Association of cardiac autonomic neuropathy and microalbuminuria in non-insulin-dependent diabetes mellitus.

OBJECTIVE: To evaluate the relationship between microalbuminuria and autonomic neuropathy in diabetes mellitus. METHODS: A consecutive series of 151 patients with non-insulin-dependent diabetes mellitus underwent assessment in a single medical practice during a 3 1/2-year period for the presence of microalbuminuria and cardiac autonomic neuropathy. On the basis of microalbuminuria, the patients were categorized into two groups for comparison. RESULTS: Of the overall group of 151 patients, 91 had increased urinary albumin (50 mg/L or more), and 60 had normal albumin excretion (20 mg/L or less). Cardiac autonomic neuropathy was detected in 54% of the former group and 35% of the latter group. Thus, the presence of microalbuminuria was highly associated with cardiac autonomic neuropathy (results of chi2 analysis were significant at 2.3%). Other factors--duration of diabetes, blood pressure, and serum cholesterol and creatinine levels--did not differ between the two study groups. CONCLUSION: Results of this study indicate that the incidence of cardiac autonomic neuropathy is higher in those patients with increased urinary albumin levels than in those with normal excretion of albumin.

Isolated adrenocorticotropic hormone deficiency with antepartum pituitary infarction in a type I diabetic.

Isolated adrenocorticotropic hormone (ACTH) deficiency was documented after cesarean delivery in a patient with type I diabetes. A preceding severe headache, subsequent declining insulin requirements, and hypotension are consistent with pituitary infarction in a patient without computed tomography evidence of a pituitary tumor. Antepartum incomplete pituitary infarction with isolated ACTH deficiency is an unusual but potentially catastrophic complication of the pregnant diabetic.

Relationship between sex hormones, myocardial infarction, and occlusive coronary disease.

An alteration in sex hormones has been considered a risk factor for myocardial infarction. In this study, estradiol (E2) and testosterone (T) levels were evaluated in healthy firefighters, patients with myocardial infarction acutely and during their convalescence, patients with no evidence of occlusive coronary artery disease on arteriography, and patients with chronic angina pectoris in whom there was at least one vessel that indicated 50% occlusive coronary artery disease. Although T levels were similar in all groups, E2 levels were substantially higher in patients with myocardial infarction and in patients with chronic angina pectoris. These results support the hypothesis that elevated estrogen levels may be a risk factor for myocardial infarction and coronary artery disease, possibly by promoting clotting or coronary spasm.

The effect of rapid weight loss due to jejunoileal bypass on total cholesterol and high-density lipoprotein.

Twelve patients undergoing a 10 to 4 inch end-to-side jejunoileal bypass for morbid obesity were measured pre- and postsurgically for total cholesterol and high-density lipoprotein (HDL) cholesterol levels. After a mean weight loss period of 7 months, results showed a significant decrease in total cholesterol (p less than 0.001) and in the total cholesterol: HDL cholesterol level (p less than 0.01). The change in HDL cholesterol levels was not significant (p less than 0.05). The decrease in total cholesterol accompanied by no change in HDL cholesterol indicates an increased transport of cholesterol as HDL in these patients. This results suggests that these subjects are placed at a decreased risk of coronary heart disease postsurgically.

Colchicine in the treatment of Paget disease of bone: a new therapeutic approach.

Paget disease of the bone (PDB) has been treated effectively with various agents including calcitonins, diphosphonates, and mithramycin. Each agent has relatively serious toxic side effects or practical inconveniences associated with its use. An effective agent with fewer adverse reactions and a more convenient route of administration would be preferable. The purpose of this study was to evaluate the effect of colchicine for the treatment of PDB in five patients. All patients were symptomatic and had typical changes on roentgenograms and bone scans consistent with the disease. Serum alkaline phosphatase ranged from 408 to 1,311 mU/ml (normal, 30 to 115 mU/ml), and urinary excretion of total hydroxyproline ranged from 68 to 205 mg/24 hr (normal, 30 to 65 mg/24 hr). Colchicine, 0.6 mg, was given orally three times a day to each patient, who had subsequent follow-up with clinical and laboratory determinations evaluated at each visit. The duration of follow-up was eight to 28 weeks, with a mean of 20 weeks. Pain was relieved in all patients, and two became asymptomatic. Serum alkaline phosphatase decreased 18% to 38%, and urinary hydroxyproline decreased 26% to 53% from the pretreatment values. The biochemical values and and clinical symptoms changed markedly in two patients, correlating with withdrawal and reinstitution of colchicine. These results indicate that colchicine may be effective in the treatment of PDB. Although the mode of action and long-term efficacy of colchicine in this disorder remains to be evaluated, the antimitotic effect on osteoprogenitor cells, the adherence of colchicine to the microtubular structures in preexisting osteoblasts, and the nonspecific anti-inflammatory effect of this agent may explain the therapeutic response noted in this study.

Elevated testosterone-binding globulin in Klinefelter's syndrome.

Seven consecutive patients with Klinefelter's syndrome were studied and found to have elevated levels of testosterone-binding globulin. The mechanism could not be accounted for by increased levels of circulating estradiol.

Temperature dependence of the chromatographic assay of hemoglobin A1 and application of a temperature controlled assay to clinical evaluation of diabetic control.

We investigated the temperature dependence of the cation-exchange chromatographic properties of hemoglobin A1 using the "Fast Hemoglobins Test System" obtained from Isolab, Inc., Akron, OH, U.S.A. and a temperature control chamber constructed in our laboratory. Six patient samples, two each from the "normal" range (5--8.5%, "transitional" range (8.5--12.0%) and "uncontrolled diabetic" range (12--20%) described by Isolab (as measured at 24 degrees C) were collected, hemolyzed and assayed according to product insert instructions. Each sample was assayed in triplicate in three separate runs at 20 degrees C, 22 degrees C, 24 degrees C, 26 degrees C and 28 degrees C in the temperature controlled (+/- 0.25 degrees C) chamber. Resultant mean increases in assay results of 0.8, 1.1 and 1.6% hemoglobin A1 per 2 degrees C increase in temperature for the three ranges respectively, indicate that the temperature dependence of the microcolumn assay for hemoglobin A1 is at least partially a function of the relative percentage of glycosylated hemoglobin in the sample. By controlling assay temperature we have reduced interassay variation throughout all concentration ranges by more than one-half to less than 5%. We applied this temperature controlled assay to measurement of hemoglobin A1 levels in 33 non-diabetic subjects and to the screening of hemoglobin A1 levels in 77 diabetic patients regularly attending the diabetic-endocrine outpatient clinic of this hospital. No non-diabetic subject had a HbA1 level above 8.5% and of the diabetic patients, 26% fell within the "normal" range, 43% within the "transitional" range and 31% within the "uncontrolled diabetic" range.

Effect of dietery weight loss on sex steroid binding sex steroids, and gonadotropins in obese postmenopausal women.

Measurements of SSBG, E2, T, and gonadotropins were performed in 12 obese postmenopausal women before, during, and after a supplemented fast. Weight loss (mean 18 kg) was associated with an increase in SSBG to levels above those seen in nonobese postmenopausal women, a decrease in serum E2 levels, unchanged T levels, and an increase in both gonadotropins. Thus we conclude that weight change or the circumstances associated with it lead to alterations in circulating levels of SSBG. These observations are consistent with the presence of elevated free T and possibly higher free E2 levels in obese postmenopausal women.

PIP: Measurements of sex steroid-binding globulin (SSBG), estradiol (E2), follicle stimulating hormone (FSH), luteinizing hormone (LH), and testosterone (T) were performed in 12 obese postmenopausal women before, during, and after a supplemented fast. Weight loss (mean 18 kg) was associated with an increase in SSBG to levels above those seen in non-obese post-menopausal women, a decrease in serum E2 levels, unchanged T levels, and an increase in both gonadotropins. It is concluded that weight change or the circumstances associated with it lead to changes in circulating levels of SSBG. These observations are consistent with the presence of elevated free T and possibly higher free E2 levels in obese post-menopausal women.

Effect of chronic combined glucocorticoid and estrogen on serum androgens and androgen binding in hirsutism.

Forth-six patients with hirsutism are presented herein. Twenty-four of these patients had menstrual irregularities. Treatment with 5 mg prednisone at bedtime, and 0.625 to 1.25 mg conjugated estrogens daily except during menses resulted in a signficant decrease in serum 17 beta-ol androgens, and an even more statistically significant increase in serum androgen binding. Thus the biochemical abnormalities associated with hirsutism were improved and no apparent side effects were observed.