Biomedical subjects
Publications and source records attributed to N L Pillay.
A patient with Graves' disease who had inappropriately increased thyroid stimulating hormone (TSH) concentrations and TSH response to thyrotrophin-releasing hormone is reported. No pituitary tumour could be demonstrated and the patient is considered to be an example of selective resistance of the pituitary thyrotroph to thyroid hormone action.
Serum angiotensin-converting enzyme (SACE) and Kveim-Siltzbach test results were obtained in 25 patients with clinically active sarcoidosis. Twenty of these patients had elevated SACE levels and 17 had positive Kveim-Siltzbach tests. One patient had normal SACE activity and a negative Kveim-Siltzbach test. Four of the 6 patients with a normal SACE level had a positive Kveim-Siltzbach test and 7 of the 8 patients with a negative Kveim-Siltzbach test had elevated SACE levels. These results indicate that the two tests are complementary and increase the diagnostic specificity in sarcoidosis. We conclude that the concurrent use of SACE measurement and Kveim-Siltzbach tests is of value in the diagnosis of sarcoidosis.
Over a 5-year period 14 patients with acromegaly and gigantism were seen at the endocrine clinic of King Edward VIII Hospital: 9 were Blacks and 5 Indians; 8 of the patients were women. The mean age of the patients was 46 years. Surprisingly, only 2 patients complained of acral overgrowth. Symptomatology was varied and not characteristic of the condition. On examination all patients had unequivocal signs of soft-tissue and bony overgrowth, 64% had visual abnormalities and 50% hypertension. Radiologically, 88% showed an enlarged pituitary fossa. On biochemical investigation, the fasting levels of growth hormone (GH) were increased in 12 patients and during oral glucose tolerance tests, the GH levels in these 12 patients were not suppressed. One patient in whom the fasting GH level was not increased had progressed to the stage of panhypopituitarism, in the remaining patient challenge with thyrotrophin-releasing hormone (TRH) led to increased GH levels and L-dopa challenge resulted in a paradoxical decrease in GH levels. Seven patients with increased GH levels who were challenged with L-dopa showed the typical decrease in GH levels found in this condition; in 5 of these patients, challenged with TRH, GH levels increased. The findings emphasize that despite the ease of clinical diagnosis, appropriate biochemical investigations are necessary to confirm the exact status of the disease, which is rare in the population studied.
Non-insulin-dependent diabetes mellitus (NIDDM) with onset below 35 years of age was studies in 43 Indian and 9 Black patients. NIDDM was diagnosed in 10.0% and 1.6% of diabetes in the respective racial groups. The mean age of the patients was 35.4 years and the mean duration of diabetes 7.5 years. Nearly 50% of patients were significantly obese, and more than 50% had a positive family history of diabetes. In all patients the diabetes was symptomatic at presentation, although frequently insidious in onset. In all cases the symptoms could be controlled without insulin therapy. Despite persistence significant hyperglycaemia in several patients, ketosis did not occur at any stage. Complications were detected in 40% of the Indian and 22% of the Black patients, but were unrelated to the duration of diabetes or severity of hyperglycaemia. Basal insulin levels and postglucose insulinaemic responses were lower in the Black than the Indian diabetes.
Insulin-dependent diabetes mellitus (IDDM) with onset below 35 years of age was studied in 52 Black and 38 Indian patients. IDDM accounted for approximately 10.4% and 1.1% of diabetes in the respective racial groups. The mean age and body weight in the Black and Indian diabetics were 27.6 years and 24.7 years, and 60.2 kg and 54.7 kg, respectively. The duration of diabetes in the majority of Blacks was 1-4 years, and that in Indians 5-9 years. The initial presentation in more than 80% of the patients was acute, with severe keto-acidosis in 15%. A positive family history of diabetes was obtained in more than 50% of Indians and in less than 6% of Blacks. Complications were present in 33% of Indian patients and were related to the duration of illness and dose of insulin required. Basal growth hormone, cortisol, cholesterol and triglyceride concentrations in serum were higher in Indians than in Blacks, but the differences were not significant. The disease was unrelated to excess alcohol intake or to pancreatic calcification.
During a 3-year period of 16 Black and Indian patients were diagnosed as having hypopituitarism. Their ages ranged from 9 to 58 years; 9 were women. Headaches and visual disturbances constituted the commonest presenting symptoms, and this was related to the fact that tumours accounted for the hypopituitarism in 11 of the 16 patients. The commonest hormonal deficiency was of growth hormone and the commonest combined deficiency was of growth hormone and gonadotrophin. Hyperprolactinaemia was present in 4 patients. The spectrum of hypopituitarism ranged from 1 patient with monohypopituitarism to 2 patients who were deficient in all the hormones tested, the majority of patients, however, being deficient in only some of the hormones.
The thyroid status of twenty-seven African patients with gestational trophoblastic neoplasia (GTN) was studied. Fifteen patients were found to be biochemically hyperthyroid (eight patients with choriocarcinoma; seven with hydatidiform mole). Of these fifteen patients, nine were clinically thyrotoxic. The most serious complication of thyrotoxicosis was life-threatening acute pulmonary oedema with associated cardiac failure. It was found that when serum levels of the human chorionic gonadotrophin (hCG) reached a level of about 0.1 X 10(6) iu/1, thirteen of sixteen patients were biochemically hyperthyroid; at serum levels of 0.3 X 10(6) iu/1 of hCG most patients were clinically thyrotoxic. A feature of hyperthyroidism associated with GTN is that whereas T4 is invariably raised the T3:T4 ratio tends to be low (0.015 +/- 005); rT3:T3 ratios were high in this group. TSH levels were not increased.
A 46-year-old Black woman who was treated with 131I for hyperthyroidism subsequently developed hypoparathyroidism, a very rare complication. The clinical and biochemical findings are presented and the relevant literature is discussed.
Serum angiotensin-converting enzyme (SACE) activity was measured in 29 patients with sarcoidosis, 51 reference subjects, 7 patients with active tuberculosis and 8 patients with other lung diseases. SACE activity was increased in 93% of the patients with sarcoidosis as compared with the reference subjects. Patients with active tuberculosis and other lung diseases did not have increased SACE activity.
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