[Comparison of MR and CT in a radiological study of Cushing's syndrome. A report on 16 cases]

In 16 patients with high cortisol plasma levels MRI and CT investigation of adrenal gland region was performed; 13 also had the pituitary region examined. CT and MRI results in Cushing's Syndrome due to adrenal glands etiology (8 cases) are overlapping. The morphological criteria utilized consist in the radiological finding of bilateral adrenal hyperplasia or adrenal mass (adenoma, carcinoma). The great amount of retroperitoneal fat increases the normal contrast with both techniques. In the pituitary Cushing's Syndrome MRI was more sensible than CT as far as it concerns ACTH producing pituitary lesion assessment; this technique may show 5 mm diameter adenomas for their high signal intensity.

Is magnetic resonance imaging more sensitive than computed tomography in the location of corticotropin secreting pituitary adenomas?

Two cases of pituitary-dependent Cushing's syndrome are described in which the computed tomography (CT) examination was negative; as the hormone dynamic investigations were directed towards the presence of corticotropin (ACTH) secreting pituitary formations, magnetic resonance imaging (MRI) of the pituitary was performed, which evidenced the presence of such lesions; subsequent neurosurgery confirmed in both cases the location indicated by MRI. In conclusion, the higher sensitivity of MRI compared to CT in the diagnosis of ACTH secreting pituitary adenomas can be noted.

[Clinical problems of osteoporosis]

In this paper we summarize the main problems connected with the diagnosis of primary osteoporosis, after evidencing the remarkable social importance of the disease, linked to the great increase of aged population; finally the pathogenetic hypotheses more documented are described. From a diagnostic point of view common laboratory investigations are not mostly able to provide sufficient significant informations; recently the dosage of osteocalcin as index of osteoblastic activity and as marker of bone turnover has been suggested. Mainly traditional radiology does not provide sufficient information about the real demineralization rate, while the radiogrammometry can offer sufficiently reliable indications about bone mineral content. Of a greater diagnostic meaning can be considered the bone mineral absorptiometry and in particular the double photonic ray absorptiometry, effected at the level of lumbar spine, that is to say a side earlier affected by the osteoporotic process. With this methodology we are able to obtain precise information about the quantity of the bone mineral content, identifying, at an earlier stage, the patients at risk of osteoporosis.

[Osteoporosis: a new social disease?]

Main epidemiological studies about osteoporosis are described: the availability of sophisticated techniques as double photon absorptiometry permits to establish that in U.S.A. there is at least 1.2 million osteoporosis fractures each year, mainly at trabecular level and in postmenopausal women. Moreover the hip fractures induce a significant reduction in life expectancy (between 12% and 20%) with very important social costs. In Italy some recent data documented that the social costs in relation to osteoporosis fractures can be evaluated in 1983 between 80 and 153 milliard liras. Some data about annual bone density decrement in normal population are reported: 0.38%/year in females and 0.22%/year in males. Moreover the theoretical fracture threshold, defined as B.M.D. level 2.5 SD under the mean value founded in young age, was evaluated (0.67 gHA/cm2). Finally in 15% of our patients with more than 65 years almost one vertebral fracture was found.

[Recent diagnostic and therapeutic findings on postmenopausal and senile osteoporosis]

The incidence of osteoporosis in the West is considerable and its complications are such as to make it a common and disabling problem. Recent developments in the classification, pathogenesis and diagnosis of the disease are reported. Certain laboratory techniques have recently been developed that can provide adequate information about the degree of demineralisation present. Furthermore the accurate in vivo assessment of bone density is made possible by the development of double beam photon osteodensitometry that measures bone mineral content (BMC) with sensitivity and accuracy. On the treatment side, the various drugs available are reviewed with particular reference to estrogen, vitamin D, anabolisers (recently reassessed in radiogrammometric and densitometric studies) fluorides and calcitonin. Finally certain treatment protocols for post-menopausal and senile osteoporosis are proposed that should produce good results in a reasonably short space of time.

[Ultrasonic evaluation of primary hyperparathyroidism]

The authors evaluated the diagnostic reliability of echotomography in detecting parathyroid masses: 37 patients were studied with primary hyperparathyroidism, in four cases recurrent. They all underwent surgical ablation of the mass, identification of all glands, and biopsy of an apparently normal parathyroid. Echotomography was accurate in 91.4% of cases: it identified 27 out of 39 pathological glands (sensibility 69.2%) and gave no false-positive results (specificity 100%). Since parathyroid is often ectopic, oblique scans are suggested, i.e. of jugulum while the patient is swallowing. Such scans were always used in our study, in order to identify lesions even in case of "difficult" locations, such as the superior mediastinum.

Vertebral bone density in non-amenorrhoeic hyperprolactinaemic women

Recently, a decrease in bone mineral content (BMC) in hyperprolactinaemic women with long-lasting amenorrhoea has been reported, and attributed either to a direct effect of PRL on bone or secondary to the oestrogen deficiency. To verify if PRL by itself has a direct effect on bone, we have studied BMC at the lumbar level by double-photon absorptiometry in 22 patients with hyperprolactinaemia, selected on the basis of normal or near-normal oestradiol levels. The results were compared with those obtained in 28 healthy closely-matched women, and seven hyperprolactinaemic patients with long-lasting amenorrhoea and oestrogen deficiency. No significant difference in BMC was observed between hyperprolactinaemic patients with normal oestrogen levels (mean +/- SEM = 3.87 +/- 0.10 gHA/cm) and normal subjects (mean +/- SEM = 3.76 +/- 0.10 gHA/cm). Moreover, no significant change was observed during a 6 month follow-up in 13 patients. On the other hand, a significant difference (P less than 0.05) was detected in BMC between the hyperprolactinaemic patients with normal oestradiol levels and those with long-lasting amenorrhoea and oestrogen deficiency (mean +/- SEM = 3.39 +/- 0.18). These results suggest that hyperprolactinaemia by itself is not a risk factor for the development of osteoporosis.

Effect of naloxone on gonadotropin secretion before and after testosterone in Klinefelter's syndrome

A study was performed on eight subjects with Klinefelter's syndrome to assess the relation between gonadal hormones and opioid inhibition of gonadotropin secretion through comparison of their gonadotropin response to naloxone (NAL) (0.3 mg/kg; 1/3 bolus iv. at time 0 and 2/3 iv. for 120 min) before and after testosterone propionate (TP) 100 mg/day im. for 5 days. Under basal conditions, NAL failed to induce a significant change in LH levels. After TP, however, despite unchanged basal LH levels (mean +/- S.E.M.: 27.0 +/- 3.4 vs 21.2 +/- 3.21 microU/ml), LH significantly increased in response to NAL. FSH did not respond to NAL either before or after TP administration, though FSH levels were significantly reduced by TP. These findings suggest that in man, as in animals, gonadal hormones regulate opioid inhibition of LH secretion. The negative feedback of testosterone and its ability to activate opioid inhibiting tone may be dissociated, in keeping with the view that gonadal hormones control gonadotropin secretion through the activation of distinct, albeit concomitant, mechanisms.

Effects of naloxone on the insulin and GH responses to alpha-adrenergic stimulation with clonidine

To find if endorphins can influence hormonal responses mediated by noradrenergic pathways, we examined the effects of naloxone, an opiate receptor blocker, on the GH and insulin responses to clonidine, a drug which acts by stimulation of alpha-adrenergic receptors. Intravenous clonidine (0.15 mg in 10 min) induced a significant fall of plasma insulin and a marked increase of plasma GH. Intravenous naloxone (bolus of 1.6 mg followed by 50 micrograms/min) did not change the insulin response to clonidine, and seemed to induce only a slight delay in the GH response.

Plasma levels of testosterone, LH and FSH after prostatic adenomectomy

Changes in blood testosterone, LH and FSH induced by the surgical management of BPH were studied. It is felt that the observation of depressed testosterone and enhanced LH mean levels one year after surgery, substantiates a previously advanced personal view that hyperplastic nodules are heavy consumers of testosterone.

[Determination of LH and FSH levels before and after prostatic adenomectomy (author's transl)]

Plasma testosterone, LH, and FSH levels were measured in 29 patients with adenoma of the prostate, before and after adenomectomy. Blood testosterone levels showed significant variations which were probably related to operation stress, as after a moderate reduction--they returned to pre-operative levels. No significant modifications in plasma LH or FSH levels were observed.

[Use of releasing hormones in endocrinological diagnosis]

The identification and synthesis of thyrotrophin-releasing hormone (TRH) and luteinising hormone releasing hormone (LHRH) has widened our knowledge of hypothalamo-hypophyseal-thyroid and hypothalamo-hypophyseal-gonad diseases. More precisely, administration of these two releasing factors, by permitting the evaluation of pituitary TSH, LH, and FSH reserves, reveals otherwise undefinable changes in hypophyseal function. An account of the manner of execution and measurement, the administration route, and side-effects related to TRH and LHRH tests is followed by a description of the main diseases in which they offer the greatest degree of diagnostic assistance.

[A case of primary hyperparathyroidism sustained by parathyroid adenocarcinomatosis]

Primary hyperparathyroidism may at times be associated with carcinoma of the parathyroids. A personal case of primary hyperparathyroidism was operated on by total thyro-parathyroidectomy. The histological picture presented atypical cell patterns and infiltrations of the thyroid capsule, together with adenomatuous parathyroid formations suggesting the possibility of a malignant transformation of initially benign process. Given the benign clinical course, it is possible that when subjected to radical, timely measures, even atypical parathyroid processes may be cured completely.

[Hyperparathyroidism in pregnancy]

A case of adenoma-based hyperparathyroidism operated at the 4th month of pregnancy (third reported case) is described. The clinical picture was extremely flimsy and diagnosis was formulated exclusively on the observation of the characteristic alterations in the calcium-phosphorus metabolism. The validity of examining renal phosphate excretion for the diagnosis of hyperparathyroidism is considered and proposed evaluation indices (P.E.I. of Nordin and Fraser; I.P.E. OF Nordin and Bulusu) are discussed. The gravity of foetal prognosis in hyperparathyroid women is sufficient justification for surgery during pregnancy.