PubMed Health⌕ Search

Biomedical subjects

E G Lever

Publications and source records attributed to E G Lever.

17 recordsLinked to original sources
PubMed1987

Hyponatraemia and hypothyroidism in a previously irradiated case of carcinoma of the tongue.

A case of squamous cell carcinoma of the tongue was complicated by post operative hyponatraemia. The criteria for the syndrome of inappropriate secretion of anti diuretic hormone, [ADH] (SIADH) were met but the patient remained hyponatraemic despite adequate treatment. The patient had previously received radical external radiotherapy to the neck and was found to be profoundly hypothyroid. Correction of the hypothyroid state led to clinical and biochemical recovery. The frequency of post-irradiation hypothyroidism and the possible mechanisms of hypothyroid-induced hyponatraemia are discussed.

Aged↗
PubMed1987

Cardiovascular and hormonal responses to thyrotrophin releasing hormone in acromegalics.

The effect of TRH (200 micrograms) on blood pressure, pulse rate, TSH and GH release was investigated in 10 acromegalics, four patients with non-GH secreting pituitary tumours, and seven normal controls. TRH produced a rapid-onset, short-lived pressor response in the acromegalic group (delta mean blood pressure 33 mmHg) compared to the two control groups (P less than 0.001). There was no response to the same volume of saline. The pressor response in the acromegalic group was not different in those who did or did not release GH. The pressor response to TRH was linearly related over the range 50-200 micrograms. Measurement of plasma noradrenaline and plasma renin activity during TRH testing in six acromegalics indicated that the pressor effect was neither mediated by adrenergic mechanisms, nor the renin-angiotensin system. Echocardiographic monitoring in five of these six patients showed that there was a significant increase in directly measured end systolic, end diastolic dimensions and heart rate (all P less than 0.02), and calculated stroke volume (P less than 0.001) and cardiac output (P less than 0.01) without changes in systemic vascular resistance. These data suggest that increase in preload, probably via venoconstriction, is the most likely factor producing the pressor response to TRH in acromegalics.

Acromegaly↗
PubMed1986

Subacute combined degeneration of the cord due to folate deficiency: response to methyl folate treatment.

Subacute combined degeneration of the cord is a rare complication of folate deficiency. Disturbance of methylation reactions in nervous tissue probably underlie subacute combined degeneration of the cord arising from folate as well as vitamin B12 deficiency. Methyl tetrahydrofolate is the form in which folic acid is transported into the CNS. Therefore methyl tetrahydrofolate treatment of the neurological and psychiatric manifestations of folate deficiency would seem to be theoretically advantageous. A case of subacute combined degeneration of the cord due to dietary folate deficiency and associated with an organic brain syndrome is reported. There was striking haematological, neurological and psychiatric response to methyl folate treatment.

Female↗
PubMed1986

Infarction of a growth hormone-secreting macroadenoma during a TRH test.

Pituitary infarction occurring immediately after TRH injection (200 micrograms) is reported in a patient with gigantism due to a growth hormone-secreting pituitary macroadenoma. Evidence of infarction was seen in CSF and in serial CT scans. Regression of symptoms and sign of acromegaly, abolition of abnormal growth hormone secretion, and virtually complete anterior and partial posterior pituitary failure rapidly followed. The infarction was probably initiated by a hypertensive response to TRH. TRH testing in acromegalic subjects may require smaller doses of TRH to avoid unwanted pressor responses.

Acromegaly↗
PubMed1984

Auto-immune Addison's disease associated with hyperprolactinaemia.

Four cases of auto-immune Addison's disease are reported in association with hyperprolactinaemia. Two of the females had galactorrhoea. In three cases complete resolution of hyperprolactinaemia occurred with corticosteroid replacement, but it was only partial in the fourth. We suggest that hyperprolactinaemia was due to cortisol deficiency operating directly or indirectly at the level of the pituitary. These data support the animal and in vitro evidence for the influence of corticosteroids on prolactin release.

Addison Disease↗
PubMed1984

Pancreatic hormone profiles and metabolism posthepatectomy in the dog. Evidence for a hepatotrophic role of insulin, glucagon, and pancreatic polypeptide.

Gut-related peptide hormones, especially insulin and glucagon, have been implicated in promoting hepatic regeneration. To elucidate the interrelationship between pancreatic peptide hormones and hepatic regenerative activity, we evaluated pancreatic hormone levels and their metabolism before and over a 15-day period after limited (42%) and extended (72%) hepatectomy in the dog. Serum insulin, glucagon, and pancreatic polypeptide levels increased significantly after both limited and extended hepatectomy but not after sham laparotomy. In the case of glucagon only, these increases were related to the extent of liver resection. No significant changes in plasma somatostatin levels were observed posthepatectomy. Plasma glucose levels remained normal throughout the period of study. Metabolic clearance rates and plasma half-lives for insulin, glucagon, and pancreatic polypeptide did not change over the study period. Peripheral C-peptide/insulin molar ratios were unchanged posthepatectomy, indicating no change in hepatic insulin extraction. In the absence of demonstrable changes in hormone metabolism or metabolic stimuli to secretion, these increases in pancreatic hormone levels, coinciding with the period of known maximal hepatic regenerative activity, are compatible with the notion that these are hepatotrophic responses, which could conceivably be mediated by humoral feedback signals from the liver to the endocrine pancreas.

Animals↗
PubMed1983

The value of serum thyroglobulin measurement in clinical practice.

Thyroglobulin (TG) is a normal constituent of serum detectable by radioimmunoassay in 75% to 90% of healthy adults. Levels are altered in a number of physiological and pathological conditions. Although the indications for serum TG measurements have not been clearly established, it is simple, inexpensive, and presents no risk of radiation exposure. Problems include variable sensitivity and reproducibility of assays, interference by TG autoantibodies, and changes induced by certain diagnostic or therapeutic interventions. Serum TG measurements is primarily used as a tumor marker in thyroid carcinoma. Values are almost invariably high with disseminated metastases. After total ablation of thyroid tissue, serum TG determination is useful in separating patients in remission from those with residual metastatic disease. Serial measurements in the same patients are useful in monitoring the effect of treatment of nonfunctioning thyroid metastases. It is of no proved value in the initial diagnosis of thyroid carcinoma. Controversy still exists regarding the advantages of measuring TG during hormonal therapy. The assay may aid in the diagnosis of thyrotoxicosis factitia, painless subacute thyroiditis, and neonatal hypothyroidism.

Adult↗
PubMed1983

Primary hyperparathyroidism masked by hypothyroidism.

In a woman with myxedema and normal total and ionized plasma calcium levels, persistent hypercalcemia developed when she was treated with thyroxine. A parathyroid adenoma was subsequently removed, with return of plasma calcium levels to normal. Hypothyroidism may therefore be a further cause of "masked" primary hyperparathyroidism. The mechanism of masking is likely to have been mediated by hypomagnesemia.

Adenoma↗
PubMed1983

Predominance of renal and absence of hepatic metabolism of pancreatic polypeptide in the dog.

Pancreatic polypeptide (PP) metabolism was studied in the dog. Metabolic clearance rate (MCR) of PP was found to be 9.5 +/- 0.9 ml . kg-1 . min-1, accounted for predominantly by renal extraction (34.9 +/- 2.6% of exogenous PP), which comprised 45.5 +/- 5.8% of total PP clearance. Hepatic extraction of both endogenous (-9.9 +/- 6.1%) and exogenous (2.2 +/- 1.4%) PP infused to pharmacological levels was negligible, as was its splanchnic extraction (4.2 +/- 0.9%). Renal organ clearance of exogenous PP (3.7 +/- 0.3 ml . kg-1 . min-1) closely approximated that of inulin (3.6 +/- 0.3 ml . kg-1 . min-1), indicating that renal PP metabolism occurs entirely by glomerular filtration without contribution from peritubular uptake mechanisms. Urinary PP, chromatographically indistinguishable from that in plasma but quantitatively accounting for less than 1% of overall renal PP uptake, indicated virtually complete renal degradation of the peptide to nonimmunoreactive fragments. Renal PP extraction was shown to be nonsaturable. Plasma half disappearance time of PP was 10.1 +/- 1.0 min and apparent distribution space 307 +/- 39 ml/kg. Linkage between the hepatic action and degradation of insulin and glucagon has been proposed, and in this light absent hepatic PP extraction is noteworthy. This finding, reminiscent of the hepatic handling of metabolically inert C-peptide and biologically inactive glucagon peptides, is consistent with the absence of demonstrable physiological function of PP.

Animals↗
PubMed1983

Addison's disease, psychosis, and the syndrome of inappropriate secretion of antidiuretic hormone.

A case of tuberculous Addison's disease presenting with psychosis, profound hyponatraemia, and detectable plasma antidiuretic hormone is reported. Clinical and biochemical improvement after corticosteroid replacement was followed by relapse with further psychosis and inappropriate antidiuretic hormone secretion: both were promptly reversed by demethylchlortetracycline. The association of psychological symptoms with Addison's disease, the role of anti-diuretic hormone secretion in Addison's disease, and the inter-relationship between Addison's disease, psychosis and anti-diuretic hormone secretion are discussed.

Addison Disease↗
PubMed1983

Inherited disorders of thyroid metabolism.

In summary, we have presented a brief survey of the current state of knowledge of inherited disorders of thyroid metabolism. Analysis of cases shows that the biochemical classification covers a wide range of abnormalities and it is likely that further biochemical studies will increase this heterogeneity as well as refining it. Genetic studies are often incomplete, and few in number compared with the classical study by Hutchison and McGirr of Scottish tinker families. Most important, this survey indicates that further research is needed to elucidate the precise molecular mechanisms of the working of the iodide pump, the oxidation and iodination and coupling mechanisms. Study of animal models and DNA sequencing and hybridization work will continue to expand our understanding of abnormalities of thyroglobulin metabolism. We urgently need to find the key to resistance of peripheral and pituitary tissues to thyroid hormone. Subtle dyshormonogenetic abnormalities may await discovery in the field of multinodular goiter and intrathyroidal calcification with goiter. Neonatal screening for hypothyroidism is likely to expand the number of cases for investigation and detailed study. There is an important relationship of dyshormonogenesis to follicular carcinoma. It is hoped that in time we will be able to transform inborn errors into areas of understanding in the realm of the thyroid gland.

Adolescent↗
PubMed1983

The influence of percutaneous fine needle aspiration on serum thyroglobulin.

To determine whether percutaneous needle aspiration of the thyroid affects tests of thyroid function, in particular thyroglobulin (TG), serum TG, T4, free T4 index, T3, and TSH were measured before and after percutaneous needle aspiration biopsy of the thyroid in 25 subjects. Seven control subjects were tested before and after vigorous external manual palpation of the thyroid. Serial measurements were made additionally in 3 subjects undergoing thyroid surgery to assess how quickly serum TG increases after injury. The results were analyzed, and statistically significant differences between paired results were defined if the differences were greater than the maximum interassay variation in 11 consecutive assays. Eleven out of 25 patients had statistically significant elevations of serum TG after aspiration. None of the seven who underwent external manual palpation of the thyroid gland had elevation of serum TG. With three exceptions, there were no significant changes in serum T4, free T4 index, T3, and TSH in either group. Marked elevations in serum TG occurred within 2 min after open manual palpation, diathermy, and excision. The results were analyzed and correlated with factors that might lead to release of TG from the thyroid during needle aspiration. No positive correlation was observed with the apparent degree of trauma, the size of nodule, the TG content, volume or character of aspirate, or the time elapsed from aspiration to withdrawal of the blood sample. Correlation of serum TG elevation with final diagnosis did not show a significant trend; however, the existence of a possible relationship needs further studies. We conclude that serum for TG measurement should be obtained before percutaneous thyroid aspiration biopsy.

Adolescent↗
PubMed1983

Albright's syndrome associated with a soft-tissue myxoma and hypophosphataemic osteomalacia. Report of a case and review of the literature.

We report a rare case of Albright's syndrome associated with both a soft-tissue myxoma and hypophosphataemic osteomalacia. Renal tubular function was preserved, except for glycosuria. Serum levels of 1,25(OH)2 vitamin D3 were normal. Excision of the myxoma did not influence the biochemical abnormalities, nor did standard doses of vitamin D3 or 1 alpha-OH vitamin D3. The previously reported cases of hypophosphataemic osteomalacia associated with fibrous dysplasia and mesenchymal tumours are reviewed and the underlying mechanism discussed.

Cholecalciferol↗
PubMed1983

Coexisting thyroid and parathyroid disease--are they related?

A high prevalence of non-C cell, thyroid gland disease associated with primary hyperparathyroidism (HPT) has been reported in 11 uncontrolled studies. Yet experimental evidence linking these thyroid and parathyroid gland lesions is lacking. To test the hypothesis that the coexistence of these lesions is significant, we analyzed 124 consecutive cases of parathyroidectomy (110 women, mean age 53.5 +/- 12.7 years). Patients in the group with HPT who had visible or palpable thyroid disease at the time of operation were age-, sex-, and race-matched with autopsy controls. There was no statistical difference in the prevalence of total macroscopic thyroid lesions between the autopsy control group (46.4%) and the group of patients with HPT (54%, P = 0.8). Microscopic lesions in the absence of macroscopic abnormalities were found in an additional 26% of the autopsy control patients. Since in the surgical group, only those with macroscopic abnormalities underwent thyroid biopsy, no accurate calculation can be made of the microscopic lesions in those 55 patients with HPT who did not have macroscopic abnormalities. There was no difference in the prevalence of autoimmune or thyroid nodular disease between the two groups except for the presence of seven macroscopic nonmedullary thyroid carcinomas in the HPT group and none in the autopsy control group (P less than 0.001). One microscopic carcinoma was found in the autopsy group, however. An increased prevalence of parathyroid adenomas in nonmedullary thyroid disease has been suggested by other studies. We were unable to confirm this association. In fact, the incidence of parathyroid adenomas found unsuspectedly in 229 consecutive thyroidectomies was 0.43%. Thus with the exception of macroscopic, nonmedullary carcinomas, there was no evidence that thyroid disease accompanies HPT. Furthermore, parathyroid adenomas were not more frequent in surgical thyroid disease. Lesions of the thyroid and parathyroid glands are prevalent in middle-age women. This probably is the major factor that accounts for their coexistence.

Biopsy↗