Robert Rubens

Androgen plasma levels in male diabetics

Plasma level of androgens were studied in 47 normal male controls (20–50 yr-old; mean age 38 yr) and in a group of forty-one male diabetics (23–55 yr-old; mean age: 37.5 yr). Of these 36 showed type 11 and 5 type I diabetes. The results showed that while the mean basal plasma LH was unchanged, there was a decrease in testosterone levels in the diabetics. Moreover, testosterone binding globulin (TeBG) capacity appeared to be augmented and, as a consequence, the apparent free testosterone concentration (AFTC) was markedly decreased. It is interesting to note that the anomalies in androgen secretion observed are rather similar to those found in elderly man and could play some role (with other factors) in the onset of the frequent sexual disturbances in male diabetics.

Cardiac involvement in pheochromocytoma.

We report the details of a 40-year-old farmer, a cigarette smoker, who was admitted with general malaise, nausea, vomiting, upper abdominal pain, with ST-elevation on ECG suggestive of an acute anterolateral myocardial infarction. He was treated with nitrates, heparin, beta-blockade and angiotensin-converting enzyme (ACE) inhibitors. Because of the presence of some blood while vomiting no thrombolysis was given and abdominal echography was performed. This revealed a nodular mass at the right adrenal gland. Urinary catecholamines and abdominal magnetic resonance imaging confirmed the suspected diagnosis of pheochromocytoma. Before adrenectomy, a coronary angiography under alpha blocker therapy was performed, which demonstrated no significant coronary artery disease, although the patient showed ST-elevations on ECG. Pathological examination of the adrenal tumor was compatible with a diagnosis of pheochromocytoma. Postoperatively urinary catecholamines dropped dramatically, and the ECG normalised slowly over time. After 8 months the patient is still well. Blood pressure is well controlled with no antihypertensive drugs and exercise testing shows no evidence of myocardial ischaemia.

Progesterone-transforming enzyme activity in the hypothalamus of the male rat.

The aim of the present study was to assess the activities of the progesterone (Pr) transforming enzyme systems 3alpha-oxidoreductase (3alpha-OR), 5alpha-reductase (5alpha-R) and 20alpha-oxidoreductase (20alpha-OR) in the hypothalamus of the male rat, at different stages of sexual maturation and following castration and adrenalectomy. Special attention was paid to transformation to 3alpha-reduced compounds previously shown to inhibit FSH synthesis and secretion. Homogenates of hypothalamic tissue were incubated with 14C-progesterone. Pr-metabolites were isolated, identified by gas chromatography/mass-spectrometry (GC/MS) and measured by liquid scintillation counting (LSC). In adult rats a ratio of 6:2.5:1 for 5alpha-R:3alpha-OR:20alpha-OR enzyme- activities was found. The hypothalamic 5alpha-R and particularly 3alpha-OR activities were considerably higher before puberty (10-20 day old rats) than in adulthood. Adrenalectomy in adult rats resulted in an increased activity of the three enzyme systems. No significant changes were seen following castration. Among the isolated metabolites, 3alpha-hydroxy-pregn-4-en-20-one (3alpha-Pr) and 3alpha-hydroxy-5alpha-pregnane-20-one (5alpha,3alpha-Pr) were identified. Conversion to both these neurosteroids was considerably higher during prepuberty than in adulthood. The finding that before puberty the hypothalamus has a markedly increased capacity to convert Pr to 3alpha-reduced compounds, such as 3alpha-Pr, known to effectively inhibit FSH release, warrants further research into the mechanisms regulating the hypothalamic formation of biologically active Pr derivatives and their role in the regulation of gonadotropin secretion.

Pregnancy complicated by insulinoma. Case report.

An insulinoma was excised during pregnancy. The tumor was located by radiography and severe hypoglycaemia made it necessary to administer diazoxide to the mother. The out come of the pregnancy was satisfactory. The rationale and risks of giving diazoxide in pregnancy are discussed.

Relationship between left ventricular mass index and 24-h urinary free cortisol and cortisone in essential arterial hypertension

OBJECTIVEnBesides arterial blood pressure, nonhemodynamic factors are known to induce cardiac hypertrophy. In Cushings syndrome, severe ventricular hypertrophy has been linked not only to increased aortic pressure, but also to elevated plasma cortisol. The aim of this study was to examine the relationship between the cortisol/cortisone levels and left ventricular mass index (LVMI) in essential arterial hypertension with and without echocardiographic left ventricular hypertrophy (LVH).nnnDESIGNnEighteen untreated Caucasian patients (nine men, nine women, mean age 48+/-6 years) with essential hypertension (163+/-26/100+/-14 mm Hg) were enrolled. An age-matched control group of 13 subjects (seven men, six women) with normotension (121+/-9/79+/-7 mm Hg) were enrolled also. Left ventricular dimensions were echocardiographically assessed and cortisol production evaluated by 24-h urinary free cortisol and cortisone concentrations.nnnRESULTSnLVMI averaged 115+/-31 g/m2 and 24-h urinary free cortisol and cortisone were 23+/-14 microg per 24 h and 31+/-18 microg per 24 h. Prevalence of echocardiographic LVH was 56%. LVMI correlated significantly with 24-h urinary free cortisol (r = 0.61, P = 0.007) and cortisone (r = 0.60, P = 0.009). Patients with echocardiographic LVH were characterized by higher daytime ambulatory blood pressure, LVMI (particularly the posterior wall), and 24-h urinary cortisol, while office blood pressure, septal: posterior wall ratio and 24-h urinary cortisone were comparable in all patients. In control individuals, LVMI averaged 91+/-18 g/m2 and 24-h urinary free cortisol and cortisone, respectively, were 34.7+/-6.6 microg per 24 h and 64.3+/-10.8 microg per 24 h (P<0.05 versus patients). Neither LVMI nor the contributing ventricular dimensions showed significant correlation with 24-h urinary free cortisol or cortisone in the control group.nnnCONCLUSIONSnOur data provide evidence for a significant relationship between LVMI and cortisol production independently of arterial blood pressure in untreated mild to moderate hypertension.

Diabetes insipidus and pregnancy

A case of a pregnant woman with diabetes insipidus is reported. The course of the pregnancy was uneventful except for a slightly increased need for vasopressin during the last trimester. Neurophysin levels increased at a rate similar to that seen in the normal pregnant state. The combination of normal neurophysin physiology and undisturbed spontaneous labor demonstrating normal oxytocin secretion suggests that there is a singular deficiency of antidiuretic hormone in essential diabetes insipidus.

CLINICAL-STUDY OF TICLOPIDINE IN DIABETIC-RETINOPATHY.

In this multicentre double-blind study, 100 insulin-treated diabetics with background retinopathy were randomly assigned to treatment with either 250 mg ticlopidine b.i.d. (49 patients) or placebo (51

Diagnostic Approach to Patients with Primary Hyperaldosteronism

We report the case of a 38-year-old patient with primary hyperaldosteronism. The diagnosis was made by the demonstration of a non-suppressible high aldosterone level in association with a hypokalemia, an inappropriate kaliuresis and low plasma renin activity. As the choice of the therapeutic approach is dictated by the subtype, further investigation was needed. Using a number of hormonal studies and noninvasive imaging techniques, we could establish the diagnosis of adrenocortical adenoma. Histological examination confirmed our diagnosis. We further discuss briefly the characteristics of the four subtypes of primary hyperaldosteronism and show that the used biochemical markers and imaging techniques are able to differentiate them.

Plasma testosterone levels in women in normal and pathological conditions

Abstract Several parameters have been used in the past to evaluate androgenicity in the female; plasma testosterone levels seem to be by far the most reliable parameter applicable in the clinical routine. Using a very sensitive method we found a mean plasma testosterone level in the normal female of 35 ng ± 15 ng 100 ml ; the latter shows a slight diurnal variation, with highest values in the morning, and a moderate cyclical variation with higher levels in the luteal phase of the menstrual cycle. During pregnancy the plasma testosterone increases and reaches a plateau of about 100 ng 100 ml from the second trimester on. Among the pharmacologic agents, A.C.T.H. causes a significant increase and corticoids a decrease of plasma testosterone levels, whereas gonadotrophins and clomiphene citrate increase slightly plasma testosterone levels. As far as pathological conditions are concerned, plasma testosterone levels are generally highly increased in congenital adrenal hyperplasia and in the adrenogenital syndrome; in virilizing ovarian tumors, the polycystic ovary syndrome, idiopathic hirsutism, acne and sebaceous alopecia as well as in hyperthyroidism a moderate increase is generally, although not always, observed. Occasional discrepancies between plasma testosterone levels and clinical androgenicity disappear almost completely when the free, non-protein bound, testosterone is determined. The latter seems at the present time, the best single parameter of androgenicity. We suggest that the determination of the free testosterone concentration should be introduced into clinical routine.