William W. Engstrom

Chronic hyperosmolarity of the body fluids with a cerebral lesion causing diabetes insipidus and anterior pitutiary insufficiency

Abstract A case is presented of a patient with diabetes insipidus and anterior pituitary insufficiency who exhibited chronic hypernatremia and hyperchloremia and a defective thirst mechanism. The hypertonicity of the body fluids was entirely alleviated with pitressin. After discontinuance of pitressin the hyperosmolar state promptly recurred, mainly through a process of salt retention when cortisone was available and through water diuresis when cortisone was not available. In a separate study the administration of 100 mg. of cortisone per day for four days did not aggravate the diabetes insipidus and the administration of pitressin did not cause increased renal losses of salt. No direct antagonism between ADH and cortisone on the renal tubular absorption of water or salt was demonstrated. Marked postpitressin retention of sodium and chloride was noted in two patients with uncomplicated diabetes insipidus. Salt retention rather than diuresis of water characterized the first forty-eight hours after the use of pitressin for three days. It is suggested that adrenal cortical activity, but not necessarily increased activity, permits this reaction. Some of the cases reported in the literature of hypernatremia in patients with neurologic lesions may represent examples of diabetes insipidus and a disturbed thirst mechanism.

Effect of Estrogens on Serum Precipitable Iodine.

Summary The serum precipitable iodine (SPI). an index of the level of the circulating thyroid hormone, rises in men or women during the administration of estrogen and falls to control values when the estrogen is discontinued.

The relationship of thyroid function to endometrial hyperplasia and endometrial carcinoma

A RELATIONSHIP between tumor growth and the endocrine glands has long been observed. Much of this work has been with experimental animals. Until recent years methods of assaying the functional activity of the human endocrine glands have been crude, The serum precipitable iodine determination, as a practical research method, is now available for precise evaluation of human thyroid function since it measures the amount of circulating thyroid hormone. Endometrial hyperplasia and endometrial carcinoma have been associated with each other and with disturbed endocrine function13 2 This study was designed to compare serum precipitable iodine determinations of patients with endometrial hyperplasia and endometrial carcinoma with those of a cont.rol group. Clinically, hypothyroidism as well as hypcrthyroidism is associated wit II every degree of menstrual disturbance from amenorrhea to nlenometrorrhagia.:l-G This certainly does not seem unreasonable in view of Gillman and Gilbert ‘s’ study of ten thyroidectomized baboons. They noted disturbances of mcnstrlml rhythm in all ten. The complex and variable reactions of the cndometrium, perineal skin, and ovaries were felt to be a consequence of a widespread met.abolic dist,urbanee involving not only a modified gonadotropic activity hut also a modified responsiveness of the ovaries to the pituitary hormone. On the other hand, Goldsmith and associates8 noted that a characteristic feature of 7 of 10 myxedcmatous women was ovulatory failure with a continuous estrogenic effect on the cndometrium leading to the syndrome of metropathia hemorrhagica. .I11 ol’ thrse patients resumed normal ovulatory menses after therapy. TTertiw and his associatesg-I1 ‘a report that women with benign cystic entlotnctrial hyperplasia prior to the menopause are ten times as likely to tlcvclol~ endometrial carcinoma as women without this condition and those with aI ypica I hyperplasia in the majority of instances later develop carcinoma. The effects of varying the amount of endogenous and exogenous t,h,vroitl hormone on tumor growth in humans and experimental animals has been the subject of much study and speculation. Hertig and co-workers found that many patirnt.s with cndometrial carcinoma have an associatntl endocrine dist.urbanec~ -diabetes, two to three times the normal incidence; and thyroid discasc in 3.1 per cent.

The Diagnosis and Treatment of Toxic Nodular Goiter

Because toxic nodular gaiter occurs frequently in elderly persons who have associated degenerative diseases, it presents unusual problems in diagnosis and treatment. The difficulty in diagnosis may be compounded by the sporadic function of the toxic thyroid nodule with fluctuating clinical and laboratory findings.The pathogenesis of toxic nodular gaiter is reviewed, as are the clinical picture, laboratory findings, and choice of therapy. In general, surgical resection is the most effective definitive form of therapy, but it carries a significant risk which must be evaluated carefully.