G. Pirens

Cyclical Cushing's disease and its successful control under sodium valproate.

Several subgroups of Cushing’s disease were recently described (anterior or intermediate lobe origin, hyper-or hypo-pulsatility of Cortisol, presence or absence of response after GRH or TRH, cyclical Cushing’s disease). We present here a detailed case report on a patient suffering from Cushing’s disease whose endocrine functions were extensively investigated. Treatment with bromocriptine, as well;as subsequent transsphenoidal surgery, were followed by rapid but transient reversal of symptoms. When clinical manifestations reoccurred, daily measurements of free urinary Cortisol revealed a cyclic pattern of Cortisol hyperexcretion. A study of ultradian rhythm revealed hyperpulsatility of Cortisol secretion. More interestingly, a treatment with sodium valproate, a drug known to inhibit CRH production, was followed by a rapid and longstanding normalization of clinical and biological data for 2 years. Based on these data, and on information from the literature, the present case of Cushing’s disease exhibits characteristics suggesting a possible hypothalamic origin.

A highly sensitive radioimmunoassay for human growth hormone using a monoclonal antibody.

Biozzi-strain mice were immunized with a highly purified preparation of 20K variant of hGH. Spleen-cells were fused with SP2/0Ag14 myeloma cells. Clone productions were screened for specificity toward 20K and 22K hGH and for the affinity constant of antibody-antigen reaction. For the selected monoclonal antibody, Ka was 1.02.10(11) L/M using 22K hGH as both tracer and reference preparation. No cross reactivity was found with PRL and other pituitary hormones; hPL reactivity was 0.002 percent that of hGH. According to these antibody characteristics, a highly sensitive RIA system was developed and used for specific GH measurement in human serum. Using logit-log co-ordinates, the slope of the standard curve was -1.099 and the minimum detected dose was 0.5 uIU/ml. Excellent correlation (r = 0.9575) was found between assay data in this system and those of a conventional RIA method using specific polyclonal rabbit antiserum. The International Reference preparation (66/217) could adequately be used to calibrate the monoclonal antibody system since the in house internal 22K GH standard and international one were equally well recognized by the monoclonal antibody.

Familial inappropriate TSH secretion: evidence suggesting a dissociated pituitary resistance to T3 and T4

The study of pituitary thyroid relationships of a 40 - year-old woman, suffering from recurrent goiter, is presented. The characteristics of this case were the following: i) constant hyperthyrotropinemia (range 8.2 to 29 μU/ml) despite high thyroid hormone levels (mean total T4: 13.4 μg/dl; mean total T3: 255 ng/dl) and clinical euthyroidism; ii) thisTSH hypersecretion is not regulated by an excess of T4, while a suppressive effect is easily observed with T3. Together with the clinical effects observed with administration of T3 and T4, this suggests that thyroid hormone resistance predominates at the pituitary level, for T4 while not for T3; iii) evidence is presented for the familial distribution of the trait and its mode of transmission. The clinical aspect and the pattern of resistance exhibited by the propositus and her progeny appear distinct from those of previous observations of thyroid hormone resistance.

Dosage Radioimmunologique De L’Hormone Thyreostimulante Etude Immunologique Du Système Et Application Clinique

SummaryThe determination of serum thyrotropin (TSH) by radio-immunoassay is now part of the usual investigations performed for patients suffering from thyroid disorders.We describe here an original radioimmunoassay of h.TSH using an antiserum raised against porcine thyrotropin and a highly purified h.TSH prepared in our laboratory as tracer and standard.Immunological analysis of this system demonstrates its complete hormonal specificity. Its sensitivity is better than that obtained with most of the techniques described by others, and allows the detection of 4. 10-5 pmole of the hormone.Clinical material resulting from a two year period of use is presented and the usefulness of the method is emphasized for the study of thyroid and hypothalamopituitary pathology as well as in the adjustment of suppletive or antithyroid treatments.