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Biomedical subjects

E Arteaga

Publications and source records attributed to E Arteaga.

At least 73 records · Page 4Linked to original sources
PubMed1991

[Polycystic ovary syndrome as expression of 3-beta-hydroxysteroid dehydrogenase deficiency].

Late-onset adrenal enzymatic deficiencies are a common cause of hirsutism. They can produce a PCO syndrome-like clinical course, underscoring the multi-causality of this condition. We report a 18 year old woman with secondary amenorrhea and hirsutism, whose serum levels of testosterone and DHEA-S were 175 ng/dl and 7.3 micrograms/ml and the LH/FSH ratio was 5.9. Dexamethasone decreased testosterone and DHEA-S levels, while the ACTH stimulation test increased the 17 hydroxypregnenolone serum concentration and the 17 hydroxypregnenolone/17 hydroxyprogesterone ratio to values considered diagnostic of 3 beta hydroxysteroid dehydrogenase deficiency.

3-Hydroxysteroid Dehydrogenases↗
PubMed1990

[Unilateral adrenalectomy for cortisol producing adenoma: prolonged suppression of the hypothalamus-pituitary-adrenal axis].

Hypercortisolism induces a functional suppression of the hypothalamus-pituitary-adrenal axis which is expected to subside within a year following either the removal of the cortisol producing adrenal adenoma or the withdrawal of glucocorticoid therapy. We report 3 women (35, 40 and 43 years old) with Cushing's syndrome due to cortisol producing adrenal adenoma. All had typical clinical and biochemical features of the syndrome dating from up to 4 years before surgery. Cortisol supplementation was given during the postoperative period (20 mg/day po at 9 AM, reduced to 10 mg/day after 6 months). Cortisol was withdrawn 16, 20 and 39 months after surgery, when 9 AM plasma concentration raised over 10 ug/dl [corrected]. An ACTH stimulatory test was performed until a normal response was obtained. Patients showed and abnormal response up to 16, 17 and 30 months after surgery, respectively. Complete recovery took place at 21, 36, and 55 months after the operation. We concluded that risk of hypocortisolism may persist up to 30 months after surgery for cortisol producing adenomas, due to complete or partial suppression of the hypothalamus-pituitary-adrenal axis.

Adenoma↗
PubMed1990

[National medical grading].

A new, common system for grading medical graduates from the 6 Chilean Schools of Medicine has been agreed by consensus: the National Medical Grading. This was an evident need since up to now each school applied a different criterion to qualify its graduates; the resulting disparity in the scores with which graduates applied for the National calls in postgraduate training programs, general practice positions and the like, elicited uneasiness both among graduates and academic staff. In the new system, the final grade is calculated giving equal relative importance to the marks in licensure (60%), internships (30%) and final clinical examinations (10%). The National Medical Grading has been applied for the first time by the Ministry of Health in the 1989 call, and by the University of Chile and Catholic University's Medical Schools (call for postgraduate training programs). It is hoped that within 2 or 3 years a National Medical Examination will be designed and applied.

Educational Measurement↗
PubMed1990

[The effect of a peripheral androgenic blockade on plasma lipoproteins in hirsutism patients].

We studied the effect of flutamide, a peripheral androgenic blocking agent, 500 mg daily for 28 days in 7 non ovulating patients with hirsutism. Total and HDL cholesterol, triglycerides, testosterone and dehydroepiandrosterone sulphate (S-DHEA) plasma levels were measured in patients and in 6 non ovulating control women of similar age and weight. Only basal HDL levels were lower in patients than in controls (40.2 +/- 1.6 vs 51.4 +/- 3.3 mg/dl, p < 0.01). A decrease in S-DHEA levels was observed after flutamide in patients with hirsutism (3.2 +/- 0.4 to 2.1 +/- 0.4, p < 0.01) which may be attributed to the lowering of cortisol clearance induced by the drug. Total testosterone and plasma lipoproteins remained stable. Thus, peripheral androgenic blockade does not modify the decreased levels of HDL cholesterol in non ovulating patients with hirsutism.

Adult↗
PubMed1990

[Cushing's syndrome: the diagnostic and treatment problems in 27 cases].

Problems of diagnosis and treatment were analyzed in 27 patients with Cushing syndrome (25 confirmed by anatomic findings) followed for a mean of 50 months. The etiology was Cushing disease in 14 (52%), suprarenal tumor in 9 (33%) and ectopic secretion of ACTH in 4 (15%). Determination of plasma cortisol levels at 4 PM or 11 PM was a highly sensitive test for the presence of this syndrome (100%). High resolution computed tomography was considerably more effective than conventional X ray studies of the sella in patients with Cushing disease (42 vs 20%). Treatment has been totally effective in all patients with benign suprarenal lesions. Cure was obtained in 64% of patients with pituitary lesions and 0% of patients with Cushing syndrome associated to malignancy.

Adenoma↗
PubMed1989

The paradoxical response of growth hormone (GH) to thyrotropin-releasing hormone (TRH) in constitutionally tall children involves a cholinergic pathway.

To investigate whether or not a cholinergic pathway is involved in the paradoxical response of GH to TRH in constitutionally tall children, we studied 8 healthy prepubertal children aged 4 2/12-7 10/12 yr, whose heights were over the 95th percentile of the NCHS tables. We defined as "paradoxical" a GH increment greater than 5 ng/ml in response to TRH. Five out of 8 children showed a paradoxical response of GH to TRH (mean GH peak after TRH of 10.7 +/- 1.1 ng/ml). Pretreatment with atropine (0.01 mg/kg IM 30 min prior to the TRH administration) abolished the TRH induced GH rise (peak GH after TRH of 1.5 +/- 1.0 ng/ml, p less than 0.01) but did not modify the TSH response (peak TSH after TRH: basal conditions 8.7 +/- 0.8 microU/ml, post atropine: 9.5 +/- 1.4 microU/ml, p greater than 0.05). Our results demonstrate that a cholinergic pathway is involved in the paradoxical response of GH to TRH in constitutionally tall children.

Acetylcholine↗
PubMed1989

[Primary hyperparathyroidism: usefulness of high resolution echography in local diagnosis].

Recent reports show a better surgical outcome in primary hyperparathyroidism when an accurate preoperative localization of the lesion in available. We performed high resolution sonography in 23 consecutive patients (20 women) with biochemically proven hyperparathyroidism. Twenty two of them were operated on and their sonographic reports were compared to the surgical and pathological findings (20 adenomas, 1 carcinoma and 1 hyperplasia). One patient did not have surgery but the sonogram was compared to a Tl 201-Tc99 scintigram that suggested an adenoma. Sonography showed a single parathyroid tumor in 17 patients and failed to demonstrate a lesion in six. There were two false positives and 6 false negatives. The sensitivity was 71.5% and the positive predictive value was 88%. Three out of 6 patients with a negative sonography had an adenoma located out of reach for the method. Our results show that the high resolution sonography is a useful, non invasive method to localize abnormally enlarged parathyroid glands in hyperparathyroidism and we think it should be performed in every patient with a biochemical diagnosis of this disease.

Adult↗
PubMed1989

[Cushing syndrome caused by macronodular adrenal hyperplasia, independent of ACTH: report of a case].

A 45 year old female with Cushing's syndrome due to non-ACTH dependent bilateral adrenal macronodular hyperplasia (AMH) is reported. The diagnosis of Cushing's syndrome was based on the typical clinical features and on the demonstration of high urinary levels of free cortisol (microF) (630 micrograms/24 h) and 17 hydroxysteroids (17-OHS) which failed to suppress during the Liddle test (17-OHS, (mg/g creat), Basal: 68.5, post Dexamethasone 2 mg: 59.6 and post Dexamethasone 8 mg: 69.9). The adrenal CT scan showed bilateral multinodular enlargement while the pituitary CT scan was normal. Due to the presence of severe hypertension (240/150) and depression, the patient was treated with ketoconazole (800 mg/d) during 8 months achieving eucortisolism (microF 14-39 micrograms/24 h); however, plasma ACTH was not detectable at the end of this period. A bilateral adrenalectomy was performed, and both adrenals showed multiple nodules (0.3-4.5 cm in diameter) and weighed 136 and 31 g respectively. The lack of suppression of the 17-OHS with 8 mg of Dexamethasone, the persistence of an adequate inhibition of cortisol biosynthesis with ketoconazole, and the absence of plasma ACTH suggest that the patient had a non-ACTH dependent AMH. The possible pathogenic factors involved in this case are discussed.

Adrenal Glands↗
PubMed1988

Zona glomerulosa function after life-long suppression in two siblings with the hypertensive virilizing form of congenital adrenal hyperplasia.

The function of the adrenal zona glomerulosa was studied in two pubertal siblings with the hypertensive virilizing form of congenital adrenal hyperplasia who had never been treated. Initially, their plasma 11-deoxycortisol and 11-deoxycorticosterone (DOC) levels were very high, PRA was suppressed, and plasma aldosterone and 18-hydroxycorticosterone (18-OHB) were undetectable. To selectively study zona glomerulosa function, the patients and five normal subjects were given dexamethasone (2 mg/day; thus suppressing zona fasciculata function), and their sodium intake was restricted to 10 mmol/day. After 3-5 days, the zona glomerulosa was stimulated with either angiotensin II or potassium chloride. The same protocol was repeated in the patients at various intervals up to 39 months after beginning maintenance therapy with dexamethasone (0.25 mg twice daily). PRA, plasma aldosterone, and 18-OHB remained low during the first 6 months of treatment. After the first year, PRA recovered, and the zona glomerulosa began to respond. Plasma aldosterone and 18-OHB levels reached normal basal and stimulated values in one of the patients after 2 yr of treatment, but remained subnormal after 39 months of treatment in the other patient. Both patients, however, had persistently elevated plasma DOC concentrations, suggesting slight but definite impairment of 11 beta-hydroxylation in the zona glomerulosa. We conclude that in spite of a severe and persistent 11 beta-/18-hydroxylation deficiency in the zona fasciculata, the zona glomerulosa can recover almost completely after prolonged treatment. Appropriate stimulation, however, discloses a minor 11 beta-hydroxylation impairment also in the zona glomerulosa. In addition, the lack of parallelism in zona glomerulosa 11 beta- and 18-hydroxylation of DOC provides evidence for the concept of different 18-hydroxylating systems in the adrenal cortex.

18-Hydroxycorticosterone↗
PubMed1987

Adrenocortical hormone secretory response to chronic NH4Cl-induced metabolic acidosis.

We examined the effect of chronic metabolic acidosis on adrenocortical hormone production by administering NH4Cl for 5 days to four normal subjects. Plasma aldosterone concentration, aldosterone secretion, and urinary excretion of aldosterone-18-glucuronide increased significantly, whereas there were no significant changes in the plasma concentrations of cortisol, corticosterone, or deoxycorticosterone, or in the urinary excretion of 17-hydroxycorticoids. By day 2, plasma renin activity (PRA) and concentration (PRC) were not significantly different from control, and the slope of the regression line relating plasma aldosterone concentration to PRA was significantly greater than the slope in the control period, i.e., the sensitivity of aldosterone secretion to renin stimulation was increased. By day 5, however, PRA and PRC were increased above control. Plasma potassium concentration did not change significantly. Thus chronic NH4Cl-induced acidosis induces a sustained stimulation of aldosterone secretion in the absence of a change in adrenocorticotropin-dependent adrenocortical hormone secretion. Factors other than an increase in renin secretion and plasma potassium concentration may be involved in at least the early phase of aldosterone stimulation, suggesting that plasma hydrogen ion concentration might be a separate regulator of aldosterone secretion.

Acidosis↗