Biomedical subjects
J Köbberling
Publications and source records attributed to J Köbberling.
[Dietary iodine deficiency. Its consequences in the aged].
Persisting dietary iodine deficiency in the Federal Republic of Germany is reflected in endemic goiter, in particular in the elderly. Among 581 over-60-year-olds, 48.8% revealed enlargement of the thyroid gland on sonography. Thyroid nodules were present in 101 cases, and a cystic lesion in another 43. Goiter is appreciably less responsive to levothyroxine in the elderly than in younger patients. The indication for initiating such medication should therefore be established on an individual basis. A specific problem of iodine deficiency goiter in the elderly is the increasing development with age of autonomously functioning nodules in the thyroid. Iodine contamination can induce thyrotoxicosis, which is often difficult to treat; in the individual case, thyroidectomy must be performed.
Treatment of iodine deficiency goiter with iodine, levothyroxine or a combination of both.
During recent years several studies have been published comparing different ways of pharmacological treatment of a goiter due to iodine deficiency. These studies usually were performed with 300 to 500 micrograms of iodine, 100 to 150 micrograms levothyroxine, or a combination of in most cases 100 micrograms levothyroxine and 100 micrograms iodine. The largest data have been accumulated in 166 patients with in most cases diffuse goiter. Group A (n = 61) received 150 micrograms levothyroxine per day, group B (n = 50) 400 micrograms iodine per day and group C (n = 55) a combination of 75 micrograms levothyroxine and 200 micrograms iodine per day. During the eight months of therapy, in all three groups a significant and comparable mean decrease in goiter size was documented (-32.1% in group A, -37.3% in group B and -38.7% in group C [n.s. between the three groups]). Striking differences between the three groups are evident in the changes of basal and thyrotropin releasing hormone (TRH) stimulated thyrotropin (TSH). In group A, after eight months a sharp and significant decrease of TSH occurred (from 1.2 mU/l to 0.4 mU/l; mean; p < 0.05), while in group B TSH showed only a minor decrease (from 1.3 mU/l to 0.9 mU/l) and remained significantly higher compared to both, group A and C (p < 0.01). Similar changes were documented when the TSH after TRH administration was calculated. It is concluded, that all three therapeutic approaches are effective for goiter reduction.(ABSTRACT TRUNCATED AT 250 WORDS)
Problems in evaluating dose equivalences of glucocorticoids.
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Prevalence of thyroid dysfunction in elderly subjects from the general population in an iodine deficiency area.
The prevalence of thyroid disorders was investigated in 466 (403 female, 63 male) subjects over the age of 60 years (79.2 +/- 7.5 years; mean +/- SD) from the general population in an area of iodine deficiency. In addition to thyroid hormone assays, thyroid antibodies and urinary iodine excretion were determined. In cases with thyroid dysfunction, ultrasound investigations were performed. Twenty-two of the 466 subjects (4.7%) showed hyper- or hypothyroidism; 7 subjects were hyperthyroid (1.5%), 5 had primary hypothyroidism (1.1%), and 10 showed "subclinical" hypothyroidism (2.2%). The latter constellation is defined as an elevation of thyrotropin (TSH) with normal values for thyroxine and triiodothyronine. Most subjects with hyperthyroidism had a goiter by palpation (6/7); thyroid volume by ultrasound (median) was 26.2 mL with an inhomogeneous echo pattern in 6 of the 7 subjects. In 4 cases, a rise in urinary iodine excretion was documented; none had TSH-receptor antibodies. Most subjects with overt or subclinical hypothyroidism had a homogeneous or low-echogenic pattern by ultrasound; thyroid volume (median) was 12.9 mL and 12.7 mL, respectively. By palpation, 8 of the 15 subjects had no goiter. In general, these persons had no rise in urinary iodine excretion (11/13), but most showed an elevation of antibodies against the microsomal antigen and/or thyroglobulin (11/15).(ABSTRACT TRUNCATED AT 250 WORDS)
Sodium lithium countertransport is acutely influenced by heparin-induced extracorporal LDL precipitation.
Sodium lithium countertransport may be a genetic marker for arterial hypertension and for the risk of diabetic nephropathy in type 1 diabetic patients. Since various factors seem to influence the transport velocity including serum lipid alterations, erythrocytes of seven patients with severe hyperlipoproteinaemia who were chronically and intermittently treated with LDL apheresis were examined before and immediately after therapy. The LDL apheresis reduced sodium lithium countertransport significantly (0.383 vs 0.269, P less than 0.02). Therefore, we conclude that serum lipid composition must be considered when interpreting sodium lithium countertransport velocity.
Thyroid volume and goitre prevalence in the elderly as determined by ultrasound and their relationships to laboratory indices.
In 569 unselected elderly subjects over 60 years from the general population of an iodine-deficient area, a palpation and an ultrasound investigation of the thyroid were performed. Additionally, thyroid hormone values were determined in 466 of the 569 subjects (81.9%) and urinary iodine excretion in 491 subjects (86.3%). By palpation, no thyroid enlargement was noticed in 302 subjects (54.2%), goitre Ia in 98 (17.6%), goitre Ib in 94 (16.9%), goitre II in 53 (9.5%), and goitre III in 10 (1.8%). The thyroid volumes (medians) by ultrasound were 18.6 ml in the entire group, in women (N = 489) 19.2 ml, and in men (N = 80) 16.6 ml. One hundred and one subjects had a thyroid nodule (17.6%), 43 persons cystic lesions (7.6%). If, according to the literature, a goitre is defined as a thyroid enlargement of more than 18 ml in women and more than 25 ml in males, a goitre prevalence of 54.2% in females and of 22.5% in males was obtained. The goitre prevalence in the entire group was calculated as 49.7%. Thyroid hormone measurements showed in subjects with goitre a significant lower TSH value (p less than 0.001) and a higher thyroglobulin value (p less than 0.001). In summary, the study shows a high prevalence of goitre in elderly subjects, a high prevalence of nodules in these thyroids, a negative correlation of goitre volume with TSH, and a positive correlation of goitre volume with the thyroglobulin concentration.
Genetic and nutritional factors in the etiology and pathogenesis of diabetes mellitus.
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The fructosamine assay in diagnosis and control of diabetes mellitus scientific evidence for its clinical usefulness?
The fructosamine assay is about to be used for the control of diabetic patients and for the diagnosis of diabetes mellitus. An analysis of the original literature is presented to answer the question whether the evaluation of the test is methodologically reliable. Altogether 65 studies are evaluated. Thirty of these studies deal with technical aspects of the test (phase 1). A comparison of the distributions of test results for diabetic and non-diabetic patients is presented in 28 studies (phase 2). However, serious shortcomings in methodology and presentation are apparent. "Significant" differences and correlation coefficients are the basis for optimistic conclusions. Only 7 studies are identified where fundamental test parameters such as sensitivity and specificity are given, or can be calculated (phase 3). None of them achieves a satisfactory standard of methodology (selection of patients unclear, assessment made not mutually blind). There is no reliable phase-3-study for the metabolic control of diabetes mellitus. It can be concluded that the fructosamine test is not evaluated sufficiently to allow its routine clinical use. In fact, contrary to a widely quoted opinion, the results presented so far do not suggest a reliable test.
Evaluation of a new enzyme immunoassay system for free thyroxine (Enzymun-Test FT4).
Free thyroxine (FT4) represents the metabolically active fraction of the circulating thyroid hormone thyroxine (T4). In this paper the results of the evaluation of a newly developed FT4 assay are reported. This assay system is based on an enzyme-labelled one-step immunoassay. The within-run imprecision, checked using serum pools and several commercial reference materials, showed a coefficient of variation (CV) of between 0.8 and 9.8%, depending on the reference material used. The between-run imprecision showed a CV of between 1.0 and 13.2%. Accuracy experiments yielded values between 80 and 116%. When the new FT4 was compared with the calculation of an index for free thyroxine (FT4I; derived from either the ratio of T4/thyroxine binding coefficient of from T4/thyroxine binding globulin) in a number of samples in the hypo-, eu- and hyperthyroid range, a good correlation was obtained. The same was true when the new FT4 assay was compared with a widely used two-step radioimmunoassay (y = -0.146 + 0.943 x). In euthyroid subjects the measured FT4 concentration was 10.3-25.8 pmol/l. No effect was evident when the influence of EDTA and citrate was investigated, whereas addition of heparin led to an increase in FT4 concentration of about 12 to 15%. Investigation of the possible influence of a large number of drugs showed that probenezid, carbamazepine and furosemide led to an increase in the measured FT4 concentration. Dialysis increased the FT4 concentration, as measured in patients before and after haemodialysis. No effect of alteration in protein concentration and/or protein distribution of FT4 concentration could be detected. In pregnancy, FT4 values were within the normal range.(ABSTRACT TRUNCATED AT 250 WORDS)
Treatment of endemic goitre due to iodine deficiency with iodine, levothyroxine or both: results of a multicentre trial.
Preliminary clinical studies and recent in vitro investigations suggest that iodine administration may be an effective alternative in the treatment of the diffuse euthyroid goitre of iodine deficiency. Therefore a 12-month multicentre study was initiated in which 166 patients were randomly assigned to take either 150 micrograms levothyroxine day-1 (group A, n = 61), 400 micrograms iodine day-1 (group B, n = 50), or a combination of 75 micrograms levothyroxine and 200 micrograms iodine day-1 (group C, n = 55) for 8 months with follow-up examinations at 4 and 8 months as well as 4 months after cessation of treatment. Initially, thyroid volume, as determined by ultrasound, was not significantly different in the three groups. In all three groups, during treatment a significant and comparable mean decrease in goitre size was documented (-32.1% in group A, -37.3% in group B, -38.7% in group C). After cessation of treatment in group A mean thyroid volume again increased to near the baseline value (-12.0% compared to the initial investigation), while the therapeutic effect was sustained in group B (-32.5%). In group C, only a slight rebound effect was observed (-26.3% vs baseline volume). Total thyroxine (T4) increased sharply and significantly in group A from 7.8 +/- 1.9 to 10.9 +/- 2.8 micrograms dl-1 after 8 months (P less than 0.001), but only slightly, although significantly in group B (from 7.8 +/- 1.5 micrograms dl-1 to 8.9 +/- 1.6 micrograms dl-1; P less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)
[Genetic determinants of diabetes mellitus].
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Isolated ACTH deficiency and type 1 diabetes mellitus.
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Bilateral virilizing adrenal tumor in a 17 year old woman.
We report on a 17 year old female patient with amenorrhea, hirsutism and slight acne. Hormonal blood analyses showed markedly increased levels for dehydroepiandrosteronesulfate, testosterone and androstenedione. Ultrasound investigation revealed a large tumor above the left kidney and a small area above the right kidney, suspicious for a tumor on the contralateral side. This was confirmed by angiography. During surgery, bilateral tumors were removed. Pathological diagnosis was made as bilateral adenomas of the adrenal cortex. Postoperatively, an impressive normalization was observed, accompanied by a rapid decrease of the elevated hormone concentrations. This case is the first report of a bilateral occurrence of a virilizing tumor of the adrenal cortex.
Diabetes mellitus; a new look at diagnostic criteria.
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Chronic dopamine receptor stimulation using bromocriptine: failure to modify thyroid function.
Administration of 2.5 mg bromocriptine (Parlodel), a dopamine agonist, on two occasions to six normal volunteers did not alter the plasma TSH response to an i.v. injection of 100 micrograms TRH, but significantly (P less than 0.01) blunted it after 200 micrograms. Chronic bromocriptine treatment (7.5--50 mg/day) of fifteen acromegalic subjects failed to influence basal plasma TSH or the response pattern to 200 micrograms TRH. The thyroxine Binding Index (TBI) and the levels of T3 and T4 were not modified by treatment. These results indicate that chronic dopaminergic therapy with bromocriptine does not alter thyroid function.
[Cortisol substitution in adrenal cortex insufficiency].
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HLA-typing in juvenile diabetics with and without positive family history and in families with one and two diabetic siblings.
HLA-typing was performed in two groups of juvenile-onset diabetics, one with (n = 58) and one without (n = 109) a family history of the disease. The association of this type of diabetes with certain HLA antigens (excess of B8 and B15, shortage of B7) was confirmed. No heterogeneities could be established between the two groups. This suggests that the aetiologic basis in single and familial cases of juvenile diabetes is the same. The hypothesis, that the B8 associated gene is more penetrant than the B15 associated gene, cannot be confirmed. Haplotypes were determined in families with one and two diabetic siblings. The findings of high haplotype concordance among diabetic siblings was confirmed: concordance of 2, 1 and 0 haplotypes in 7, 5 and 3 pairs respectively. There was a low degree of haplotype concordance between diabetics and nonaffected siblings in the families with two diabetics: 2, 1, and 0 haplotypes in 2, 8 and 6 pairs respectively. This led to the hypothesis of negative selection against these HLA-linked "diabetogenic" genes. This tendency was not, however, observed in families with only one diabetic. The report of a high recombination rate in families with juvenile diabetics could not be confirmed.