Lipid level differences and hypertension effect in blacks and whites with type II diabetes.

We sought to determine whether lipid levels in black patients with type II diabetes with and without hypertension differ from those in white patients. Lipid levels were screened in 207 blacks and 103 whites with type II diabetes visiting a weekly diabetes clinic in a southeastern US regional community hospital. Levels of high- and low-density lipoprotein cholesterol were significantly higher in blacks than in whites: 1.30 +/- 0.34 vs 1.05 +/- 0.27 mmol/L (P < .001) and 3.73 +/- 1.23 vs 3.31 +/- 1.11 mmol/L (P = .01), respectively; triglycerides were higher in whites: 3.90 +/- 4.58 vs 1.96 +/- 1.51 mmol/L (P < .001). White hypertensive women had higher cholesterol and triglyceride levels and lower high-density lipoprotein cholesterol levels than white normotensive women (adjusted for age); no differences existed between black hypertensive and normotensive women when we adjusted for age. Seventy-two percent of blacks and 85% of whites had an abnormal lipid value (P = .01). Phenotype distribution was significantly different: 58.7% of blacks with abnormal lipids were in phenotype IIA (elevated low-density lipoprotein cholesterol with normal triglycerides), and 16.7% in IVA and B combined (elevated triglycerides) (P < .001), whereas whites were 17.0% and 52.3%, respectively. Blacks demonstrated a different dyslipidemia compared to whites. The contrasting effect of hypertension on triglyceride and cholesterol levels in white women with diabetes compared to black women suggests a racial difference in the relationship between hypertension and lipids among patients with diabetes.

Abnormal thyrotropin and prolactin levels in untreated corticotropin deficiency.

A patient with isolated corticotropin deficiency demonstrated hyperresponsiveness of both thyrotropin and prolactin after protirelin stimulation. Following glucocorticoid replacement therapy, responses decreased to normal. Since true primary hypothyroidism may occur in association with cortisol-deficient states, it is necessary to reserve final evaluation until after glucocorticoid replacement. The finding of combined thyrotropin and prolactin hyperresponsiveness to protirelin suggests a related glucocorticoid feedback function.

Cancer in thyroid nodules. A community hospital survey.

There is little available evidence of the efficiency of preoperative screening for cancer in solitary thyroid nodules in the community hospital setting, and limited composite data for comparison. A three-year survey was made in a 480 bed community hospital to determine the percentage cancer index (PCI) found in patients operated on for solitary thyroid nodules. Cancer was diagnosed in ten of 153 patients with a PCI of 6.5%. For comparison, an extensive literature review revealed a mean PCI ranging from 13.8% to 27.9%, depending on the preoperative selection process. Periodic surveys of PCI in solitary nodules in community hospitals would yield pertinent information in relation to the general "state of the art" and encourage attainment of a PCI as high as feasible.

Acquired hypertrichosis lanuginosa. Rare manifestation of urinary bladder carcinoma.

Hypertrichosis lanuginosa developed in a patient with carcinoma of the bladder. After regional lymph node metastases became evident, soft, fine, blond hair developed on his entire body, with the exception of the soles and the palms. Extensive endocrinologic evaluation demonstrated depressed testosterone levels and elevated levels of leutinizing hormone, changes not thought to be related to the hair growth. To our knowledge, this patient constitutes the second reported case of this rare syndrome in association with bladder carcinoma.

Renin aldosterone system and potassium levels in chronic lead intoxication.

Renin activity and aldosterone were evaluated relative to potassium levels and lead intoxication in 33 patients with a history of "moonshine" ingestion. Patients were divided into three groups: I, lead intoxicated with hyperkalemia; II, lead intoxicated without hyperkalemia; and III, not lead intoxicated without hyperkalemia. Those in group I demonstrated suppressed plasma renin activity, baseline and after furosemide, and blunted aldosterone responsiveness to furosemide. Plasma renin activity was not different in groups II and III, whereas aldosterone responsiveness was less in group II than in III. Group I patients tended to be older, had lower creatinine clearances, and six of nine had mild hyperchloremic acidosis. Diabetes and cortisol insufficiency were not present. Chronic lead intoxication due to illicit alcohol ingestion is associated with hyporeninemic hypoaldosteronism and hyperkalemia which appear to develop as the lead nephropathy progresses with duration and/or aging.

The effects of ephedrine and theophylline on dexamethasone metabolism in bronchial asthma.

The effect of ephedrine (nine patients) and theophylline (seven patients) on dexamethasone metabolism was studied before and after three weeks of drug therapy in 16 asthmatics. Five patients were studied similarily but treated with placebo. After treatment with ephedrine, there was a mean decrease in plasma dexamethasone half-life (t1/2) of 132 minutes, or 36 per cent (P less than 0.025), and mean increase in metabolic clearance rate (MCR) of 148 liters/day, or 42 per cent (P less than 0.001). Increase in the excretion of urinary radioactivity, predominantly in the conjugated fractions, was noted. In contrast, theophylline and placebo therapy resulted in no significant changes in dexamethasone t1/2 or MCR. The rate of urinary excretion of radioactivity was reduced after theophylline treatment. Since ephedrine accelerates labeled dexamethasone clearance while theophylline does not, caution is necessary when prescribing ephedrine for asthmatics requiring long-term therapy with dexamethasone and probably other corticosteroids. It would appear from the present investigation that theophylline is a more appropriate bronchodilator for these patients.

The effects of diethylstilbestrol and medroxyprogesterone acetate on kinetics and production of testosterone and dihydrotestosterone in patients with prostatic carcinoma.

Alterations in the metabolism of testosterone (T) and dihydrotestosterone (DHT) induced by diethylstilbestrol (DES) or medroxprogesterone acetate (MPA) could account for the beneficial therapeutic effect of these agents in prostatic carcinoma. To investigate this possibility we sutdied plasma kinetics of T and DHT in 17 elderly patients with prostatic carcinoma, before and after treatment with DES (1 or 5 mg/d) or MPA (10 or 30 mg/d) for 30 days. Metabolic clearance rates (MCR) were determined with the single injection technique and by use of two compartment model, plasma concentrations (PC) of T and DHT by radioimmunoassay, the per cent of T bound to plasma protein (T-binding) by charcoal adsorption of the unbound steroid. Production rate (PR) and PC of T were lower, PR and PC of DHT were higher in our patients than in normal men. With both DES regimens, PR, PC and MCR of either androgen declined; however, T was suppressed to a much greater extent than DHT. In either instance, the decrease may have been caused by direct suppression of testicular androgen synthesis and/or by decreased gonadotropin stimulation. Enhanced T-binding played an additional role in reducing the free testosterone index. High and low dose of DES were equally effective. The low dose regimen of MPA did not influence androgen metabolism. MPA in the higher dose suppressed PR and PC of T and DHT, possibly due to effects on testicular synthesis or by gonadotropin suppression as suggested for DES. In contrast to DES, MPA failed to cause profound changes in MCR of either androgen or in T-binding. When judged by its influence on the metabolism of T and DHT in prostatic carcinoma, MPA in higher doses is much less effective than either dose regimen of DES.

PIP: The effects of diethylstilbestrol(DES) and medroxyprogesterone acetate (MPA) on plasma kinetics and production of testosterone(T) and dihydrotestosterone (DHT), and on plasma protein binding of T were measured in 17 patients (50-93 years of age) suffering with metastatic carcinoma of the prostate both before and during treatment for this disease. Blood samples were obtained before injection of 30 mcCi tritiated T or tritiated DHT and at 10, 15, 20, 40, 55, 70, and 90 minutes after injection. T and DHT were measured by radioimmunoassay. Metabolic clearance rates were measured as well. Production rate (PR) and plasma concentrations (PCs) of T and DHT were higher in these patients than in normal men. When DES was given, PR, PC,and metabolic clearance rates of T and DHT declined, with T suppressed to a greater extent. There was also enhanced T-binding. In patients treated with MPA, 10 mg given for 30 enhanced T-binding. In patients treated with MPA, 10 mg given for 30 days, significantly different changes were seen in the kinetics of T and DHT in 8 patients. Patients treated with 30 mg of MPA for 30 days showed suppression of PR and PC of T and DHT. MPA failed to cause profound changes in the metabolic clearance rate of either androgen or in T-binding. These results indicate that MPA is less effective than DES.

Renin profiling in hypertension and its use in treatment with propranolol and chlorthalidone.

We compared methods of classifying hypertension according to plasma renin activity in 54 patients with essential hypertension and examined the validity of using these classifications to choose between two hypotensive drugs. A prospective, double-blind crossover study was used. Normal values for plasma renin activity were established from 111 control subjects. Plasma renin activity was related to race and inversely to age in hypertensive patients (P less than 0.05) but not in normal subjects. Three methods of classification correlated well but did not identify exactly the same renin-suppressed patients. Chlorthalidone produced a greater reduction in blood pressure and restored blood pressure to normal in a larger percentage of patients in both low-renin (59 per cent) and normal-renin (32 per cent) subgroups than propranolol (12 and 16 per cent). Renin determinations are of limited benefit in the choice of therapy for most patients with essential hypertension.

Plasma renin activity in juvenile diabetes mellitus and effect of diazoxide.

Low plasma renin activity (PRA) has been reported in patients with long-term diabetes mellitus complicated by hypertension and nephropathy. We have assayed PRA in twelve normal subjects and in eight age- and sex-matched juvenile diabetics of greater than twelve years' duration without hypertension and nephropathy under control conditions and following stimulation with diazoxide. During control conditions PRA did not decrease with time in the diabetics as it did in the normals. Following diazoxide infusion, PRA increased in both groups, and although the levels were often higher in diabetics than in normals, the mean differences were not statistically significant. The findings are consistent with the suggestion that PRA is normal or possibly elevated in clinically uncomplicated insulin-dependent diabetes mellitus and decreases with establishment of hypertension and nephropathy.