Low dehydroepiandrosterone sulfate (DHEA-S) level is not a good predictor of hormonal activity in nonselected patients with incidentally detected adrenal tumors.

To assess its differential diagnostic value, dehydroepiandrosterone sulfate (DHEA-S) was measured in a nonselected cohort of 84 patients with incidentally detected adrenal tumors (incidentaloma). Of the 38 histologically confirmed cases, 6 of 12 patients with primary or metastatic malignant tumor of the adrenals and 7 of 14 patients with benign cortical adenoma had low DHEA-S levels. Thus, the sensitivity, specificity, and predictive value of a low DHEA-S level to indicate a benign adrenal tumor were 0.35, 0.50, and 0.60, and the values to indicate a cortical adenoma were 0.50, 0.67, and 0.47, respectively. Of the 14 cases of histologically confirmed benign cortical adenoma, 10 had signs of hormonal activity, but DHEA-S was suppressed in only 7 cases. Thus, the sensitivity, specificity, and predictive value of a low DHEA-S level to indicate clinically significant hormonal activity of a benign cortical adenoma were 0.60, 0.75, and 0.86, respectively. For comparison, 5 of 5 males and 2 of 5 females with metastatic carcinomatosis, but without involvement of the adrenals, also had low DHEA-S levels. The data clearly show that in nonselected cases of incidentaloma a suppressed DHEA-S level is not a good predictor of hormonal activity and that DHEA-S measurement may be valuable only after having ascertained the cortical origin and benign feature of the tumor.

Prevalence of thyroid dysfunction in different geriatric subpopulations from a moderately iodine-deficient Hungarian region. Comparative clinical and hormonal screening.

The aim of this study was to investigate the prevalence of thyroid dysfunction in different geriatric subpopulations from a moderately iodine-deficient Hungarian region and to compare the efficacy of clinical versus hormonal screening. A screening study was done on 279 chronically ill geriatric patients (Group I) and 256 consecutive hospital admissions over 60 years of age (Group II). The method of clinical screening was different from those used so far: the object was not to search for symptoms of hypo- or hyperthyroidism but to find any sign justifying a further thyrotrophin-based biochemical evaluation, i.e. history of thyroid disease or goitre or any clinical sign of hormonal dysfunction. The rates of overt hypothyroidism, overt hyperthyroidism, subclinical hypothyroidism and subclinical hyperthyroidism discovered by the hormonal screening were 2.9, 1.1, 3.6 and 5.7% in Group I and 3.5, 2.3, 3.9 and 2.0% in Group II. The sensitivities of the clinical screening to suspect overt or overt+subclinical dysfunctions were, respectively, 0.82 and 0.64 in Group I and 1.0 and 0.7 in Group II (or 0.67 and 0.4 if the clinical investigation was done not by an endocrinologist but by the medical attendants). A primarily clinical investigation-based screening would have spared 171/279 thyrotrophin estimation in Group I and 161/256 in Group II, but would have missed 2/11 overt and 11/26 subclinical dysfunctions in Group I. In Group II, no overt but 9/15 subclinical dysfunctions would have been lost in this way. Our approach of a clinical investigation-based screening was rather efficient in suspicion of overt thyroid dysfunction but failed to detect many cases with subclinical dysfunction.(ABSTRACT TRUNCATED AT 250 WORDS)

Incidentally detected adrenal tumours (incidentalomas): histological heterogeneity and differentiated therapeutic approach.

OBJECTIVES: To find a differentiated therapeutical approach to incidentalomas. DESIGN: Prospective study of incidentalomas: their histology, hormonal activity, and growth if primarily non-operated. SETTING: Admissions to an academic tertiary care centre because of incidentaloma. PATIENTS: Thirty-eight female, 25 male, 27-85 years old. INTERVENTIONS: Ultrasound, computed tomography and adrenal scintigraphy when appropriate; investigations to exclude malignancy giving metastasis into the adrenal gland; ACTH, cortisol, aldosterone, renin activity, androgene, catecholamine measurements; surgery or follow-up. MAIN OUTCOME MEASURES: Rate of malignancy; linkage of tumour size to probability of malignancy; prevalence of tumours with subtle hormone excess. RESULTS: Cortical adenomas occurred in 13/31, metastases in 7/31 of the histologically confirmed cases. In 10/31 cases, the computed tomography indicated a size that was smaller than the pathological size (mean = 20 mm). 20.6% of all incidentalomas and 61.5% of the 13 operated corticol adenomas showed subtle hormonal activity. Twenty-seven incidentalomas < 30 mm were followed-up (3-41 months; mean 18 months) and showed growth in only one case. Sensitivity, specificity, and predictive value (PV) of a tumour > or = 30 mm to indicate malignancy were: 1.0, 0.56 and 0.27, respectively. The PV of a < 30 mm tumour to exclude malignancy was 1.0. CONCLUSIONS: Oncological screening tests are necessary in all incidentalomas. Tumours > or = 30 mm should be operated but smaller ones can be followed-up, because they are usually benign and rarely show progressive growth. Cortical adenomas with subtle hormonal overproduction and hypertension, diabetes or osteoporosis should be operated, irrespective of their size, but in the absence of relevant clinical symptoms they can be followed-up.

[Haemosuccus pancreaticus]. / Haemosuccus pancreaticus.

A case of haemosuccus pancreaticus is reported. A short description of the pathogenesis is also given. Bleeding from the pancreatic duct of the 40 year old male patient ensued as a complication of chronic pancreatitis and pseudocyst of the pancreas. Diagnosis was made by endoscopy, abdominal ultrasonography and angiography. Bleeding ceased spontaneously without surgical intervention.

Ultrasonography of the thyroid gland in hospitalized, chronically ill geriatric patients: thyroid volume, its relationship to age and disease, and the prevalence of diffuse and nodular goiter.

Ultrasongraphy of the thyroid gland was performed in a screening study of 177 chronically ill, hospitalized geriatric patients older than 60 years of age, from an area with only moderate iodine deficiency. The normal reference ranges of thyroid volume for males (1.7 mL to 22.2 mL) and for females 2.4 mL to 20.9 mL) were similar. The thyroid volume decreased with age in the euthyroid group and was also smaller in euthyroid females in bad health. The prevalence of goiter and thyroid nodules were 7.9% and 11.3%, respectively. Thus, the decrease of the thyroid volume in this geriatric population is probably related to both old age and diseases of the aged.

[Sonographic volumetry of the thyroid]. / Sonographische Schilddrüsen-volumetrie.

The utility of ultrasound volumetry of the thyroid is discussed on the basis of 414 different examinations. Analysis of the possible errors in calculations and the importance of the experience as well as practice are emphasized. According to the results of the cadaver studies, the difference between the in situ size and the size of the removed thyroid is explained by the changes of the blood, lymph and colloid flows after stasis. The preliminary data on the thyroid volume values in a randomized population pattern may serve as a model for a wide-ranging study aimed at the determination of the normal value in Hungary. Different volume values in the two phases of the menstruation period draw the attention to the effect of the female sex hormones on the thyroid volume, a factor that has to be considered in follow-up studies of female thyroid patients. Ultrasound volumetry is an indispensable method for the correct estimation of the thyroid volume changes in the course of suppressive treatment.

Differentiation of coeliac disease and other malabsorption diseases using specific serum antigliadin IgG subclass profiles and IgA1 levels.

The differential diagnostic potential of serum gliadin-specific IgG subclass antibodies was assessed by comparing the antigliadin IgG1, 2, 3, 4 profile at different stages of coeliac disease with that of gastro-intestinal infection and also conditions associated with increased intestinal permeability. The IgG subclass profile of untreated coeliac disease was found to be the same as in healthy controls (IgG1 approximately IgG2 > IgG3 > IgG4), with only the magnitude of the individual subclass responses being increased in coeliac patients. Coeliac adults and children on gluten-free diets had different antigliadin IgG subclass profiles with IgG2 being elevated. Increased intestinal permeability or recent gastro-intestinal infection did not alter the antigliadin subclass profile from that observed in healthy individuals. Assessment of the diagnostic potential of antigliadin IgA1 and IgG1-4 measurements in screening for coeliac disease demonstrated that measurement of subclasses of gliadin-specific IgA and IgG was less sensitive and specific compared with the combined use of total antigliadin IgA and IgG. Therefore it is suggested that IgG subclasses should not be used for routine screening for coeliac disease.

A reliable screening test for coeliac disease: enzyme-linked immunosorbent assay to detect anti-gliadin antibodies in serum.

A simple, rapid, highly reproducible enzyme-linked immunosorbent assay detecting anti-gliadin antibodies in serum to screen for coeliac disease (CD) is described. By combining the results of anti-gliadin IgA and IgG determinations the overall sensitivity of the assay was found to be 100% and the specificity 96% for children and 99% for adults. Significantly elevated antigliadin IgA and IgG antibodies were detected in all 20 children and all 25 adults with untreated CD. False positive results were found in 1/79 histologically normal control and 5/86 disease control children, while for adults false positive rates were 0/74 and 1/34 for the healthy and disease control groups, respectively. Anti-gliadin IgA and IgG was measured in serum samples from 52 coeliac patients (11 children and 41 adults) treated with a gluten-free diet (GFD). Each of the children and 28 of the adults who followed a strict GFD had significantly lower IgA and IgG levels than untreated CD patients. The serum anti-gliadin IgA and IgG levels of the 13 adults not complying with a GFD were similar to those found for untreated CD patients. This assay is recommended as a screening test for CD as well as a tool for follow-up of treated patients.

Role of ultrasonography in the differential diagnostics of neck masses.

Ultrasonography of 70 cases of palpable neck masses are analyzed. On the basis of histological diagnoses the cases are put into groups of cysts, tumors and other lesions of the neck. According to this grouping the aetiological factors are also discussed (congenital lesions: mainly cysts, lesions of the salivary glands and the parotid gland, thyroid and parathyroid diseases, vascular lesions). The diagnostic value of ultrasonography is calculated in view of the morphological signs of a given lesion. The specificity, sensitivity and the accuracy of ultrasonography in our material supports the view that in the differential diagnostics of neck masses ultrasonography is a useful, simple and effective tool.

Liquid crystal thermography of the thyroid.

The results of 102 thyroid liquid crystal thermography (LCT) examinations are discussed. Clinical and laboratory examination, scintigraphy, ultrasonography and LCT were performed in all of the cases. LCT is not suitable for obtaining morphological data and not accurate enough in evaluating thyroid function, but it is a good additional study. It is inexpensive, not hazardous and fast, and can be the first examination in an endocrine outpatient clinic as well as in the follow up of patients with thyroid disease.

[Significance and value of ultrasonography in the study of thyroid diseases]. / Stellung und Wert der Ultrasonographie bei der Untersuchung von Schilddrüsenkrankheiten.

Two hundred-fifty ultrasonic examinations of the thyroid gland were performed in 213 patients within a 2-year period. The size and the structure of the thyroid can be determined by sonography. Ultrasound proved to be of primary importance in the diagnosis of thyroid cysts and provides additional information in other thyroid diseases. Aspiration for cytological examination can be more effective with sonographic guidance. Changes during treatment can also be followed up without discontinuing the suppressive treatment.

Determination of euthyroid thyroid mass.

Proposals have been made for modification of different formulas used to determine the thyroid weight, by which the 'most probable' value of the normal thyroid mass can be determined. With the help of this method, thyroid masses of euthyroid individuals located in Budapest and its surroundings were determined using a combined scintigraphic and ultrasound method. As an average of 103 cases, the 'most probable' value of normal thyroid mass of the population is 20.9 g (range 15.1-38.8 g).