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Biomedical subjects

J G Devlin

Publications and source records attributed to J G Devlin.

At least 19 recordsLinked to original sources
PubMed1996

An open 36-month study of lipid changes with growth hormone in adults: lipid changes following replacement of growth hormone in adult acquired growth hormone deficiency.

Interest in adult growth hormone replacement has increased since identification of the associated vascular morbidity and mortality. Although total cholesterol and low density lipoprotein reduction and high density lipoprotein increases are anticipated, reports are conflicting and there is no uniformity in lipoprotein(a) changes. In 1990 we commenced an open trial of therapy with human recombinant GH and now have results to 36 months for 21 patients. Deficiency status was confirmed by insulin stress test with flat GH response < 2.0 ng/ml, mean insulin-like growth factor-I value 122 ng/ml (+/- 69 SD). Lipoprotein(a) was measured by monoclonal assay. Lipid analysis yields two subgroups: baseline cholesterol levels of greater or less than 6.22 mmol/l, with hypercholesterolaemic patients showing an enhanced hypolipaemic response. ANOVA was utilized, with 95% confidence limits. The most significant changes are of reductions in cholesterol and low density lipoprotein; the rate of change is greatest at 6 and 12 months but not sustained to 36 months. High density lipoprotein rises as expected, not to full significance. Lipoprotein(a) levels rose significantly in six patients of the cohort, and the increase was sustained over 36 months.

Adult↗
PubMed1994

Successful pregnancy in I.D.D.M. with intravenous programmable insulin pump.

Management of subcutaneous insulin resistance remains a difficult problem which can be treated by administering insulin intravenously by means of infusion pumps. We wish to report the case of a 31 year old primigravida with subcutaneous insulin resistance who developed a hitherto undescribed clinical complication of clot formation at the catheter tip, successfully treated with anti-coagulant therapy. Previous publications on the use of pumps in pregnancy have reported on the intraperitoneal route for insulin administration.

Adult↗
PubMed1994

Delirium and the dexamethasone suppression test in the elderly.

It has been suggested that delirium in the elderly is caused by abnormally high levels of circulating glucocorticoids or by an increased vulnerability to their effects. We performed a dexamethasone suppression test (DST) in 16 consecutive patients without depression or dementia admitted to an acute-care geriatric unit with a clinical diagnosis of lower respiratory tract infection. Seven of 9 (78%) patients who developed delirium were non-suppressors on the DST compared with 1 of 7 (14%) patients without delirium (p = 0.04). Clinical and laboratory indicators of the severity of illness did not differ between the two groups. Of the 8 patients with an abnormal DST, 1 died and another was not available for repeat assessment. On re-examination 8 weeks later, after resolution of the delirium and of the chest infection, 5 of 6 non-suppressors still had an abnormal DST. It is known that some non-demented and non-depressed elderly patients fail to suppress cortisol in response to 1 mg of dexamethasone. Our results suggest that such patients may be at increased risk for developing delirium during acute illness.

Acute Disease↗
PubMed1992

Doxazosin in the management of hypertensive diabetes--a cautionary note (?).

Twenty-two patients with diabetes and hypertension were treated with Doxazosin. An acceptable fall in blood pressure was found with 1 mg. in 50% of patients and 2-8 mgs. in 50%. An increase in HDL cholesterol and a fall in LDL cholesterol levels which reached statistical significance was observed. A small but significant increase in HBA1 levels occurred in the 50% of patients on the higher Doxazosin dose.

Antihypertensive Agents↗
PubMed1990

Late onset adrenal hyperplasia in a group of Irish females who presented with hirsutism, irregular menses and/or cystic acne.

The aims of this study were to determine the frequency of late-onset adrenal hyperplasia due specifically to 21-hydroxylase deficiency in a group of Irish women who presented at a Dublin Clinic with symptoms of hyperandrogenism, including hirsutism, menstrual irregularities and/or cystic acne, and to determine if those with 21-hydroxylase deficiency showed particular HLA associations. 119 women had blood samples taken basally and 1 h after an injection of 0.25 mg synacthen with the following hormones profiled: 17-hydroxyprogesterone, 11-deoxycortisol, androstenedione, testosterone, DHEAS and cortisol. Blood sampling was carried out between 0900 and 1000 h during the early follicular phase of the menstrual cycle (when applicable). Ninety-six subjects were new referrals to the Clinic for investigation of hyperandrogenism and 23 were acting as controls. In this study, 6% of patients showed evidence of partial 21-hydroxylase deficiency. In addition, 3 of the 6 with partial 21-hydroxylase deficiency had normal baseline levels of 17-hydroxyprogesterone, with the biochemical abnormality becoming manifest only on synacthen stimulation. Late-onset adrenal hyperplasia due to partial deficiency of this enzyme should always be considered as a possible diagnosis in women who present with symptoms of hyperandrogenism. Synacthen stimulation is an important diagnostic tool in elucidating partial enzyme deficiency as baseline 17-hydroxyprogesterone may be normal in such patients.

Acne Vulgaris↗
PubMed1988

[Treatment of resistance to subcutaneous insulin with implanted insulin infusion pumps].

Four female patients, resistant to insulin administered subcutaneously, were treated with an implanted insulin infusion pump (Infusaid; constant rate infusion). They had all experienced as many as four episodes of ketoacidosis per month despite extremely high doses of insulin injected subcutaneously or intramuscularly, and none of the treatment approaches attempted--insulin delivery via subclavian catheter, Schade-port, insulin infusion with an external portable pump or various insulin additives--had been successful. After implantation of the pump the daily insulin dose, which had been between 300 and 3000 units during subcutaneous therapy, was reduced to 30 to 70 units per day. The patients' condition improved, no further episodes of ketoacidosis occurred and hospital stays were reduced significantly. In the further course of treatment pump and catheter-related complications had to be overcome.

Adult↗
PubMed1987

Familial Prader-Willi syndrome.

Three adult sisters with previously unrecognized Prader-Willi syndrome (PWS) demonstrated the six diagnostic features of this congenital condition: neonatal hypotonia, hypomentia, hypogonadism, obesity, short stature, and dysmorphism. Detailed endocrine investigations were performed, including ovarian biopsy in the propositus. HLA genotype A2 was present in each patient. The normal high-resolution prometaphase karyotypes indicated heterogeneity; the absence of the deletion 15q12 frequently found in patients with sporadic PWS distinguished this sibship as representing a possible autosomal recessive type of PWS. Current evidence suggests that the diagnosis of PWS may be often overlooked. Increased clinical awareness of the features of PWS should result in prompt diagnosis and optimal management of affected patients, together with increased understanding of this enigmatic condition.

Adult↗