Dissociation of cortisol and adrenal androgen secretion in the hypophysectomized, adrenocorticotropin-replaced chimpanzee.

We tested the hypothesis that adrenal androgen production is supported by a pituitary factor distinct from ACTH. Six adult male chimpanzees who had completed adrenal maturation (adrenarche) were castrated and either hypophysectomized or sham hypophysectomized. Hypophysectomized animals received synthetic ACTH-(1-24) and T4 to prevent adrenal insufficiency and hypothyroidism. Adrenal function was evaluated with a 3-h ACTH infusion before and 7, 21, 40, 120, and 180 days after hypophysectomy. Plasma cortisol (F), dehydroepiandrosterone (DHA), DHA sulfate (DHAS), and androstenedione (delta 4A) were measured at six time points during the ACTH infusions. The mean ratios of DHA to F, DHAS to F and delta 4A to F during ACTH infusion were calculated as indices of the relative activity of the androgen pathway compared to that of the cortisol pathway. The DHA to F ratio during ACTH infusion was 31% of the pretreatment level 40 days after hypophysectomy (P less than 0.01 compared to the sham-hypophysectomized controls). The DHAS to F ratio during ACTH infusion, which paralleled the DHA to F ratio, also fell significantly (P less than 0.025). Hypophysectomy did not alter the delta 4A to F ratio. None of the ratios was altered by sham hypophysectomy. MCRs for F and DHA, which were measured before and 180 days after hypophysectomy or sham hypophysectomy, did not change significantly. Additionally, plasma corticosteroid-binding globulin levels remained unchanged throughout the study for both groups of chimpanzees. Thus, the changes in the DHA to F ratio cannot be explained by alterations in the MCRs of DHA or F or in the plasma transport protein for F. These data suggest that ACTH maintained normal F and delta 4A secretion after hypophysectomy but failed to maintain normal DHA and DHAS secretion. This is consistent with the hypothesis that normal delta 5-adrenal androgen secretion is dependent upon a non-ACTH pituitary factor or with the hypothesis of different ACTH requirements for the maintenance of F and delta 5-adrenal androgen secretion.

Generous craniectomy for Kleeblattschädel anomaly.

In the case presented, Kleeblattschädel, or cloverleaf skull deformity, was treated successfully with a two-staged, generous craniectomy. The pertinent aspects of this rare anomaly are reviewed in light of information from other cases described previously. The present case illustrates that an early surgical approach of subtotal calvariectomy may improve the commonly predicted poor prognosis in patients with Kleeblattschädel anomaly if the clinical severity of the disease is not immediately overwhelming.

Persistent otic artery.

A patient with a persistent otic artery is presented. The radiographic anatomy is presented in the anteroposterior as well as the lateral plane. The significance of the otic artery is twofold. First, it is important in understanding the embryogenesis of the cerebral vessels. Secondly, it is an anatomical variant that is important in performing and evaluating cerebral arteriograms.

Occipital encephalocele with holoprosencephaly and aqueduct stenosis.

A case is described in which an occipital encephalocele was removed in a newborn and in which a midline monoventricle did not appear until some months later, suggesting the diagnosis of holoprosencephaly. The relationship of encephaloceles and holoprosencephaly is discussed.

A complication of nasogastric intubation: intracranial penetration.

A patient with severe maxillofacial trauma had a nasogastric tube inserted into the intracranial cavity. Two such case reports were found in the literature and in both instances the patients expired. The present patient is believed to be the first who survived intracranial passage of a nasogastric tube.

Fracture of the anterior superior iliac spine following anterior cervical fusion using iliac crest. Case report.

A case is presented in which fracture of the right anterior superior iliac spine occurred 2 weeks after the right iliac crest had been used as the donor site for a two-level anterior disectomy and fusion.

Aphasia and left thalamic hemorrhage.

Left thalamic hemorrhage as a cause of aphasia has not been widely recognized. Large thalamic hemorrhages cause coma, making speech examination impossible; smaller thalamic hemorrhages were difficult to document until recent diagnostic advances. Nine cases of thalamic hemorrhage with aphasia have been described in the literature. This report presents four additional cases. These patients had acute onset of aphasia, supranuclear paralysis of upward gaze, right hemisensory deficits, and mild right hemiparesis. Three of the four patients responded to ventriculostomy drainage with rapid clearing of the supranuclear paralysis of upward gaze, and two later required placement of permanent ventricular shunts. After 1 year, two patients exhibited no clinically detectable speech malfunction and the other two were severely aphasic. The hemiparesis, hemisensory deficits, and ocular pareses all cleared. These cases are discussed with respect to present models of the role of the thalamus in speech.