that IGF-2 mRNA labelling had already occurred in the original tumour specimen, 11 years before the onset of hypoglycaemic symptoms. These observations confirm the hypothesized hypoglycaemic effects of high-molecular-weight (HMW) IGF-2, but also point to the presence of a prolonged compensation of this effect. A literature review, based on 17 similar cases of haemangiopericytoma with hypoglycaemia, is presented. Our observation and findings in the literature review support the idea that non-islet-cell tumour hypoglycaemia is caused by an overproduction of a HMW IGF-2 peptide. The insulin-like effect is mediated via non-specific binding to the insulin receptors. To anticipate patients at risk of developing this kind of hypoglycaemia, the histopathological investigation should include not only immunohistochemical analyses of the presence of IGF-2 peptide, but also in situ hybridization of the IGF-2 mRNA expression.

Aged↗

PubMed1997

Nitric oxide synthase and cGMP in the anterior pituitary gland: effect of a GnRH antagonist and nitric oxide donors.

Using immunohistochemistry and in situ hybridization, it has been previously shown that gonadotropes and folliculo-stellate cells in the rat anterior pituitary gland express nitric oxide (NO) synthase (NOS), and that NOS expression is increased by gonadectomy. Using the indirect immunofluorescence technique in conjunction with antibodies raised to conjugated cGMP, we have attempted to establish the target cells for NO in the anterior pituitary and to define the mediator of NO regulation. After incubation of pituitary slices with several NO donors, numerous endocrine cells, but no folliculo-stellate cells, expressed cGMP. Most of these cells stained for LH, that is they were gonadotropes. However, there were apparently cGMP-positive, LH-negative and LH-positive, cGMP-negative endocrine cells. The increase in cGMP could be virtually completely blocked by a guanylyl cyclase inhibitor. cGMP was not expressed in corticotropes, but cGMP-positive cells often contained NOS-like immunostaining. Incubation with GnRH did not result in detectable levels of cGMP. However, when castrated rats were pretreated with a potent longlasting GnRH antagonist, antide, the castration-induced increase in NOS was completely blocked. This suggests that GnRH is involved in the in vivo upregulation of NOS after castration, but that GnRH cannot induce cGMP accumulation in normal pituitary slices in vitro. Taken together, the present results give further evidence for a role of NO in the control of, in particular, LH secretion from the anterior pituitary gland in the rat.

Animals↗

PubMed1996

Effect of oxytocin on growth hormone release in vitro.

The effect of oxytocin (OT) on growth hormone (GH) secretion was investigated using dispersed rat anterior pituitary cells. OT dose-dependently inhibited GH secretion as well as GHRH-stimulated GH release. The inhibitory actions of OT on GH release were totally abolished by pretreatment with the OT-antagonist VAP 259. The peptides galanin and cholecystokinin did not affect the OT-induced inhibition on basal or GHRH-stimulated GH release. Several possible mechanisms by which OT may influence GH release are discussed.

Animals↗

PubMed1996

Expression of leptin receptor mRNA in the hypothalamic arcuate nucleus--relationship with NPY neurones.

The obese phentotype of ob/ob mice is linked to a mutation in the ob gene that results in expression of a truncated inactive protein. The ob gene product, leptin, is synthesized in adipose tissue and is a circulating factor that regulates body weight. Leptin receptors were recently cloned and a mutation in the leptin receptor gene in obese db/db mice was identified. Leptin receptor mRNA has been detected in brain, including hypothalamus, but the cellular localization has so far not been clarified. Here we report on the cellular localization of leptin receptor mRNA in the mouse brain using in situ hybridization. Strong hybridization was observed in the choroid plexus and hypothalamic arcuate nucleus. Weaker hybridization was detected in the hippocampal formation and in the cerebral cortex. Within the arcuate nucleus, cell bodies expressing leptin receptor mRNA were distributed in its ventromedial subdivision. Hybridization of semiadjacent sections with a probe to neuropeptide Y (NPY) showed a co-distribution of labelled cell bodies, suggesting the presence of leptin receptors on NPY-containing neurones.

Animals↗