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Biomedical subjects

H Vierhapper

Publications and source records attributed to H Vierhapper.

At least 55 records · Page 3Linked to original sources
PubMed1999

Anaplastic (undifferentiated) thyroid carcinoma (ATC). A retrospective analysis.

BACKGROUND: Old age, reduced general condition and far advanced tumor stage associated with poor prognosis induced the belief that, apart from verifying the diagnosis of anaplastic thyroid carcinoma (ATC) by biopsy, no additional surgery would be justified. However, in some cases, an ultraradical approach was recommended in order to improve the quality of life and survival. METHODS: These are the results of a retrospective analysis involving 120 patients subjected to restricted radical surgery (excising as much as possible of the tumor and local metastases, foregoing ultraradical removal of vital organs such as esophagus, larynx and trachea). RESULTS: Irrespective of the surgical approach used, 6+/-2% of the patients were alive after 5 years (median survival time: 3.1 months). Patients without tumor residues (R0-resections; extending to soft tissue only; Kaplan-Meier estimate - cumulative survival 15+/-5%) had a significantly better prognosis than patients with tumor residues (R1/R2-resections; no patient survived 5 years; P<0.001). Tumor morphology (spindle cells, giant cells, mixed cells) or differentiated parts of the tumor as well as lymph-node involvement had no statistically significant impact on the prognosis. CONCLUSIONS: In ATC, the objective should be to remove as much of the carcinoma as possible (in the ideal case, a thyroidectomy); if lymph nodes are affected, neck dissection should be the goal, if possible (restricted radical approach, improving quality of life). Ultraradical surgery to include segmental resection of larynx, trachea or esophagus do not seem to be indicated, as prolonged survival is questionable and quality of life is certainly diminished.

Adult↗
PubMed1999

Alterations in angiotensin II release and vascular reactivity in hypertensive men: a pilot study.

Cold- and insulin-mediated release of angiotensin II (AII) and endothelin-1 (ET-1), as well as vascular reactivity to exogenous ET-1 and to insulin, were compared in hypertensive and normotensive subjects. Peripheral vascular release of AII and of ET-1 was investigated in 10 hypertensive (H; 29.2+/-5.8 years) and 12 normotensive (N; 29.1+/-4.6 years) men in two separate trials. Net transfemoral balance of AII and of ET-1 was calculated from the respective Arterio-Venous (A-V) differences in plasma concentrations (PC) of the peptides and the regional plasma flow (indocyanine-green dye method), both at baseline conditions and after a cold stimulus (immersion of one hand into ice water) in 7H and 6N, or during short-time hyperinsulinemia (hyperinsulinemic euglycemic clamp: biosynthetic human insulin, 1 mU/kg/min) in 7H and 7N. Moreover, hemodynamic changes to sequential exogenous ET-1 infusion (1, 2.5, 5, 10, 20, 40 ng/min) or during hyperinsulinemic clamp were studied in 7H and 6N and 7H and 7N, respectively. Baseline net-transfemoral balance of ET-1 and of AII were similar in the two subject groups. The cold stimulus provoked a similar increase in transfemoral ET-1 release in H and N (H: 257.0+/-31.7 to 526.2+/-393.7 pg/min; N: 280.2+/-112.7 to 524.0+/-393.7 pg/min, mean +/- SD, P<.05). In contrast, the cold-induced increase in transfemoral AII release was somewhat more pronounced in H than in N (H: 162.2+/-304.6 to 1081.7+/-1037.7 pg/ min, P<.05; N: 83.9+/-166.3 to 317.6+/-187.8 pg/ min, P<.02; maximum value H v. N P<.05). During the hyperinsulinemic clamp the PC of insulin increased from 5.8+/-2.8 to 69.1+/-15.5 microU/ mL in H and from 4.6+/-1.7 to 67.5+/-9,5 microU/mL in N; P<.0005. Hyperinsulinemia induced a similar elevation of norepinephrine PC in H and N, but an increase in transfemoral ET-1 release in N only (219.7+/-161.2 to 512.2+/-279.0 pg/min, P<.02). In contrast, hyperinsulinemia increased transfemoral AII formation in H (730.4+/-554.3 to 1088.6+/-597.9 pg/min, P<.05), but not in N. Insulin-mediated vasodilation was observed only in N, whereas ET-1-induced vasoconstriction was blunted in H. We conclude that the cold-induced increase in peripheral vascular release of AII is more pronounced in H than in N, whereas insulin provokes an increase in AII formation in hypertensives only. Moreover, insulin-mediated vasodilation and ET-1-dependent vasoconstriction are blunted in hypertensive subjects.

Adult↗
PubMed1999

Elevation of plasma leptin concentrations in obese hyperinsulinaemic hypothyroidism before and after treatment.

BACKGROUND: Plasma leptin is considered to play a role in maintenance of energy balance and body weight by neuroendocrine mechanisms. Thyroid hormones are permissive for adrenergic activation, which in turn has been shown to decrease leptin expression. This study was therefore designed to test the hypothesis that hyperthyroidism results in lower leptin concentrations, whereas hypothyroidism leads to higher plasma leptin concentrations. In addition, the effects of normalization of thyroid function on plasma leptin were investigated. MATERIALS AND METHODS: Fasting plasma leptin concentrations and body fat mass (total body electrical conductivity) were measured in patients with overt hypothyroidism and hyperthyroidism before and after successful treatment. Plasma leptin, glucose, insulin and free fatty acid concentrations were monitored during an oral glucose tolerance test (OGTT 75 g). RESULTS: Fasting plasma leptin concentrations were similar in lean patients, independently of their thyroid function (hyperthyroid 12.5 +/- 2 ng mL-1, hypothyroid 10.2 +/- ng mL-1, euthyroid 12.7 +/- 3 ng mL-1). In obese hypothyroid patients, plasma leptin was threefold higher (P < 0.0005) than in lean hypothyroid patients, twofold higher (P < 0.005) than in obese hyperthyroid patients matched for fat mass and 30% increased (P < 0.01) compared with obese euthyroid subjects. There were no differences between fasting and post-prandial (OGTT) leptin concentrations in any group. Normalization of thyroid function did not affect plasma leptin, which remained elevated (P < 0.005) in formerly obese hypothyroid patients. Plasma leptin was not associated with serum thyroid hormones but highly correlated with body mass index and body fat mass in all patients (r = 0.85, P < 0.001). Plasma leptin correlated with plasma insulin concentration only in hyperthyroid patients (P < 0.01, r = 0.64), who presented with blunted stimulation of insulin release and higher plasma glucose (P < 0.05) than hypothyroid subjects. CONCLUSION: The results indicate that (a) the correlation of leptin with body fat mass is preserved in thyroid dysfunction, (b) plasma leptin is markedly increased in obese hypothyroid hyperinsulinaemic patients and (c) plasma leptin is not affected by oral glucose loading.

Adult↗
PubMed1999

Prevalence of primary hyperparathyroidism in 13387 patients with thyroid diseases, newly diagnosed by screening of serum calcium.

Primary Hyperparathyroidism (PHP) often goes unrecognised. Evidence of the influence of thyroid diseases on parathyroid activity exists. In order to determine the prevalence of primary hyperparathyroidism (PHP) in patients with thyroid diseases, a series of patients referred to an outpatient department for patients with thyroid diseases were examined for additional PHP. In addition to screening for thyroid diseases, serum calcium concentration (S-Ca) was measured in a series of persons who came to our outpatients' service for patients with thyroid diseases during the period 1992 to 1998. 13387 persons, median age 48 y, m = 2367, f = 11020, among them 9017 patients with thyroid diseases and 4370 persons without thyroid dysfunction, were studied. In patients with S-Ca outside the normal range, further diagnostic tests relating to PHP were performed. 106/13387 persons showed S-Ca > or = 2.6 mmol/L, in 31 cases due to PHP. In comparison to persons without thyroid diseases, the occurrence of PHP was significantly higher in patients with thyroid diseases (4/4370 = 0.09% vs. 26/9017 = 0.29%). Furthermore, 2 patients with normal S-Ca were diagnosed as having PHP in addition to another endocrine disease (acromegaly, multiple endocrine neoplasia type IIa, resp.). 31 of the 54 persons with S-Ca > 2.6mmol/L and who showed no other reasons for hypercalcaemia were found to be in a hyperthyroid state. The prevalence of PHP was significantly higher in patients with euthyroid goitre (p < 0.05) and in patients with thyroid carcinoma (p = 0.01) as compared to other persons with thyroid diseases. The groups of patients did not differ with regard to age. However, patients without thyroid diseases were significantly younger (median age 38y). Above the age of 50, the prevalence of PHP became higher in patients with euthyroid goitre or thyroid carcinoma than in those with a healthy thyroid gland. In contrast, in persons of under 50 y, there was no difference between these groups. The percentage of males with PHP was higher than in the total population studied (30% vs. 21.5%). In conclusion, a high occurence of PHP could be demonstrated in patients with thyroid diseases (0.29%) as compared to persons without thyroid dysfunction (0.09%), the highest prevalence being in patients with thyroid carcinoma. A clinically not relevant influence of thyroid function on S-Ca was seen in some patients with hyperthyroidism. Determination of S-Ca is recommended for each patient referred to a thyroid outpatients' department because of the high number of PHP cases in this context.

Adolescent↗
PubMed1999

Is medullary thyroid cancer predictable? A prospective study of 86 patients with abnormal pentagastrin tests.

BACKGROUND: The aim of this prospective study was to distinguish biochemically between C-cell hyperplasia (CCH) and medullary thyroid cancer (MTC) before surgery. METHODS: Eighty-six consecutive patients with an abnormal stimulated calcitonin level (> 100 pg/mL) underwent thyroidectomy and lymph node dissection. In sporadic MTC, histopathologic findings and postoperative biochemical outcomes were documented prospectively and correlated with preoperative basal and stimulated calcitonin levels. RESULTS: Analysis of variance revealed a highly significant difference in basal/stimulated calcitonin levels (P < .0001), with a comparison of CCH (n = 39 patients) and sporadic MTC (n = 38 patients). With a comparison of sporadic MTC N0 M0 (n = 25 patients) and N1 M0/1 (n = 12 patients), the basal calcitonin level was significantly different (P < .05). There was a close correlation between the n-log of basal/stimulated calcitonin level and the n-log of the tumor volume; there were also different distributions of the n-log of basal/stimulated calcitonin level among CCH, MTC N0, and MTC N1. Assuming that a basal calcitonin level of more than 64 pg/mL and/or a stimulated calcitonin level of more than 560 pg/mL implies MTC, 31 of 38 patients with sporadic MTC were detected before surgery. Three patients were predicted false positive (neoplastic CCH). Patients with stimulated calcitonin levels of less than 129 pg/mL had CCH only. Patients with basal calcitonin levels of less than 22 pg/mL and sporadic MTC (7/38 patients) were node negative. CONCLUSIONS: All patients with abnormal pentagastrin tests showed C-cell pathologic evidence. Sporadic MTC was predicted in 81% of the patients; CCH or N0 was predicted in 36% of the patients. Central neck dissection is recommended to avoid difficult reoperations. Lateral neck dissection is possible "on demand."

Adult↗
PubMed1999

Increase in serum concentrations of thyroxine-binding globulin and of cortisol-binding globulin after the induction of normal thyroid function in previously hyperthyroid patients.

Serum concentrations of thyroxine-binding globulin (TBG) were determined in 36 female patients with hyperthyroidism due to either Graves' disease (n = 33), or autonomous thyroid adenomas (n = 3). After the induction of euthyroidism by antithyroid drugs, serum concentrations of TBG rose from 13.7 +/- 2.4 ng/mL to 17.1 +/- 2.8 ng/mL (p < 0.001) whereas those of sex hormone-binding globulin (SHBG) fell from 142.2 +/- 66.4 nmol/L to 53.6 +/- 21.8 nmol/L (p < 0.001). Serum concentrations of cortisol-binding globulin (CBG) rose to 42.9 +/- 10.3 microg/mL (basal: 36.8 +/- 9.4 microg/mL; p < 0.001) but serum concentrations of total and of free cortisol remained unchanged. Thus, thyroid hormones exert different effects on the production of various carrier proteins in vivo. Whereas they stimulate the production of SHBG, they suppress the level of CBG and of their own carrier protein, TBG.

Antithyroid Agents↗
PubMed1999

Basal calcitonin levels and the response to pentagastrin stimulation in patients after kidney transplantation or on chronic hemodialysis as indicators of medullary carcinoma.

Plasma concentrations of calcitonin (hCT) were determined in 150 patients with chronic renal failure on chronic hemodialysis therapy (CHD) and in 800 patients after successful kidney transplantation (KT). Basal hCT concentrations exceeded 10 pg/mL in 44 of 150 patients (29%) with CHD and in 48 of 800 (6%) in patients with KT. Among these patients with elevated basal hCT, pentagastrin-stimulated concentrations of hCT exceeded 100 pg/mL in 4 patients with CHD and in 7 with KT. Thyroidectomy was performed in 8 patients (5 with KT, 3 with CHD) revealing the presence of medullary thyroid carcinoma (MTC) (n = 2) or of C-cell hyperplasia (n = 6). Two patients with C-cell hyperplasia had the neoplastic form of this disorder. One patient with MTC and 1 with C-cell hyperplasia also presented a papillary microcarcinoma. Stimulated concentrations of hCT were only moderately elevated in the remaining 3 patients and follow-up rather than surgery was deemed appropriate due to their concomitant severe medical problems. In conclusion, basal concentrations of hCT higher than 10 pg/mL are more common in patients with CHD (29%) and after successful KT (6%) than previously described in patients with thyroid nodular disease (3%). In spite of various additional factors complicating the interpretation of elevated hCT in CHD, pentagastrin-stimulated values above 100 pg/mL must be considered to indicate the presence of C-cell hyperplasia and/or of medullary thyroid carcinoma. Although thyroidectomy would theoretically be the therapy of choice, the potential benefit of the operation must be seen in the context of the patient's general condition.

Adult↗
PubMed1999

Sonography and scintigraphy are necessary in diagnostics of cystic thyroid lesions.

Thyroid sonography in an otherwise asymptomatic 50-year-old woman revealed a mainly cystic lesion within the right thyroid lobe. Thyroid (99)Tc scan showed an enhanced uptake over the right thyroid lobe with suppressed activity over the remaining thyroid tissue. Following aspiration of 6 ml of cyst fluid, a solid lesion became apparent in the location of the original cyst corresponding to the scintigraphically detected autonomous adenoma. This case report emphasizes that ultrasonography and scintigraphy are complementary methods and should be used as such in the primary evaluation of thyroid nodules.

Adenoma↗
PubMed1998

[Preventive iodine administration and iodine excretion in the Vienna area and in the forest quarter].

In order to reduce the still substantial iodine deficiency in the Austrian population, compulsory iodisation of salt was increased in 1990 from 10 mg potassium iodide/kg salt to 20 mg potassium iodide/kg. In this investigation we evaluated the adequacy of iodine supply in Vienna and the Waldviertel, a rural region northwest of Vienna. Daily iodine excretion (which reflects daily iodine intake) was investigated in 92 persons from the Waldviertel (all without thyroid gland pathology) and 110 persons from Vienna (54 with unremarkable thyroid glands, 56 with endemic goiter). Daily iodine excretion was higher in persons from the Waldviertel (161 +/- 90.7 micrograms/24 h, p < 0.05) than in those from Vienna (with healthy thyroid glands 126.4 +/- 42.9 micrograms/24 h and with goiter 117.2 +/- 60.5 micrograms/24 h, resp.). In both populations iodine supply as defined by the WHO (excretion of > 150 ug iodine/day) was inadequate. The recommended level was not achieved in 50% of the persons from the Waldviertel region and in 75% of persons from Vienna (healthy thyroid glands 76%, goiter: 75%). Iodine deficiency (intake < 100 micrograms/24 h) was present in 42% persons from the Waldviertel and in 31% and 24% persons, respectively, from Vienna with unremarkable thyroid glands and goiter. We conclude that although the iodine content of salt was increased, an iodine deficiency was present in a considerable portion of the population of an industrialized country (approximately 40% of persons from a rural region and 30% from the city of Vienna).

Adult↗
PubMed1998

Consanguinity in question in two patients with congenital adrenal hyperplasia who bear an identical first and last name--second look.

Two patients with identical first and last name, both suffering from Congenital Adrenal Hyperplasia due to 21-hydroxylase deficiency, were investigated in our endocrine outpatient unit. The families of the two girls did not know of each other's existence. Although paternal ancestors were identified up to the 11th and 9th previous generations, respectively, and a common area of origin, roughly 50 km apart, in the northwestern part of the Czech Republic (formerly Austrian Silesia) was established, no common ancestor was found. The patients' respective paternal CYP 21B allele was identical. However, by means of analysis of class I-and class II-HLA regions in both patients and their respective parents no common paternal haplotype was established. In order to still postulate consanguinity by the same paternal haplotype it is necessary to assume that two recombinations in the HLA region must have occurred. The probability that these two events have taken place within the past 11 generations is 0.11%.

Adolescent↗
PubMed1998

Failure of short-term hyperinsulinemia to affect testosterone production rates in healthy men.

Production rates for testosterone were determined in seven healthy men before and during a euglycemic clamp using a stable labeled tracer (1alpha,2alpha-D-testosterone 0.13 +/- 0.04 mg/h) and analysis by gas chromatography-mass spectrometry (GC-MS). Following an equilibration period of 12 hours (8 PM to 8 AM), blood samples obtained at 20-minute intervals from 8 AM until 2 PM were subsequently pooled and evaluated for three 2-hour periods. Following determination of basal endogenous production (8 AM to 10 AM), the investigation was continued during two 2-hour periods of induced euglycemic hyperinsulinemia (10 AM to 2 PM). Production rates for testosterone (basal, 245 +/- 91 microg/h) remained unchanged during the first (234 +/- 87 microg/h) and second (207 +/- 94 microg/h) period of this euglycemic clamp. These results suggest that short-term hyperinsulinemia has no effect on endogenous production rates of testosterone in healthy men.

Adult↗
PubMed1998

Treatment with growth hormone suppresses cortisol production in man.

The effect of biosynthetic human growth hormone (GH) on the cortisol production rate was determined in healthy men (N=8) using the stable isotope dilution technique and mass spectrometry. 1alpha,2alpha-D-Cortisol was infused at a dose of 110+/-9 microg/h for 10 hours (8 AM to 6 PM). Blood samples obtained at 20-minute intervals from 2 PM to 6 PM were pooled during two 2-hour periods. Subsequently, each subject received a daily dose of biosynthetic human GH (4 IU/d subcutaneously [SC]) for 7 days. This resulted in an increase of plasma somatomedin C from a basal level of 0.65+/-0.13 U/mL to 1.18+/-1.2 U/mL on day 7 (P < .0001). Plasma concentrations of corticotropin (ACTH) and cortisol-binding globulin (CBG) were similar before and after administration of GH. Determination of the cortisol production rate was repeated on day 7 of treatment with GH. Due to its physiological diurnal rhythmicity, endogenous production of cortisol during basal conditions was higher (P < .05) between 2 and 4 PM (0.70+/-0.30 mg/h) versus 4 to 6 PM (0.55+/-0.28 mg/h). Following treatment with GH, the values were 0.40+/-0.11 mg/h (2 to 4 PM, P < .01 v day 1) and 0.31+/-0.11 mg/h (4 to 6 PM, P < .01 v day 1). Thus, in healthy men, treatment with SC, GH induces a decrease in endogenous cortisol production rates.

Adrenocorticotropic Hormone↗
PubMed1998

Sex-specific differences in cortisol production rates in humans.

Production rates of cortisol were determined in healthy men (n = 7) and in healthy women during the follicular phase of their menstrual cycle (n = 7) using the stable-isotope dilution technique and analysis by gas chromatography/mass spectrometry (GC/MS). 1Alpha,2alpha-D-Cortisol was infused for 10 hours (116 +/- 6 microg/h; 8 AM to 6 PM). Blood samples obtained at 20-minute intervals during the last 4 hours (2 PM to 6 PM) were pooled and used for analysis. Estimated production rates of cortisol were 0.94 +/- 0.15 mg/h and 0.38 +/- 0.14 mg/h in healthy men and women, respectively. Even when corrected for body-surface area, production rates of cortisol in men (0.48 +/- 0.09 mg/m2 x h) were higher (P < .001) than in women (0.22 +/- 0.08 mg/m2 x h). An increased production rate of cortisol was seen in 12 patients with Cushing's syndrome, although in four of nine female patients, it was within the range considered normal for healthy men. It is concluded that women have a lower production of cortisol than men and that this sex-specific difference is of clinical relevance in patients with endogenous hypercortisolism.

Adult↗
PubMed1998

Role, sensitivity and validity of GH stimulation tests in the diagnosis of growth hormone deficiency in adults.

This study was conducted to evaluate whether stimulated concentrations of growth hormone (GH) are of practical use in establishing the diagnosis of acquired GH deficiency. The secretion of GH as stimulated by GH releasing hormone (GHRH; 100 microg i.v.) was studied in 33 patients with non-functioning pituitary macroadenomas prior to and after trans-sphenoidal adenomectomy, as well as in 25 non-selected subjects who had been referred for evaluation of various suspected non-pituitary diseases. Patients with pituitary macroadenomas, who needed substitution therapy for at least one additional pituitary hormone, presented with lower (P<0.05) GHRH-stimulated GH secretion (3.2 +/- 4.3 ng/ml) than the remaining patients with pituitary tumours (7.2 +/- 6.6 mg/ml). Both groups showed a marked overlap with the control group (7.1 +/- 5.5 ng/ml). Although GH stimulation tests are superior to other biochemical criteria of GH deficiency, they are still an inadequate method to reliably diagnose GH deficiency in an individual patient. In clinical practice GH replacement therapy should, therefore, only be considered if, in addition to impaired GH secretion, the patients present with additional defects in anterior pituitary function and clinical symptoms are compatible with a lack of GH.

Adenoma↗
PubMed1998

Elevated numbers of reticulated platelets in hyperthyroidism: direct evidence for an increase of thrombopoiesis.

We studied thrombopoietic activity in hyperthyroidism by determination of reticulated platelet counts. At the time of hyperthyroidism 14/15 patients had higher reticulated platelets than after achievement of euthyroidism (P<0.001). There was no difference in peripheral platelet counts and mean platelet volumes at the time of hyperthyroidism when compared to euthyroidism. Three patients had pan- and auto-reactive platelet antibodies during hyperthyroidism. These antibodies were directed against GPIIb/IIIa in two patients and against GPIb/IX in one patient. Our findings provide direct evidence that hyperthyroidism is associated with increased platelet production, as reflected by an increase in reticulated platelets.

Adult↗
PubMed1998

Normal serum concentrations of sex hormone binding-globulin in patients with hyperthyroidism due to subacute thyroiditis.

Serum concentrations of sex hormone binding-globulin (SHBG) were determined in patients with hyperthyroidism (n = 94; 12 men, 82 women) due to either Graves' disease (n = 59; 11 men, 48 women), autonomous thyroid adenomas (n = 23; 1 man, 22 women), or subacute thyroiditis (n = 12; all women). Elevated serum concentrations of SHBG were initially seen in 57 of 82 patients (69%) with hyperthyroidism due to either Graves's disease or due to autonomous adenoma. Elevated serum SHBG concentration was more frequent in patients with serum total thyroxine (TT4) concentrations greater than 15.0 microg/dL (32/39 [82%]; including 3 patients with autonomous adenoma) compared to those with serum TT4 concentration between 11.0 and 15.0 microg/dL (21/27 [77%]; including 7 patients with autonomous adenoma), or patients with an isolated elevation of serum total triiodothyronine (TT3) concentration (4/16 [25%]; including 2 patients with autonomous adenoma). Serum SHBG concentration normalized when patients became euthyroid. Only 1 of 12 patients in the hyperthyroid phase of subacute thyroiditis had an elevated serum concentration of SHBG. Serum concentrations of thyroid binding globulin (TBG) and transcortin (CBG) were normal in all but 1 patient. In patients with hyperthyroidism as a result of Graves' disease or autonomous adenoma serum SHBG concentrations were elevated with the greatest elevation found in patients with the highest serum T4 concentrations. The normal concentrations of SHBG in the hyperthyroid phase of subacute thyroiditis most likely reflects the shorter duration of exposure to increased thyroid hormone in this condition.

Adenoma↗
PubMed1998

C-cell hyperplasia and medullary thyroid carcinoma in patients routinely screened for serum calcitonin.

Routine screening of calcitonin serum levels in patients with nodular thyroid disorders has led to an increased rate of total thyroidectomies. We investigated prevalence and interrelationship of C-cell hyperplasia (CCH) and medullary thyroid carcinoma (MTC) in patients with thyroid and parathyroid disorders that showed increased calcitonin serum levels detected by routine screening. Within two years, 30 (mean age, 60 +/- 14 years) of 667 patients had a pentagastrin-stimulated calcitonin level of more than 100 pg/mL. All 30 underwent total thyroidectomy and were tested for germ-line mutations of the ret protooncogene. Entire surgical specimens were blocked, and C-cell disorders were assessed using conventional histology and immunohistochemistry. C-cell hyperplasia was defined by the presence of more than 50 C cells/l low-power field in both lobes and was classified as focal, diffuse, nodular, or neoplastic. Nineteen patients (female/male = 14/5) had MTC, and 11 males but no females had CCH only. Six of 16 patients with sporadic MTC had concomitant CCH. Three patients were index cases of new MTC families. We conclude that MTC with concomitant CCH is an unreliable marker for hereditary MTC risk and that CCH has a preneoplastic potential in the absence of germ-line mutations. In this series, CCH alone was not found in females.

Adult↗