Therapeutic plasmapheresis in patients with severe hyperthyroidism in whom antithyroid drugs are contraindicated.

Four patients with Graves' disease in whom antithyroid drugs could not be used were treated by plasmapheresis preoperatively. On admission all patients had severe hyperthyroidism. All patients were treated by beta blockers, cholestyramine and inorganic iodine before plasmapheresis. Plasmapheresis course consisted of three sessions. Removed plasma was replaced by a synthetic colloid solution and human albumin other than fresh-frozen plasma. Plasmapheresis led to decreases in serum T3 concentrations >78-40% and free T4 concentrations >69%. Near-total thyroidectomy could be performed in all patients. Although screening coagulation tests were within normal limits, patients 1 and 4 experienced more blood loss than usual during the operative procedure. Plasmapheresis could be used as an alternative therapeutic option in the preoperative management of severe hyperthyroid patients with contraindications to antithyroid drugs. However, this is an invasive procedure and patients should be followed carefully for prolonged clinic/subclinic coagulopathy due to plasma exchange.

Associations among sex hormone binding globulin concentrations and characteristics of the metabolic syndrome in obese women.

The aim of this study was to determine sex hormone binding globulin (SHBG) concentrations in premenopausal obese women who were otherwise healthy, and to evaluate the relationships between SHBG concentrations and features of the metabolic syndrome; 307 premenopausal women (mean age 30.9+/-10.2 years) were studied. Subjects were divided into two groups according to the BMI: Group I, women with BMI <30 kg/m2 (n=69) and Group II, women with BMI > or = 30 kg/m2 (n=238). Insulin resistance was determined according to the Homeostasis Model Assessment (HOMA) formula. Median SHBG concentration of Group I was 75.9 nmol/l. Group II was divided into two subgroups according to the median SHBG concentration of Group I; women with high SHBG (SHBG concentration > or = median level of the control group, i.e. > or = 76 nmol/l) and women with low SHBG (i.e. <76 nmol/l). The low SHBG group was significantly younger, with higher waist-to-hip ratio (WHR). Triglycerides, uric acid, insulin and HOMA values were significantly higher and HDL-cholesterol was significantly lower in the low SHBG group. Multiple regression analysis revealed that age and uric acid concentrations were significant independent predictors of SHBG concentrations in the whole group (regression summary, adjusted r2=0.1414, F=10.5627, p<0.001). It is concluded that low SHBG concentrations may indicate a severe degree of insulin resistance in premenopausal obese women.

Determination of endothelial function and early atherosclerotic changes in healthy obese women.

The aim of this study was to determine the associations between vascular endothelial function, intima-media thickness (IMT) of the common carotid artery and anthropometric/metabolic parameters in healthy obese women without obesity-related metabolic complications and age-matched healthy lean controls. Twenty-four obese [body mass index (BMI) > 30 kg/m2; age 31.4 +/- 7.4 yr] and 14 lean (BMI < 24 kg/m2; age 30.5 +/- 7.2 yr) women were studied. All of the subjects had normolipemia. Insulin resistance was calculated according to the homeostasis model assessment (HOMA) formula. Endothelial function was measured by flow-mediated dilation (FMD) of the brachial artery. IMT of the common carotid artery was calculated from high-resolution ultrasound imaging of the two common carotid arteries. Obese and lean women were matched with respect to age, smoking status, blood pressure, glucose, insulin concentrations and HOMA. IMT of common carotid artery was significantly higher (0.56 +/- 0.09 vs 0.45 +/- 0.06 mm, p < 0.001) and FMD (percentage of change from baseline) was significantly lower (13.3 +/- 6.5% vs 25.2 +/- 13.9%,p < 0.001) in the obese subjects. Lipid profile, blood pressure, indirect measurement of insulin resistance, leptin concentrations and anthropometric parameters did not predict the FMD or IMT in the obese and lean groups. It is concluded that even in healthy obese women with a normal metabolic profile, deterioration in endothelial function and early atherosclerotic changes are evident compared with healthy lean counterparts. Some undetermined factors in our study other than obesity-related well-known risk factors could be responsible for this observation.

Clinical laboratory findings and results of therapy in 55 patients with Cushing's syndrome.

In this study, 55 patients with Cushing's syndrome (CS) (50 female, 5 male; mean age 34 +/- 12.3 yr) who attended our clinics between the years 1983 and 2000 were retrospectively evaluated for clinical and laboratory features and modalities and results of therapy, due to a few similar studies over the last ten years. Cushing's disease was diagnosed in 39 patients (71%), adrenal adenoma in 13 patients (23.6%) and adrenal carcinoma in 3 patients (5.5%). Centripedal obesity, moon face, hypertension, hirsutism and purplish stria were the most frequent findings. Loss of normal serum F circadian rhythm was found in all patients with CS. The overnight 1 mg oral dexamethasone suppression test and low-dose dexamethasone suppression test (LDDST) yielded 100% and 100% diagnostic sensitivity for CS, respectively. Sensitivity and specivity of the high-dose dexamethasone suppression test (HDDST) in distinguishing Cushing's disease was found to be 82% and 100%, respectively. All of the patients with adrenal CS were not suppressed with HDDST. Sellar CT and/or MRI accurately identified the tumor in 58% of these patients. Recurrence was observed in 3 (11%) of the 28 patients with Cushing's disease, treated by transsphenoidal adenomectomy. Recurrence was diagnosed 1.5, 3 and 6 yr after the operation in these 3 patients. One patient had residue tumor. In our case series, bilateral adrenalectomy plus pituitary irradiation achieved the highest remission rate (100%) in Cushing's disease. In 2 out of 4 patients (50%) treated by left adrenalectomy associated with pituitary irradiation, recurrence was observed. Panhypopituitarism due to tumor apoplexy was observed in one of the patients with Cushing's disease. All of the patients with adrenal CS, the tumor was accurately localized with imaging methods before the operation. The appropriate operative procedure resulted in complete remission in patients with adrenal adenoma. Consequently, Cushing's disease was the most common form of CS. The overnight 1 mg oral DST and 24-h urine free F excretion (UFC) as screening tests, 2-day LDDST as diagnostic test and 2-day HDDST as differential diagnostic test were good studies. More successful outcomes have been achieved in treatment of Cushing's disease with the development of pituitary surgery in the recent years, as well as in our case series. Surgery is also curative for adrenal adenoma patients. Survival remains poor among carcinoma patients.

Determination of oxidative protein and lipid damage in adult hypopituitary patients with GH deficiency.

The aim of this study is to determine oxidative protein and lipid damage in adult hypopituitary GH-deficient patients. Eighteen hypopituitary GH-deficient--otherwise healthy-adults on conventional replacement therapy other than GH (9 male, 9 female, age 41.8 +/- 16.4 yr) and 18 healthy subjects (6 male, 12 female, age 40.3 +/- 16.2 yr) participated in the study. Plasma products of oxidative protein damage [protein carbonyl (PCO) and nitrotyrozine (NT)], plasma oxidized LDL (oxLDL), plasma product of oxidative lipid damage [lipid hydroperoxide (LHP)] and antioxidant status of the plasma [total thiol (T-SH)] were measured. Body fat percentage, total and LDL-cholesterol concentrations were significantly higher in the hypopituitary group. Plasma PCO, NT, LHP and T-SH concentrations did not differ significantly between patients and controls. OxLDL concentration was significantly higher in the hypopituitary patients (62.4 +/- 17.8 vs 43.1 +/- 11.3 U/l, p = 0.001). In the patients, oxLDL correlated significantly with the duration of hypopituitarism (r = 0.6323, p = 0.01). In the controls, oxLDL correlated significantly with blood pressure, total and VLDL-cholesterol concentrations. Increased oxLDL concentration may indicate increased oxidative stress within the vascular compartment and may contribute to the proatherogenic state in GH-deficient hypopituitary patients independent from conventional risk factors.

Immunohistochemical detection of E-cadherin, alpha- and beta-catenins in papillary thyroid carcinoma.

E-cadherin and catenins play a major role in neoplastic cell behavior as a suppressor of invasion and/or metastasis. The aim of this study was to determine E-cadherin, alpha-catenin and beta-catenin expressions in papillary thyroid carcinoma (PTC) and to correlate the results of expression to initial clinicopathological parameters and clinical outcome. Forty-one cases (mean age 37.3 +/- 11.2 yr) with PTC were studied. Patients were followed-up with a mean period of 47.6 +/- 27.0 months. A retrospective immunohistochemical analysis of E-cadherin, alpha-catenin and beta-catenin was performed on paraffin-embedded tissue sections. Tissues from ten patients with benign goiter were used as controls. E-cadherin, alpha- and beta-catenin immunoreactivities were found in 80% (33/41), 76% (31/41) and 97% (40/41) of patients respectively. No correlation was found between E-cadherin, alpha- and beta-catenin immunoreactivities and sex, local invasion or lymphatic spread at the time of initial examination. Distant metastases and/or local recurrences developed in 6 patients during follow-up. Recurrences/metastases developed both E-cadherin, alpha- and beta-catenin positive and negative primary tumors. Disease-free survival curves according to Kaplan-Meier analysis and log-rank test did not show any significant differences between E-cadherin, alpha- and beta-catenin positive and negative patients. According to our findings, E-cadherin, alpha- and beta-catenin expressions may not add any valuable information to the follow-up in a subgroup of PTC patients with a relatively benign course.

Left ventricular diastolic function abnormalities in hypopituitary patients with GH deficiency: evidence for a subclinical cardiomyopathy.

The aim of this study was to evaluate cardiac performance, in particular diastolic function, in adult patients with adulthood onset GH deficiency. The study group was composed of 19 GH deficient adult hypopituitary patients with at-least 3 additional pituitary hormone deficits and 19 age, sex and BMI matched healthy controls. Mean duration of hypopituitarism was 108.6 +/- 77.0 months. None of the patients and controls presented with or had previous diagnosis of concomitant diseases that could affect cardiac function. All hormone deficiencies, except for GH, were appropriately replaced in the patients. Left ventricular function and geometry were evaluated by two-dimensional, M-mode and Doppler echocardiography. Body composition was evaluated by bioelectrical impedance analysis. Not significant differences were observed with respect to left heart dimensions and left ventricular systolic function between patients and controls. Nevertheless 2 of the left ventricular diastolic function parameters, deceleration time and isovolumetric relaxation time, were significantly prolonged in the patients compared with controls (247.88 +/- 70.65 vs 143.26 +/- 31.70 milliseconds (ms) and 122.31 +/- 18.24 vs 89.47 +/- 12.12 ms respectively, p<0.001). Duration of hypopituitarism was significantly correlated with percent body fat mass (r=0.6119, p<0.01) and percent lean body mass (r=-0.5949, p<0.01). It is concluded that in adults affected by hypopituitarism, GH deficiency predominantly impairs diastolic function while systolic function at rest is spared. This observation might indicate a preclinical stage of a cardiomyopathy.

Cushing's syndrome caused by ectopic corticotropin secretion by multiple peripheral pulmonary carcinoids and tumorlets of carcinoid type.

Multiple peripheral pulmonary carcinoid tumors or their smaller counterparts (tumorlets of carcinoid type) are the most unusual form of carcinoids as a cause of ectopic corticotropin syndrome. Only three case reports were found in the literature. We describe a 35 year-old female patient with ectopic corticotropin secretion due to multiple peripheral pulmonary carcinoid tumors and tumorlets. A high-dose dexamethasone suppression test result led to the diagnosis of Cushing's disease in our case. But no tumor was identified on sella imaging and bilateral inferior petrosal sinus sampling was non-diagnostic. Computed tomography of the lungs revealed multiple acinar-nodular parenchymal infiltrations confined to the left lung. Corticotropin-dependent hypercortisolism persisted after bilateral adrenalectomy. A second operation was necessary to remove the hyperplastic adrenal remnants. Meanwhile, computed tomography findings of the thorax were unchanged. We decided to explore these nodules by open lung biopsy. During the procedure multiple nodules ranging 12 to 3 mm in diameter scattered throughout the left lung were observed and left pneumonectomy was performed. Histopathological diagnosis was multiple peripheral carcinoid tumors and tumorlets of carcinoid type showing positive immunostaining with corticotropin. This observation emphasizes a rare form of carcinoids as a cause of ectopic corticotropin secretion and its unusual response to high dose dexamethasone suppression test.

Serum lipid and leptin concentrations in hypopituitary patients with growth hormone deficiency.

OBJECTIVE: To investigate the effects of growth hormone (GH) deficiency on serum lipid and leptin concentrations in hypopituitary patients taking conventional replacement therapy and to determine the relations between leptin and gender and anthropometric and metabolic variables. SUBJECTS: Twenty-one GH deficient adult hypopituitary patients (15 women, six men) and 21 (14 women, seven men) age, sex and body mass index (BMI) matched healthy controls. MEASUREMENTS: After an overnight fast, anthropometric parameters were measured and body composition was determined by a bioelectrical impedance analyser. Venous blood samples were obtained for the measurements of glucose, total cholesterol, high density lipoprotein (HDL) cholesterol, triglyceride, intact insulin, insulin-like growth factor 1 (IGF-1) and leptin concentrations. Serum leptin and hormones were analysed by radioimmunoassay. RESULTS: Hypopituitary patients with GH deficiency showed significantly higher triglyceride, total and low density lipoprotein (LDL) cholesterol and lower HDL cholesterol concentrations on conventional replacement therapy. The unfavourable lipid profile was particularly evident in women. Significantly higher leptin concentrations were found in patients compared with healthy controls with similar body fat content (23. 5+/-11.8 ng/ml vs 11.7+/-6.9 ng/ml, P=0.01). This difference remained significant even when leptin values were expressed in relation to fat mass percentage (0.79+/-0.40 vs. 0.42+/-0.17 ng/ml%, P<0.05) and fat mass kg (1.32+/-0.81 vs 0.66+/-0.30 ng/ml kg, P<0. 05). Significant positive correlations were observed between leptin concentrations and body fat percentage and age in the control group. In patients the sole significant relation between leptin and study parameters was the positive correlation observed between leptin and total cholesterol concentrations. Serum leptin concentrations were significantly higher in women than men in the control group, but not in the patients. No significant gender difference was observed when leptin concentrations were expressed in relation to fat mass (percentage and kg). CONCLUSION: Growth hormone deficient hypopituitary patients (particularly women) on conventional replacement therapy have a more atherogenic lipid profile. Leptin concentrations are increased in GH deficient adults even after adjustment for percentage body fat and body fat mass (kg). Although the nature of our data does not allow us to draw any conclusions on the mechanism(s) of increased leptin concentrations in GH deficiency, decreased central sensitivity to leptin and increased leptin production from per unit fat mass, or alterations in leptin clearance, might be operative.

A young female patient with an androgen-secreting tumor: a rare malignant disease.

A 23-year-old female patient presented with hirsutism and fatigue nine months after delivery. Endocrine assessment showed high testesterone, DHEA-S and androstenedione levels. Abdominal computed tomography and ultrasonography revealed the presence of a large tumor in the right renal region. Right adrenalectomy was performed resulting in a diagnosis of a functional adrenal tumor. Pathological examination showed a steroidogenically active tumor. Adjuvant chemotheraphy was administered postoperatively. At three months following surgery all endocrinological tests normalized, but liver metastases were detected by abdominal CT. Eight months after the operation the patient died of hepatic and renal failure. Androgen-secreting adrenal tumors are seen very rarely, yet the prognosis is poor due to their agressive nature.

Clinical course of a pituitary macroadenoma in the first trimester of pregnancy: probable lymphocytic hypophysitis.

Recent findings revealed that the clinical features of lymphocytic hypophysitis are more complicated than previously thought. It is rarely described in the first trimester of pregnancy and signs of meningeal irritation are infrequently reported. In this study, a pregnant woman in her first trimester of pregnancy with clinical and radiological characteristics of a pituitary macroadenoma is described. The patient's pituitary profile revealed a relatively low prolactin for her stage of pregnancy. Unusual findings were neck stiffness associated with headache, nausea and vomiting. She was treated conservatively. Spontaneous complete resolution of the pituitary mass in the postpartum period led us to conclude that the correct diagnosis should be hypophysitis. Hypophysitis should be considered in the differential diagnosis of a pituitary mass presenting in early stages of pregnancy with symptoms mimicking hyperemesis gravidarum and/or meningeal irritation.

Evaluation of signal-averaged electrocardiogram in healthy obese women: effects of subcutaneous adipose tissue.

OBJECTIVE: To determine the correlations between signal-averaged electrocardiography (SAECG) indices and various anthropometric parameters in obese women. SUBJECTS: Twenty-seven healthy obese women (mean age 29.7 +/- 9.6 y, mean body mass index 35.2 +/- 6.0 kg/m2). MEASUREMENTS: SAECG was performed using a Marquette, MAC 12/15 system. Bidirectional filtering, low-pass filtering 250 Hz and 25, 40 and 80 Hz high-pass filter settings were employed on the same averaged beats. At least 200 beats were averaged to achieve a noise level <1 microV. Body mass index, waist to hip circumference ratio, neck circumference, arm circumference and conicity index were determined for all subjects. Skinfold thicknesses were measured in triceps, biceps, subscapular, supra-iliac and para-umbilical regions. RESULTS: Significant correlations were observed between the root mean square (RMS) voltage of the terminal 40 ms of the filtered ORS complex at 25 and 40 Hz and skinfold thicknesses measured at different sites. Significant correlations were obtained between the noise level at 25 and 40 Hz and skinfold thicknesses measured at subscapular, biceps and triceps regions also. The only SAECG parameter correlated significantly with the noise level was the RMS voltage at 25 and 40 Hz high-pass filter settings. CONCLUSIONS: In obese women SAECG must be performed with 80 Hz high-pass filter setting which eliminates the random noise originating from the subcutaneous adipose tissue. In addition RMS voltage which shows positive linear correlations with the noise level of 25 and 40 Hz high-pass filter settings might be inappropriate for the definition of abnormal SAECG criteria in obese women.

Acromegalic cardiomyopathy: evaluation of the left ventricular diastolic function in the subclinical stage.

It is recently shown that the majority of acromegalic patients without concomitant heart disease have diastolic dysfunction at rest. The aim of this study is to evaluate left ventricular diastolic function in normotensive acromegalic patients without any evidence of heart disease. Eleven acromegalic patients and 16 normal subjects of comparable age and sex distribution were studied by echocardiography. Left ventricular end-diastolic diameter, interventricular septal thickness, left ventricular posterior wall thickness, left ventricular end-diastolic volume and stroke volume were found to be significantly higher in acromegalic patients. Left ventricular mass and left ventricular mass index increased significantly in acromegalics in comparison with controls (229.16 +/- 46.11 g versus 167.17 +/- 24.57 g and 124.99 +/- 26.91 g/m2 versus 95.09 +/- 13.29 g/m2 respectively, p < 0.001). Mitral A wave desceleration rate and isovolumetric relaxation time (IVRT)-two of the studied parameters of left ventricular diastolic filling- were significantly prolonged in patients as compared with controls (p = 0.03 and p < 0.001 respectively). Four (36%) of the acromegalic patients had peak early/late diastolic mitral velocity ratio lower than 1, indicating diastolic dysfunction. All of the patients had IVRT longer than 90 ms (mean + 2 standart deviations of normals). It is concluded that in acromegalic patients without any other evidence of heart disease left ventricular diastolic function is impaired. This indicates a specific cardiomyopathy exists in the subclinical stage. IVRT is found to be more sensitive than other studied parameters for detecting diastolic dysfunction at this stage.

Primary hypothyroidism with hyperprolactinaemia and pituitary enlargement mimicking a pituitary macroadenoma.

Hyperprolactinaemia can occur in patients with hypothyroidism. A 32-year-old woman with primary hypothyroidism presented with amenorrhoea and galactorrhoea of two years' duration. She had hyperprolactinaemia, low basal morning cortisol levels and evidence of a pituitary macroadenoma on magnetic resonance imaging. Therapy with L-thyroxine resulted in induction of regular menses, resolution of galactorrhoea, normalisation of hormone levels and disappearance of the image of pituitary macroadenoma. It seems that enlargement of the pituitary due to thyrotroph and/or lactotroph cell hyperplasia secondary to hypothyroidism is responsible for this 'pseudotumour' image on radiological study. Recovery of her low basal cortisol values during treatment could also be explained by the dissolution of the pressure effect of enlarged pituitary in addition to the regression of hypothyroidism. In subjects with primary hypothyroidism and hyperprolactinaemia and pituitary enlargement, thyroid hormone replacement should be a first line treatment preceding pituitary surgery and bromocriptine use.

Relationship between adrenal cortex pathology in Cushing's syndrome and its response to the dexamethasone suppression test.

Cushing's syndrome is a severely disabling condition which can cause death if left untreated. Endogenous Cushing's syndrome can be ACTH-dependent or ACTH-independent. The ACTH-dependent type is more common and is usually caused by diffuse hyperplasia on the adrenal cortex. This study investigated the response to low- and high-dose dexamethasone suppression testing of 30 adrenalectomized patients with Cushing's syndrome, average age 37.3 +/- 9.7 years. Twenty-four (79.3%) patients were female, and six (20.7%) were male. Bilateral adrenalectomy was performed in 14 (48.2%) patients and unilateral adrenalectomy (nine and seven right adrenalectomy) in 16 (51.8%). Two of the bilateral adrenalectomies were applied via endoscopic surgical approach. In the histopathological evaluation, diffuse hyperplasia was diagnosed in 13 (44.8%) patients and nodular hyperplasia in eight (26.6%), three macronodular and five micronodular hyperplasia. Adrenal cell adenoma was diagnosed in nine (28.6%) patients. Classic dexamethasone suppression testing was performed on all patients. Plasma levels of cortisol were not significantly decreased after low-dose testing, but plasma levels of cortisol were significantly decreased after high-dose testing in the diffuse hyperplasia group. In summary, due to the pathological changes of the adrenal cortex, dexamethasone suppression testing can differentiate between the two types of Cushing's syndrome.

Pituitary macroadenoma in Addison's disease.

Long-standing primary failure of pituitary-dependent endocrine glands may lead to hyperplasia of the pituitary cells. These changes in the pituitary gland may be correlated with the severity and duration of target-endocrine gland insufficiency. Production of adrenocorticotrophic hormone by the pituitary tumour and modest hyperprolactinaemia may develop due to adrenocortical insufficiency, but production of prolactin by the pituitary tumour due to primary adrenal insufficiency is rare. A case study is presented, with primary adrenal insufficiency associated with hyperprolactinaemia and pituitary macroadenoma (most probably prolactinoma). Plasma levels of prolactin were found to decrease after glucocorticoid, mineralocorticoid and bromocriptine therapy.

Clinical and laboratory evaluation of 40 patients with Sheehan's syndrome.

Forty patients with typical obstetric history of Sheehan's syndrome were reviewed retrospectively. Together with baseline laboratory values, insulin hypoglycemia test was evaluated in 15 patients, thyrotropin-releasing hormone (TRH) in 27 and luteinizing hormone-releasing hormone (LH-RH) in 7 patients. Baseline hormone values suggested secondary hypothyroidism, hypogonadotropic hypogonadism and hypocortisolemia. According to the results of the anterior pituitary stimulation tests, one patient (6.6%) showed normal cortisol response and one patient (6.6%) showed normal growth hormone response to hypoglycemia. Nine patients (33.3%) who were clinically and biochemically hypothyroid demonstrated adequate TSH response to TRH. None of the patients showed normal prolactin response to TRH. Four out of seven amenorrheic patients (57.1%) had adequate follicle-stimulating hormone and/or LH responses to LH-RH. It has been concluded that isolated anterior pituitary hormone deficiencies may occur in patients with Sheehan's syndrome. Prolactin response to TRH seems the most sensitive screening test for detecting Sheehan's syndrome in patients with typical obstetric history.

Human lymphocyte antigens (HLA) and Graves' disease in Turkey.

To evaluate the association of HLA types with Turkish patients with Graves' disease, HLA typing, clinical findings, and thyroid antibodies were correlated. The HLA types, clinical findings (ophthalmopathy and age at onset), and thyroid stimulating hormone (TSH) receptor (TRAb) and antithyroid microsomal antibodies (MAb) were analyzed. Seventy Turkish patients with Graves' disease and 306 control subjects were assessed. Serological HLA typing was performed in HLA A, B, C, DR, and DQ loci. There was a significantly increased prevalence of HLA B8, B49, DR3, DR4, and DR10 in Graves' disease. The association of Graves' disease with HLA DR3 was found to be less strong than previously described. The HLA DR4 antigen may contribute to the predisposition of Graves' disease in Turkey. The results suggest that HLA B7, B13, DR7, DQw2, and DQw3 may confer a protective effect for Graves' disease in Turkey. Patients carrying HLA B12, B18, and B44 haplotypes had a tendency to develop the disease at a later age. The difference from the other studies may be the result of the selection of the controls; in part, of the variability in serological typing reagents; and, also, of the rather weak HLA associations with the disease.

Growth hormone secretion in protein energy malnutrition.

Plasma hGH levels were assessed in 15 infants with protein energy malnutrition following insulin induced hypoglycemia, arginine and L-Dopa provocation tests and intravenous glucose tolerance test. Fasting hGH levels were high in 85.7% of the cases. An adequate hGH response to stimulation was obtained in only 42.8% of the cases with insulin induced hypoglycemia; in 52.5% with arginine; in 30.8% with L-Dopa. Response to at least one type of provocation was obtained in all 5 cases to which all three tests were applied. Exaggerated or delayed response to provocative stimuli was also encountered in a number of the cases. Intravenous glucose tolerance test did not lead to suppression in hGH secretion or to increase in insulin secretion in these subjects. The results indicate that marasmic protein energy malnutrition may lead to defects in the hGH secretory function of the hypothalamopituitary axis.