Adrenocortical 11 beta-hydroxylation defect in adult women with postmenarchial onset of symptoms

Four cases in adults of a deficiency in the 11 beta-hydroxylation of corticosteroids were investigated by both basal and dynamic biological studies. Symptoms varied from patient to patient; hirsutism, menstrual disturbance, acne, deepening of the voice, and arterial hypertension appeared post puberty. Basal testing demonstrated elevated levels of plasma androgens. These include delta 4-androstenedione (patients, 3.80-6.43 ng/ml; normal, 1.33 +/- 0.33 ng/ml), urinary 17-ketosteroids (patients, 11.8-16.7 mg/24 h; normal, 5-10 mg/24 h), and urinary dehydroepiandrosterone. The basal tests were often insufficient to show the accumulation of the precursors (especially 17-hydroxyprogesterone) which are often given as evidence for an increase in ACTH stimulation. In studying the levels of the mineralocorticoids, there was shown to be an increased basal level of tetrahydrodeoxycorticosterone (patients, 142-317 microgram/24 h; normal, 60-80 microgram/24 h) which was raised by ACTH stimulation. These results, therefore, confirm the characteristic partial enzyme defect and give evidence for the heterogeneity of this syndrome. Based on the above observations, we believe it is appropriate to rename this condition adult adrenocortical 11 beta-hydroxylation defect rather than late-onset congenital adrenal hyperplasia.

[Malignant tumour of adrenal with feminizing syndrome and primary hyperaldosteronism (author's transl)]

Feminizing tumour of adrenals are rare. Gynecomasty, abdominal tumour are the more frequently observed symptoms. The described case in a 38 years aged man is of special interest because of association with primary hyperaldosteronism. Studies in vivo and in vitro are reported. In vitro studies shown a high 18 hydroxylation biosynthetic activity of tumoral fragment and a great synthesis of polar phenolsteroids with testosterone as precurseurs.

[The effects of acebutolol on endocrine and metabolic reactions induced by acute hypoglycaemia. Study in normal subjects and in insulin-dependent diabetics (author's transl)]

Six normal subjects and six normotensive insulin-dependent diabetics underwent two insulin hypoglycaemia tests after administration for three days of either a placebo or of acebutolol--a cardioselective beta-blocker--at a dose of 400 mg per day. The order in which the tests were performed was decided by random selection. Acebutolol suppressed the tachycardia which occurred as a reaction to hypoglycaemia but did not interfere with other warning symptoms and signs. In both normal subjects and diabetics, acebutolol neither worsened the initial hypoglycaemia nor did it delay a return to normal values. The increase in lactate levels following hypoglycaemia was not reduced by acebutolol but free fatty acid rebound was suppressed. Hormonal responses (glucagon, cortisol, growth hormone) were unaffected by the beta-blocker. If they are confirmed by long term studies, these results would suggest that acebutolol is safer to use than non-cardioselective beta-blockers in the treatment of coronary insufficiency and of hypertension in diabetics exposed to the risk of hypoglycaemia.

Biochemical abnormalities of the human diabetic glomerular basement membrane

Since the biochemical composition of the diabetic glomerular basement membrane is still a controversial area, a study was carried out using kidneys from seven diabetic and seven nondiabetic subjects. In diabetic membranes, the glycine, hydroxylysine, glucose, galactose, and hydroxylysine-linked disaccharide unit content was increased together with a decrease in the half-cystine and sialic acid content. These findings support the view of a biochemical alteration in the human diabetic glomerular basement membrane.

[HbA1c: need of its dosage in diabetics (author's transl)]

HbA1c is the product of a slow, virtually irreversible reaction, occurring continuously throughout the 120 day life-span of the erythrocyte, between HbAo and glucose. It has been shown to represent the time-averaged blood glucose concentration of the preceeding 2 month period, and is independant of day to day fluctuations in the blood glucose concentration. HbA1c therefore acts as a biochemical marker and permits clinicans, by one test, to judge the quality of the diabetic control, in their patients.

Effect of somatostatin on platelet aggregation and plasma factor VIII level in normal man

As impairment in coagulation and platelet function has been reported following acute administration of somatostatin, a reevaluation of the effects of the cyclic and linear form of the peptide was undertaken. In vitro somatostatin had no effect by itself on platelet aggregation and no effect on ADP- or ristocetin-induced aggregation. In vivo ten healthy men infused with cyclic or linear somatostatin (loading dose of 250 microgram and three hour-infusion with 1,500 microgram) and five control subjects were investigated during the infusion and for three hours after the end of the infusion. With this dose, sufficient in man for maintaining plasma growth hormone and insulin at fasting levels under arginine stimulation, no abnormalities in platelet count, in ADP-induced platelet aggregation and in plasma VIII von Willebrand factor, factor VIII procoagulant activity and factor VIII related antigen levels were observed.

Glucagon secretion in diabetic patients with idiopathic haemochromatosis

The aim of the present investigation was to determine in patients with idiopathic haemochromatosis whether diabetes is of the primary type or secondary to pancreatic injury due to iron deposition. For this purpose, plasma glucagon concentrations were determined following arginine infusion or an oral glucose load in eight patients with diabetes and idiopathic haemochromatosis. The enhanced glucagon response to arginine and the nonsuppressibility of glucagon secretion by oral glucose found in these patients were similar to the results found in the same tests performed in our previous series of patients with "idiopathic" diabetes and at variance with those reported by others in patients with chronic pancreatitis.

Effect of somatostatin on plasma C-peptide immunoreactivity in normal man

The effect of somatostatin on plasma C-peptide immunoreactivity was studied in seven normal men following an intravenous 25 g glucose load. No elevation in plasma insulin was observed and similarly no rise in plasma C-peptide immunoreactivity occurred, indicating that somatostatin inhibits glucose-induced C-peptide release as well as insulin release.

Retinopathy and plasma growth hormone levels in idiopathic hemochromatosis with diabetes

In patients with idiopathic hemochromatosis, retinopathy was investigated by ophthalmoscopy and fluorescein angiography and was present in eight out of 23; this prevalence is similar to that reported in patients with diabetes aged between 30 and 60 years at onset of diabetes and with the same duration of the disease; in these eight patients retinopathy was of mild degree, with no impairment of visual acuity, fewer than 10 microaneurysms in each fundus, and no other retinal abnormatic islets directly. These studies confirm that anticholinergic drugs may be useful adjuvants in treating these patients.

[A case of carcinoma of the stomach with calcification (author's transl)]

The authors found only 25 cases of calcified carcinoma of the stomach in the literature. The course in this case was rapidly fatal. Calcification within the tumour infiltrates the gastric wall and has a very characteristic miliary appearance, permitting one to make the diagnosis on a straight X-Ray of the abdomen. The mechanism of precipitation of calcium within certain mucus-secreting carcinomas has not been determined. Various theories are suggested.