Stephen Podolsky

INCREASED FREQUENCY OF DIABETES MELLITUS IN PATIENTS WITH HUNTINGTON'S CHOREA

Abstract Six of ten patients with documented Huntingtons chorea had an unusual form of diabetes mellitus characterised by marked hyperglycaemia, resistance to ketosis, absence of glycosuria, and markedly elevated insulin levels in response to the administration of glucose or arginine. Four patients (group I) had normal fasting plasma glucose and insulin levels and a normal response to the glucose-tolerance test (G.T.T.). The other six (group II) had normal fasting glucose levels but slightly elevated fasting insulin levels; the G.T.T. was abnormal. In group I arginine resulted in normal glucose and insulin rise, and peak insulin at 30 minutes was 44·0±6·1 μU. per ml. In group II, despite a similar degree of glucose elevation after arginine, peak insulin at 30 minutes was 96·3±21·3 μU. per ml. Clinically no correlation other than duration of disease could be made with the metabolic findings. Whether these data may be explained by an abnormal genetic linkage between Huntingtons chorea and carbohydrate intolerance, or by a primary imbalance of biogenic amines, is not yet established.

Potassium depletion in hepatic cirrhosis. A reversible cause of impaired growth-hormone and insulin response to stimulation.

Abstract Seven of 17 patients with cirrhosis and impaired carbohydrate tolerance were found to have potassium depletion as judged by rises of body potassium from 12.7 to 35.8 per cent of the initial value during potassium chloride administration. Plasma insulin and growth-hormone response to the administration of glucose or arginine was initially below normal in the potassium-depleted patients but elevated above normal in those without potassium depletion. Administration of 180 mEq of potassium chloride daily for a period of two or more weeks resulted in increased body potassium, improved glucose tolerance and increased insulin and growth-hormone responses in the seven potassium-depleted cirrhotic patients, but no significant change in any of these measurements in the others. These observations indicate that potassium depletion in cirrhotic patients is associated with a diabetic glucose tolerance test and reduced output of both insulin and growth hormone and that potassium repletion may be accompanied by ...

Absence of sleep‐related growth hormone elevations in myotonic dystrophy

There is evidence that in myotonic dystrophy, the endocrine and central nervous systems are affected. To study a possible relationship between both defects, we investigated nocturnal sleep patterns and associated growth hormone secretion in two men and three women with myotonic dystrophy. In three patients who were clinically the most severely affected by myotonic dystrophy, plasma growth hormone elevations related to the slow-wave phase of sleep were absent. The two least severely affected patients had plasma growth hormone increases of low magnitude and brief duration (from 0.4 ng per milliliter to 13.0 ng per milliliter). These data suggest a failure of integration at a subcortical level of the slow-wave phase of sleep with the hypothalamic-pituitary mechanisms of growth hormone secretion. Thalamic neuronal lesions occurring in myotonic dystrophy could be responsible for such failure.

EFFECT OF MARIJUANA ON THE GLUCOSE‐TOLERANCE TEST*

The sensation of hunger or increased appetite is not uncommonly reported during marijuana smoking or hashish ingestion. The symptom of “marijuana hunger” has been known for many years, and frequently a special craving for sweets has been described. Hunger comes on at various intervals following the drug, up to three hours afterward or longer.’ Ames2 reported that although his subjects did not experience hunger during the first three hours after Cannabis, they ate with great relish when food was offered. Recently HollisteI3 published studies that further document reports of increased appetite and hunger after oral administration of marijuana. Furthermore, there was actually increased total food intake (chocolate milk shakes) when this was measured. Hollister noted that stimulation of appetite by marijuana was by no means invariable, since it occurred in only slightly more than half the subjects. While rodents given marijuana extract generally show a decrease in fighting a striking increase in aggressive behavior occurs after the drug if food is simultaneously withheld.6 The change is more marked in female rats. Hypoglycemia, or rapid decreases in blood-glucose levels, are known to be associated with sensations of hunger or increased appetite. These symptoms are present whether the blood-sugar lowering occurs spontaneously or is due to antidiabetic drug therapy. Several observers have considered the possibility that the hunger sensation occurring after marijuana may develop because the drug lowers blood-sugar levels. Miras,’ Hollister’ss and Weil’s9 groups have all reported, however, that neither smoked marijuana in small doses nor orally ingested tetrahydrocannabinol (THC) in large doses has any significant effect on peripheral glucose levels. In some of these studies the subjects were not fasting, and in none of them were the effects of marijuana on carbohydrate metabolism evaluated in a systematic fashion. The present study was designed to clarify further the possible role of hypoglycemia or alterations in blood-glucose levels in the genesis of “marijuana hunger.” Some slang synonyms for marijuana, as currently used in the United States, are as follows: grass weed pot joint stick reefer loco weed hashish Texas tea roach Acapulco gold smoke.

Special needs of the diabetic undergoing surgery.

Although diabetics undergoing surgery require special attention, their mortality and morbidity need not be excessive. Most patients do well if the physician takes measures to avoid ketosis and hypoglycemic reactions, gives half the usual dose of insulin before and half after an operation requiring spinal or general anesthesia, uses spinal anesthesia when feasible, and closely follows electrolytes, fluids and blood sugar postoperatively.

Biogenic Amines in the Hypothalamus: Effect of L-DOPA on Human Growth Hormone Levels in Patients with Huntington's Chorea

Publisher Summary This chapter discusses the effect of L-3,4-dihydroxyphenylalanine (L-DOPA) on human growth hormone levels in patients with huntingtons chorea. Huntingtons chorea, transmitted as an autosomal dominant trait, is a progressively deteriorating disease of the central nervous system. The primary pathology is loss of small neurons and associated gliosis in the corpus striatum. There is also neuronal loss in the cerebral cortex as well as paraventricular, supraoptic and lateral tuberal hypothalamic nuclei and dorsomedial nucleus of the hypothalamus. 10 patients with documented Huntingtons chorea had human growth hormone (HGH) levels measured during a 5-hour oral glucose tolerance test. Nine of them had HGH levels measured during a repeat glucose tolerance test (GTT) that had been modified by a 3-day course of L-DOPA administration. Human growth hormone is known to be released from the anterior pituitary secondary to the release of growth hormone-releasing factor (GRF) from the tuberoinfundibular system of the hypothalamus.

Analysis of stable iodinated insulin by neutron-activation techniques

Abstract Neutron activation analysis of stable iodinated insulin has been performed [127I(n, γ)128I]. Using a lithium-drifted germanium detector for counting the 128I gamma ray of 0·442 MeV, we have successfully analyzed less than one microgram of iodine without the necessity of pre- or post-irradiation chemistry. The theoretical lower limit for 128I using this technique appears to be 40–50 ng of iodine. Increased sensitivity was achieved by using a NaI (Tl) well detector with post-irradiation chemistry. The results indicated that with this destructive method, we should be able to measure as low as 1–2 ng of iodine. Excellent recovery of insulin by immunoassay, after neutron activation, provided evidence that the technique using freeze drying of insulin and a Ge (Li) detector did not damage the insulin molecule. We conclude that using two different detector systems after neutron activation, accurate and reliable studies could be performed with iodinated insulin and other proteins in biological functions studies.

Endocrine Complications of Pregnancy

This series demonstrates the effectiveness of a team approach by obstetrician and internist in managing pregnancies complicated by endocrine abnormalities. Fetal loss in the diabetic group was 2.9 percent, a striking improvement over the 25.9 percent loss in previous pregnancies. Much of the success in the diabetic group is attributed to reliable determination of the expected date of delivery and meticulous metabolic control plus serial urinary estriol measurements.