Homozygous transfusion-dependent beta-thalassemia patients manifest cardiac, hepatic, endocrine, ... more Homozygous transfusion-dependent beta-thalassemia patients manifest cardiac, hepatic, endocrine, and metabolic disorders attributable to chronic anoxia and iron overload. Short stature, delayed sexual maturation, diabetes mellitus, hypothyroidism, hypoparathyroidism, and metabolic bone disease can and should be diagnosed as early as possible so that the intervention can be fruitful. Primary or secondary amenorrhea is due primarily to pituitary gonadotrope hemosiderosis, as attested by pathology data and the demonstration in vivo of nonstimulable follicle-stimulating hormone and luteinizing hormone release and secretion after the exogenous administration of gonadotropin-releasing hormone or its agonistic analogs. Ovulation can be achieved with the use of exogenous gonadotropins provided that the ovary has no siderosis (as seen in neglected patients) or damage induced by drugs used for bone marrow transplantation. Once pregnancy is achieved, it should be considered high risk and be de...
Many patients with medullary thyroid carcinoma (MTC) have persistently elevated calcitonin levels... more Many patients with medullary thyroid carcinoma (MTC) have persistently elevated calcitonin levels after initial treatment, indicating disease recurrence. Conventional imaging is often negative or shows equivocal findings. In this study we report our experience with 2-deoxy-2-[(18)F]fluoro-D-glucose positron emission tomography/computed tomography ([(18)F]FDG-PET/CT) in the evaluation of this specific group. Between February 2007 and May 2009, 38 [(18)F]FDG-PET/CT scans were performed on 32 patients with MTC and elevated calcitonin levels for localization of recurrent disease. Six of these patients had a second [(18)F]FDG-PET/CT scan. Among the 38 [(18)F]FDG-PET/CT scans there were 18 positive and 20 negative scans. Out of the 18 positive scans, 17 were true positive and one false positive. These findings suggest that [(18)F]FDG-PET/CT provides additional information in almost half of all cases (overall per patient sensitivity of 47.4%) but using a serum calcitonin cut-off of 1000 pg/ml this rate is increased to 80%. An interesting finding of the study was that none of the six patients with multiple endocrine neoplasia type IIA syndrome had a positive [(18)F]FDG-PET/CT scan for MTC. When these patients were excluded, the overall per patient sensitivity rose to 60% and in patients with calcitonin levels >1000 pg/ml this rate increased to 100%. The mean SUV(max) of all lesions showing [(18)F]FDG uptake was 3.96 + or - 1.61 (range, 2-7). [(18)F]FDG-PET/CT seems to be valuable for the detection of recurrence in patients with highly elevated calcitonin levels and negative conventional imaging findings. In addition, it seems that the sensitivity of [(18)F]FDG-PET/CT may be higher in patients with sporadic or familial MTC than in patients with MTC as part of multiple endocrine neoplasia type IIA syndrome.
ABSTRACT The reviewers are a general clinical, though academic, endocrinologist and one with a sp... more ABSTRACT The reviewers are a general clinical, though academic, endocrinologist and one with a special interest in states of excess cortisol secretion (ed.).
The Journal of Clinical Endocrinology and Metabolism, Jun 1, 1977
The acute effect of pyridoxine (B6) on serum GH and PRL levels and its chronic effects on galacto... more The acute effect of pyridoxine (B6) on serum GH and PRL levels and its chronic effects on galactorrhea in nine subjects (group I, n=4, idiopathic galactorrhea with normal PRL levels and normal menses; Group II, n=5, galactorrhea-amenorrhea with increased PRL levels) have been studied. Pyridoxine did not acutely alter GH or PRL levels. There was no decrease in galactorrhea, no resumption of menses and no decrease in PRL following tow months of B6 therapy. In contrast, bromocriptine was effective in suppressing galactorrhea and restoring normal menses in group II subjects and remains the therapy of choice for this purpose.
In contrast to mitral regurgitation (MR) caused by structural abnormality of the valve (&... more In contrast to mitral regurgitation (MR) caused by structural abnormality of the valve ("primary" MR), about which there is increasing consensus regarding treatment, there is increasing controversy around the management of functional or "secondary" MR, of which "ischemic mitral regurgitation" (IMR) is a common cause. While the trend in the management of primary MR is increasingly aggressive, with wide agreement on the preference for repair over replacement such that debate centers on earlier and earlier repair even among asymptomatic patients, the situation is reversed in the setting of secondary MR with uncertainly beyond the mode of management (repair or replacement) to the value of intervening at all. This is, in part, because the term IMR has been somewhat loosely applied by the medical and surgical communities to include regurgitation secondary to active myocardial ischemia, as well as that resulting from a completed myocardial infarct. As a result, there is considerable variability in reported outcomes of surgical interventions for IMR. In addition, the natural history of IMR is quite adverse-more so than that of many solid organ malignancies-and its surgical treatment has traditionally carried a higher operative mortality than many cardiac surgical procedures, including similar operations for primary MR and incidental coronary artery disease. Added to this, with recent advances in both the medical and surgical treatment of heart failure improving nonoperative outcomes and simultaneously reducing operative risk compared to reports from previous decades, the landscape has been quite dynamic. Here, we review the issues surrounding surgical treatment for IMR, along with available evidence supporting different approaches, to lend an informed perspective on the divergent opinions among experts in this field and guide the appropriate management of the individual patient.
Many patients with medullary thyroid carcinoma (MTC) have persistently elevated calcitonin levels... more Many patients with medullary thyroid carcinoma (MTC) have persistently elevated calcitonin levels after initial treatment, indicating disease recurrence. Conventional imaging is often negative or shows equivocal findings. In this study we report our experience with 2-deoxy-2-[(18)F]fluoro-D-glucose positron emission tomography/computed tomography ([(18)F]FDG-PET/CT) in the evaluation of this specific group. Between February 2007 and May 2009, 38 [(18)F]FDG-PET/CT scans were performed on 32 patients with MTC and elevated calcitonin levels for localization of recurrent disease. Six of these patients had a second [(18)F]FDG-PET/CT scan. Among the 38 [(18)F]FDG-PET/CT scans there were 18 positive and 20 negative scans. Out of the 18 positive scans, 17 were true positive and one false positive. These findings suggest that [(18)F]FDG-PET/CT provides additional information in almost half of all cases (overall per patient sensitivity of 47.4%) but using a serum calcitonin cut-off of 1000 pg/ml this rate is increased to 80%. An interesting finding of the study was that none of the six patients with multiple endocrine neoplasia type IIA syndrome had a positive [(18)F]FDG-PET/CT scan for MTC. When these patients were excluded, the overall per patient sensitivity rose to 60% and in patients with calcitonin levels >1000 pg/ml this rate increased to 100%. The mean SUV(max) of all lesions showing [(18)F]FDG uptake was 3.96 + or - 1.61 (range, 2-7). [(18)F]FDG-PET/CT seems to be valuable for the detection of recurrence in patients with highly elevated calcitonin levels and negative conventional imaging findings. In addition, it seems that the sensitivity of [(18)F]FDG-PET/CT may be higher in patients with sporadic or familial MTC than in patients with MTC as part of multiple endocrine neoplasia type IIA syndrome.
A prolactinoma was removed from a nulliparous woman who had acromegaly, galactorrhea-amenorrhea, ... more A prolactinoma was removed from a nulliparous woman who had acromegaly, galactorrhea-amenorrhea, elevated serum growth hormone and prolactin, and hypogonadotropinism. Postoperatively galactorrhea decreased and cyclic vaginal bleeding ensued; serum prolactin concentration was normal but growth hormone remained elevated and the acromegalic complex was unchanged, even after subsequently administered bromocriptine. At a second transsphenoidal operation, an adenoma of somatotropes was removed; improvement in symptoms and signs and normalisation of pituitary function, including growth hormone, followed. The possible presence of distinctly separate pituitary adenomas should be considered in patients with galactorrhea associated with acromegaly.
Acromegaly mainly associated with the presence of a growth hormone (GH)-secreting pituitary tumor... more Acromegaly mainly associated with the presence of a growth hormone (GH)-secreting pituitary tumor causes considerable morbidity and carries a risk of premature mortality. Treatment includes surgery, radiotherapy, and the use of dopaminomimetic drugs and somatostatin agonist analogs (octreotide and lanreotide). The use of long-acting somatostatin analogs is limited to adjuvant therapy following failure of surgery and/or radiotherapy and/or bromocriptine. But it may be considered the drug of choice for childhood acromegaly and for syndrome of plurihormonal pituitary overproduction in association with excess GH-releasing hormone (GHRH) and a McCune/Albright-like syndrome. Octreotide has been administered de novo as primary and/or presurgical preparatory therapy. Octreotide doses of 100 to 1500 micrograms were used in two large series in Europe and the United States, which mainly included acromegalics in whom all other modalities had failed (> 65%). Clinical improvement, which was sustained for over 6 months of follow-up evaluation, was reported for more than 50% to 70% of patients. In evaluable patients with visual-field defects, there was a definite amelioration, even if the tumor mass was not reduced, and there was no worsening during therapy; the same is true for the adenoma mass, which showed a variable reduction (median, 15 to 22%). A reduction of serum GH and insulin-like growth factor-1 (IGF-1) levels was found in more than 90% of patients, with GH serum values < 5 ng/mL and IGF-1 serum values < 2 U/mL recorded in 46% and 49%, respectively. Relapse occurred when treatment stopped. Future developments are expected to improve the clinical usefulness of somatostatin analogs.
Our objective was to assess the endocrine and morphological response of polycystic ovary syndrome... more Our objective was to assess the endocrine and morphological response of polycystic ovary syndrome (PCOS) in patients receiving 6 months of therapy with the long-acting gonadotrophin releasing hormone agonist (GnRH agonist) decapeptyl (3.75 mg monthly injections). Eighteen documented PCOS patients were basally evaluated for hirsutism, gonadotrophin and androgen concentrations and ovarian morphology using trans-vaginal ultrasonography. Measurements were repeated at 3 and 6 months. The results (values as mean +/- SD) showed a significant improvement in hirsutism (Ferriman score 11.0 +/- 5.9 versus 6.6 +/- 2.7, P < 0.01), acne and seborrhoea. A significant post-treatment decrease in gonadotrophins [follicle-stimulating hormone (FSH): 5.8 +/- 1.8 versus 3.8 +/- 1.1 IU/l, P < 0.01; luteinizing hormone (LH): 10.8 +/- 8.3 versus 3.4 +/- 3.3 IU/l, P < 0.01], LH/FSH ratio (1.8 +/- 1.1 versus 0.8 +/- 0.6, P < 0.01) and androgen concentrations (free testosterone: 4.0 +/- 1.9 versus ...
The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception, 1997
Polycystic ovary syndrome is a common endocrine disorder, presenting with menstrual irregularitie... more Polycystic ovary syndrome is a common endocrine disorder, presenting with menstrual irregularities, hirsutism, obesity, infertility and abnormal ovarian morphology. In addition, polycystic ovary syndrome is associated with a self-perpetuating imbalance involving the endocrine system and metabolic pathways, in which carbohydrates, lipids and growth factors are involved. Because of its chronicity, it is considered to be a substantial risk factor for atherogenesis and hormone-dependent neoplasia. The etiology and pathophysiology of the syndrome remain elusive. However, during the last decade, several clues have emerged from human and animal studies that may have significant repercussions in the treatment of polycystic ovary syndrome. Therapeutic maneuvers should be directed towards the dominant abnormalities present in individual patients with polycystic ovary syndrome. Gonadotropin releasing hormone (GnRH) agonists can directly affect the gonadotropin generator and secondary downstrea...
Hypercalcemia of cancer is due to secretion of substances with parathyroid hormone (PTH)-like act... more Hypercalcemia of cancer is due to secretion of substances with parathyroid hormone (PTH)-like activity from tumours of the respiratory, gastrointestinal and urogenital tract as well as hematologic malignancies and breast cancer. PTH-related Protein (PTHrP) is secreted mainly from solid tumours and it has been recently recognized as being responsible for hypercalcemia mediated primarily via an increased renal reabsorption of calcium and secondly by an increased bone resorption. PTHrP-mRNA is expressed in a variety of normal tissues and has multiple physiologic and paracrine actions. Bone resorbing factors like the cytokines-lymphokines, interleukins, prostaglandins, TNF-alpha/TNF-beta, GM-CSF/G-CSF, TGF-alpha and TGF-beta are produced by certain solid and hematologic cancers and have also been implicated in tumour-induced hypercalcemia. The recently introduced PTHrP antagonists are hopeful therapeutic measures for the future.
A patient had continuous paroxysms of the specific ventricular arrhythmia of the "Torsades d... more A patient had continuous paroxysms of the specific ventricular arrhythmia of the "Torsades de Pointes" type during attacks of variant angina. The arrhythmia was refractory to lidocaine and procainamide and only responded dramatically to verapamil, initially intravenous and afterwards oral. The low success rate in the treatment of such arrhythmias by other drugs and available experimental data suggest that verapamil should be further evaluated.
Pseudocyesis was clinically established in a 39-year-old woman. Pituitary function was assessed w... more Pseudocyesis was clinically established in a 39-year-old woman. Pituitary function was assessed with the use of hypothalamic peptides and dopamine receptor agonists. Basal serum concentrations of anterior pituitary and ovarian hormones were normal. An exaggerated rise in luteinizing hormone (LH) and prolactin levels was seen following the administration of luteinizing hormone-release hormone and thyrotropin-releasing hormone (TRH), respectively. A paradoxic rise in growth hormone (GH) levels followed TRH administration, whereas the response to dopamine receptor agonists was normal. Pituitary hormone secretion after deflation remained similar to that before deflation, although a normal response of GH to apomorphine was reestablished. These data indicate that the amenorrhea of pseudocyesis is associated with normoprolactinemia and a readily releasable pituitary LH pool, which suggests a suprahypophyseal etiology of the amenorrhea. The abnormalities in GH secretion may also support thi...
In part, prolactin controls its own rate of secretion through negative feedback mechanisms, but c... more In part, prolactin controls its own rate of secretion through negative feedback mechanisms, but complex interactions of prolactin inhibiting and releasing factors also are involved. Hyperprolactinemia is the most common result of neuroendocrine management are described for various hyperprolactinemic states.
Four women 5 to 8 weeks into pregnancy, scheduled for therapeutic abortions, were given an analog... more Four women 5 to 8 weeks into pregnancy, scheduled for therapeutic abortions, were given an analog of gonadotropin-releasing hormone, D-tryptophan-6-LHRH, in an effort to interrupt pregnancy. The treatment consisted of 100-micrograms injections, given twice daily for 5 to 10 days. No decline in serum beta-hCG or progesterone was noted, and menstrual extraction was needed in all women for pregnancy interruption. These data indicate that D-Trp-6-LHRH is not effective as an abortifacient in established pregnancy.
Homozygous transfusion-dependent beta-thalassemia patients manifest cardiac, hepatic, endocrine, ... more Homozygous transfusion-dependent beta-thalassemia patients manifest cardiac, hepatic, endocrine, and metabolic disorders attributable to chronic anoxia and iron overload. Short stature, delayed sexual maturation, diabetes mellitus, hypothyroidism, hypoparathyroidism, and metabolic bone disease can and should be diagnosed as early as possible so that the intervention can be fruitful. Primary or secondary amenorrhea is due primarily to pituitary gonadotrope hemosiderosis, as attested by pathology data and the demonstration in vivo of nonstimulable follicle-stimulating hormone and luteinizing hormone release and secretion after the exogenous administration of gonadotropin-releasing hormone or its agonistic analogs. Ovulation can be achieved with the use of exogenous gonadotropins provided that the ovary has no siderosis (as seen in neglected patients) or damage induced by drugs used for bone marrow transplantation. Once pregnancy is achieved, it should be considered high risk and be de...
Many patients with medullary thyroid carcinoma (MTC) have persistently elevated calcitonin levels... more Many patients with medullary thyroid carcinoma (MTC) have persistently elevated calcitonin levels after initial treatment, indicating disease recurrence. Conventional imaging is often negative or shows equivocal findings. In this study we report our experience with 2-deoxy-2-[(18)F]fluoro-D-glucose positron emission tomography/computed tomography ([(18)F]FDG-PET/CT) in the evaluation of this specific group. Between February 2007 and May 2009, 38 [(18)F]FDG-PET/CT scans were performed on 32 patients with MTC and elevated calcitonin levels for localization of recurrent disease. Six of these patients had a second [(18)F]FDG-PET/CT scan. Among the 38 [(18)F]FDG-PET/CT scans there were 18 positive and 20 negative scans. Out of the 18 positive scans, 17 were true positive and one false positive. These findings suggest that [(18)F]FDG-PET/CT provides additional information in almost half of all cases (overall per patient sensitivity of 47.4%) but using a serum calcitonin cut-off of 1000 pg/ml this rate is increased to 80%. An interesting finding of the study was that none of the six patients with multiple endocrine neoplasia type IIA syndrome had a positive [(18)F]FDG-PET/CT scan for MTC. When these patients were excluded, the overall per patient sensitivity rose to 60% and in patients with calcitonin levels &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;1000 pg/ml this rate increased to 100%. The mean SUV(max) of all lesions showing [(18)F]FDG uptake was 3.96 + or - 1.61 (range, 2-7). [(18)F]FDG-PET/CT seems to be valuable for the detection of recurrence in patients with highly elevated calcitonin levels and negative conventional imaging findings. In addition, it seems that the sensitivity of [(18)F]FDG-PET/CT may be higher in patients with sporadic or familial MTC than in patients with MTC as part of multiple endocrine neoplasia type IIA syndrome.
ABSTRACT The reviewers are a general clinical, though academic, endocrinologist and one with a sp... more ABSTRACT The reviewers are a general clinical, though academic, endocrinologist and one with a special interest in states of excess cortisol secretion (ed.).
The Journal of Clinical Endocrinology and Metabolism, Jun 1, 1977
The acute effect of pyridoxine (B6) on serum GH and PRL levels and its chronic effects on galacto... more The acute effect of pyridoxine (B6) on serum GH and PRL levels and its chronic effects on galactorrhea in nine subjects (group I, n=4, idiopathic galactorrhea with normal PRL levels and normal menses; Group II, n=5, galactorrhea-amenorrhea with increased PRL levels) have been studied. Pyridoxine did not acutely alter GH or PRL levels. There was no decrease in galactorrhea, no resumption of menses and no decrease in PRL following tow months of B6 therapy. In contrast, bromocriptine was effective in suppressing galactorrhea and restoring normal menses in group II subjects and remains the therapy of choice for this purpose.
In contrast to mitral regurgitation (MR) caused by structural abnormality of the valve (&amp;... more In contrast to mitral regurgitation (MR) caused by structural abnormality of the valve (&amp;amp;amp;amp;amp;amp;quot;primary&amp;amp;amp;amp;amp;amp;quot; MR), about which there is increasing consensus regarding treatment, there is increasing controversy around the management of functional or &amp;amp;amp;amp;amp;amp;quot;secondary&amp;amp;amp;amp;amp;amp;quot; MR, of which &amp;amp;amp;amp;amp;amp;quot;ischemic mitral regurgitation&amp;amp;amp;amp;amp;amp;quot; (IMR) is a common cause. While the trend in the management of primary MR is increasingly aggressive, with wide agreement on the preference for repair over replacement such that debate centers on earlier and earlier repair even among asymptomatic patients, the situation is reversed in the setting of secondary MR with uncertainly beyond the mode of management (repair or replacement) to the value of intervening at all. This is, in part, because the term IMR has been somewhat loosely applied by the medical and surgical communities to include regurgitation secondary to active myocardial ischemia, as well as that resulting from a completed myocardial infarct. As a result, there is considerable variability in reported outcomes of surgical interventions for IMR. In addition, the natural history of IMR is quite adverse-more so than that of many solid organ malignancies-and its surgical treatment has traditionally carried a higher operative mortality than many cardiac surgical procedures, including similar operations for primary MR and incidental coronary artery disease. Added to this, with recent advances in both the medical and surgical treatment of heart failure improving nonoperative outcomes and simultaneously reducing operative risk compared to reports from previous decades, the landscape has been quite dynamic. Here, we review the issues surrounding surgical treatment for IMR, along with available evidence supporting different approaches, to lend an informed perspective on the divergent opinions among experts in this field and guide the appropriate management of the individual patient.
Many patients with medullary thyroid carcinoma (MTC) have persistently elevated calcitonin levels... more Many patients with medullary thyroid carcinoma (MTC) have persistently elevated calcitonin levels after initial treatment, indicating disease recurrence. Conventional imaging is often negative or shows equivocal findings. In this study we report our experience with 2-deoxy-2-[(18)F]fluoro-D-glucose positron emission tomography/computed tomography ([(18)F]FDG-PET/CT) in the evaluation of this specific group. Between February 2007 and May 2009, 38 [(18)F]FDG-PET/CT scans were performed on 32 patients with MTC and elevated calcitonin levels for localization of recurrent disease. Six of these patients had a second [(18)F]FDG-PET/CT scan. Among the 38 [(18)F]FDG-PET/CT scans there were 18 positive and 20 negative scans. Out of the 18 positive scans, 17 were true positive and one false positive. These findings suggest that [(18)F]FDG-PET/CT provides additional information in almost half of all cases (overall per patient sensitivity of 47.4%) but using a serum calcitonin cut-off of 1000 pg/ml this rate is increased to 80%. An interesting finding of the study was that none of the six patients with multiple endocrine neoplasia type IIA syndrome had a positive [(18)F]FDG-PET/CT scan for MTC. When these patients were excluded, the overall per patient sensitivity rose to 60% and in patients with calcitonin levels &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;1000 pg/ml this rate increased to 100%. The mean SUV(max) of all lesions showing [(18)F]FDG uptake was 3.96 + or - 1.61 (range, 2-7). [(18)F]FDG-PET/CT seems to be valuable for the detection of recurrence in patients with highly elevated calcitonin levels and negative conventional imaging findings. In addition, it seems that the sensitivity of [(18)F]FDG-PET/CT may be higher in patients with sporadic or familial MTC than in patients with MTC as part of multiple endocrine neoplasia type IIA syndrome.
A prolactinoma was removed from a nulliparous woman who had acromegaly, galactorrhea-amenorrhea, ... more A prolactinoma was removed from a nulliparous woman who had acromegaly, galactorrhea-amenorrhea, elevated serum growth hormone and prolactin, and hypogonadotropinism. Postoperatively galactorrhea decreased and cyclic vaginal bleeding ensued; serum prolactin concentration was normal but growth hormone remained elevated and the acromegalic complex was unchanged, even after subsequently administered bromocriptine. At a second transsphenoidal operation, an adenoma of somatotropes was removed; improvement in symptoms and signs and normalisation of pituitary function, including growth hormone, followed. The possible presence of distinctly separate pituitary adenomas should be considered in patients with galactorrhea associated with acromegaly.
Acromegaly mainly associated with the presence of a growth hormone (GH)-secreting pituitary tumor... more Acromegaly mainly associated with the presence of a growth hormone (GH)-secreting pituitary tumor causes considerable morbidity and carries a risk of premature mortality. Treatment includes surgery, radiotherapy, and the use of dopaminomimetic drugs and somatostatin agonist analogs (octreotide and lanreotide). The use of long-acting somatostatin analogs is limited to adjuvant therapy following failure of surgery and/or radiotherapy and/or bromocriptine. But it may be considered the drug of choice for childhood acromegaly and for syndrome of plurihormonal pituitary overproduction in association with excess GH-releasing hormone (GHRH) and a McCune/Albright-like syndrome. Octreotide has been administered de novo as primary and/or presurgical preparatory therapy. Octreotide doses of 100 to 1500 micrograms were used in two large series in Europe and the United States, which mainly included acromegalics in whom all other modalities had failed (&gt; 65%). Clinical improvement, which was sustained for over 6 months of follow-up evaluation, was reported for more than 50% to 70% of patients. In evaluable patients with visual-field defects, there was a definite amelioration, even if the tumor mass was not reduced, and there was no worsening during therapy; the same is true for the adenoma mass, which showed a variable reduction (median, 15 to 22%). A reduction of serum GH and insulin-like growth factor-1 (IGF-1) levels was found in more than 90% of patients, with GH serum values &lt; 5 ng/mL and IGF-1 serum values &lt; 2 U/mL recorded in 46% and 49%, respectively. Relapse occurred when treatment stopped. Future developments are expected to improve the clinical usefulness of somatostatin analogs.
Our objective was to assess the endocrine and morphological response of polycystic ovary syndrome... more Our objective was to assess the endocrine and morphological response of polycystic ovary syndrome (PCOS) in patients receiving 6 months of therapy with the long-acting gonadotrophin releasing hormone agonist (GnRH agonist) decapeptyl (3.75 mg monthly injections). Eighteen documented PCOS patients were basally evaluated for hirsutism, gonadotrophin and androgen concentrations and ovarian morphology using trans-vaginal ultrasonography. Measurements were repeated at 3 and 6 months. The results (values as mean +/- SD) showed a significant improvement in hirsutism (Ferriman score 11.0 +/- 5.9 versus 6.6 +/- 2.7, P < 0.01), acne and seborrhoea. A significant post-treatment decrease in gonadotrophins [follicle-stimulating hormone (FSH): 5.8 +/- 1.8 versus 3.8 +/- 1.1 IU/l, P < 0.01; luteinizing hormone (LH): 10.8 +/- 8.3 versus 3.4 +/- 3.3 IU/l, P < 0.01], LH/FSH ratio (1.8 +/- 1.1 versus 0.8 +/- 0.6, P < 0.01) and androgen concentrations (free testosterone: 4.0 +/- 1.9 versus ...
The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception, 1997
Polycystic ovary syndrome is a common endocrine disorder, presenting with menstrual irregularitie... more Polycystic ovary syndrome is a common endocrine disorder, presenting with menstrual irregularities, hirsutism, obesity, infertility and abnormal ovarian morphology. In addition, polycystic ovary syndrome is associated with a self-perpetuating imbalance involving the endocrine system and metabolic pathways, in which carbohydrates, lipids and growth factors are involved. Because of its chronicity, it is considered to be a substantial risk factor for atherogenesis and hormone-dependent neoplasia. The etiology and pathophysiology of the syndrome remain elusive. However, during the last decade, several clues have emerged from human and animal studies that may have significant repercussions in the treatment of polycystic ovary syndrome. Therapeutic maneuvers should be directed towards the dominant abnormalities present in individual patients with polycystic ovary syndrome. Gonadotropin releasing hormone (GnRH) agonists can directly affect the gonadotropin generator and secondary downstrea...
Hypercalcemia of cancer is due to secretion of substances with parathyroid hormone (PTH)-like act... more Hypercalcemia of cancer is due to secretion of substances with parathyroid hormone (PTH)-like activity from tumours of the respiratory, gastrointestinal and urogenital tract as well as hematologic malignancies and breast cancer. PTH-related Protein (PTHrP) is secreted mainly from solid tumours and it has been recently recognized as being responsible for hypercalcemia mediated primarily via an increased renal reabsorption of calcium and secondly by an increased bone resorption. PTHrP-mRNA is expressed in a variety of normal tissues and has multiple physiologic and paracrine actions. Bone resorbing factors like the cytokines-lymphokines, interleukins, prostaglandins, TNF-alpha/TNF-beta, GM-CSF/G-CSF, TGF-alpha and TGF-beta are produced by certain solid and hematologic cancers and have also been implicated in tumour-induced hypercalcemia. The recently introduced PTHrP antagonists are hopeful therapeutic measures for the future.
A patient had continuous paroxysms of the specific ventricular arrhythmia of the "Torsades d... more A patient had continuous paroxysms of the specific ventricular arrhythmia of the "Torsades de Pointes" type during attacks of variant angina. The arrhythmia was refractory to lidocaine and procainamide and only responded dramatically to verapamil, initially intravenous and afterwards oral. The low success rate in the treatment of such arrhythmias by other drugs and available experimental data suggest that verapamil should be further evaluated.
Pseudocyesis was clinically established in a 39-year-old woman. Pituitary function was assessed w... more Pseudocyesis was clinically established in a 39-year-old woman. Pituitary function was assessed with the use of hypothalamic peptides and dopamine receptor agonists. Basal serum concentrations of anterior pituitary and ovarian hormones were normal. An exaggerated rise in luteinizing hormone (LH) and prolactin levels was seen following the administration of luteinizing hormone-release hormone and thyrotropin-releasing hormone (TRH), respectively. A paradoxic rise in growth hormone (GH) levels followed TRH administration, whereas the response to dopamine receptor agonists was normal. Pituitary hormone secretion after deflation remained similar to that before deflation, although a normal response of GH to apomorphine was reestablished. These data indicate that the amenorrhea of pseudocyesis is associated with normoprolactinemia and a readily releasable pituitary LH pool, which suggests a suprahypophyseal etiology of the amenorrhea. The abnormalities in GH secretion may also support thi...
In part, prolactin controls its own rate of secretion through negative feedback mechanisms, but c... more In part, prolactin controls its own rate of secretion through negative feedback mechanisms, but complex interactions of prolactin inhibiting and releasing factors also are involved. Hyperprolactinemia is the most common result of neuroendocrine management are described for various hyperprolactinemic states.
Four women 5 to 8 weeks into pregnancy, scheduled for therapeutic abortions, were given an analog... more Four women 5 to 8 weeks into pregnancy, scheduled for therapeutic abortions, were given an analog of gonadotropin-releasing hormone, D-tryptophan-6-LHRH, in an effort to interrupt pregnancy. The treatment consisted of 100-micrograms injections, given twice daily for 5 to 10 days. No decline in serum beta-hCG or progesterone was noted, and menstrual extraction was needed in all women for pregnancy interruption. These data indicate that D-Trp-6-LHRH is not effective as an abortifacient in established pregnancy.
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Papers by George Tolis