[Severe cardiac failure as complication of primary hypothyroidism]. / Insuficiencia cardíaca grave como complicación de hipotiroidismo primario.

We report a 29 years old female admitted due to a congestive cardiac failure that failed to respond to therapy with furosemide and enalapril. Serum thyroid hormone profile showed a TSH over 40 microIU/ml, a thyroxine of 0.8 microgram/dl and a triiodothyronine below 20 ng/dl. Levothyroxine therapy was started with remission of cardiac failure. The study of thyroid function in patients with cardiac failure of unknown origin and resistant to therapy, should be bone in mind.

Serum osteocalcin in normal menstrual cycle.

Serum osteocalcin (OC) was serially measured along an ovulatory menstrual cycle in 4 healthy unmedicated volunteers (age 33-38 years). During the study the women maintained their normal diet and daily physical activity. Starting at days 4-5 of the cycle, blood samples were taken between 09-11 AM every 2 or 3 days for OC, FSH, LH, E2 and P determinations. Daily ultrasound assessment of ovulation was performed in all subjects between days 7-18 of the cycle. Hormone determinations and OC were performed by RIA. While blood levels of FSH, LH, E2 and P changed during the cycle, according to the expected ovulatory pattern, serum OC concentrations remained stable during the cycle in each subject. In conclusion, serum OC is independent of the gonadotropin and ovarian steroid variations during the normal menstrual cycle.

Serum osteocalcin in normal menstrual cycle

La concentración de Osteocalcina (OC) es un buen marcador del remodelamiento óseo. La influencia del estradiol sobre la OC ha sido descrita en el embarazo, lactancia y postmenopausia. No existe acuerdo si los cambios en la concentración plasmática de estradiol del ciclo menstrual normal se relacionan con modificaciones de la OC. En este estudio la OC sérica fue medida seriadamente a lo largo de un ciclo mesntrual normal en 4 voluntarias sanas, libres de toda medicación (edad 33-38 años). Durante el estudio las mujeres mantuvieron su dieta y actividad física habitual. A partir del día 4 ó 5 del ciclo, se tomaron muestras de sangre entre las 09 y 11 am, cada 2 ó 3 días, para determinación de OC, FSH, LH, E2 y P. Se realizó seguimiento folicular ecográfico día por medio entre los días 7 y 18 del ciclo. Las determinaciones hormonales fueron realizadas por RIA utilizando reactivos aportados por la OMS. La OC fue determinada por RIA (incstar OC 125 I Kit, Incstar, Stillwater, MN) con límite de sensibilidad de 0,78 ng/ml y coeficiente de variación intraensayo de 4,6%. Todas las muestras fueron corridas en el mismo ensayo. El análisis estadístico incluyó la prueba de Kolmogorow-Smirnow (KS) y el coeficiente de correlación temporal de Sperman (S). Las concentraciones sanguíneas de FSH, LH, E2 y P cambiaron durante el estudio de acuerdo al caráter ovulatorio del ciclo. Como se muestra en la Tabla 1, las concentraciones de OC permanecieron estables a lo largo del ciclo en cada una de las 4 mujeres. Los valores de OC se expresan como promedio ñ ES de todas las muestras tomadas a lo largo del ciclo de cada mujer. d*: diferencia absoluta máxima entre el valor observado y la distribución teórica normal según la prueba de Kolmogorov. r**:, coeficiente de correlación temporal para los valores de OC. En conclusión, aparece como independiente de las variaciones de las gonadotrofinas y esteroides ováricos del ciclo menstrual normal. De este modo, la evaluación de la formación ósea no debería ser influenciada por el día o la fase del ciclo menstrual en el cual la muestra es obtenida

Serum osteocalcin in normal menstrual cycle.

Serum osteocalcin (OC) was serially measured along an ovulatory menstrual cycle in 4 healthy unmedicated volunteers (age 33-38 years). During the study the women maintained their normal diet and daily physical activity. Starting at days 4-5 of the cycle, blood samples were taken between 09-11 AM every 2 or 3 days for OC, FSH, LH, E2 and P determinations. Daily ultrasound assessment of ovulation was performed in all subjects between days 7-18 of the cycle. Hormone determinations and OC were performed by RIA. While blood levels of FSH, LH, E2 and P changed during the cycle, according to the expected ovulatory pattern, serum OC concentrations remained stable during the cycle in each subject. In conclusion, serum OC is independent of the gonadotropin and ovarian steroid variations during the normal menstrual cycle.

Serum osteocalcin in normal menstrual cycle

La concentración de Osteocalcina (OC) es un buen marcador del remodelamiento óseo. La influencia del estradiol sobre la OC ha sido descrita en el embarazo, lactancia y postmenopausia. No existe acuerdo si los cambios en la concentración plasmática de estradiol del ciclo menstrual normal se relacionan con modificaciones de la OC. En este estudio la OC sérica fue medida seriadamente a lo largo de un ciclo mesntrual normal en 4 voluntarias sanas, libres de toda medicación (edad 33-38 años). Durante el estudio las mujeres mantuvieron su dieta y actividad física habitual. A partir del día 4 ó 5 del ciclo, se tomaron muestras de sangre entre las 09 y 11 am, cada 2 ó 3 días, para determinación de OC, FSH, LH, E2 y P. Se realizó seguimiento folicular ecográfico día por medio entre los días 7 y 18 del ciclo. Las determinaciones hormonales fueron realizadas por RIA utilizando reactivos aportados por la OMS. La OC fue determinada por RIA (incstar OC 125 I Kit, Incstar, Stillwater, MN) con límite de sensibilidad de 0,78 ng/ml y coeficiente de variación intraensayo de 4,6%. Todas las muestras fueron corridas en el mismo ensayo. El análisis estadístico incluyó la prueba de Kolmogorow-Smirnow (KS) y el coeficiente de correlación temporal de Sperman (S). Las concentraciones sanguíneas de FSH, LH, E2 y P cambiaron durante el estudio de acuerdo al caráter ovulatorio del ciclo. Como se muestra en la Tabla 1, las concentraciones de OC permanecieron estables a lo largo del ciclo en cada una de las 4 mujeres. Los valores de OC se expresan como promedio ñ ES de todas las muestras tomadas a lo largo del ciclo de cada mujer. d*: diferencia absoluta máxima entre el valor observado y la distribución teórica normal según la prueba de Kolmogorov. r**:, coeficiente de correlación temporal para los valores de OC. En conclusión, aparece como independiente de las variaciones de las gonadotrofinas y esteroides ováricos del ciclo menstrual normal. De este modo, la evaluación de la formación ósea no debería ser influenciada por el día o la fase del ciclo menstrual en el cual la muestra es obtenida (AU)

Serum osteocalcin in normal menstrual cycle.

Serum osteocalcin (OC) was serially measured along an ovulatory menstrual cycle in 4 healthy unmedicated volunteers (age 33-38 years). During the study the women maintained their normal diet and daily physical activity. Starting at days 4-5 of the cycle, blood samples were taken between 09-11 AM every 2 or 3 days for OC, FSH, LH, E2 and P determinations. Daily ultrasound assessment of ovulation was performed in all subjects between days 7-18 of the cycle. Hormone determinations and OC were performed by RIA. While blood levels of FSH, LH, E2 and P changed during the cycle, according to the expected ovulatory pattern, serum OC concentrations remained stable during the cycle in each subject. In conclusion, serum OC is independent of the gonadotropin and ovarian steroid variations during the normal menstrual cycle.

Zona glomerulosa function after life-long suppression in two siblings with the hypertensive virilizing form of congenital adrenal hyperplasia.

The function of the adrenal zona glomerulosa was studied in two pubertal siblings with the hypertensive virilizing form of congenital adrenal hyperplasia who had never been treated. Initially, their plasma 11-deoxycortisol and 11-deoxycorticosterone (DOC) levels were very high, PRA was suppressed, and plasma aldosterone and 18-hydroxycorticosterone (18-OHB) were undetectable. To selectively study zona glomerulosa function, the patients and five normal subjects were given dexamethasone (2 mg/day; thus suppressing zona fasciculata function), and their sodium intake was restricted to 10 mmol/day. After 3-5 days, the zona glomerulosa was stimulated with either angiotensin II or potassium chloride. The same protocol was repeated in the patients at various intervals up to 39 months after beginning maintenance therapy with dexamethasone (0.25 mg twice daily). PRA, plasma aldosterone, and 18-OHB remained low during the first 6 months of treatment. After the first year, PRA recovered, and the zona glomerulosa began to respond. Plasma aldosterone and 18-OHB levels reached normal basal and stimulated values in one of the patients after 2 yr of treatment, but remained subnormal after 39 months of treatment in the other patient. Both patients, however, had persistently elevated plasma DOC concentrations, suggesting slight but definite impairment of 11 beta-hydroxylation in the zona glomerulosa. We conclude that in spite of a severe and persistent 11 beta-/18-hydroxylation deficiency in the zona fasciculata, the zona glomerulosa can recover almost completely after prolonged treatment. Appropriate stimulation, however, discloses a minor 11 beta-hydroxylation impairment also in the zona glomerulosa. In addition, the lack of parallelism in zona glomerulosa 11 beta- and 18-hydroxylation of DOC provides evidence for the concept of different 18-hydroxylating systems in the adrenal cortex.

Inhibition of the kallikrein-kinin system and vascular reactivity in Bartter's syndrome.

To study the significance of the increased activity of the kallikrein-kinin system described in patients with Bartter's syndrome, we investigated the pressor response to infused angiotensin II in four patients with the syndrome receiving no treatment and during the administration of aprotinin and of indomethacin. Five normal subjects served as controls. Aprotinin is a proteolytic enzyme that inhibits the formation of kinins by inhibiting plasma and glandular kallikrein. Indomethacin, a prostaglandin-synthesis inhibitor, can also inhibit the kallikrein-kinin system and normalizes vascular responsiveness to angiotensin II in Bartter's syndrome. All patients had increased urinary kallikrein and prostaglandin E2 concentrations. Aprotinin significantly decreased the dose of infused angiotensin II required to induce a 20 mm Hg increase in diastolic blood pressure, from 11 +/- 4 ng/kg/min to 7.0 +/- 2.0 ng/kg/min (mean +/- SD; p less than 0.05) in normal subjects and from 135 +/- 57 ng/kg/min to 70 +/- 26 ng/kg/min (p less than 0.05) in the patients with Bartter's syndrome, without significantly changing plasma renin activity, mean control blood pressure, or urinary prostaglandin E2 concentration. Indomethacin normalized the pressor response to angiotensin II in three patients who had been pretreated for 4 days (pressor dose, 10 ng/kg/min) but not in one patient who received a single oral dose of indomethacin 5 hours before the test. Our results suggest that inhibition of the kallikrein-kinin system alone accounts for approximately a 50% decrease in vascular resistance to the pressor effect of angiotensin II in Bartter's syndrome, while additional suppression of prostaglandins entirely normalizes the vascular response to angiotensin II.(ABSTRACT TRUNCATED AT 250 WORDS)

Fever of unexplained origin, biochemical Cushing's disease and cerebral dysrhythmia corrected by valproate sodium.

A patient with cerebral dysrhythmia and fever of unexplained origin for 2 years is described. She had elevated and nonsuppressible levels of urinary 17-hydroxycorticosteroids but no clinical features of hypercortisolism. Treatment with valproate sodium corrected all the abnormalities. It is postulated that cerebral dysrhythmia can affect the hypothalamic mechanisms of body temperature and regulation of adrenocorticotropic hormone levels.