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Biomedical subjects

R G Wieland

Publications and source records attributed to R G Wieland.

At least 19 recordsLinked to original sources
PubMed1985

Isolated adrenocorticotropic hormone deficiency with antepartum pituitary infarction in a type I diabetic.

Isolated adrenocorticotropic hormone (ACTH) deficiency was documented after cesarean delivery in a patient with type I diabetes. A preceding severe headache, subsequent declining insulin requirements, and hypotension are consistent with pituitary infarction in a patient without computed tomography evidence of a pituitary tumor. Antepartum incomplete pituitary infarction with isolated ACTH deficiency is an unusual but potentially catastrophic complication of the pregnant diabetic.

Adrenocorticotropic Hormone↗
PubMed1979

Effect of chronic combined glucocorticoid and estrogen on serum androgens and androgen binding in hirsutism.

Forth-six patients with hirsutism are presented herein. Twenty-four of these patients had menstrual irregularities. Treatment with 5 mg prednisone at bedtime, and 0.625 to 1.25 mg conjugated estrogens daily except during menses resulted in a signficant decrease in serum 17 beta-ol androgens, and an even more statistically significant increase in serum androgen binding. Thus the biochemical abnormalities associated with hirsutism were improved and no apparent side effects were observed.

Adolescent↗
PubMed1979

Effect of dietery weight loss on sex steroid binding sex steroids, and gonadotropins in obese postmenopausal women.

Measurements of SSBG, E2, T, and gonadotropins were performed in 12 obese postmenopausal women before, during, and after a supplemented fast. Weight loss (mean 18 kg) was associated with an increase in SSBG to levels above those seen in nonobese postmenopausal women, a decrease in serum E2 levels, unchanged T levels, and an increase in both gonadotropins. Thus we conclude that weight change or the circumstances associated with it lead to alterations in circulating levels of SSBG. These observations are consistent with the presence of elevated free T and possibly higher free E2 levels in obese postmenopausal women.

Body Weight↗
PubMed1978

Experience with low-dose insulin infusion in diabetic ketoacidosis and diabetic hyperosmolarity.

Forty patients with diabetic ketoacidosis and eight patients with the diabetic hyperosmolar state were treated with low-dose insulin infusion in four teaching hospitals in the Cleveland area. The clinical and biochemical responses observed support previous favorable reports on this treatment modality. Two elderly patients with the hyperosmolar syndrome died. The advantages of this form of treatment over intermittent insulin schedules are emphasized. Early potassium administration, unless otherwise contraindicated, is recommended. Rarely, increasing doses of insulin may be required if insulin resistance is encountered.

Adolescent↗
PubMed1977

Unusual events preceding hyperthyroidism with diffuse goiter.

Two unique patients with hyperthyroidism are presented here. A 48-year-old woman with a family history of Graves' disease was first evaluated and treated for a toxic adenoma with radioactive iodine. Three months later, she was again hyperthyroid, was found to have a diffuse thyromegaly, and was treated with radioactive iodine for the second time. This patient represents, to our knowledge, the first reported case of two sequential forms of endogenous hyperthyroidism. The second patient, a 64-year-old woman, had well-documented hypothyroidism that was presumably primary. She was admitted in thyroid storm and subsequently died. The autopsy disclosed characteristic changes in the thyroid of hyperthyroidism and a normal pituitary gland. The timing of the onset of Graves' disease with hyperthyroidism cannot be accurately determined.

Adenoma↗
PubMed1976

Impaired Leydig cell reserve and altered serum androgen binding in the aging male.

The hormonal profile of the aging male reveals an associated decrease in free testosterone and 5 alpha-dihydrotestosterone (DHT) levels and increased luteinizing hormone levels. Later events consist of a decrease in total testosterone, stable DHT, and increased follicle-stimulating hormone and estradiol levels. Although most available information supports the concept of impaired Leydig cell reserve, our study suggests some degree of hypothalamic-pituitary dysfunction. The signal for increased androgen binding with age is not clear. There is a great deal of individual variation in the time of onset of these events.

Aged↗
PubMed1976

Certain metabolic consequences of jejunoileal bypass.

Jejunoileal bypass for obesity has been shown to be associated with increased hepatic triglycerides during the period of brisk weight loss. The current report describes certain metabolic changes observed in 29 patients 21 months after bypass. Significant decreases in serum cholesterol, serum triglycerides, blood sugar after a glucose load, and fasting plasma insulin levels were noted. Increased oxalate excretion and occasional episodes of hypomagnesemia occurred. Repeated clinical and laboratory observations by a medical-surgical team offer the best opportunity to evaluate this procedure.

Adolescent↗
PubMed1976

Community screening for diabetes by blood glucose measurement. Results of a five-year experience.

The Diabetes Association of greater Cleveland screened 307,000 individuals in the metropolitan area for diabetes with a 75-gm. oral load of carbohydrate. Of these subjects 12,600 (4.1 per cent) had a two-capillary blood glucose level of greater than 139 mg. per cent and were defined as positive. Seventy per cent of the positives were retested, and 65 per cent of these again had two-hour levels greater than 139 mg. per cent. Seventy-one per cent of the original screening values were between 104 and 199 mg. per cent. The rate of positivity on retesting increased with the original screening bracket reaching 90 per cent at an original screening level of 240 mg. per cent or higher. The frequency of positive retests also increased with age irrespective of whether the original screening level was less than or greater than 200 mg. per cent. The implications of this large detection experience for conducting future mass surveys for diabetes are discussed.

Age Factors↗
PubMed1976

17beta-ol androgens and free index in hirsute and hirsute obese women.

We have found the mean levels of combined serum testosterone and dihydrotestosterone (T+DHT) and the free index (FI) to be significantly higher and the mean dihydrotestosterone precipitation index (DHT-PI) to be significantly lower in hirsute women than in normal women. Although the mean T+DHT values of the different groups of hirsute patients were comparable, the FI value of the oligomenorrheic and/or obese patient was higher than that of the nonobese, normally menstruating group. In addition, the mean DHT-PI level of obese patients was significantly lower than that of nonobese patients. The lowest androgen binding was found in obese patients with oligomenorrhea. In our experience, hirsutism is associated with T+DHT values of 150 ng/dl or lower. Measurement of androgen binding and androgen levels in unchromatographed serum extracts provides valuable information in the treatment of hirsute women.

Adolescent↗
PubMed1975

Effect of synthetic gonadotropin-releasing hormone (GnRH) in a patient with the "fertile eunuch" syndrome.

A patient with isolated LH deficiency ("fertile eunuch" syndrome) was given synthetic gonadotropin releasing hormone (GnRH) by a single intravenous injection and serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone and dihydrotestosterone were measured. A significant rise in both gonadotropins was found after GnRH and the increase was similar to that reported for normal men. No significant change was noted in the serum androgen levels. The patient was re-tested with another single intravenous injection after a 6-h infusion of GnRH two days later. The rise in serum Fsh and LH levels during the infusion was greater than with the initial bolus. A further increase in LH but not FSH concentration was noted when a 150 mug bolus was given at the end of the infusion. Acute (4 day) treatment with human chorionic gonadotropin (hCG) resulted in an increase in the serum testosterone and dihydrotestosterone levels to those observed in normal adult males. The "fertile eunuch" syndrome thus appears to be a hypothalamic disorder. It is consistent with the concept of more than one hypothalamic factor controlling gonadotropin secretion. Other possibilities would be deficient or defective production of a releasing factor affecting one or both gonadotropins. The lack of a definite response of serum androgens to GnRH would appear to be secondary to a decreased number of differentiated Leyding cells.

Adult↗