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Biomedical subjects

G M Besser

Publications and source records attributed to G M Besser.

At least 145 records · Page 8Linked to original sources
PubMed1994

Identification of olfactory dysfunction in carriers of X-linked Kallmann's syndrome.

OBJECTIVE: The aim of the study was to test the hypothesis that clinically unaffected female carriers of X-linked Kallmann's syndrome have an olfactory defect. DESIGN: Assessment of the olfactory threshold to seven standard odorants, each at a concentration of 1-10(-8) mol/l. PATIENTS: Five families with X-linked Kallmann's syndrome (KS) were tested, containing 19 males with KS, and 9 female carriers. Related but unaffected males (n = 8) were used as a control group, and in addition seven patients with Turner's syndrome (XO) were assessed. MEASUREMENTS: The olfactory threshold was taken as the lowest concentration at which each odorant was clearly distinguished from control (liquid paraffin). The threshold for each odorant was compared between the subject groups using the non-parametric Mann-Whitney test. RESULTS: All patients with KS were anosmic to all odorants. The female carriers had hyposmia, with a significant reduction in the olfactory threshold to putrid, peppermint, floral and pungent odorants compared to control subjects, and to peppermint, floral and pungent odorants compared to subjects with Turner's syndrome. The latter had olfactory thresholds which were statistically identical with the control group. CONCLUSIONS: Obligate female carriers of X-linked Kallmann's syndrome are hyposmic compared to control subjects. The overlap between the two groups, however, makes olfactory testing unreliable as a diagnostic test.

Female↗
PubMed1994

Treatment with GHRH(1-29)NH2 in children with idiopathic short stature induces a sustained increase in growth velocity.

OBJECTIVE: Therapy with GHRH in patients with mild GH insufficiency appears to be more effective than in those with severe insufficiency. We, therefore, studied the clinical response of children with idiopathic short stature to treatment with GHRH(1-29)NH2 (GHRHa) for a period of 12 months. DESIGN: Eighteen short pre-pubertal children (aged 4.3-11.0 years, 17 male) with idiopathic short stature (height < 3rd centile, peak GH to provocative testing > 20 mU/l) were recruited to receive GHRHa 20 micrograms/kg by twice daily s.c. injection for one year. One patient was non-compliant and was withdrawn prior to 3 months of therapy. Pretreatment height velocity was calculated for 12 months and subjects were measured 3-monthly during therapy. Overnight GH profiles and s.c. GHRH tests (20 micrograms/kg) were performed at 0, 3, 6 and 12 months of therapy. In addition, an i.v. GHRH test (1 microgram/kg) was performed at the start and after 1 month of therapy. MEASUREMENTS: Overnight GH profiles were analysed using the Pulsar program. RESULTS: Mean (SD) height velocity (HV) increased from 4.8(0.9)cm/year pre-treatment to 7.2(1.6)cm/year after 12 months of therapy (P = 0.001). The children growing slowly (HV < 25th centile) before treatment had a greater growth response than those growing normally (HV > or = 25th centile) before treatment. Final height prediction increased by a mean (SD) of 3.4(2.6)cm. Overnight GH levels and GH responses to GHRH testing fell during the 12 months of therapy. Fasting blood glucose and insulin levels increased during therapy, as did IGF-I. Cessation of GHRHa was followed by catch-down growth during the first 3 months off therapy: mean (SD) HV 3.89(1.82)cm/year (P < 0.04), although the HV after 6 months (4.9(1.0))cm/year) and 12 months (4.4(1.0)cm/year) was not different from pretreatment values. CONCLUSIONS: Short-term therapy with twice-daily s.c. injection of GHRHa (20 micrograms/kg) promoted linear growth in short children who were not GH-insufficient. The improved height velocity was sustained throughout the 12 months of treatment, followed by catch-down growth, and returned to pretreatment velocity after cessation of therapy.

Blood Glucose↗
PubMed1994

Effects of follicular phase exercise on luteinizing hormone pulse characteristics in sedentary eumenorrhoeic women.

OBJECTIVE: Current studies reveal little regarding the inception of exercise-induced LH changes during physical training. This study aimed to assess the susceptibility of the hypothalamic-pituitary axis to the acute physical stress of exercise in untrained, physically inactive women. The acute effects of submaximal endurance exercise upon the pulsatile LH secretion in the follicular phase were compared with those accompanying leisurely strolling for a similar time period. SUBJECTS: All subjects were eumenorrhoeic, as determined by biphasic temperature patterns, detection of the urinary LH surge, and mid-luteal serum progesterone levels. Subjects were not physically active and had little history of strenuous exercise (VO2max = 38.0 +/- 1.8) (mean +/- SEM) ml/kg/min). DESIGN: All women completed a 13.5-hour pulsatility test which included three consecutive 20-minute runs on a treadmill at 50, 60 and 70% of the subjects' maximum oxygen uptake (n = 16). Six of these same subjects completed a separate test on another occasion in which one hour of leisurely strolling was substituted for exercise. Blood was sampled every 10 minutes via an indwelling cannula for 4.5 hours before and 8 hours after one hour of exercise and or strolling. MEASUREMENTS: A pulse algorithm (Pulsar) was used to quantify LH pulse characteristics. RESULTS: Exercise produced no significant effects upon LH pulse frequency or mean serum LH concentration. However, exercise of moderate intensity caused a significant increase in LH pulse amplitude (P < 0.05). Strolling produced no significant changes in LH secretion. CONCLUSION: Acute exercise of moderate intensity in the follicular phase of untrained women is an insufficient stimulus to inhibit the GnRH pulse generator in the post-exercise period, yet may produce a slight stimulatory effect on the amount of LH released per pulse.

Adult↗
PubMed1994

The effect of recombinant IGF-I on anterior pituitary function in healthy volunteers.

OBJECTIVE: Insulin-like growth factor-I is the mediator of many of the actions of GH and is a potent metabolic regulator. Recombinant IGF-I (rhIGF-I) is of potential value in the treatment of syndromes associated with either GH or insulin resistance. This study was designed to assess the effects of subcutaneous (s.c.) rhIGF-I on anterior pituitary function. DESIGN: Double-blind, placebo controlled, randomized cross-over study. The interval between investigations was 2 weeks. SUBJECTS: Twelve normal volunteers received on one occasion a single s.c. dose of 40 micrograms/kg rhIGF-I and on the other, placebo. MEASUREMENTS: Circulating levels were measured, over 24 hours, of GH, LH, FSH, PRL, TSH, cortisol, ACTH, glucose, IGF-I, IGF-II, insulin, C-peptides; IGF binding proteins by Western ligand blotting; total IGF bioactivity using FRTL-5 thyroid cells; and glucose by the glucose oxidase method. RESULTS: Recombinant IGF-I increased AUC for plasma IGF-I, measured by radioimmunoassay (rhIGF-I mean 7065 +/- SEM 33 vs 3895 +/- 204 micrograms/l, P < 0.0001) and IGF bioactivity (22.5 +/- 3.4 vs 14.2 +/- 1.8 U/ml, P < 0.001) but plasma IGF-II fell (9308 +/- 403 vs 11052 +/- 451 micrograms/l, P < 0.0001). There was no biochemical or clinical evidence of hypoglycaemia and no difference in mean glucose levels. No difference existed in AUC for GH, LH, FSH, ACTH and cortisol between rhIGF-I and placebo; additionally, pulse number and amplitude for GH and LH were unaffected. TSH fell following rhIGF-I (33.0 +/- 3.36 vs 42.5 +/- 5.98 mU h/l, P = 0.01). Both mean plasma C-peptide (0.73 +/- 0.06 vs 0.91 +/- 0.05 nmol/l, P = 0.03), and insulin (10.81 +/- 1.02 vs 15.36 +/- 1.18 mU/l, P = 0.03) were lower following rhIGF-I. There was no change in IGFBPs. CONCLUSION: A single injection of 40 micrograms/kg of subcutaneous rhIGF-I does not cause hypoglycaemia. IGF bioactivity was increased without inhibition of GH secretion. The only change observed in anterior pituitary function was a fall in plasma TSH.

Adrenocorticotropic Hormone↗
PubMed1994

Gonadal function and response to human chorionic and menopausal gonadotrophin therapy in male patients with idiopathic hypogonadotrophic hypogonadism.

OBJECTIVE: This study was designed to determine the response to therapy using human chorionic gonadotrophin (hCG) and human menopausal gonadotrophin (hMG) in males with idiopathic isolated hypogonadotrophic hypogonadism (IHH), and to compare the responses in patients presenting with and without cryptorchidism. DESIGN: Analysis of male patients with IHH treated with hCG or combined hCG/hMG for a minimum of 6 months at St Bartholomew's Hospital. Clinical and endocrine assessment was performed in all patients prior to commencing therapy. PATIENTS: A total of 26 males with IHH have been treated with exogenous gonadotrophins. Thirteen patients (Group 1) had cryptorchidism (unilateral in 7, bilateral in 6) at presentation, and 13 (Group 2) did not. MEASUREMENTS: All patients had basal serum testosterone, LH and FSH determinations. An i.v. GnRH test was performed in 25 patients and an i.m. hCG stimulation test in 19. Testicular volume and serum testosterone were measured during both hCG and combined hCG/hMG therapy. Seminal analysis was performed at the start and monthly during hCG/hMG therapy. RESULTS: Eighty-five per cent of the 13 patients in Group 1 had an olfactory defect (Kallmann's syndrome), compared with 23% of Group 2. Both groups of patients showed a subnormal response to initial i.v. GnRH and i.m. hCG testing. During hCG therapy only three patients in Group 1 and six in Group 2 achieved normal adult testosterone levels. The non-cryptorchid group achieved a higher mean testicular volume on hCG therapy than the cryptorchid group (mean (SD); 4.7 (1.8) ml vs 3.0 (1.6) ml (P < 0.02)), and for all patients there was a correlation between initial and maximal testicular volume (R = 0.69, P = 0.001). Four patients in Group 1 and five patients in Group 2 were treated with combined hCG/hMG for 6-15 months to induce fertility; only one patient in Group 1 achieved spermatogenesis, compared to all patients in Group 2 (leading to three pregnancies). CONCLUSIONS: These data indicate that patients with idiopathic hypogonadotrophic hypogonadism (IHH) have a poor response to hCG therapy in terms of testicular growth and normalization of serum testosterone. Final testicular volume is dependent on initial testicular size. In addition, patients with IHH associated with cryptorchidism have a poor fertility potential to combined hCG/hMG therapy.

Adolescent↗
PubMed1994

Unilateral renal aplasia in X-linked Kallmann's syndrome.

Unilateral renal agenesis is an uncommon association with Kallmann's syndrome (KS) (hypogonadotrophic hypogonadism and olfactory defect). We have investigated affected individuals from six pedigrees: five with X-linked KS, and one with X-linked KS and X-linked ichthyosis (XLI). Seventeen affected individuals have had renal imaging performed, and six scans demonstrated only one kidney. In addition, two pedigrees had males who died in the neonatal period with bilateral renal agenesis. Only two of the four affected individuals in the family with X-linked KS and X-linked ichthyosis (Pedigree 6) showed unilateral renal agenesis, despite all four patients demonstrating an interstitial deletion within the short arm of the X-chromosome. These data indicate that unilateral renal agenesis is much commoner than previously suspected in patients with X-linked Kallmann's syndrome, but that it may have incomplete penetrance within a family.

Genetic Linkage↗
PubMed1994

Bilateral phaeochromocytomas in von Hippel-Lindau disease: diagnosis by adrenal vein sampling and catecholamine assay.

Three unrelated patients with von Hippel-Lindau disease had phaeochromocytomas diagnosed as a result of screening in their third decade. All had raised 24-h urinary noradrenaline levels and obvious unilateral adrenal tumours on ultrasound scanning and computed tomography. The contralateral adrenal appeared either normal or equivocally abnormal using the same imaging techniques. Radiolabelled meta-iodo-benzylguanidine uptake and enhanced T2-weighted magnetic resonance signals confirmed the ipsilateral lesion, but showed no abnormality in the contralateral adrenal. Nevertheless, venous sampling demonstrated abnormally elevated noradrenaline:adrenaline ratios (normal < 1) in blood draining both adrenals in all three patients. All underwent bilateral adrenalectomy: histological examination confirmed bilateral phaeochromocytomas in all three patients, with the smaller adrenal showing tumours between 3 and 11 mm in diameter. A fourth patient with von Hippel-Lindau disease was also evaluated because of a left 'suprarenal' mass discovered by ultrasound scanning. Urinary and plasma catecholamines were normal. Computed tomography showed a normal right adrenal, with a left para-aortic mass lying superior to the left adrenal. Magnetic resonance scanning showed an enhanced T2 signal from the mass, which also showed positive uptake with radiolabelled mIBG. At operation, a non-secretory left para-aortic paraganglioma was found. Venous sampling suggested that the left adrenal was normal, and this was confirmed on histology. Venous sampling for catecholamine assays is effective in locating small bilateral phaeochromocytomas and defining a normal adrenal gland, and can be useful in preventing unnecessary or repeat operations in patients with non Hippel-Lindau disease.

Adrenal Gland Neoplasms↗
PubMed1993

The radiological investigation of occult ectopic ACTH-dependent Cushing's syndrome.

The radiological features of 14 patients with Cushing's syndrome due to 'occult' ectopic ACTH syndrome have been reviewed. In 11 of the 14 patients (79%), the ACTH-producing tumour was located in the thorax. Bronchial carcinoid tumours (eight patients) were the single most common source of 'occult' ectopic ACTH production with thymic carcinoid tumours (two patients) and mediastinal metastases from a medullary carcinoma of the thyroid gland (one patient) accounting for the other intrathoracic tumours. The tumours were usually small with five of the eight bronchial carcinoid tumours measuring between 4 and 10 mm in diameter. Since it remains difficult to distinguish between pituitary-dependent Cushing's disease and 'occult' ectopic ACTH-dependent Cushing's syndrome both clinically and biochemically, the role of radiology remains vital.

ACTH Syndrome, Ectopic↗
PubMed1993

Imaging neuroendocrine tumours with radiolabelled somatostatin analogues and X-ray computed tomography: a comparative study.

Various endocrine neoplasms, including a number of carcinoid and pancreatic islet cell tumours, express somatostatin receptors. These tumours may be difficult to localize using conventional techniques. Radiolabelled somatostatin analogues 123I-Tyr-3-octreotide and 111In-pentatreotide have been used for imaging these tumours. In a retrospective study of 24 patients, the sensitivities of somatostatin receptor scintigraphy and X-ray computed tomography (CT) were compared. Ten patients were scanned using 123I-Tyr-3-octreotide and 14 with 111In-pentatreotide. All patients had CT scans. Twenty patients had neuroendocrine tumours with a total of 45 lesions in the anatomical areas included on both scans. CT detected 42 while somatostatin receptor scanning detected 31 of these lesions. Three lesions were missed by CT which were detected by scintigraphy, and there were six CT false positive lesions. In a further four patients investigated for suspected neuroendocrine tumours, no lesion was shown using either modality and subsequent investigations and clinical follow-up have shown no evidence of a tumour. We conclude that while CT is more sensitive than somatostatin receptor scintigraphy, the techniques are complementary, especially in patients with disseminated pathology, equivocal lesions on CT, or a negative CT and strong clinical or biochemical evidence of a neuroendocrine tumour.

Adolescent↗
PubMed1993

Acceleration of pubertal development following pituitary radiotherapy for Cushing's disease.

A 7-year-old boy with pituitary dependent Cushing's disease was treated with pituitary irradiation following unsuccessful microadenomectomy. This led to normalization of the hypercortisolaemia, but was followed by GH deficiency. Two years after radiotherapy he had the onset of pubertal development with testicular enlargement to 8 ml bilaterally. Pubertal regression was induced using the long-acting GnRH analogue goserelin. Acceleration of skeletal maturation was also arrested, resulting in improvement of final height prediction. Irradiation directly to the hypothalamo-pituitary region, as well as whole brain irradiation, may thus be associated with accelerated pubertal development.

Child↗
PubMed1993

Treatment of malignant phaeochromocytoma, paraganglioma and carcinoid tumours with 131I-metaiodobenzylguanidine.

131I-metaiodobenzylguanidine (MIBG) has been used for the therapy of neural crest tumours. We report our experience with this agent in nine patients (malignant phaeochromocytoma 2; malignant paragangliomas 3; malignant carcinoid tumours 4). Six patients had soft tissue metastases alone while three had both soft tissue and bone metastases. The follow-up period ranged from 8 to 110 months, the number of doses ranged from one to seven with 3.1 to 11.1 GBq per administration and a cumulative activity from 4.8 to 40.1 GBq, while the tumour response was assessed according to World Health Organization (WHO) criteria. None of the patients showed complete tumour regression. Five patients showed complete symptomatic and three showed complete hormonal responses. Three patients with carcinoid tumours died. 131I-MIBG is thus a useful therapeutic modality which provides temporary palliation of these difficult tumours, but is rarely curative.

3-Iodobenzylguanidine↗
PubMed1993

Localization of neuroendocrine tumours and insulinomas using radiolabelled somatostatin analogues, 123I-Tyr3-octreotide and 111In-pentatreotide.

OBJECTIVE: A number of neoplasms are known to express somatostatin receptors; the use of somatostatin receptor imaging in their localization has recently been described, but the resolution and discrimination of the isotopes used remains sub-optimal. We have looked at the use of a new 111In-labelled analogue of somatostatin, pentatreotide, in the visualization and functional characterization of a number of neoplastic conditions. PATIENTS: Thirteen patients with proven neoplasms were scanned using this agent. Planar and single-photon-emission computerized tomographic (SPECT) images of the relevant part of the body were obtained using a gamma-camera at 10 minutes and 4 and 21 hours after injection of the radiopharmaceutical. In six patients (three carcinoid, three insulinomas) scanning was also performed using 123I-Tyr-3-octreotide. RESULTS: Primary tumours or metastases were visualized in six of the seven patients with neuroendocrine tumours, and three of six patients with insulinoma. One patient with an insulinoma who had a positive scan showed absent uptake when rescanned after tumour removal. A rise in blood glucose (more than twice basal) in response to octreotide was seen only in those insulinoma patients with positive scans. In cases where both 111In-pentratreotide and 123I-Tyr-3-octreotide scans were performed, both radiopharmaceuticals identified the same 4/6 tumours; however, tumour definition (reflecting high tumour to background ratio) was better with pentatreotide on the 21-hour images with minimum biliary and gut activity, allowing better resolution of the tumour image. CONCLUSION: It appears that 111In-pentatreotide scintigraphy is a rapid and safe procedure for the visualization of neuroendocrine tumours possessing somatostatin binding sites. A positive scan may be predictive of neuroendocrine responsiveness to octreotide therapy. In addition, it also appears that 111In-pentatreotide has superior kinetics compared to 123I-Tyr-3-octreotide, typically achieving more satisfactory tumour to background ratios, and may thus be more useful in the localization of endocrine tumours.

Adult↗
PubMed1993

Transsphenoidal resection in Cushing's disease: undetectable serum cortisol as the definition of successful treatment.

OBJECTIVE: We tested the hypothesis that in Cushing's disease, ACTH secretion from the normal pituitary surrounding an ACTH-secreting adenoma is inhibited and hence removal of the entire adenoma should result in an undetectable serum cortisol in the immediate post-operative period. DESIGN: A retrospective study of patients undergoing transsphenoidal selective adenomectomy, hemi-hypophysectomy or total hypophysectomy for Cushing's disease at St Bartholomew's Hospital between 1985 and 1990. PATIENTS: Forty-eight consecutive patients (33 women, mean age 43, range 7-69 years) undergoing transsphenoidal hypophysectomy for Cushing's disease. Ten patients who underwent a second operation were re-evaluated; the patients were followed for a median time of 40 months after operation (range 15-70). MEASUREMENTS: Post-operatively, serum cortisol was measured daily at 0900 h. Serum TSH, T4, prolactin, LH, FSH, testosterone or oestradiol plus plasma and urine osmolality were measured. RESULTS: After initial surgery, post-operative serum cortisol was undetectable (< 50 nmol/l) in 20 out of 48 patients (42%) and < 300 nmol/l in 32 out of 48 patients (67%). Re-exploration of the pituitary fossa in 10 patients found undetectable cortisol levels in 25 (52%) and levels < 300 nmol/l in 39 (81%) patients. Cushing's syndrome has not recurred, clinically or biochemically, in any patient in whom the post-operative cortisol was < 50 nmol/l. Post-operatively, hypothyroidism was present in 40% of patients and hypogonadism in 53% of men and 30% of premenopausal women. Diabetes insipidus, persisting for at least six months, occurred in 46% of patients. CONCLUSIONS: Cushing's disease has not recurred in any patient with an undetectable serum cortisol (< 50 nmol/l) post-operatively. Serum cortisol should be regarded as a tumour marker in Cushing's disease and the aim of transsphenoidal hypophysectomy for Cushing's disease should be to render the immediate post-operative serum cortisol undetectable.

Adenoma↗
PubMed1993

The relationship between cortisol production rate and serial serum cortisol estimation in patients on medical therapy for Cushing's syndrome.

OBJECTIVE: The aim was to determine the target range into which mean daily serum cortisol should be lowered in patients on medical therapy for Cushing's syndrome, using isotopically estimated cortisol production rates as 'gold standard'. DESIGN: Patients with Cushing's syndrome on medical treatment were given 12 ng of tritiated cortisol intravenously and a 24-hour urine collection was made in a single day. On the same day, serum cortisol was measured at 0900, 1200, 1500, 1800, 2100, and at 2400 h in in-patients. In addition, serum cortisol was measured at the same times as above in a group of healthy volunteers. SUBJECTS: Twenty-two patients on medical therapy for Cushing's syndrome were studied on a total of 29 occasions. In addition, serum cortisol profiles were obtained in 12 healthy volunteers. RESULTS: The median serum cortisol in patients with Cushing's syndrome was 400 (range 66-839) nmol/l, and in the healthy volunteers 178 (range 137-299) nmol/l. The median isotopic cortisol production rate in the patients with Cushing's syndrome was 84 mumol/24 h, range 10-343 (normal range 22-83) mumol/24 h. In the patients with Cushing's syndrome, the correlation of mean serum cortisol to cortisol production rate was +0.77 (P < 0.001). Normal rates were found when mean serum cortisol levels were between 150 and 300 nmol/l. CONCLUSIONS: The aim of drug therapy for Cushing's syndrome should be to lower the mean serum cortisol through the day into the range 150-300 nmol/l.

Cushing Syndrome↗
PubMed1993

Linkage analysis of 7 polymorphic markers at chromosome 11p11.2-11q13 in 27 multiple endocrine neoplasia type 1 families.

The multiple endocrine neoplasia type 1 (MEN1) locus has been previously localized to 11q13 by combined tumour deletion mapping and linkage studies. Family linkage analysis has defined the locus order as 11 cen-PGA-(PYGM, MEN1)-(D11S97, D11S146)-INT2-11qter, and tumour deletion mapping studies have suggested that the MEN1 locus is proximal to D11S146 but distal to PYGM. In order to establish further the location of MEN1, we have utilized the seven polymorphic DNA probes: D11S288, D11S149, PGA, PYGM, D11S97, D11S146 and INT2, in linkage studies of 339 members (116 affected) from 27 MEN1 families. Linkage between MEN1 and 6 of the 7 loci was established, and the highest peak lod scores [Z(theta)] were observed with PYGM and D11S97 at Z(theta) = 13.71, theta = 0.047 and Z(theta) = 13.76, theta = 0.076 respectively. Multilocus analysis suggested the most likely locus order as: 11 pter-(D11S288, D11S149)-11 cen-PGA-PYGM-MEN1-D11S97-D11S146-INT2-1 1qter. In addition, an examination of individual recombinants indicated a centromeric location of D11S149 in relation to D11S288. Thus, the results of our study, which favoured a location of MEN1 proximal to D11S97 and distal to PYGM, have established a panel of recombinants that will facilitate further meiotic mapping studies of the MEN1 locus.

Chromosomes, Human, Pair 11↗
PubMed1993

Effect of octreotide on gall stone prevalence and gall bladder motility in acromegaly.

Octreotide therapy in acromegaly is associated with an increased prevalence of gall stones, which may be the result of an inhibition of gall bladder motility. Gall stone prevalence in untreated acromegalic patients relative to the general population is unknown, however, and the presence of gall stones and gall bladder motility in these patients and in acromegalic patients receiving octreotide was therefore examined. Thirty four percent of 39 patients who had taken octreotide for a mean of 20 months had gall stones compared with 16% of 38 patients who had not been treated with octreotide (p < 0.005). In a subgroup of 21 patients studied prospectively over 4 to 18 months, two patients developed stones. No patient had symptoms referrable to their gall stones. In 31 untreated acromegalic patients, the mean fasting gall bladder volume was similar to that in normal subjects. Maximal percentage emptying, however, was impaired (34 v 64%, p < 0.001) and the mean postprandial residual gall bladder volume increased (21.7 v 9.0 ml, p < 0.001). Treatment with octreotide increased the mean postprandial residual volume further to 36.8 ml (p < 0.001). Gall bladder emptying in untreated acromegalic subjects is impaired. Octreotide further increases postprandial residual gall bladder volume and this may be a factor in the increased gall stone prevalence seen in these patients.

Acromegaly↗
PubMed1993

Plasma and 24 h-urinary catecholamine concentrations in normal and patient populations.

Using a single HPLC-ECD methodology, plasma catecholamine data were compiled from 545 patients and 144 healthy subjects, and 24 h urinary free catecholamine data from 106 patients. From these data, normal reference ranges were derived for the clinical investigation of suspected phaeochromocytomas, specifically to address the question as to when a result is normal and when further investigation may be required. We have shown that noradrenaline and adrenaline concentrations in plasma and urine are not normally distributed, and basal plasma noradrenaline is significantly lower in normal volunteers than in hospital patients. We have also demonstrated that a reference range which does not take account of these factors will give a significant number of false-positive results. Age and sex did not appear to be significant variables for either plasma or urinary catecholamines. In the investigation of phaeochromocytoma, 95% confidence limits may be used as a warning to repeat sampling and 99% confidence limits as rendering the diagnosis extremely probable. In patients with phaeochromocytomas, urinary catecholamines had a 99.5% specificity and 100% sensitivity in the diagnosis, and thus provide for a rapid and efficient diagnostic screen.

Adolescent↗