ABSTRACT
The referral of a patient with features of Cushing's syndrome but with suppressed plasma cortisol and adrenocorticotrophic hormone concentrations prompted us to study the effect of medroxyprogesterone acetate (MPA) therapy on the adrenal axis. 11 women (aged 54-82 years) who were receiving 200-400 mg/day MPA were studied. Of these, four had subnormal plasma cortisol responses to a short synacthen test, and two more had borderline responses (30 min post-synacthen plasma cortisol results of 411 and 511 nmol/L). We conclude that suppression of the adrenal axis occurs relatively frequently in patients on MPA and that such patients should be checked for evidence of suppression before MPA therapy is withdrawn.
Subject(s)
Antineoplastic Agents, Hormonal/adverse effects , Cushing Syndrome/chemically induced , Hypothalamo-Hypophyseal System/drug effects , Medroxyprogesterone Acetate/adverse effects , Pituitary-Adrenal System/drug effects , Aged , Aged, 80 and over , Depression, Chemical , Female , Humans , Middle AgedABSTRACT
In the biochemical evaluation of hirsutism, 50% or less of patients have an elevated total serum testosterone. Recent work has suggested that measuring salivary testosterone or a derived serum 'free testosterone index' may be of use in the evaluation of hyperandrogenism. We have measured serum total, derived serum free indices and salivary concentrations of testosterone and 5 alpha-dihydrotestosterone in an unselected group of hirsute patients in order to assess their value in the routine evaluation of hirsutism. The assays were performed using a novel oxidation procedure to overcome the need for chromatographic separation. The 'free testosterone index' gave the best discrimination. Salivary androgen concentrations were comparatively poor and cannot be recommended for routine use.
Subject(s)
Androgens/analysis , Hirsutism/metabolism , Saliva/analysis , Adult , Androgens/blood , Circadian Rhythm , Contraceptives, Oral, Hormonal/metabolism , Dihydrotestosterone/analysis , Dihydrotestosterone/blood , Female , Humans , Testosterone/analysis , Testosterone/bloodABSTRACT
We have previously reported that specific thromboxane synthetase inhibition may be associated with a reduction in albumin excretion rate in insulin-dependent diabetics (IDD). We now report studies of retinal morphology assessed by serial fluorescein angiography in 25 insulin-dependent diabetics during a 16-week double-blind, randomized, placebo-controlled study of the specific thromboxane synthetase inhibitor UK-38,485. Assessment of angiograms was by, computerized image analysis indicating the percentage area of vascularization and, panel scoring by 4 ophthalmologists who scored the posterior pole in each of the 4 angiograms "blind" according to a prearranged system. There was no significant change in percentage area of vascularization in either placebo or "active" group during the study. Panel scoring, however, suggested that some patients deteriorated whilst others remained unchanged or improved. There was, however, no significant difference in these parameters between those subjects on UK-38,485 and those on placebo. We conclude that specific thromboxane synthetase inhibition is not associated with any significant change in diabetic retinopathy over a 4-month period of study.
Subject(s)
Diabetes Mellitus, Type 1/complications , Diabetic Retinopathy/drug therapy , Imidazoles/therapeutic use , Thromboxane-A Synthase/antagonists & inhibitors , Adult , Clinical Trials as Topic , Diabetes Mellitus, Type 1/drug therapy , Diabetic Retinopathy/diagnosis , Double-Blind Method , Female , Fluorescein Angiography , Humans , Male , Middle AgedABSTRACT
Approximately one year after the devolution of testosterone assays from the SAS, the Analytical Methods Working Party of the Association of Clinical Biochemists set up a working party to investigate the performance of the assays, to survey the available methodology and to give guidance on the factors that influence the assay. This document represents a summary of the deliberations of the group and forms one of a series of similar reports.
Subject(s)
Testosterone/blood , Evaluation Studies as Topic , Humans , Indicators and Reagents , Quality Control , Radioimmunoassay/methods , Reagent Kits, DiagnosticABSTRACT
A case of 5 alpha-reductase deficiency is described who presented clinically as primary amenorrhoea. Plasma levels of the two isomers resulting from the 5 alpha-reduction of testosterone provide a simple method for diagnosing this condition. An intermediate abnormality was found in other family members consistent with the heterozygous state.
Subject(s)
3-Oxo-5-alpha-Steroid 4-Dehydrogenase/deficiency , Disorders of Sex Development/enzymology , Oxidoreductases/deficiency , Testosterone/blood , Adult , Chorionic Gonadotropin/pharmacology , Dihydrotestosterone/blood , Disorders of Sex Development/diagnosis , Disorders of Sex Development/genetics , Female , Humans , Male , Testis/pathologyABSTRACT
Albumin excretion rates (AER) were measured in 30 insulin-dependent diabetics during a 16-week double-blind, randomised, placebo-controlled study of the specific thromboxane synthetase inhibitor UK-38,485.6 of 15 subjects in the active group had microalbuminuria (defined as mean pretreatment AER 20-150 micrograms/min); in these patients AER fell from 32 +/- 3 micrograms/min to 11 +/- 1 micrograms/min at 8 weeks and 9 +/- 1 micrograms/min at 16 weeks. The AER rose again (to 29 +/- 8 micrograms/min) within 12 weeks of stopping the drug. There was no significant change in the 10 patients with microalbuminuria who received placebo. There was a strong correlation between change from baseline values and the baseline values themselves in the active, but not in the placebo group, and the change from baseline differed significantly between the two groups. There was no change in glycosylated haemoglobin or mean blood glucose levels during the study. In a separate study UK-38,485 caused significant suppression of thromboxane B2 synthesis in diabetic and non-diabetic subjects.
Subject(s)
Albuminuria , Diabetes Mellitus, Type 1/urine , Imidazoles/pharmacology , Oxidoreductases/antagonists & inhibitors , Thromboxane-A Synthase/antagonists & inhibitors , Adult , Clinical Trials as Topic , Creatinine/urine , Diabetes Mellitus, Type 1/blood , Diabetic Nephropathies/prevention & control , Double-Blind Method , Female , Humans , Male , Middle Aged , Thromboxane B2/bloodABSTRACT
A convenient and inexpensive radioimmunoassay for bloodspot 17 alpha-hydroxyprogesterone (17-OHP) has been evaluated in the screening of newborn infants for congenital adrenal hyperplasia (CAH) and for home monitoring of CAH patients on steroid replacement therapy. In the screening study, analysis of 491 bloodspots taken for routine screening programmes for phenylketonuria and hypothyroidism established the upper limit of normal for infants aged 5-10 days as 64 nmol 17-OHP/l blood (99.9 centile). Home monitoring of patients by examination of fingerprick bloodspot 17-OHP profiles taken by parents over Saturday and Sunday on consecutive weekends showed that changes in control occurred as a result of transition from inpatient to outpatient treatment or following adjustment of steroid replacement regimens. The method was found to be valuable in the diagnosis and management of children with CAH.
Subject(s)
Adrenal Cortex Hormones/therapeutic use , Adrenal Hyperplasia, Congenital/diagnosis , Hydroxyprogesterones/blood , Monitoring, Physiologic/methods , 17-alpha-Hydroxyprogesterone , Adrenal Hyperplasia, Congenital/blood , Adrenal Hyperplasia, Congenital/drug therapy , Child , Child, Preschool , Female , Home Nursing , Humans , Infant, Newborn , Male , Mass Screening , Radioimmunoassay , Steroid 21-Hydroxylase/geneticsABSTRACT
A method of measuring glucose in capillary blood spotted on to filter paper was evaluated. Between-batch reproducibility was about 6%, and the glucose remained stable in the spots for up to four days. Adoption of the method should improve control of diabetes, particularly insulin-dependent forms.
