Nicholas Woodhouse

The Antidiabetic Activity of Aloes: Preliminary Clinical and Experimental Observations

The dried sap of the aloe plant (aloes) is one of several traditional remedies used for diabetes in the Arabian peninsula. Its ability to lower the blood glucose was studied in 5 patients with non-insulin-dependent diabetes and in Swiss albino mice made diabetic using alloxan. During the ingestion of aloes, half a teaspoonful daily for 4-14 weeks, the fasting serum glucose level fell in every patient from a mean of 273 +/- 25 (SE) to 151 +/- 23 mg/dl (p less than 0.05) with no change in body weight. In normal mice, both glibenclamide (10 mg/kg twice daily) and aloes (500 mg/kg twice daily) induced hypoglycaemia after 5 days, 71 +/- 6.2 and 91 +/- 7.6 mg/dl, respectively, versus 130 +/- 7 mg/dl in control animals (p less than 0.01); only glibenclamide was effective after 3 days. In the diabetic mice, fasting plasma glucose was significantly reduced by glibenclamide and aloes after 3 days. Thereafter only aloes was effective and by day 7 the plasma glucose was 394 +/- 22.0 versus 646 +/- 35.9 mg/dl, in the controls and 726 +/- 30.9 mg/dl in the glibenclamide treated group (p less than 0.01). We conclude that aloes contains a hypoglycaemic agent which lowers the blood glucose by as yet unknown mechanisms.

Classical Pituitary Apoplexy Presentation and a Follow-Up of 13 Patients

Thirteen patients who presented with signs and symptoms of pituitary disease gave a history of classical pituitary apoplexy. Six presented with acute symptoms and in 7 the history antedated the admission by a mean of 887 days (range 365-2,190 days). All patients had an enlarged eroded sella. CT scans revealed a bleed in the tumor in 11 (histologically confirmed in all 8 patients operated), evidence of residual tumor in 1 and an empty sella (ES) in 1 patient. Hypopituitarism was present in 9, 4 were endocrinologically normal, 8 had visual problems requiring decompressive surgery and radiotherapy (RT) was given to 7 patients. They were subsequently followed for a median period of 730 days (range 365-3,385 days). During this time an empty sella developed in 5, 2 of whom had no surgery or RT; 4 remained endocrinologically normal, and a second hemorrhage occurred in 2 patients. Histological evidence of previous bleeds was noted in 6 of the 8 patients treated surgically. We conclude that apoplexy (1) may produce complete or partial tumor destruction with or without preservation of endocrine function; (2) recurrent, often silent, bleeding into a pituitary tumor appears to be a common event; (3) RT should be withheld unless recurrent tumor is documented (since at least 2 patients in this study have experienced spontaneous resolution of the tumor); and (4) the presence of an enlarged eroded fossa with an ES is reasonable presumptive evidence of an infarction of a pre-existing pituitary tumor.

Case report: idiopathic giant cell granuloma of the hypophysis: an unusual cause of panhypopituitarism.

A 37-year-old man presented with headache and reduced libido. He suffered from panhypopituitarism, and the walls of the pituitary fossa were noted to be thickened, sclerotic, and irregular. Computed tomography scans showed an intrasellar and suprasellar, patchy enhancing tumor. From a biopsy taken at transsphenoidal surgery, a giant cell granuloma was diagnosed, for which there was no obvious cause. Inflammatory disease within the pituitary fossa should be suspected if a reaction is seen in the surrounding bone.

The Use of SMS 201-995 (Somatostatin Analogue) in Insulinomas

A 76-year-old man, a known case of insulinoma, was well controlled for 11 days on 50 micrograms SMS 201-995 every 12 h; clinical recovery was immediate with normalization of blood sugars and C-peptide levels. The potential value of this new drug in the management of insulinomas is illustrated by this case and by 11 additional case reports which are reviewed. A rise in C-peptide levels during treatment without concomitant hypoglycaemia might be the first indication of a loss of control.

Extrasellar Prolactinomas: Successful Management of 24 Patients Using Bromocriptine

24 patients with an extrasellar prolactinoma (mean prolactin 4,722 ng/ml), 8 of whom had previously had surgery, received 5-40 mg bromocriptine daily for 13-252 weeks. The mean prolactin level had fallen 89% at 2 days, 95% at 6 weeks, and 15 patients achieved normal values. Tumor shrinkage occurred in all 9 patients rescanned within 2 weeks and later was documented in 23; in 18 the extrasellar tumour disappeared. 12 patients had visual abnormalities; 7, including 2 who had been completely blind, improved within 1 week. 2 patients had normal prolactin levels after withdrawal of bromocriptine, 1 following radiotherapy and the other during two uncomplicated pregnancies. Bromocriptine is safe and effective. We conclude that medical treatment should always precede surgery unless pituitary apoplexy causes sudden deterioration of vision. Most patients will subsequently require radiotherapy or surgery for permanent cure.

Prolactinomas and Optic Nerve Compression: Disappearance of a Suprasellar Extension and Visual Recovery after Two Weeks Bromocriptine Treatment

4 patients with prolactinomas and visual field defects are presented. 2 were treated with bromocriptine alone; 1 patient with an 8-month history of visual disturbance had complete recovery of visual fields after 2 weeks and an acute fall in serum prolactin levels. This coincided with disappearance of the suprasellar extension on computer tomography (CT) scanning. The second patient, with a 2-year history, had no visual improvement after 1 year of treatment, although CT scanning showed absence of the suprasellar extension when repeated after 3 months. 2 other patients initially had neurosurgery; 1 with a 2-year history had complete visual recovery, the other with a 1-year history did not recover. Both needed subsequent bromocriptine treatment. In all 4 patients this drug produced a sustained fall in serum prolactin levels. We conclude that bromocriptine therapy can rapidly reduce prolactinoma tumor size and should obviate the necessity for acute neurosurgical intervention in carefully selected patients.

Prolactin Levels in Pregnancy: Comparison of Normal Subjects with Patients Having Micro- or Macroadenomas after Early Bromocriptine Withdrawal

14 previously infertile patients, 11 with radiologically abnormal fossae, and a mean prolactin level of 761 ng/ml (range 49-4,500 ng/ml) conceived on 19 occasions during bromocriptine treatment. So far, 15 healthy infants have been delivered. Treatment was withdrawn soon after conception and the subsequent prolactin changes compared with those of 44 normal subjects. Prolactin levels returned to pretreatment values in 7, but stayed within our normal range (less than 350 ng/ml) in the 6 remaining patients studied. No patient developed signs or symptoms of tumor enlargement. 2 patients, 1 of them with the largest tumor, have now normal prolactin levels and can be considered as cured. Bromocriptine treatment can restore fertility and be safely withdrawn during pregnancy even in patients presenting with large tumors. Nevertheless, patients should be carefully monitored and treatment with bromocriptine re-introduced if necessary.

High-Dose Iodine 131 Treatment of Hyperthyroidism: Experience at King Faisal Specialist Hospital and Research Centre

ABSTRACT We have treated 186 Saudi patients (110 females, 76 males) with hyperthyroidism in the last 10 years. Case records of 100 patients were randomly selected for review. The female:male ratio ...

One-Stage Complete Genital Reconstruction for Patients with Congenital Adrenal Hyperplasia

We performed 1-stage complete genital reconstruction on 20 female subjects with congenital adrenal hyperplasia. The blood and nerve supply to the glans was retained by preserving the neurovascular bundle, as well as the ventral mucosal strip. Preservation of the neurovascular bundle was simplified. The phallic skin was used to form labia minora and a flap vaginoplasty was performed simultaneously. There were no operative complications and all 20 patients had satisfactory results.

Male Hypothalamic Hypogonadism: Induction of Spermatogenesis by Subcutaneous Pulsatile Gonadotrophin-Releasing Hormone

Six male patients (aged 21-34 years) with isolated hypothalamic hypogonadism were given subcutaneous pulses of gonadotrophin-releasing hormone every 90 min for 14-74 weeks. The therapy produced an increase in testicular volume (4 patients) and a rise in serum luteinizing hormone, follicle-stimulating hormone, and testosterone levels in every patient. Motile sperm developed in 3 patients after a mean of 17 weeks, but were not seen in other patients who were less sexually developed after a mean of 31 weeks of therapy. Computerized tomography scans of the pituitary fossa revealed an empty sella in 4 patients and a partially empty sella in 2. Subcutaneous pulsing of gonadotrophin-releasing hormone is a simple and safe way of inducing spermatogenesis, but it is more likely to be successful in patients whose pubertal development is otherwise near completion. Previous human chorionic gonadotrophin and/or testosterone treatment does not interfere with and may benefit subsequent gonadotrophin-releasing hormone therapy.