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Biomedical subjects

W R Skowsky

Publications and source records attributed to W R Skowsky.

17 recordsLinked to original sources
PubMed1995

Toxic hematoma: an unusual and previously undescribed type of thyrotoxicosis.

The present case describes a new and unusual variant of thyrotoxicosis: transient hyperthyroxinemia following acute and massive hemorrhage into a previously normal thyroid gland. A 74-year-old woman presented with a large painful neck mass, palpitations, rapid atrial fibrillation, and hyperthyroxinemia following a fall and neck trauma while treated with excessive oral anticoagulants. Ultrasound and computerized tomography of the neck were consistent with a massive intrathyroidal hematoma. Elevation in serum T4 and T3 levels with suppressed TSH normalized over 3-4 weeks in parallel with hematoma shrinkage. Her tests were consistent with extensive bleeding into thyroidal tissue producing release of stored hormone. Her clinical course was compatible with the known disappearance rate of thyroxine and she returned to her euthyroid status without antithyroid therapy.

Aged↗
PubMed1991

Iodine 131 metaiodobenzylguanidine scintigraphy of medullary carcinoma of the thyroid.

We have presented a case of sporadic medullary carcinoma of the thyroid with documentation of localization of tracer 131I-MIBG within the primary neoplasm. A review of the nuclear medicine literature of localization techniques for MCT demonstrates that 131I-MIBG, while an excellent choice for diagnosis of pheochromocytoma and neuroblastoma, produces low yield and unpredictable concentration in other neural crest apudomas, including MCT. A low incidence of true-positive results with 131I-MIBG uptake and a high incidence of false-negative results make this radiopharmaceutical a suboptimal choice for diagnostic studies, but a potentially promising one as a therapeutic agent.

3-Iodobenzylguanidine↗
PubMed1984

Occult pulmonary malignancy in syndrome of inappropriate ADH secretion with normal ADH levels.

Although the syndrome of inappropriate ADH secretion (SIADH) has many causes, principally pulmonary, central nervous system or neoplastic disease, and drugs, patients may present with SIADH in whom the etiology is not readily evident. We measured serum ADH levels in such an individual in both the eunatremic and water-loaded states and found levels to be undetectable despite failure to dilute the urine. A small oat cell pulmonary carcinoma was ultimately diagnosed with lung tomograms and cytology. Following a partial response to water restriction, demeclocycline was effective in producing a water diuresis that restored the serum sodium concentration to normal. Patients with clinical SIADH but low serum ADH levels can harbor a malignant or benign process that, notwithstanding the low ADH levels, may still remain responsive to demeclocycline, suggesting either neoplastic production of a biologically-active, immunologically-inactive ADH-like peptide, or increased renal tubular sensitivity to ADH.

Carcinoma, Small Cell↗
PubMed1982

Preservation of normal adrenal androgen secretion in end stage renal disease.

A common endocrine defect in uremia is gonadal dysfunction with decreased testosterone production. Since gonadal and adrenal tissues share androgen biosynthetic pathways, we studied the stimulated adrenal androgen response in uremic patients. In contrast to the delayed or subnormal gonadal response to hCG reported by others, the adrenal response of androgens, as well as cortisol and aldosterone, to cosyntropin stimulation was unimpaired. In summary, the secretory reserve capacity of the adrenal gland for androgen, glucocorticoids and mineralocorticoids in uremia was studied with cosyntropin stimulation and found to be wall preserved.

Adrenal Glands↗
PubMed1979

Effects of sex steroid hormones on arginine vasopressin in intact and castrated male and female rats.

In the present study we have examined the effects of androgens and estrogens on circulating arginine vasopressin (AVP). Adult male Wistar rats had serum AVP levels of 0.4 microU/ml. Two weeks after bilateral castration, AVP rose to 2.6 microU/ml, but daily testosterone administration (100 microgram/100 g BW) to the castrate males prevented the AVP increase (0.8 microU/ml). During a normal estrous cycle, adult female Wistar rats had AVP values of 0.6 microU/ml during diestrus, 4.6 microU/ml on the morning of proestrus, 1.3 microU/ml on the afternoon or proestrus, and 1.5 microU/ml on the day of estrus. These changes in AVP paralleled the presumed changes in serum estradiol. Two weeks after bilateral ovariectomy of the adult female rats, AVP was 1.4 microU/ml but daily estradiol injections (100 microgram/100 g BW) to the castrate females produced a rise of serum AVP to 5.0 microU/ml. The results suggest an androgen inhibition and an estrogen stimulation of serum AVP levels.

Animals↗
PubMed1978

The role of vasopressin in the impaired water excretion of myxedema.

The plasma vasopressin response to acute water ingestion was evaluated in 20 patients with myxedema prior to definitive treatment and in eight of these same patients following therapy of their hypothyroidism. Vasopressin levels were elevated and failed to completely suppress following water ingestion in 15 subjects (75 per cent). Two hypothyroid patients with elevated plasma vasopressin levels (10 per cent) had a normal renal response to the water challenge suggesting partial end organ hormonal unresponsiveness. In three (15 per cent) of the five patients with suppressible vasopressin, water excretion was impaired indicating a nonvasopressin-mediated renal defect. In eight patients restudied after achievement of a euthyroid state, vasopressin inhibition and urinary excretion were normal following the oral water load. Although intrinsic renal changes in the hypothyroid state may contribute to the observed defect in water diuresis, the present study suggests a role of endogenous vasopressin in this disorder.

Adult↗
PubMed1977

Fetal neurohypophyseal arginine vasopressin and arginine vasotocin in man and sheep.

Immunoreactive arginine vasopressin (AVP) and arginine vasotocin (AVT) were quantitated in 15 of 17 human fetal pituitary glands early in gestation (11-19 weeks) and in 8 of 9 ovine fetal pituitary glands late in gestation (109-137 days). In 14 of 15 human fetal glands, AVT content exceeded that of AVP. There was a significant rise of AVP (as a percentage of total AVP plus AVT content) with gestational age over the period of 12-19 weeks (P less than 00.01). The ovine fetal glands demonstrated a preponderance of AVP over AVT. The mean AVP and AVT content in the ovine glands was 5.7 +/- 2.9 and 0.8 +/- 0.2 mU/mg gland weight, respectively, compared with the values in the human fetal pitiutaries, 0.8 +/- 0.2 and 1.2 +/- 0.2 mU/mg gland weight, respectively. The relative percentage of AVP and AVT in the ovine fetal pituitaries was 76.0+/- 9.6% and 23.9 +/- 9.6%, respectively, as contrasted to the human fetal glands, 36.7 +/- 2.7% AVP and 63.3 +/- 2.7% AVT. The preponderance of AVT over AVP in the early gestational age mammalian fetus may represent a primative first step in molecular evolution of the neurohypophyseal peptides.

Animals↗
PubMed1977

Arginine vasopressin secretion in thyroidectomized sheep..

Indwelling, exteriorized, jugular vein catheters were placed in five thyroidectomized ewes at a time when myxedema was manifested clinically and chemically and three euthyroid sheep were used as controls. Post-operatively, tracer doses of [125I]-iodovasopressin were injected and serial blood specimens were obtained for determination of volume of distribution, plasma disappearance, and blood production rates. Serum vasopressin was measured by radioimmunoassay. The mean volumes of distribution for vasopressin in the hypothyroid and euthyroid sheep, respectively, were 8.15 and 5.90 liters, mean t1/2 of vasopressin 9.5 and 19.3 min, mean serum vasopressin concentrations 5.1 and 1.2 muU/ml, and mean blood production rates 2.84 and 0.23 mU/kg/h. Renal and organ biologic effectiveness of the elevated vasopressin levels was suggested by the lowered serum osmolalities in the hypothyroid sheep over controls (272 vs. 301 mosmol/kg). These results suggest an augmented secretion of vasopressin in the myxedematous state.

Animals↗
PubMed1977

Release of antidiuretic hormone during mass-induced elevation of intracranial pressure.

There are complex osmotic and non-osmotic factors regulating release of antidiuretic hormone (ADH). A wide variety of intracranial pathological processes may trigger ADH release sufficient to produce clinically recognizable hyponatremia, or the "inappropriate ADH syndrome." We systematically studied one non-osmotic trigger, namely mass-induced elevated intracranial pressure (ICP). Initial experiments established baseline data in normal rhesus monkeys: anesthetized animals displayed appropriate rises and falls in immunoreactive urinary ADH in response to intravenously administered hypertonic and hypotonic infusions. Next, ballon catherters were implanted subdurally over temporal lobes and the animals were allowed to recover. The final experiment consisted of anethetizing the animals, monitoring arterial blood pressure and blood gases, and retrieving timed urinary specimens while continuously recording ICP during infusion-pump expansion of the subdural ballon. A nonlethal and a lethal series of ballon-expansion experiments were done. Control values of urinary ADH were 783 +/- 125 muU/15 min, and ICP was less than 10 mm Hg. During nonlethal mass expansion ADH output rose of 3433 +/- 269 millimicronU/15 min while ICP averaged 65 mm Hg (measured at completion of mass expansion). While the mass was maintained, hypotonic infusion produced unchanged urinary ADH output of 3452 +/- 277 muU/15 min. During lethal experiments, urinary ADH rose still higher to 4339 +/- 1887 muU/15 min associated with ICP averaging 100 mm Hg. We concluded that there is a direct relationship between the magnitude of ICP and the amount of ADH release, and that during elevated ICP the ADH release is not suppressed by hypotonic infusion.

Animals↗
PubMed1976

The pituitary-gonadal axis in spinal cord injury.

Our study documented that serum levels of luteinizing hormone, follicle-stimulating hormone, testosterone, and estradiol in 14 of 15 males with spinal cord injury (SCI) were within the normal range of those of age-matched controls. One patient had gynecomastia with compensated gonadal insufficiency of undetermined etiology. Five males with SCI showed a normal rise in serum testosterone levels following stimulation with human chorionic gonadotropin. Testicular biopsy in one of two males with SCI showed spermatogenic arrest. One of the biopsies showed immunoglobulin G immunofluorescence around the seminiferous tubule; the other demonstrated immunoglobulin A immunofluorescence in the spermatogonia. These findings suggest that, if a high incidence of impaired spermatogenesis does occur in spinal cord-injured patients, it is unlikely to be secondary to hormonal imbalance.

Adult↗
PubMed1976

Effect of TRH on serum arginine vasopressin in euthyroid and hypothyroid subjects.

To test the effect of thyrotropin-releasing hormone (TRH) on serum arginine vasopressin (AVP) in euthyroid and hypothyroid individuals, 500 mug of TRH was administered to four euthyroid subjects and three patients with primary hypothyroidism. Serum AVP was significantly depressed below basal levels from 30 to 60 min in the euthyroid and hypothyroid subjects after administering the releasing agent. The basal serum AVP in the hypothyroid subjects (3.1 +/- 1.1 muU/ml) was not significantly greater than the basal serum AVP in the euthyroid subjects (2.8 +/- 1.2 muU/ml). The maximal incremental depression in serum AVP after TRH in the hypothyroid subjects (1.4 +/- 0.7 muU/ml) was similar to the depression observed in the euthyroid subjects (1.8 +/- 0.9 muU/ml). These data suggest that TRH may have a physiologic role in modulation of AVP release in man.

Arginine Vasopressin↗
PubMedDate not supplied

A pilot study of chronic recombinant interferon-alfa 2a for diabetic proliferative retinopathy: metabolic effects and opthalmologic effects.

The objective of this study was to evaluate the metabolic effects and opthalmologic effects of alpha-interferon therapy in diabetes mellitus patients with proliferative diabetic retinopathy (PDR). Three volunteer patients [insulin-dependent diabetes mellitus (IDDM), insulin requiring non-insulin-dependent diabetes mellitus (NIDDM), and maturity onset diabetes of the young (MODY)] threatened with blindness due to progressive PDR were treated with alpha interferon for 4 months and were evaluated at intervals of 1-2 weeks to monitor the drug effects on carbohydrate tolerance and possible beneficial therapeutic effects on the preexisting PDR. Metabolic studies included basal and postsustacal glucose, c-peptide and glucagon, fasting serum cortisol, free fatty acids, growth hormone, insulin-like growth factor-1, and urinary microalbumin excretion. Ophthalmologic studies included visual acuity, slit lamp examination, gonioscopy, fluorescein angiography, and standard colored fundus photographs. In all subjects, hyperglycemia worsened with duration of increasing dosage of interferon therapy, requiring progressively higher daily insulin requirements of 17%-68% above pretreatment values. Lowered levels of stimulated C-peptide were observed in the NIDDM and MODY subjects. The counterregulatory hormones (cortisol, growth hormone, and glucagon) were elevated during the 4 months of interferon therapy. In all subjects, visual acuity appeared to stabilize. No new retinal hemorrhages occurred during the 4 months of interferon administration, although all subjects experienced hemorrhage within 6 weeks of termination of the drug. Although only three subjects were investigated, the 1-2 week frequency of metabolic and opthalmologic studies permit some conclusions. The metabolic effects of alpha interferon in our diabetic subjects were consistent worsening of carbohydrate tolerance associated with impaired beta-cell secretion and increased insulin resistance. The extensive opthalmologic investigation suggested protection from retinal hemorrhage while receiving interferon, but further studies are indicated to validate these proposed and antiangiogenic properties.

Adult↗