Laurence H. Kyle

Phosphate clearance in the diagnosis of parathyroid dysfunction

Abstract Measurement of the ratio of filtered to reabsorbed phosphorus (per cent TRP), while of diagnostic value in hyperparathyroidism, is less satisfactory as a diagnostic test in parathyroid deficiency, and requires measurement of the glomerular filtration rate. A study was therefore made of the applicability of the simpler measurement of phosphate clearance (Cp) in the diagnosis of parathyroid dysfunction. In twenty-five normal subjects the mean Cp, measured during the forenoon under fasting conditions, was 10.8 ± 2.7 ml./min. Except in one patient with associated severe renal disease, Cp was substantially elevated in hyperparathyroidism. In ten patients with parathyroid deficiency Cp was significantly depressed even when the hypocalcemia was corrected by vitamin D 2 therapy. These studies indicate that measurement of phosphate clearance is a valuable screening test for hyperparathyroidism and of diagnostic aid in parathyroid deficiency.

Renal hyperchloremic acidosis: Familial occurrence of nephrocalcinosis with hyperchloremia and low serum bicarbonate

Abstract 1.1. A classification of the clinical features of renal acidosis is presented together with a clarification of the terms under which the disease has been described. 2.2. Two additional patients with the disease are reported. 3.3. Observations on the family of one patient are offered as the first known demonstration that this disease can exist on a familial basis. 4.4. Pathogenesis of the disease is discussed.

Cushing's syndrome and bronchogenic carcinoma.

Abstract The clinical and pathological features of a case illustrating the combination of Cushings syndrome and bronchogenic carcinoma are presented. Six patients with a similar syndrome have been reported and two others have been mentioned in the medical literature. All seven patients had the same histological type of pulmonary lesion, an undifferentiated (oat cell) carcinoma, and demonstrated adrenal hyperplasia. The clinical pattern of this combination of disorders includes three significant features: (1) weight gain or maintenance of normal weight in the presence of rapidly progressive carcinoma; (2) acute development of features of adrenal hyperfunction; and (3) a rapidly fatal course. Hypokalemic, hypochloremic alkalosis appears to be a frequent component of this syndrome, as contrasted with its relative rarity in uncomplicated Cushings syndrome. The incidence of the association of these two relatively rare diseases appears to exceed mere chance occurrence but no explanation can be advanced concerning possible cause and effect relationships. The association of Cushings syndrome due to adrenal hyperplasia and undifferentiated bronchogenic carcinoma appears to constitute a distinct syndrome.

Comparative Effects of Caloric Restriction and Total Starvation on Body Composition in Obesity

Excerpt Total starvation as a treatment of obesity was introduced by Bloom (1), popularized by Duncan and associates (2, 3), and elaborated upon by Drenick and colleagues (4, 5). An increasing numb...

PANCREATIC INSUFFICIENCY AND HYPERPARATHYROIDISM

Excerpt The most frequent cause of hyperparathyroidism is an adenoma of a parathyroid gland. The course of events leading to adenoma formation in the parathyroids, as in other tissues of the body, ...

Evaluation of the relative value of diagnostic tests in hyperparathyroidism.

Excerpt Since the introduction of the measurement of phosphate excretion as a diagnostic test in parathyroid dysfunction, data supplied from a number of laboratories have stimulated discussion alon...

MEASUREMENT OF CHANGE IN TOTAL BODY FAT

Growing interest in the mechanisms and management of obesity has promoted investigation of methods for measuring total body fat, and has emphasized the need for accurate and practical methods of quantifying change in fat. Expressions based on either volume distribution or densitometric analysis lack validity when applied singly under conditions of abnormal hydration and provide doubtful accuracy in extreme obesity or severe emaciation (1). Substitution of parallel measurements of total body water and body density into the same fat prediction equation circumvents hydration abnormality, but requires the difficult measurement of body volume, which to date has been most satisfactorily accomplished by underwater weighing (2). More important, estimation of fat with methods that require densitometric analysis necessitates dependence upon the possibly invalid assumption of a known and constant density of the fat-free body. Edelman, Brooks and Moore have explored the utility of concurrent measurement of nitrogen balance and volume distribution of deuterium oxide to assay change in fat (3). Behnke, Osserman and Welham commented upon the feasibility of checking the validity of such techniques by parallel densitometric analysis (4). The present study concerns: 1) evaluation of the use of measurement of nitrogen balance and total body water to estimate change in body fat; and 2) comparison of the loss or gain in fat so determined with changes obtained by parallel densitometric analysis.

Effect of administration of ACTH and cortisone upon blood glutathione levels.

Summary Blood glutathione (GSH) and total glutathione (GSH plus GSSG) were determined in eleven patients during ACTH therapy and in eleven patients during the administration of cortisone. GSH values were significantly decreased from a pretreatment average of 36.6 mg per 100 cc to 26.9 mg by ACTH while cortisone produced a decrease from an average pretreatment value of 35.0 mg per 100 cc to 29.1 mg. The latter decrease, statistically, is of a low order of significance. The total glutathione values showed no changes following the administration of either ACTH or cortisone. During treatment with ACTH the greatest decrease in blood GSH occurred in the patients showing the greatest increase in blood sugar. There is suggestive evidence that although patients with normal glucose tolerance may show diabetic patterns during treatment, those who demonstrate mildly diabetic patterns prior to therapy show no further decrease in glucose tolerance and minimal reduction in GSH values after ACTH or cortisone therapy.

BODY COMPOSITION BEFORE AND AFTER SURGICAL CORRECTION OF CUSHING'S SYNDROME*

The influence of gluconeogenic hormones of the adrenal cortex on body composition-and particularly on body fat-has received more speculation than experimental scrutiny because of the di5culties inherit in studying this aspect of human biology. Previous reports from this laboratory indicated a substantial increase in adipose tissue during the administration of This study involves the utilization of densitometric, volume distribution, and balance techniques before and after the surgical correction of Cushing’s syndrome to assess the compartmental changes resulting from normalization of adrenal function.

THE CLINICAL AND METABOLIC EFFECTS OF PROGESTERONE AND ANHYDROHYDROXY-PROGESTERONE IN RHEUMATOID ARTHRITIS

Excerpt Despite Henchs observation in 19331that improvement of the joint symptoms in rheumatoid arthritis commonly followed the occurrence of jaundice, practical application of this information me...