Pituitary hormone reserve in the Laurence-Moon-Bardet-Biedl syndrome.

A patient who presented with hypgonadism was found to have classical features of the Laurence-Moon-Bardet-Syndrome. He had oligospermia and low serum testosterone. Basal serum thyroid stimulating hormone (TSH), prolactin (PRL), growth hormone (GH), cortisol, luteinising hormone (LH) and follicle stimulating hormone (FSH) were normal. Stimulation with thyrotropin releasing hormone. (TRH) showed normal pituitary reserve for TSH and PRL. Adequate insulin hypoglycaemia caused a normal rise of GH and cortisol. LH and FSH showed normal peaks after luteinishing hormone releasing hormone (LHRH). These results indicate normal pituitary hormone reserve and hypogonadotrophic hypgonadism secondary to hypothalamic dysfunction.

Pituitary resistance to L-thyroxine after thyroidectomy. A case report.

The clinical and laboratory findings in a 29-year-old Saudi Arabian woman were compatible with a state of resistance to thyroid hormones by the pituitary gland. Symptoms of hypothyroidism, amenorrhoea and secondary infertility developed 10 years after partial thyroidectomy for an euthyroid goitre. Before therapy, serum thyroxine (T4) and thyroid-stimulating hormone (TSH) values were elevated; serum tri-iodothyronine (T3) value was at the upper limit of normal while %T3 resin uptake and serum free T4 level were both normal. Treatment with L-thyroxine 150 micrograms/dl was not effective. After this was increased to 200 micrograms/d, serum T4 value rose, TSH was still elevated and there was improvement in symptomatology, and a return of both menses and fertility.

Hypothyroidism in Zambia.

Nine patients with clinical and laboratory evidence of hypothyroidism are reported on. All had primary hypothyroidism; 8 were females and 1, the only indigenous Zambian in the group, was male. The mean serum thyroxine (T4) level (+/- 2 SD) in the 9 patients before optimal replacement therapy with L-thyroxine was 3,2 +/- 2,8 microgram/dl. In 3 patients on optimal replacement therapy it was 9,3 +/- 1,2 microgram/dl. This difference is statistically significant (P less than 0,01). The mean serum-tri-iodothyronine (T3) level in the 9 patients before optimal replacement therapy was 56,7 +/- 70 ng/dl, while in 4 patients on optimal replacement therapy it was 141 +/- 36 ng/dl. Although all the optimally treated patients had T3 levels within the normal range, this difference was not statistically significant (P greater than 0,1). In 8 patients the mean serum thyroid-stimulating hormone (TSH) level was elevated before optimal replacement therapy (29,1 +/- 33 microU/ml), while in 2 patients on optimal replacement therapy it was 5,6 +/- 1 microU/ml. The difference between these levels was not statistically significant (P greater than 0,1); however, in the 2 patients on optimal replacement therapy the serum TSH level was within the normal range, while in the 1 patient in whom replacement therapy was suboptimal the TSH level was elevated (16,8 microU/ml), indicating undertreatment of the primary hypothyroidism. In spite of the fact that iodine deficiency goitre is endemic in Zambia primary hypothyroidism appears to be very uncommon among indigenous Zambians.

Liver scanning using indium-113m at the University Teaching Hospital, Lusaka, Zambia.

Liver scanning, using the radio-isotope indium-113m (113mIn), can now be routinely performed at the University Teaching Hospital, Lusaka, Zambia. The dose used is 1 - 4 mCi. Liver scans have been performed on 48 subjects, including 10 healthy individuals, 16 patients with histologically proven hepatocellular carcinoma, 11 with clinical and laboratory evidence of portal hypertension and 11 with miscellaneous illnesses. Seven representative scans are illustrated. The procedure is easy, and gives a fairly accurate functional estimate of Kupffer cell mass. In hepatoma, the scan may be either larger than or smaller than normal and reflects more accurately the residual function of the Kupffer cells. In cirrhosis of the liver with portal hypertension, residual Kupffer cell mass is small. Consequently, most of the 113mIn is taken up by the splenic reticuloendothelial system, resulting in a large spleen scan. This technique, although fraught with major limitations, is a useful additional diagnostic tool in the management of chronic liver disease.

Presentation of diabetes mellitus at the University Teaching Hospital, Lusaka.

The mode of presentation of 118 insulin-dependent (IDD) and 187 non insulin-dependent diabetics (NIDD) is outlined. The complications as well as associated diseases are presented. Eighty-six males were insulin-dependent and ninety-eight males were non insulin-dependent. Thirty-two females were insulin-dependent while eighty-nine females were non insulin-dependent. The age range was 14-50 years with a mean of 34.3 years for the insulin-dependent patients while the age range and mean for the non insulin-dependent patients was 30-50 years and 45.7 years respectively. The range for the duration of diabetes mellitus was 0.5-312 months with a mean of 52 months for the insulin-dependent patients while it was 1-228 months and 55 months respectively for the non insulin-dependent patients. In the insulin-dependent group there were 107 Africans, 9 Asians and 2 Europeans while in the non insulin-dependent group there were 143 Africans, 43 Asians and 1 European.

Blood glucose profiles in insulin-dependent Zambian diabetics.

Six male stable insulin dependent diabetics were admitted to the University Teaching Hospital (U.T.H.) to define the insulin regiment that best controls their fasting and 2 hr postprandial blood glucose. Lente and Soluble insulin regiments were evaluated. For this study, blood glucose was estimated in six control subjects and in the six diabetic patients before breakfast lunch and supper and two hours after each of these meals. Each diabetic was allowed three days to stabilise on his usual insulin regimen and for the next three days blood glucose was estimated at the times indicated. Then for the next three days the patient was given the other insulin regimen and then for the last three days and while still on this second regimen blood glucose was estimated at the time indicated. Lente insulin was given as a twice daily dose before breakfast and supper while soluble insulin was administered either as a twice daily dose before breakfast and supper or as a thrice daily dose before breakfast, lunch and supper. The overall control of blood glucose before and two hrs meals was better with soluble insulin regiment than with the Lente insulin regimen.

Serum thyroxine, serum % -- T3 -- binding, and serum T3 in Zambians.

Serum total thyroxine (T4) was measured in clinically euthyroid and clinically hyperthyroid subjects, using the method of competitive protein binding. In 26 euthyroid subjects the mean +/- 1SD was 7.7 +/- 1.8 micrograms/dl and in 17 clinically hyperthyroid subjects, the mean +/- 1SD was 18.1 +/- 3.1 micrograms/dl. This difference is statistically significant. Serum % 125(1) -- T3 binding was measured using the principle of competition for 125(1) -- T3 between the unknown serum and the resin in the assay kit. In 18 clinically euthyroid subjects, the mean +/- 1SD was 112.6 +/- 4.4 % while in 14 clinically hyperthyroid subjects the % 125(1) -- T3 binding had a mean +/- 1SD of 71.4 +/- 11%. The difference is statistically significant. Serum total triiodothyronine was measured by radioimmunoassay. In 31 clinically euthyroid subjects the mean +/- 1SD was 146 +/- 19.8 ng/dl while in 19 clinically hyperthyroid sugjects the mean +/- 1SD was 390 +/- 111 ng/dl. This difference is statistically significant. There was a negative correlation which was not statistically significant between the serum T4 and % T3 binding. The measurements of these thyroid function indices were precise.

Serum thyroxine-binding globulin: determination by competitive ligand-binding assay in thyroid disease and pregnancy.

Serum thyroxine-binding globulin (TBG) concentrations were measured by competitive ligand-binding assay in normal subjects and patients with a variety of abnormalities of thyroid hormone production or TBG production. The mean serum TBG concentration in 73 normal adults was 3.4 +/- 0.6 mg/100 ml. No correlations with age, sex or serum thyroxine (T4) or triiodothyronine (T3) concentrations were found. Serum TBG concentrations were normal in patients with hyperthyroidism. They were significantly elevated in hypothyroid patients, and fell to normal with thyroxine treatment. In pregnant women, serum TBG concentrations were markedly increased, being 7.1 +/- 1.2 (mean +/- SD) mg/100 ml in women in their first trimester, 9.0 +/- 1.0 mg/100 ml in the second trimester and 8.9 +/- 1.6 mg/100 ml in the third trimester. There was a positive correlation between serum TBG concentration and both serum T4 and serum T3 concentrations in pregnant women. Competitive ligand-binding assay is a simple and reliable method for TBG asay and yields results similar to those of electrophoretic saturation techniques.

Lack of T-cell immune abnormalities in peripheral blood lymphocytes in patients with Graves' disease or hypothyroidism.

Lymphocytes capable of forming nonimmune (E) and immune (EAC) rosettes with sheep erythrocytes and lymphocyte reactivity to phytohemagglutinin were determined in normal subjects, in patients with hyperthyroidism due to Graves' disease and in patients with hypothyroidism with and without goiter. Neither patient group differed from the normal subjects either in regard to lymphocyte count, the proportion of thymus dependent (t) lymphocytes forming nonimmune or bone marrow-dependnet (B) lymphocytes forming immune rosettes or lymphocyte reactivity to phytohemagglutinin. These results fail to provide evidence that these disorders are associated with an immune abnormality with increased or abnormal T cells in peripheral blood.