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PubMed1981

Gonadotrophin levels in women with Cushing's syndrome before and after treatment.

Basal serum concentrations of LH and FSH and their response to LHRH were studied in twelve pre- and ten post-menopausal women with Cushing's syndrome before and after treatment. Subnormal basal concentrations of LH were found in twelve out of twenty-two, and of FSH in ten of the twenty untreated patients. There was a correlation between the urinary free cortisol (UFC) and basal LH values, r = -0.59 (P less than 0.05), and UFC and basal FSH values, r = -0.76 (P less than 0.02) in the premenopausal women. All seven patients with a UFC value greater than 1080 nmol/24 h (normal range less than 270) had both a subnormal basal gonadotrophin level and a subnormal response of at least one gonadotrophin to the releasing hormone. In those patients in whom successful remission was obtained and who did not require replacement therapy, subnormal basal gonadotrophins were usually restored towards or into the normal range. It is concluded that while gonadotrophin levels may be normal in women with Cushing's syndrome, they are subnormal in those with the highest cortisol values. This may be due to a direct suppressive effect of cortisol on the release of stored pituitary hormone, and/or on LHRH release from the hypothalamus.

Adult↗
PubMed1987

Somatomedin-C levels in treated and untreated patients with acromegaly.

With the aid of a recently developed commercially available radioimmunoassay for Somatomedin-C (Sm-C) we measured the Sm-C levels in 38 controls, 24 untreated acromegalics, 45 inactive acromegalics and five pituitary dwarfs. With the exception of the dwarfs, the age and sex distributions for the various groups were similar. In inactive acromegalics the basal GH level (calculated as the mean of four blood samples taken during the day) was less than 5 mU/l; it was depressed to, or less than, 2.5 mU/l during the 100 g oral glucose tolerance test. The mean Sm-C level found for control subjects was 20.4 +/- 5.1 nmol/l and for untreated patients 85.6 +/- 25.7 nmol/l (mean +/- SD, P less than 0.001). The mean Sm-C level for inactive patients who had undergone surgery and invariably showed a normalized paradoxical reaction to TRH was 18.2 +/- 7.1 nmol/l (NS) vs 16.1 +/- 8.2 nmol/l (NS) for those who underwent surgery plus postoperative pituitary radiation therapy. Only one out of 45 inactive acromegalics exhibited an increased Sm-C level. The Sm-C levels correlated significantly not only with the log GH levels (r = 0.82) but also with the fasting insulin/glucose ratio the integrated incremental insulin levels, the maximal insulin increase and the integrated glucose levels during the oral glucose tolerance test as well as the 24-h urinary excretion of calcium and hydroxyproline.(ABSTRACT TRUNCATED AT 250 WORDS)

Acromegaly↗
PubMed1992

Normal bone mineral density following cure of Cushing's syndrome.

OBJECTIVE: Both endogenous and exogenous glucocorticoid excess are well established as causes of osteoporosis. However, there are few data describing bone mineral density in these subjects following the restoration of normal steroid levels. The present study addresses this issue. DESIGN: A cross-sectional assessment of bone mineral density in patients cured of Cushing's syndrome, and comparison of each with four normal subjects matched by age, sex, weight, menopausal status and race, was used. PATIENTS: Seventeen adults cured of Cushing's syndrome 8.6 +/- 1.6 years (mean +/- SEM) took part. MEASUREMENTS: The bone mineral density of the lumbar spine and proximal femur was measured by dual energy X-ray absorptiometry. RESULTS: Bone mineral densities, relative to control, were 100 +/- 16, 98 +/- 14, 97 +/- 19 and 98 +/- 16% (mean +/- SD), in the lumbar spine, femoral neck, Ward's triangle and trochanteric regions, respectively. There was a positive relationship between bone density and time since cure (r = 0.24-0.59, in the four regions). In contrast, bone density was significantly reduced in five subjects with active Cushing's disease when similarly matched (BMD = 87 +/- 4, 83 +/- 4, 75 +/- 6 and 82 +/- 6%, in the respective regions; 0.01 less than P less than 0.05). CONCLUSIONS: Bone density is reduced in subjects with Cushing's syndrome but not in those having undergone cure some years previously. This implies that steroid-induced osteoporosis is substantially reversible, though long-term prospective studies will be necessary to establish this definitively.

Adrenalectomy↗
PubMed1980

Pituitary ablation in the relief of pain in advanced prostatic carcinoma.

Fifty-five patients with diffuse pain due to bone metastases from prostate carcinoma were treated by pituitary ablation (53 with intrasellar Yttrium 90 and 2 with intrapituitary alcohol instillation). The provisional criteria of the British Prostate Group were used to assess results. Post-operatively, 44 patients (80%) were significantly free of pain and 12 of them were completely pain-free. In only 11 cases (20%) was there no relief of pain. Of the 39 patients who required narcotics before ablation, only 12 required them post-operatively. Pituitary ablation with Yttrium 90 has an important place in the relief of pain in advanced carcinoma of the prostate, although survival is not increased.

Aged↗