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To assess the value of population screening for adult hypothyroidism. Healthy people attending for a general health assessment. A thyroid-stimulating hormone (TSH) measurement was performed on people attending for a general health... more
To assess the value of population screening for adult hypothyroidism. Healthy people attending for a general health assessment. A thyroid-stimulating hormone (TSH) measurement was performed on people attending for a general health assessment (women aged 50-79 [35-49 with a family history of thyroid disease] and men aged 65-79). Those with TSH levels above 4.0 mU/L were invited to join a randomized double-blind crossover trial of thyroxine and placebo, each given in random order for four months. On entry a second blood sample was collected for a TSH measurement after the end of the trial to determine whether this would help select individuals for thyroxine treatment. The daily thyroxine dose started at 50 µg and if necessary was increased to achieve a TSH level of 0.6-2.0 mU/L. There were 341 (8%) people with a TSH level above 4.0 mU/L, 110 met eligibility criteria (64 agreed to participate), and 56 (49 women, 7 men) completed the trial. Among the 15 individuals with a repeat TSH mea...
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Background The aim of this study was to report and show the technique, results, and complications of combined endoscopic and intraoperative magnetic resonance imaging (IMRI) surgical treatment of pituitary disease from both a technical... more
Background The aim of this study was to report and show the technique, results, and complications of combined endoscopic and intraoperative magnetic resonance imaging (IMRI) surgical treatment of pituitary disease from both a technical and a surgical perspective. Methods We performed a retrospective chart review of 10 endoscopic, endonasal resections of 10 pituitary macroadenomas using the Polestar N-10 IMRI system in a tertiary health care facility. The patient demographics, tumor measurements, and postoperative symptoms and complications were assessed. The effect of the magnetic field on the video screen, the image quality of the IMRI images, and IMRI detection of residual tumor were evaluated also. Results IMRI images were obtained in all cases and were of sufficiently high quality to indicate adequate decompression of the optic chiasm and the removal of all suprasellar tumor. However, there was significant distortion of the video monitor regardless of the viewing angle. This was...
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Research Interests: Endocrinology, Treatment Outcome, Pharmaceutical Chemistry, Medicine, Humans, and 15 moreInternal Medicine, Blood Pressure, Female, Male, Clinical Sciences, Aged, Middle Aged, Adrenal Insufficiency, Adult, Time Factors, Metabolome, Area Under Curve, Glycated hemoglobin, hydrocortisone, and Paediatrics and reproductive medicine
Objective: Paediatric Cushing's syndrome (CS) remains a challenge to diagnose and exclude. We assessed the accuracy of 24-hour urinary free cortisol (UFC) determination in children referred for suspected CS. Design: We conducted a... more
Objective: Paediatric Cushing's syndrome (CS) remains a challenge to diagnose and exclude. We assessed the accuracy of 24-hour urinary free cortisol (UFC) determination in children referred for suspected CS. Design: We conducted a retrospective study of paediatric patients referred to our centre with suspected CS between 1982 and 2014. Patients: Of 66 subjects (mean age 12.9 years; range 4.4-16.9), there were 47 cases of CS (29 males), which included Cushing's disease (CD; 39 patients, 25 males), primary pigmented nodular adrenocortical disease (8 patients, 4 males) and 19 ‘controls' (6 males) in whom the diagnosis of CS was excluded. Measurements: The subjects had between one and five 24-hour UFC collections analysed by radioimmunoassay, chemiluminescent immunoassay or liquid chromatography-mass spectrometry. The data were normalised, corrected for body surface area (m2) and assessed using receiver operating characteristic analysis and an independent two-tailed t test. ...
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Sudden arousal from sleep causes a transient surge in sympathetic nervous activity. Repeated arousals, as occur in obstructive sleep apnea (OSA), are well documented to cause a more prolonged sympathetic overactivity and consequent... more
Sudden arousal from sleep causes a transient surge in sympathetic nervous activity. Repeated arousals, as occur in obstructive sleep apnea (OSA), are well documented to cause a more prolonged sympathetic overactivity and consequent elevations in 24-h urinary catecholamine levels. We describe here a series of five patients, each presenting with a clinical and biochemical picture indistinguishable from that of pheochromocytoma. Thorough investigations have failed to find catecholamine-secreting tumor in any of these subjects, but all have been diagnosed with OSA. Primary treatment of OSA with nasal continuous positive airways pressure has led to normalization of systemic blood pressure and urinary catecholamines. Pseudopheochromocytoma is therefore a rare, but treatable, presentation of obstructive sleep apnea.
Research Interests: Medicine, Case Report, Humans, Internal Medicine, Obstructive sleep apnea, and 15 moreBlood Pressure, Female, Male, Differential Diagnosis, Pheochromocytoma, Clinical Sciences, Middle Aged, Arousal, Adult, Urinary System, Sympathetic Nervous System, Apnea, Catecholamines, Continuous Positive Airway Pressure, and Paediatrics and reproductive medicine
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Incubation of rat hepatocyte plasma membranes with L-[14C]lactate resulted in the labeling of protein(s) of apparent molecular weight 40,000 when examined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The binding was... more
Incubation of rat hepatocyte plasma membranes with L-[14C]lactate resulted in the labeling of protein(s) of apparent molecular weight 40,000 when examined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The binding was saturable, irreversible, and inhibited by pyruvate, 2-oxoglutarate, and alpha-cyano-3-hydroxycinnamate, but not by D-lactate. It was markedly enhanced by L-alanine, but not D-alanine or beta-alanine. The binding protein(s) could be solubilized in cholic acid giving a single peak on gel filtration corresponding to a molecular weight of 26,000 and an isoelectric point of 5.1. This peak, when subjected to sodium dodecyl sulfate-polyacrylamide gel electrophoresis, ran in a position corresponding to an apparent molecular weight of 40,000. When membranes were treated with Triton X-100, lactate binding was retained by the Triton-insoluble fraction. The binding of L-[14C]lactate increased with incubation time, due apparently to the appearance of new binding sites and not to sequestration into vesicles. As many of the characteristics of lactate binding to rat hepatocyte plasma membranes were found to be similar to those of lactate entry into isolated hepatocytes, we speculate that the lactate-binding protein could represent part or whole of a plasma-membrane lactate transporter. Lactate-binding proteins of the same molecular weight were identified in the plasma membranes from rat erythrocytes, cardiac muscle, skeletal muscle, lung, and brain.
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We report a patient who presented with transient diabetes insipidus in pregnancy on a background of previous postoperative diabetes insipidus following surgical excision of a prolactinoma. The patient illustrates how the complex changes... more
We report a patient who presented with transient diabetes insipidus in pregnancy on a background of previous postoperative diabetes insipidus following surgical excision of a prolactinoma. The patient illustrates how the complex changes in water homeostasis occurring during normal pregnancy may unmask latent diabetes insipidus. The major factors operating appear to be a physiological reduction in the thresholds for thirst and arginine vasopressin secretion coupled with a substantial increase in placental clearance of arginine vasopressin. Reversal of these changes after delivery results in normalization of the disordered water homeostasis, with consequent resolution of the diabetes insipidus.
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For 'asymptomatic carriers' of the succinate dehydrogenase subunit B (SDHB) gene mutations, there is currently no consensus as to the appropriate modality or frequency of surveillance imaging. We present the results of a... more
For 'asymptomatic carriers' of the succinate dehydrogenase subunit B (SDHB) gene mutations, there is currently no consensus as to the appropriate modality or frequency of surveillance imaging. We present the results of a surveillance programme of SDHB mutation carriers. Review of clinical outcomes of a surveillance regimen in patients identified to have a SDHB gene mutation, based on annual MRI, in a single UK tertiary referral centre. A total of 92 patients were identified with an SDHB gene mutation. 27 index patients presented with symptoms and 65 patients were identified as asymptomatic carriers were identified. Annual MRI of the abdomen, with alternate year MRI of the neck, thorax and pelvis. Presence of an SDHB-related tumour included paraganglioma (PGL), phaeochromocytoma (PCC), renal cell carcinoma (RCC) and gastrointestinal stromal tumour (GIST). 43 PGLs, 8 PCCs and 1 RCC occurred in the 27 index patients (23 solitary, 4 synchronous, 5 metachronous). A further 15 SDH...
Research Interests: Magnetic Resonance Imaging, Adolescent, Medicine, United Kingdom, Humans, and 14 moreChild, Mutation, Female, Male, Young Adult, Clinical Sciences, Middle Aged, Adult, Neoplasms, Clinical Endocrinology, Succinate Dehydrogenase, Cohort Studies, Paediatrics and reproductive medicine, and Epidemiological monitoring
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Data obtained from studies in childhood-onset GH deficiency (CO-GHD) in adult life indicate differences in body composition in comparison with adult-onset GHD, but the response to GH replacement is qualitatively similar in terms of... more
Data obtained from studies in childhood-onset GH deficiency (CO-GHD) in adult life indicate differences in body composition in comparison with adult-onset GHD, but the response to GH replacement is qualitatively similar in terms of reduction in fat mass, serum cholesterol and LDL-cholesterol. However, because bone development is GH dependent and achievement of peak bone mass occurs some years later than completion of linear growth, continuing somatic development is a potentially important issue in the GHD adolescent. This issue has been examined in a United Kingdom multicentre study, in which patients with persisting severe GHD were randomised to continue or discontinue GH replacement at completion of linear growth. Over the course of one years, important differences were observed in bone mineral content with continued accrual in patients continuing GH therapy, in comparison with minimal change in those patients who had discontinued. A similar pattern was observed for lean body mass. Both groups demonstrated gain in fat mass, with a tendency for this to be greater in the GH discontinuation group. There were no changes observed in lipoprotein profiles. These observations and similar data from other groups have provided the basis for recommendations that young adults with CO-GHD should be offered continuing GH replacement in order to optimise bone development. Despite the wide applicability of this advice, it should be recognised that there are significant interindividual differences in clinical characteristics. Further studies are required to determine whether sabbatical periods off GH replacement are clinically appropriate and, if so, their reasonable duration.
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Impaired GH activity at target tissues, occurring when GH action is blocked or during suboptimal GH replacement ther- apy, may result in a pathological state associated with low- ering of IGF-I, but not GH levels. Such a state represents... more
Impaired GH activity at target tissues, occurring when GH action is blocked or during suboptimal GH replacement ther- apy, may result in a pathological state associated with low- ering of IGF-I, but not GH levels. Such a state represents functional but not necessarily actual GH deficiency (GHD). The aim of this study was to identify a range of IGF-I values
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Hypopituitarism most commonly results from pituitary/peripituitary tumors and their treatment. In those hypopituitary patients without structural abnormalities, transcription factor abnormalities are now increasingly recognized as... more
Hypopituitarism most commonly results from pituitary/peripituitary tumors and their treatment. In those hypopituitary patients without structural abnormalities, transcription factor abnormalities are now increasingly recognized as accounting for insidious pituitary failure that is often termed “idiopathic.” Loss of pituitary hormone secretion may be partial or complete, and although different etiologies may give rise to distinct patterns of hormone deficiency, all causes may eventually lead to panhypopituitarism. Typically, pituitary tumors lead to gradual loss of anterior pituitary hormones with disinhibition of prolactin release. Progressive pituitary failure related to tumor or irradiation results in growth hormone deficiency, followed by sequential loss of the other hormones of the anterior pituitary: luteinizing hormone, follicle-stimulating hormone, thyroid-stimulating hormone, and finally adrenocorticotropin hormone. Loss of posterior pituitary function resulting in diabetes insipidus rarely occurs as a direct result of a pituitary mass lesion, with pituitary metastasis being an important exception. Deficiency of antidiuretic hormone (ADH) commonly occurs in hypothalamic lesions, and transient or permanent ADH deficiency is not uncommon following trauma to the pituitary fossa, as seen in surgery and pituitary apoplexy.
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This round table discussion addressed the utility of insulin-like growth factor I (IGF-I) as a predictor of growth hormone (GH) action, the relationship between IGF-I response to GH and growth response, the possibility of a spectrum of... more
This round table discussion addressed the utility of insulin-like growth factor I (IGF-I) as a predictor of growth hormone (GH) action, the relationship between IGF-I response to GH and growth response, the possibility of a spectrum of both GH sensitivity and IGF-I sensitivity, and an examination of the possible need to acknowledge indicators of GH action in children which are distinct from those in adults.
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The optimal treatment of chronic conditions spanning pediatric and adult clinical practice requires the establishment of clear and robust systems for managing the important period of transition of care. This principle is particularly... more
The optimal treatment of chronic conditions spanning pediatric and adult clinical practice requires the establishment of clear and robust systems for managing the important period of transition of care. This principle is particularly relevant to the treatment of ongoing pituitary dysfunction after the achievement of final height and, in addition to the vital component of maintaining the confidence of the patient, encompasses a number of considerations that are particularly relevant to long-term health as an adult These considerations include the achievement of peak bone mass, optimization of gonadal steroid and glucocorticoid replacement, and determination of the need for continuing growth hormone replacement. It is therefore necessary to consider these issues not only from the standpoint of therapeutic principles but also in the context of practical arrangements for managing the process of transition of care. Successful transition can be achieved using a variety of models, and ther...
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Quality of life (QoL) is impaired in hypopituitary patients and patients with primary adrenal insufficiency. The aim of this study was to analyse the impact of glucocorticoid (GC) replacement on QoL. The main hypothesis was that... more
Quality of life (QoL) is impaired in hypopituitary patients and patients with primary adrenal insufficiency. The aim of this study was to analyse the impact of glucocorticoid (GC) replacement on QoL. The main hypothesis was that ACTH-insufficient patients experience a dose-dependent deterioration in QoL. This was a retrospective analysis of data from KIMS (Pfizer International Metabolic Database). Data from 2737 adult GH-deficient (GHD) hypopituitary patients were eligible for analysis. Thirty-six per cent were ACTH sufficient and 64% ACTH insufficient receiving a mean±s.d. hydrocortisone equivalent (HCeq) dose of 22.3±8.7 mg (median 20.0). QoL at baseline and 1 year after commencement of GH replacement was assessed by the QoL-assessment of GHD in adults. At baseline, no significant difference in QoL was observed between ACTH-sufficient and -insufficient patients. Increasing HCeq dose was associated with worse QoL. Patients on HCeq≤10 mg had the best and patients receiving ≥25 mg de...
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Background. Management of multiple-endocrine neoplasia type 1- (MEN1-) associated hyperparathyroidism is associated with high recurrence rates and high surgical morbidity due to multiple neck explorations. Cinacalcet, a calcimimetic agent... more
Background. Management of multiple-endocrine neoplasia type 1- (MEN1-) associated hyperparathyroidism is associated with high recurrence rates and high surgical morbidity due to multiple neck explorations. Cinacalcet, a calcimimetic agent licensed for the treatment of secondary hyperparathyroidism and parathyroid carcinoma, may provide a medical alternative for the management of these complex patients. Methods. A prospective audit was performed of eight patients; three males and five females, aged 20-38 at diagnosis. Two patients commenced cinacalcet as primary treatment and six had previous surgery. Six patients had complications of hyperparathyroidism: renal calculi, renal dysfunction, and reduced bone mineral density. All were commenced on cinacalcet 30 mg bd for MEN1 associated hyperparathyroidism; doses were subsequently reduced to 30 mg od in four patients. Results. Significant reductions were observed in serum calcium and PTH measurements. Serum calcium reduced by a median of...
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To describe the magnetic resonance (MR) imaging features of the adrenal glands in primary hyperaldosteronism and assess MR imaging in the detection and characterization of aldosterone-producing adenoma (APA). The authors retrospectively... more
To describe the magnetic resonance (MR) imaging features of the adrenal glands in primary hyperaldosteronism and assess MR imaging in the detection and characterization of aldosterone-producing adenoma (APA). The authors retrospectively reviewed the cases of 20 patients (13 female and seven male patients; age range, 14-67 years; median age, 46 years) with primary hyperaldosteronism who underwent 1.5-T MR imaging between 1995 and 1998. All patients underwent transverse T1- and T2-weighted imaging, and chemical shift imaging was performed in 17 patients. Imaging results were correlated with findings at biochemical testing, venous sampling, or surgery. Among the 20 patients, 10 (50%) had APA and 10 (50%) bilateral adrenal hyperplasia (BAH). In the detection of APA, MR imaging had a sensitivity of 70%, specificity of 100%, and accuracy of 85%. APAs (mean size, 20 x 16 mm) were iso- or hypointense relative to the liver on T1-weighted images and slightly hyperintense on T2-weighted images. With chemical shift imaging, the signal intensity decreased on the out-of-phase images in six of seven (86%) patients with APA and in eight of nine (89%) patients with BAH. MR imaging has a high specificity in the detection of APA. As with nonhyperfunctioning adenoma, APA and BAH show evidence of intracellular lipid at chemical shift imaging.
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Aim:To test prospectively 123I imaging follow-up of DTC. Method:One hundred and seven studies were evaluable in 82 patients (female/male ratio 3.5:1, papillary/follicular/mixed/hurtle cell tumour ratio 13:5:2:1) using 185 MBq 123I imaging... more
Aim:To test prospectively 123I imaging follow-up of DTC. Method:One hundred and seven studies were evaluable in 82 patients (female/male ratio 3.5:1, papillary/follicular/mixed/hurtle cell tumour ratio 13:5:2:1) using 185 MBq 123I imaging at 2 and 24 h. Results:Seventy-four studies were 123I negative (51 6 months post-ablation, 23 post-previous 131I therapy). Four showed high thyroglobulin with radiology/MIBI evidence of disease but no further 131I treatment given. Seven studies were positive (4 completed 131I therapy, 3 awaiting therapy). Twenty-six patients had both 123I imaging and 131I therapy. Twenty-two were 123I positive and post-131I therapy scan positive (greater uptake with 131I than 123I in 4). Three studies were 123I negative, post-131I therapy scan negative. One patient 123I negative with low TSH had post-131I therapy scan positive three months later. Combining these 26 studies with our previous 17 similar studies including 131I tracer negative scans gave 36 concordant 123I pre/131I post-therapy positive scans, 5 concordant negative scans and 2 discordant results, 43 studies, χ2=28, P<0.001. Conclusion:High dose 123I imaging is an excellent predictor of the post-131I therapy scan and when strategically combined with thyroglobulin has replaced 131I tracer studies in our follow-up of DTC.
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The sensitivity of computerised tomography (CT) in detecting neuroendocrine liver metastases is variable and three-phase imaging is advocated. However, patients are often young and may require prolonged follow-up, thus a technique that... more
The sensitivity of computerised tomography (CT) in detecting neuroendocrine liver metastases is variable and three-phase imaging is advocated. However, patients are often young and may require prolonged follow-up, thus a technique that avoids radiation exposure would be desirable. Our purpose was to assess the diagnostic performance of MRI, before and after administration of mangafodipir trisodium (MnDPDP), in the detection of neuroendocrine liver metastases. Patients who had undergone single-phase or multi-phase contrast-enhanced MD-CT for neuroendocrine liver metastases were invited to have MRI. Two independent observers made quantitative measurements (number and size of lesions). All measurements were made on each available CT phase and all MRI sequences independently, and repeated after an interval to assess reproducibility. The final number of lesions was agreed on by consensus of three observers. A qualitative assessment (contrast and spatial resolution) and preferred modality were agreed on by consensus. 265 lesions were detected by consensus in 11 patients. Non-contrast CT was available in 4/11, arterial phase in 6/11 and portal phase in 10/11 patients. When compared with the consensus number of lesions, MD-CT identified 17% on non-contrast, 44% on arterial and 43% on portal venous imaging. Lesion detection on MRI was 48% on T(1)W, 52% on T(2)W and 92% on MnDPDP-MRI. The number of lesions detected on MnDPDP-MRI was closest to the final consensus reading (variance = 0.994, p = 0.0027). The reproducibility of lesion size measurements was best on MnDPDP-MRI (variance = 0.033, p = 0.0021). The preferred modality subjectively was MnDPDP-MRI in 9/11 cases and T(2)W MRI in 2/11. MRI is a robust technique in the demonstration of neuroendocrine liver metastases. It is highly reproducible in both detecting the number and measuring the size of lesions. We recommend T(2)W MRI and MnDPDP-MRI in detection and follow-up of neuroendocrine liver metastases.
Research Interests: Magnetic Resonance Imaging, Neuroendocrinology, Medicine, Humans, Female, and 15 moreMale, Clinical Sciences, Aged, Middle Aged, Radiation Exposure, Adult, Computerised Tomography, Neuroendocrine Tumors, Neurosciences, Contrast Media, Edetic Acid, Pyridoxal Phosphate, Phase Contrast, liver metastases, and Liver neoplasms
External radiotherapy (ideally 3-field radiotherapy with a daily fractional dose no higher than 1.8 Gy or conformal irradiation) has been used extensively in the treatment of acromegaly, and virtually all studies have documented a... more
External radiotherapy (ideally 3-field radiotherapy with a daily fractional dose no higher than 1.8 Gy or conformal irradiation) has been used extensively in the treatment of acromegaly, and virtually all studies have documented a predictable but slow reduction in growth hormone (GH) excess, which is at its maximum in the first year after treatment (30-50%) and continues at an average rate of 10-15% thereafter in the long term. Therefore, achievement of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;safe&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; GH concentrations in an acceptable time interval after radiotherapy will be realized only in those patients who have lower GH concentrations prior to irradiation either as a result of mild disease or previous surgery. Recent studies have demonstrated the value of stereotactic radiotherapy (either as multiple arc X-irradiation or as &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;gamma knife&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; therapy) in the post-surgical treatment of acromegaly or as salvage therapy for disease persisting after conventional external irradiation. The development of potent medical therapies for acromegaly (somatostatin analogues and the GH receptor antagonist) has called into question the role of radiotherapy in the treatment of this disease. However, even if the concept of primary, open-ended medical therapy for selected patients is accepted, reference to the success rates of surgery and response rates to somatostatin analogues indicates that approximately 10-20% of all patients with acromegaly will require consideration of radiotherapy for hormonal or tumour mass control. For these reasons, radiotherapy (both conventional external and stereotactic irradiation) continues to have a major role in controlling acromegaly in selected patients.
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The physiological osmoregulatory adaptations of pregnancy include decreased thresholds for both thirst and AVP secretion and increased MCR for AVP. The combined effects of these changes may unmask subclinical DI. In view of the altered... more
The physiological osmoregulatory adaptations of pregnancy include decreased thresholds for both thirst and AVP secretion and increased MCR for AVP. The combined effects of these changes may unmask subclinical DI. In view of the altered relationship between serum osmolality and thirst, caution is required in investigating thirst and polyuria in pregnancy lest an erroneous diagnosis of psychogenic polydipsia be made.
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Research Interests: Endocrinology, Medicine, Melatonin, Humans, Internal Medicine, and 15 moreCircadian Rhythm, Female, Clinical, Cluster Analysis, Body Size, Clinical Sciences, Late onset hypogonadism, Adult, Gonadotropin Releasing Hormone, Neuronal Migration, Kallmann Syndrome, Luteinizing Hormone, Follicle stimulating hormone, hypogonadism, and Amenorrhea
Research Interests: Pharmacoepidemiology, Quality of life, Life Style, Physical Activity, Medicine, and 14 moreGrowth Hormone, Humans, Human Growth Hormone, Human Resources for Health, Female, Clinical, Male, Exercise, Clinical Sciences, Middle Aged, Hormone Replacement Therapy, Health Resources, Sick Leave, and Paediatrics and reproductive medicine
Alteration in serum protein concentration is used commonly in clinical practice as a nonspecific indicator of underlying disease or to monitor disease activity. Although hypercortisolemia may affect protein metabolism directly or... more
Alteration in serum protein concentration is used commonly in clinical practice as a nonspecific indicator of underlying disease or to monitor disease activity. Although hypercortisolemia may affect protein metabolism directly or indirectly, data regarding alterations of levels of serum protein in a large series of patients with Cushing’s syndrome (CS) have been lacking. We have now evaluated, retrospectively, the levels of circulating serum albumin, globulins, total proteins, and the albumin to globulin ratio in 99 patients with endogenous CS before, immediately after, and 3, 6, and 12 months following successful treatment. Subjects with concomitant infections or other chronic diseases were excluded from the analysis. Although mean serum albumin and total protein levels were within the normal reference ranges, in general, they gradually increased after treatment with maximal values being reached at 12 months after normalization of hypercortisolemia (P < 0.0001 for both); there w...
Research Interests: Endocrinology, Medicine, Clinical Practice, Cortisol, Humans, and 15 moreInternal Medicine, Liver, Chronic Disease, Female, Male, Regression Analysis, Clinical Sciences, Adult, Retrospective Studies, Disease Activity, Blood Proteins, Cushing Syndrome, Serum albumin, hydrocortisone, and Paediatrics and reproductive medicine
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Overproduction of thyroid hormones promotes bone resorption in vivo and in vitro, and we have evaluated whether mediators of such effects could include the osteotropic cytokines. Previous studies have demonstrated raised serum interleukin... more
Overproduction of thyroid hormones promotes bone resorption in vivo and in vitro, and we have evaluated whether mediators of such effects could include the osteotropic cytokines. Previous studies have demonstrated raised serum interleukin (IL)-6 in thyrotoxic patients, but differentiating the contribution of the elevated thyroid hormones from that of the autoimmune inflammation present in Graves’ disease (GD) has been difficult. We undertook a longitudinal study of 34 patients (19–45 yr old) with GD, toxic nodular goiter (TNG), or a history of thyroid carcinoma but no evidence of disease recurrence, receiving sufficient T4 to suppress TSH. Controls were 12 euthyroid females. The following measurements were made basally and for 6 months after carbimazole treatment: serum free T4, T3, bone-specific alkaline phosphatase (b-ALP), IL-6, IL-8, IL-1β, tumor necrosis factor-α, IL-11, and urinary deoxypyridinoline (Udpd). Compared with controls (IL-6, 1.1 ± 0.3 ng/L; IL-8, 3.2 ± 0.8 ng/L), u...
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Thyroid involvement during HIV infection can occur with such opportunistic pathogens as cytomegalovirus, Cryptococcus neoformans, Aspergillus fumigatus and Pneumocystis carinii (PC)1± 3 but recorded thyroid dysfunction is rare.... more
Thyroid involvement during HIV infection can occur with such opportunistic pathogens as cytomegalovirus, Cryptococcus neoformans, Aspergillus fumigatus and Pneumocystis carinii (PC)1± 3 but recorded thyroid dysfunction is rare. Parathyroid involvement by opportunistic organisms is unknown. We report a patient with AIDS who developed hypothyroidism and hypoparathyroidism associated with PC infection in the thyroid.