Diminished insulin receptors on monocytes and erythrocytes in hypertriglyceridemia.

Carbohydrate intolerance is a common observation in endogenous hypertriglyceridemia (HL). So far the nature of this metabolic defect, which accompanies postprandial hyperinsulinemia and a reduced hypoglycemic action of insulin, has not been elucidated. We have examined cellular insulin binding in 20 subjects affected with HL (average plasma triglyceride level, 437 +/- 311 mg/dL) to test the possibility that a receptor defect is involved in peripheral insulin resistance. Monocytes from the HL subjects bound, on the average, 34% less insulin than cells from eight normotriglyceridemic controls of comparable age and body weight (average plasma TG level, 169 +/- 34 mg/dL). Likewise, erythrocytes from the HL group bound 29.6% less insulin than did those from control subjects. Scatchard analysis of the binding data revealed that the number of insulin receptors was reduced for both types of cells. To test if the abnormality in cellular insulin-binding capacity in these subjects is an inherent defect or secondary to the hypertriglyceridemia, 11 of the subjects participated in a 4-month training program (120 minutes weekly of moderate exercise at 60% VO2 max), while the remaining nine persons served as controls. Training reduced the average plasma TG level from 373 +/- 270 to 277 +/- 139 mg/dL (P less than 0.01), but cellular insulin binding was not significantly affected. In addition, no correlation was found between the individual TG plasma concentration and cellular insulin binding. Thus, training itself also proved ineffective in enhancing insulin binding, most probably due to exertion of insufficient intensity.(ABSTRACT TRUNCATED AT 250 WORDS)

[Recurrent infantile laryngeal papillomas and antuitary insufficiency (author's transl)]. / Rezidivierende infantile Larynxpapillomatose bei Hypophysenvorderlappeninsuffizienz

The report at issue discusses the relationship between laryngeal papillomatosis and the endocrine system. It is referred to the clinical course of a 19-years-old patient suffering infantil laryngeal papillomatosis and antuitary insufficiency since childhood. The cause of hormonal insufficiency was the destruction of the hypophysis by a craniopharyngeoma. As a result of this insufficiency the total metabolic process of the patient was reduced to a "vita-minima"-function for years. Despite this metabolic depression the laryngeal papillomas have grown excessively. The number of recurrent papillomas could not even be reduced by exstirpation of the craniopharyngeom although the secundary insufficiency of the adrenal cortex and the secundary hypothyreosis have been compensated by cortisone and thyroxine. A hormonal influence on the laryngeal papillomas by the adrenocorticotrophic hormone and the thyroid hormone could be excluded. An inhibitory effect on the papillomas by the somatotrophic hormone seems unlikely. Furthermore the effect of the sexual hormones remains doubtful. The regression of laryngeal papillomas frequently observed by the end of puberty supports a hormonal influence by gonadotrophic hormone.

[Vitamin D deficiency. Osteopathy after prolonged treatment with anticonvulsents (author's transl)]. / Vitamin-D-Mangel - Osteopathie nach antikonvulsiver Langzeitbehandlung

Several substances with anticonvulsent activity can lead to hypovitamenosis D after prolonged use through their effect on vitamen D metabolism in the liver. This results in abnormal bone mineralisation and produces rickets or osteomalacia. Radiological examination of the skeleton should be performed on patients receiving prolonged anticonvulsent therapy, in order to arrive at an early diagnosis. This requires an accurate knowledge of the types of bone abnormality and of their most frequent localisation. Pathological findings such as Looser's zones, epiphyseolysis or delayed development must be considered in this context. Radiological examination provides an accurate diagnosis if combined with clinical findings and important biochemical results: reduced calcium and raised alkaline phosphatase. Treatment with vitamen D must then be instituted. Healing may be complete or leave residual changes, depending on the severity of the bone changes.

[Incidence and clinical features of pituitary tumours in cases of central Cushing's syndrome (author's transl)]. / Vorkommen und Klinik der Hypophysentumoren beim zentralen Cushing-Syndrom

Approximately 10% of all patients with untreated central Cushing's syndromes have clinically verifiable tumours of the pituitary. After bilateral adrenalectomy 10 to 20% of patients with apparently normal pre-operative pituitary glands develop clinically and roentgenologically demonstrable pituitary tumours, of the so called Nelson type. These are usually very active chromophobe adenomas which are dangerous because they expand rapidly. They secretee considerable amounts of ACTH and MSH. A typical case is described.

[Clinical and biochemical findings of acromegaly patients (author's transl)]. / Klinische und biochemische Befunde bei Akromegaliepatienten

In 32 cases of acromegaly growth hormone analyses in serum were carried out by means of intra venous dosing of glucose (hyperglycemia suppression test). Both in individual cases and collectively the growth hormone concentrations fluctuate considerably. 19 patients had average concentrations of 10 to 30, 5 of 30 to 70, 4 of more than 100 and 3 patients of 5 to 10 ng/ml. The level of the pathological growth hormone concentrations doesn't correlate with the presumable duration of the affection, the glucose tolerance and the extension of the acromegalic alterations. 5 patients showed an euthyroid recidiv goiter, 4 patients a hypothyroid goiter, 2 of these patients at the same time showed a secondary hypoadrenalism and 3 patients an autonomous thyroid adenoma. The eosinophilic hypophysis tumors were mostly intrasellar. 4 patients out of 5 with suprasellar tumor distension showed an optic chiasm syndrome.

[Principals of hormone substitution in thyrectomized patients with carcinoma of the thyroid gland (author's transl)]. / Prinzipien der Hormonsubstitution bei thyrektomierten Schilddrüsenkarzinom-Patienten

The substitution of thyrectomized patients with carcinoma of the thyroid with L-thyroxin has advantages compared to a substitution with triiodothyronine, 200 mug T4/d are sufficient to obtain a negative TRH test in most patients. For security it is suggested to performe a general substitution of these patients with 300 mug T4/d. This dose is very well tolerated. To high doses of substitution cause a "damage" of the thyreotrop in a part of the patients. This is demonstrated by a transient thyreotropic insufficiency after withdrawal of the substitution. The results demonstrated here suggest that the central suppression of TSH secretion is better correlated with plasma T4 than plasma T3 levels.