Donald A. Adams

Hypophysectomy in Diabetic Retinopathy: The Relationship Between the Degree of Pituitary Ablation and Ocular Response

Cryohypophysectomy was performed twenty-nine times in twenty-eight critically selected insulin-dependent diabetic subjects who exhibited progressive proliferative diabetic retinopathy. The procedure was safe, relatively free of significant complications, and medical management was not difficult. Various endocrine parameters of pituitary function were studied before and after surgery with emphasis on growth hormone activity. Seventeen of the twenty-eight patients demonstrated evidence of “complete” pituitary ablation with twenty (71.4 per cent) patients showing a favorable ocular response after an average follow-up of forty-three months. Fourteen (82 per cent) of the seventeen patients with “complete” pituitary ablation had a favorable ocular response. Five patients had transsphenoidal microsurgical pituitary ablation, but this procedure was not as satisfactory as cryoablation in our hands. Growth hormone ablation appeared to be a common factor in most of the cases who had favorable results, particularly illustrated by a few patients who improved only after repeat surgery ablated growth hormone that had not been eliminated by their initial operation. Our data suggest that there is a positive relationship between the degree of pituitary ablation and successful ocular response and support the hypothesis that growth hormone may play a causal role in diabetic retinopathy.

Kappa Light Chain Nephropathy without Evidence of Myeloma Cells

A rarely diagnosed nodular glomerulopathy is presented arising secondary to kappa light chain deposition and clinically characterized by hypertension, congestive heart failure, massive proteinuria and slowly progressive azotemia. Kappa light chains were detected in the urine, the glomerular nodules, and the basement membranes of both glomeruli and tubules. A malignant proliferation of plasma cells could not be detected. Two morphologic features were unusual: the presence of microaneurysms, and the deposition of immunoglobulin and complement in a similar pattern to the kappa light chains. Noteworthy clinical aspects included the elusiveness of the proper diagnosis, the massive proteinuria in the absence of amyloid deposits, and the remarkable improvement in renal function following intermittent chemotherapy.

Adrenocortical Function During Intermittent Corticosteroid Therapy

Excerpt Corticosteroid therapy regularly suppresses adrenocortical function although upon withdrawal of exogenous steroids restoration of adrenal function is said to occur within several days (1, 2...

Case Report Response of Lupus Nephritis to Plasmapheresis without Demonstration of Circulating Immune Complexes

Abstract A case of post-partum SLE in a 25-year-old Mexican-American woman is presented. The disease was associated with systemic vasculitis and diffuse proliferative glomerulonephritis. Abundant evidence for the deposition of complement activating immune complexes was found in skin and kidney biopsies, but no circulating immune complexes could be measured. Therapeutic modalities including corticosteroids administered both orally and intravenously, azathioprine, antihypertensives, and hemodialysis failed to effectuate lasting benefit. Large volume plasmapheresis led to immediate improvement and a dramatic return of renal function. A mechanism of action for the resulting effect is considered.

Contraindications for Mannitol in Aphakic Glaucoma

When prescribing mannitol to decrease intraocular pressure, the physician must be alert to potential complications. A 72-year-old woman suffered obtundation, intractable pulmonary edema, acidemia, and irreversible renal insufficiency despite vigorous hemodialysis. When renal function is compromised, careful monitoring of electrolyte levels, daily urine output, and renal function is necessary with mannitol therapy.

Ischemic Vascular Necrosis Associated with Uremic Hyperparathyroidism.

Excerpt Two recent reports have indicated that necrotizing skin and digital lesions may occur in association with the secondary hyperparathyroidism of chronic renal disease. Two such instances were...