Eugenio Reschini

Inhibitory effect of calcitonin on growth hormone and insulin secretion in man

The effect of calcitonin administration on basal and arginine-stimulated growth hormone and insulin plasma levels was investigated. The intramuscular injection of synthetic salmon calcitonin (100 U MRC) in five normal subjects produced a significant decrease (p less than 0.05) in insulin concentration. The same amount of calcitonin given 15 min before an arginine infusion test in seven normal subjects significantly reduced the response of growth hormone (p less than 0.025) and insulin (p less than 0.005) to the stimulus.

Percutaneous intranodular ethanol injection: A new treatment for autonomous thyroid adenoma

Established methods for definitive ablation of autonomous thyroid nodules are surgery and radioiodine. Since it has been demonstrated that percutaneous ethanol injection can inactivate parathyroid adenomas and small hepatocellular carcinomas, we started a trial of this treatment in patients with autonomous thyroid nodules. Twenty-eight patients, 22 toxic and 6 nontoxic, all with undetectable thyrotropin serum levels and suppressed extranodular tissue on scintigraphy, were treated. Treatment consisted of percutaneous intranodular ethanol injection under ultrasound guidance. The total amount of alcohol injected ranged from 0.4 to 2.2 times the estimated nodule volume, divided into 4 to 9 injections performed at 2 to 7 day intervals. Most patients were treated with a single cycle of injections, but 7 of them required 2 cycles. The signs and symptoms of hyperthyroidism disappeared in all cases. Apparently complete cure (normal serum free thyroid hormones, thyrotropin in basal conditions and after thyrotropin releasing hormone, reactivation of extranodular tissue on scintigraphy with nodule no longer visible) was obtained in 17 patients (13 after 1 cycle and 4 after 2 cycles). Partial cure (normal serum free thyroid hormone levels, detectable thyrotropin levels with normal or blunted response to thyrotropin releasing hormone and partial reactivation of extranodular tissue on scintigraphy with nodule or parts of it still visible) was obtained in 10 patients (8 after 1 cycle and 2 after 2 cycles). In 1 patient with a very large nodule thyrotropin levels remained undetectable, but thyroid hormone levels eventually became normal. No recurrences were observed after a follow-up of 12 to 32 months (mean 20 months). No serious side effects were encountered. A clinically valuable result was obtained in all patients. These data suggest that this form of treatment could constitute an alternative to surgery and radioiodine for the ablation of autonomous thyroid nodules.

Effect of somatostatin on blood glucose, plasma growth hormone, insulin, and free fatty acids in normal subjects and acromegalic patients

Abstract Synthetic growth-hormone-release inhibitory hormone (GRIH, somatostatin) infused in seven acromegalics significantly lowered plasma growth hormone (GH) and immunoreactive insulin (IRI) levels, did not have any effect on blood glucose, and significantly increased plasma free fatty acids (FFA). Somatostatin, when infused in three normal subjects during an arginine test, inhibited plasma GH and IRI responses. Hypoglycemia-induced GH release was also blocked by somatostatin in two normal subjects thus tested.

Role of Tc-99m sestamibi scintigraphy in the diagnosis and surgical decision-making process in primary hyperparathyroid disease

Purpose Ultrasound (US) and scintigraphy are used most frequently of all the available imaging techniques for the preoperative evaluation of patients with possible primary hyperparathyroid disease. The aim of this study was to assess the value of dual-phase Tc-99m MIBI scintigraphy compared with US in the detection of adenomatous or hyperplastic glands and in the surgical decision-making process for patients with a biochemical diagnosis of primary hyperparathyroid disease. Methods Ninety-seven patients with increased levels of parathyroid hormone and calcium, and at least 6 months’ follow-up after US and scintigraphy, were examined retrospectively to assess the influence of the diagnostic work-up on the therapeutic decision of the referring clinicians and to evaluate the sensitivity of these diagnostic tools in the surgically treated patients. Forty-eight patients underwent surgery. Results Parathyroid adenomas were found in 43 patients and hyperplasia in 1, whereas 4 patients had no evidence at surgery. The sensitivity and specificity rates were 84.4% and 95.9% for scintigraphy, and 66.6% and 98.6% for US, respectively. Of the 49 nonsurgically treated patients, 35 had negative results with both MIBI and US; only 3 had positive findings with both imaging methods. Patients treated conservatively had significantly lower parathyroid hormone and serum calcium levels than did the patients who had surgery. Conclusions The data suggest that the high sensitivity of dual-phase MIBI scintigraphy can improve the detection of hyperfunctioning parathyroid glands. Furthermore, despite the controversy surrounding the use of imaging methods in the preoperative assessment of primary hyperparathyroid disease, these data suggest that the decision of the clinician to order surgery for a patient with a moderate increase of serum PTH level may be influenced by the results of the imaging methods.

Spontaneous remission of Cushing syndrome after termination of pregnancy.

A 27-year-old women developed Cushing syndrome during pregnancy. The course of pregnancy was characterized by abnormally low urine and plasma estrogen levels despite the presence of a living fetus. The signs and symptoms of Cushing syndrome disappeared spontaneously within 2 months after delivery. Hormonal studies, however, suggested the presence of an adrenal tumor. An adrenocortical adenoma was found at surgery and removed.

Recombinant human TSH testing is a valuable tool for differential diagnosis of congenital hypothyroidism during l‐thyroxine replacement

objective The differential diagnosis of congenital hypothyroidism (CH) is aimed to distinguish transitory from permanent forms, to optimize l‐thyroxine (l‐T4) therapy to replacement or TSH‐suppressive regimens, and to reach accurate definition of the clinical and biochemical phenotype for subsequent genetic investigations and counselling. Therefore, l‐T4 therapy is presently withdrawn in most instances and investigations are performed in a disturbing hypothyroid state.

Plasma Cortisol response to ACTH does not accurately indicate the state of hypothalamic-pituitary-adrenal axis

The hypothalamic-pituitary-adrenal function was studied in 55 patients with various pituitary disorders. In particular, the consistency between the responses of plasma Cortisol to exogenous ACTH and to insulin hypoglycemia was investigated in 5 patients in whom Cortisol response to insulin was absent; four of these patients showed a Cortisol response to ACTH of variable degree. These 4 patients had surgical or functional hypothalamus-pituitary disconnection and showed a preserved Cortisol response to lysine vasopressin. These data demonstrate the unreliability of ACTH test in assessing hypothalamic-pituitary-adrenal function in hypopituitary patients.

EFFECT OF DOPAMINE INFUSION ON SERUM PROLACTIN CONCENTRATION IN NORMAL AND HYPERPROLACTINAEMIC SUBJECTS

The serum prolactin response to intravenous dopamine infusion (5μg.kg−1 min−1) was measured in twenty‐one healthy subjects, in seven hyperprolactinaemic patients without evidence of a pituitary tumour, and in twenty‐one patients with prolactinomas. Mean serum prolactin values were significantly suppressed in all three groups, without any significant difference between the degree of suppression. A decrease of serum prolactin to below 50% of basal values occurred in fifteen healthy subjects, in four patients without evidence of pituitary tumour, and in fourteen patients with prolactinomas. These findings demonstrate that most human prolactin‐secreting pituitary adenomas are normally suppressible by exogenously administered dopamine and that dopamine infusion is not able to distinguish between tumorous and non‐tumorous hyper‐prolactinaemia. Since intravenously infused dopamine is believed to inhibit prolactin secretion by acting at pituitary level, it is suggested that a normal functioning of pituitary dopamine receptors is maintained in most human prolactinomas.

Plasma ACTH-response to the corticotropin releasing factor in patients with Cushing's disease. Comparison with the lysine-vasopressin test

In three female patients with Cushings disease, 100 micrograms of synthetic ovine corticotropin releasing factor (CRF) were administered before surgery and 1 week after transsphenoidal microadenomectomy. In these patients a test with lysine-vasopressin (LVP), 10 U intramuscularly, was also performed before and after pituitary surgery. Before surgery, both stimuli induced a clear increase in plasma ACTH and cortisol in all patients; the response of ACTH to CRF was of greater magnitude. Postoperatively, the responses were virtually absent in two patients, but were still present in the third one in whom the removal of adenoma had been partially unsuccessful. The CRF test was also performed in a female patient with Cushings syndrome due to adrenal adenoma; in this patient no responses of plasma ACTH and cortisol to CRF were recorded. This paper demonstrates that pituitary microadenomas causing Cushings disease may retain the ability to respond to CRF; this stimulus may be useful in the differential diagnosis between ACTH-dependent and independent Cushings syndrome; the lack of response after microadenomectomy indicates successful removal of the tumor. CRF is more potent than LVP in releasing ACTH at the doses employed.

Prevalence of Urinary Tract Abnormalities in a Large Series of Patients with Uterovaginal Atresia

The morphology of the urinary tract was studied in 81 patients with uterovaginal atresia. Anomalies were found in 33 per cent of the cases. The most frequent abnormality was the presence of a solitary kidney either located normally or in the pelvis. These findings are discussed in light of the pertinent literature.