James W. Edmondson

Feasibility of low doses of I-131 for thyroid ablation in postsurgical patients with thyroid carcinoma

The feasibility of using low doses of l-131 (30 mCi) for ablation of thyroid remnants following surgery for papillary and follicular thyroid carcinoma was examined in 21 patients. Six weeks following near-total thyroidectomy and three days following intramuscular thyroidstimulating hormone (10 IU), patients were given 30 mCi of l-131 and scans were performed 24 to 72 hours later. Remaining thyroid tissue was identifiable in the thyroid bed in 19 patients, and two patients also had evidence of cervical metastases. Patients with metastases received an additional 100 mCi of l-131. Follow-up l-131 scans were performed at nine to 15-month intervals in ten patients who initially received 30 mCi of l-131, and only one patient showed complete ablation of the residual thyroid tissue, whereas the remaining nine patients had persistent uptake of l-131 in the same regions in which the uptake was seen in the initial postoperative scans. One of the nine patients had evidence of a cervical metastasis as well. It is therefore apparent that total or near-total thyroidectomy rarely removes all thyroid tissue and that an “out-patient” dose of l-131 is not adequate for ablation of postoperative thyroid remnants.

Direct measurement of active transport systems for alanine in freshly isolated rat liver cells

Abstract A method for the direct measurement of alanine transport in liver cells has been developed with the use of alanine aminotransferase inhibitors which block the metabolic utilization of alanine. Freshly isolated rat hepatocytes treated with DL-cycloserine or aminooxyacetate are shown to actively accumulate alanine by three neutral amino acid transport systems, analogous to the A, ASC, and L systems of Ehrlich ascites tumor cells. At a medium concentration of 1mM, these systems contribute 60, 20, and 5% respectively to hepatic alanine uptake. Passive influx accounts for the remainder.

Endocrine Response after Gamma Knife-Based Stereotactic Radiosurgery for Secretory Pituitary Adenoma

Purpose: To examine treatment outcomes of Gamma Knife-based stereotactic radiosurgery (GK-based SRS) for secretory pituitary adenomas. Materials and Methods: 25 patients were treated with GK-based SRS for secretory pituitary adenomas with ≧12 months of follow-up. Results: For prolactinomas, 2 of 4 patients (50%) showed normalization of serum prolactin at a mean time of 18 months. One of 4 had a ≧50% decrease but still abnormal prolactin levels. For adrenocorticotrophic hormone-secreting tumors, 6 of 12 patients (50%) showed normalization of their endocrine levels at a median of 10 months. An additional 2 (17%) had a ≧50% decrease. For growth hormone-secreting tumors, 4 of 9 patients (44%) showed normalization of endocrine levels at a median time of 30 months. Two patients (22%) had ≧50% lower but abnormal endocrine levels. Conclusion: GK-based SRS provides a reasonable rate of endocrine normalization of secretory pituitary adenoma. The time to endocrine response is shorter than reported for fractionated external beam radiotherapy. There is a low risk of optic neuropathy.

The effects of ionophore A23187 on erythrocytes relationship of ATP and 2,3-diphosphoglycerate to calcium-binding capacity

The divalent cation ionophore, A23187, was employed as a means to load fresh human erythrocytes with calcium, and the capacity for accumulation was characterized. Erythrocytes exposed to A23187 in calcium-containing media rapidly accumulated calcium in millimolar quantities. The final cellular concentration was dependent upon medium calcium concentration and the size of the cellular organophosphate pool. When ATP and 2,3-diphosphoglycerate contents were depleted or repleted, the cellular calcium content changed proportionally. Calcium loading of fresh erythrocytes produced no discernible change in the cellular concentrations of ATP or 2,3-diphosphoglycerate. Calcium accumulation was also accompanied by loss of cellular potassium and H2O, deterioration of cell filterability, and spheroechinocytic transformation.

Life-threatening hypercalcemia associated with primary hyperparathyroidism during pregnancy: case report and review of literature.

OBJECTIVE To report a case of life-threatening hypercalcemia attributable to primary hyperparathyroidism in a pregnant patient and discuss the management of severe hypercalcemia during pregnancy. METHODS We describe a 28-year-old pregnant woman who had life-threatening hypercalcemia (serum calcium level of 25.8 mg/dL). Primary hyperparathyroidism was diagnosed. The patients management and the published medical literature on primary hyperparathyroidism during pregnancy are reviewed. RESULTS Our patient had the highest reported serum calcium level that we could find attributable to primary hyperparathyroidism during pregnancy. After initial stabilization, parathyroidectomy was successfully performed during pregnancy. To our knowledge, this is the first report in which this profound degree of hypercalcemia did not result in an adverse maternal or fetal outcome. CONCLUSION Although uncommon, primary hyperparathyroidism during pregnancy may be associated with severe maternal and perinatal complications. Life-threatening hypercalcemia due to primary hyperparathyroidism during pregnancy can be successfully managed surgically during pregnancy, with good maternal and fetal outcome.

Acromegaly caused by a growth hormone-releasing hormone-secreting carcinoid tumor: case report.

OBJECTIVE AND IMPORTANCE We describe a patient with acromegaly and pituitary hyperplasia secondary to a growth hormone-releasing hormone-secreting gastrointestinal carcinoid tumor. This case report illustrates the importance of including this rare clinical syndrome in the differential diagnosis of acromegaly for patients with suspected or known neuroendocrine tumors. CLINICAL PRESENTATION A 19-year-old, Asian-American, male patient with a 2-year history of a nonresectable, metastatic, intestinal carcinoid tumor presented with complaints of headaches, arthralgias, sweats, and changing features. The examination revealed a young subject with acromegalic features, without visual field deficits. Magnetic resonance imaging revealed a diffuse sellar mass that extended suprasellarly to compress the optic chiasm. Endocrinological studies demonstrated a growth hormone level of more than 100 ng/ml and an inappropriately elevated growth hormone-releasing hormone level. INTERVENTION The patient underwent transsphenoidal resection of the pituitary mass for diagnostic and decompressive purposes. The pathological examination revealed pituitary hyperplasia, without evidence of an adenoma. Therapy with long-acting repeatable octreotide (Sandostatin LAR; Novartis AG, Basel, Switzerland) was initiated postoperatively, to further control the acromegaly and carcinoid tumor. The soft-tissue swelling resolved, and the patient remained free of headaches, arthralgias, and sweats at the 6-month follow-up examination. CONCLUSION Ectopic acromegaly is a rare syndrome that must be recognized by neurosurgeons because its treatment differs from that of classic pituitary acromegaly. We describe a patient for whom this syndrome was documented with magnetic resonance imaging, endocrinological testing, and pathological examinations.

Nephrolithiasis during pregnancy secondary to primary hyperparathyroidism

Nephrolithiasis secondary to primary hyperparathyroidism infrequently complicates pregnancy. It can cause severe maternal and fetal complications. We present a case of a pregnant woman with nephrolithiasis and primary hyperparathyroidism. We reviewed the management of nephrolithiasis due to primary hyperparathyroidism during pregnancy. We believe that early recognition and timely intervention can significantly reduce the incidence of complications.

Carcinoma of thyroglossal duct remnants: Report of three cases and a review of the literature

Neoplastic transformation in thyroglossal duct (TGD) remnants is estimated to occur in about 1% of TGD cysts, with a total of 243 cases reported in the literature. Three new cases and a review of the literature are presented. All cases of TGD cysts at Indiana University Medical Center between 1981 and 1994 were examined. Of 70 cases of TGD cysts, 3 were found to have TGD carcinomas (papillary carcinoma [2] and follicular carcinoma [1]). The latter is the sixth reported case. About 80% of the reported cases were papillary thyroid carcinomas. In most cases of TGD carcinoma, the diagnosis was not clinically apparent. Few reports emphasize the role of needle aspiration and imaging procedures in the preoperative diagnosis of these tumors. The Sistrunk procedure is the standard treatment of TGD carcinoma; the need for thyroidectomy, however, remains controversial. Recommendations for management include: 1) fine needle aspiration as appropriate for presurgical evaluation; 2) the Sistrunk procedure alone when the diagnosis is papillary carcinoma and there is no clinical or radiologic evidence of thyroid gland involvement; 3) total thyroidectomy and radioactive iodine therapy for TGD follicular carcinoma; and 4) long-term thyroid hormone suppressive therapy in all cases.