[Hysterotomy and focal ectomy of malignant trophoblastic tumor]

Hysterotomy and focal ectomy were performed on 25 patients with malignant trophoblastic tumor during 1979-1991, owing to the patients and their husbands desiring strongly to have reproductive function preserved. Each of the foci of malignant trophoblastic tumor was found to be single nodule with 1-4 cm in diameter and located within the myometrium. The incision of uterus was sutured interuptly with "2-0" catgut. The pregnant rate was 80% among the patients who had received this surgical therapy. The results showed that hysterotomy and focal ectomy were an effective management for some patients without children.

Restoration of gallbladder contractility after withdrawal of long-term octreotide therapy in acromegalic patients

We sought to examine how the discontinuation of octreotide in long-term octreotide-treated acromegalic patients affects the well-documented side-effect of cholelithiasis. In 14 acromegalic patients, serum growth hormone levels, insulin-like growth factor I levels and percentage of relative gallbladder contractility were measured prior to and after the discontinuation of octreotide. Compared to pretreatment values, the basal growth hormone and 5-h growth hormone profiles were 36% and 24%, and 60% and 56% at the end of 1 and 2 weeks, respectively. Octreotide was found to be eliminated completely from the serum within 3 days after its withdrawal. In all of six patients who did not develop gallstones, the percentage relative gallbladder contractility normalized within 1 week. In eight patients who developed gallstones, four of them had restoration of normal contractility within 2 weeks. Our results show that upon withdrawal of octreotide, gallbladder contractility returns to normal while growth hormone suppression persists for a longer period of time. Therefore, discontinuation of octreotide therapy may allow for the clearance of stagnated bile and hence decrease the incidence of cholelithiasis in acromegalic patients receiving long-term therapy.

CD38- and Leu6-positive cells in dermal lesions of mycosis fungoides

The phenotypes of mononuclear cells in 16 patients with mycosis fungoides (MF) (8 were in tumor stage and 8 in pretumor stage) were tested by ABC immunochemical technique. The results showed that the percentage of CD38 and Leu6(+) cells in tumor stage was higher than that in pretumor stage. CD38 was identified to be a marker of the immature lymphocytes. The change of CD38 might be helpful in staging MF and predicting the prognosis of the disease. In addition, Leu6(+) cells, oval or round in shape and without dendritic processes were found in tumor stage, suggesting that they might be immature lymphoid cells. This feature needs further investigation.

[Changes of the binding capacity of sex hormone binding globulin in patients with hyperthyroidism before and after antithyroid therapy]

We studied the change of the binding capacity of the sex hormone binding globulin (SHBG-BC) and correlated it with the serum level of thyroid hormone and sex hormone in 17 patients (10 males and 7 female) with hyperthyroidism before and during the 16 weeks of antithyroid treatment. The serum TT4, TT3, FT4I level and SHBG-BC were significantly elevated before treatment compared to normal adults. After the treatment with antithyroid drugs, serum SHBG-BC decreased significantly at 2nd weeks in female (from 312.9 +/- 39.6 to 205 +/- 18.6 nmol/L, P < 0.05) and at 8th weeks in male (from 155.7 +/- 18.6 to 109.7 +/- 7.9 nmol/L, P < 0.05). It continued to decrease to normal range (78.6 +/- 7.3 vs 65.0 +/- 24.1 nmol/L, P > 0.05) at 8th weeks in female, but was still higher than normal range (107.4 +/- 7.2 vs 41.5 +/- 10.2 nmol/L, P < 0.001) even at 16th weeks in male. The change of SHBG-BC was significantly positively correlated to the serum concentration of TT4, TT3 and FT4I(P < 0.001). In male patients the serum testosterone (T) level decreased from a high level of 41.9 +/- 6.2 nmol/L before treatment to 25.4 +/- 3.4 nmol/L at 8th weeks (P < 0.05) and to 19.8 +/- 2.8 nmol/L at 16 weeks which was in normal range. The decrease of serum T level was also positively correlated to the changes of SHBG-BC (P < 0.0001). The serum estradiol (E2) level of female patients was in the upper normal range before the antithyroid treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

[Determination of tumor necrosis factor from peripheral blood cells in patients with ovarian cancer]

The production of tumor necrosis factor (TNF) induced by LPS in the peripheral blood mononuclear cells from the patients with malignant and benign ovarian tumors were determined. Decreased production of TNF were observed in the patients with malignant ovarian tumor. In the advanced cases, TNF were lower than that in the early ones, which may indicate the progression of the tumors. These findings suggested that the TNF may be a useful indicator to diagnose the malignant tumors and prognosticate the tumors' developing.

Prospective study of the long-term effects of somatostatin analog (octreotide) on gallbladder function and gallstone formation in Chinese acromegalic patients

This article reports the changes in gallbladder function examined by ultrasonography in 20 Chinese patients with active acromegaly treated with sc injection of the somatostatin analog octreotide in dosages of 300-1500 micrograms/day for a mean of 24.2 +/- 13.9 months. During treatment with octreotide, 17 patients developed sludge, 10 had gallstones, and 1 developed acute cholecystitis requiring surgery. In all of 7 patients examined acutely, gallbladder contractility was inhibited after a single 100-micrograms injection. In 8 patients followed for 24 weeks, gallbladder contractility remained depressed throughout therapy. After withdrawal of octreotide in 10 patients without gallstones, 8 patients assessed had return of normal gallbladder contractility within 1 month. In 8 of the remaining 10 patients who developed gallstones during treatment, gallbladder contractility normalized in 5 patients (3 of whom has disappearance of their stones within 3 weeks), and remained depressed in 3 (2 of whom had stones present at 6 months). Our results suggest that the suppression of gallbladder contractility is the cause of the successive formation of bile sludge, gallstones, and cholecystitis during octreotide therapy in Chinese acromegalic patients. It is therefore very important to follow the changes of gallbladder function during long-term octreotide therapy of acromegalic patients.

[Comprehensive analysis of histological types in 14006 cases of ovarian tumors]

Fourteen thousand and six cases of ovarian tumors were reported by 15 hospitals in Zhejiang and other 5 provinces. Of all the tumors, there were 3,363 cases (24.0%) of malignancy. According to the criteria based on WHO's classification, malignant tumors of the ovary comprised of 1,999 cases (59.4%) of epithelial cancer, 646 cases (19.2%) of germ cell tumors, 273 cases (8.1%) of metastatic tumors, 236 cases (7.0%) of sex cord stromal tumors and 209 cases (6.2%) of other tumors. Mucinous cystadenocarcinoma was found to be the most frequent in borderline epithelial tumors, while serious cystadenocarcinoma to be the most one in malignant epithelial tumors. Dysgerminoma, endodermal sinus tumors and immature teratomas appeared to be similarly frequent in malignant germ cell tumors. The tumors metastasizing from gastroenteric carcinoma was the commonest in metastatic tumors. Compared with reports abroad, the different types of malignant ovarian tumors in China have the different distributive patterns. It is very important to pay attention to prevent and early diagnosis of malignant ovarian cancer.

[Application of serum somatomedin C level to assess the disease activity in patients with acromegaly]

Serum SMC level was measured in acromegalic patients with different disease activity. The serum SMC level of 10 untreated and 15 treated patients with active disease was 30.5 +/- 17.6 and 23.8 +/- 16.3 KU/L respectively. These levels were significantly higher than the value 2.7 +/- 2.8 KU/L in 7 patients during remitting state. The serum SMC level correlated with the basal and the nadir GH level and the area under the GH curve in glucose suppression test. The serum SMC levels in 6 patients with prolactinoma, 10 patients with Grave's disease and 8 patients with renal failure were all in normal range, but in 10 patients with liver cirrhosis it was 0.36 +/- 0.39 KU/L, which was significantly lower than the normal value. We concluded that serum SMC level is a good criterion for assessment of disease activity of acromegaly for it does not require a dynamic test and it does not increase in other diseases.

Prevalence of growth hormone deficiency of children in Beijing

103,753 (male 51,994, female 51,759) primary and middle school students aged 6-15 years in two districts in Beijing city were surveyed from October 1987 to April 1989. The heights of the students were measured. According to the height standard of northern cities in China, 202 students with heights below the 3rd percentile for age were requested for detailed history, physical examination, screening GH test bone age, T4, SGPT, chest X-ray, routine urine test and sex chromatin (in female). If GH less than 10 micrograms/L, two provocative tests (L-dopa or clonidine and insulin hypoglycaemia test) were done. Then the heights of the short students were observed for 1/2-2 years. GHD was diagnosed in 12 cases based on the GH peak levels less than 10 micrograms/L in two provocative tests, whose growth velocity was slower than that for students of the same age and sex. Of these subjects with GHD, total GHD (GH less than 5 micrograms/L) was present in 7 and partial GHD (GH = 5-9.9 micrograms/L) in 5. The 12 GHD students (male 9, female 3) aged 8.9-15.7 years accounted for 1/8,646 in the total surveyed students. The male and female GHD accounted for 1/5,777 and 1/17,253 in the total males and females respectively.

Endothelin stimulates aldosterone secretion in vitro from normal adrenocortical tissue, but not adenoma tissue, in primary aldosteronism

In addition to vasoconstriction, endothelin (ET) has been reported to show various endocrine actions in animals. However, no data have emerged concerning the effect of ET on adrenal function in humans. We, therefore, investigated the effects of ET on aldosterone and cortisol secretion from adrenocortical tissues obtained from normal subjects (n = 6) and patients with primary aldosteronism (n = 5). Adrenal tissue slices were incubated at 37 C for 120 min in modified Krebs-Ringer solution containing glucose and HEPES. ET increased aldosterone secretion from normal adrenocortical tissue in a dose-dependent manner, with an ED50 of 0.036 nmol/L, although the maximum response was small compared with that to angiotensin-II. ET also stimulated aldosterone secretion from tissues adjacent to the adenoma, but not from the adenoma, in patients with primary aldosteronism. The effects of ET on aldosterone secretion were significantly suppressed by calcium channel blockade with nicardipine. ET did not affect cortisol secretion from the adrenal tissues. These results suggest that ET is one of the factors that regulates aldosterone secretion in humans.

Tumors of the heart. An analysis of 79 cases

There were 79 cases of cardiac tumors seen from 1957 to July 1988. 49 (62.0%) of them were benign and 30 (38.0%) malignant. All the 49 benign tumors except 2 were surgically excised and found to be myxoma. Of them, 18 patients were male and 31 female. 85.7% of the tumors were located in the left atrium, 12.2% in the right atrium and 2.0% in the left ventricle. Palpitation, dyspnea, chest oppression, fever, episodes of syncope and hemiplegia, cough, diastolic and systolic murmurs at the apical or tricuspid area were the common symptoms and signs. Atrial fibrillation was found only in 2 cases. Echocardiographic findings were diagnostic while ECG and X-ray findings were nonspecific. Four patients died after operation. Of the 30 cases of malignant tumors, 15 were secondary tumors metastasized mainly from the lung or mediastinal malignancies. Of 11 primary tumor cases (7 males and 4 females), 3 were malignant lymphoma, 2 mesothelioma of pericardium, 2 malignant myxoma, 1 angiosarcoma, 1 leiomyosarcoma, 1 fibrosarcoma and 1 rhabdomyosarcoma. Another 4 cases were not studied histopathologically. The clinical manifestations, ECG and X-ray findings of the 11 primary tumors were nonspecific but echocardiography was helpful to the diagnosis. Six patients were operated on and 1 died during hospitalization.

Effect of small doses of somatostatin analog, octreotide, on gallbladder contractility in normal Chinese adults

The acute effects of single different doses of the somatostatin analog octreotide on the contractility of the gallbladder stimulated by fatty meal were studied in six healthy Chinese volunteers. Gallbladder contraction after a fatty meal was significantly suppressed by octreotide at doses of 50, 25, 12.5, and 5 micrograms. Mean duration of suppression lasted for more than 10 hr at doses of 25 and 50 micrograms, after which the gallbladder contractility was restored at 24 hr in three and four, respectively, of the six subjects. The percentage of relative gallbladder contraction (PRGC) in all subjects receiving 12.5 and 5 micrograms octreotide returned to pretreatment values at 10 hr but had not returned to normal 6 hr after the injection of 5 micrograms octreotide. In summary, octreotide inhibits the contraction of the gallbladder even with a dose as low as 5 micrograms. It appears that it may not be possible to avoid gallbladder dysfunction during long-term octreotide therapy by decreasing the dose. Further studies including modalities to increase the contractility of the gallbladder are recommended.

[Prospective study of functional changes in the gallbladder and formation of gallstones induced by long-term treatment of somatostatin analogue SMS201-995 in patients of active acromegaly]

We reports the result about the changes of function of gallbladder in 17 acromegalic patients after treatment with long-acting somatostatin analogue SMS201-995 for 3-36 months by ultrasonogram. The number of cases developed bile sludges, gallstones, chronic and acute cholecystitis was 14, 8, 10 and 1 respectively during therapy. The contractibility of gallbladder after fatty meal was inhibited in all of the patients during the course of therapy. A bolus injection of SMS201-995 with a dosage of 100 micrograms for acromegalic patients resulted in marked suppression of the contractibility of the gallbladder. Our result indicates that the decreased contractibility of the gallbladder leads to the formation of gallstones during the long-term therapy of SMS201-995. Therefore, it is important to follow the gallbladder carefully in the course of the therapy of SMS201-995.

In vivo administration of monoclonal antibodies to the CD3 T cell receptor complex induces cell death (apoptosis) in immature thymocytes

Some thymocytes, upon activation via the TCR complex in vitro, undergo apoptotic cell death. In this report, we examine the cell death induced in the thymus after administration of anti-CD3 or anti-TCR antibodies. We found that shortly after antibody injection, cortical thymocytes undergo apoptosis as characterized by morphologic changes and DNA fragmentation. Anti-CD3 administration led to depletion of nearly all CD4+CD8+ thymocytes, and approximately 50% of CD4+CD8- thymocytes. This depletion predominantly affected cells bearing low levels of CD3, although some depletion also occurred among cells expressing intermediate and high levels. Administration of an anti-TCR antibody also induced apoptosis, but affected significantly fewer thymocytes than anti-CD3. This effect was probably not due to different binding affinities for the two antibodies, because both antibodies show similar dose response effects in an in vitro model of activation-induced apoptosis. This work demonstrates that findings on activation-induced apoptosis in vitro can be extended to the in vivo situation, and further, that the activation of cortical thymocytes, in situ, results in apoptosis and removal of the activated cells. The possible relationships between this activation-induced cell death in immature thymocytes and the process of negative selection of autoreactive T cells is discussed.

In vivo administration of monoclonal antibodies to the CD3 T cell receptor complex induces cell death (apoptosis) in immature thymocytes

Some thymocytes, upon activation via the TCR complex in vitro, undergo apoptotic cell death. In this report, we examine the cell death induced in the thymus after administration of anti-CD3 or anti-TCR antibodies. We found that shortly after antibody injection, cortical thymocytes undergo apoptosis as characterized by morphologic changes and DNA fragmentation. Anti-CD3 administration led to depletion of nearly all CD4+CD8+ thymocytes, and approximately 50% of CD4+CD8- thymocytes. This depletion predominantly affected cells bearing low levels of CD3, although some depletion also occurred among cells expressing intermediate and high levels. Administration of an anti-TCR antibody also induced apoptosis, but affected significantly fewer thymocytes than anti-CD3. This effect was probably not due to different binding affinities for the two antibodies, because both antibodies show similar dose response effects in an in vitro model of activation-induced apoptosis. This work demonstrates that findings on activation-induced apoptosis in vitro can be extended to the in vivo situation, and further, that the activation of cortical thymocytes, in situ, results in apoptosis and removal of the activated cells. The possible relationships between this activation-induced cell death in immature thymocytes and the process of negative selection of autoreactive T cells is discussed.

High rates of ras codon 61 mutation in thyroid tumors in an iodide-deficient area

Using polymerase chain reaction and sequence-specific oligonucleotide hybridization, the frequency of three ras oncogene mutations (N-ras, Ha-ras, and K-ras) in thyroid tumors (25 adenomas, 16 follicular carcinomas, and 22 papillary carcinomas) was investigated in both iodide-deficient and iodide-sufficient areas. The ras oncogene mutation rate was significantly higher in the iodide-deficient area, being 85 versus 17% in the adenomas, and 50 versus 10% in the follicular carcinomas. No mutations were found in papillary carcinomas. The most common mutation site was Ha-ras codon 61 with Gln----Arg substitution. Two ras mutations at codon 61 (Gln----Lys in N-ras and Gln----Arg in Ha-ras) were found in a microfollicular adenoma specimen from Eastern Hungary. We conclude that dietary iodine may modulate ras oncogene mutations, and that in the iodide-deficient area, ras oncogene activation may play a more important role in the initiation and/or maintenance of follicular tumors. Additional factors are, however, necessary to initiate carcinogenesis.

Antiserum against homologous atrial natriuretic peptide diminishes the natriuretic response during mineralocorticoid escape in rats

To elucidate the physiological role of atrial natriuretic peptide (ANP) in plasma during mineralocorticoid escape, we investigated the effects of passive immunization with ANP-specific antiserum on deoxycorticosterone (DOCA)-treated rats. Sodium was retained in excess of intake during the first day after treatment with DOCA, and sodium balance returned to control values by the second day, whereas the excretion of potassium exceeded the intake during all days after DOCA treatment. These changes in electrolyte balance were associated with a significant increase in plasma levels of ANP. Administration of ANP-specific antiserum significantly impaired the return to normal sodium balance as well as the augmented kaliuresis that were observed on the second day after injection of DOCA. No significant effect was observed on either sodium or potassium balance after the injection of normal rabbit serum. These results suggest that plasma ANP plays an important role in mineralocorticoid escape.

[Comparison of the therapeutic results of bromocriptine treatment of prolactin microadenoma and macroadenoma]

26 infertile women with prolactinomas were treated by bromocriptine, 24 of them (92%) became pregnant. All of 11 cases with microadenoma restored fertility, 13 out of 15 patients with macroadenomas became fertile. The total is 32 pregnancies. 4 of 32 pregnancies developed spontaneous abortion or fetal death in uterus. In all the women with microadenomas and 11 cases with macroadenomas there were no symptom of enlargement of pituitary tumor, 2 patients with macroadenomas developed visual field defect or paralysis of left oculomotor nerves. 22 patients continued bromocriptine medication for 4.6 +/- 3.6 months and in 6 patients took bromocriptine until delivery. No congenital malformation were found, the development and intelligence were normal in their children. 4 women with microadenomas restored menses at postpartum without taking bromocriptine. The other patients still suffered amenorrhea and galactorrhea after delivery. 8 patients breast-feed their infants for 17.9 +/- 9.5 (7-33) months, no harmful effect on prolactinomas was found. Our data suggest: (1) The pregnancy rate in women with prolactinomas treated with bromocriptine was 92%. (2) Women with microprolactinomas who became pregnant appear to have a very low risk for developing complications and women with macroprolactinomas should be followed closely throughout pregnancy for pituitary tumors enlargement. (3) Bromocriptine therapy do not increase the risk of spontaneous abortion in women with prolactinoma and congenital anomalies of their offspring during pregnancy.

Cloning and sequence of the human adrenodoxin reductase gene

Adrenodoxin reductase (ferrodoxin:NADP+ oxidoreductase, EC 1.18.1.2) is a flavoprotein mediating electron transport to all mitochondrial forms of cytochrome P450. We cloned the human adrenodoxin reductase gene and characterized it by restriction endonuclease mapping and DNA sequencing. The entire gene is approximately 12 kilobases long and consists of 12 exons. The first exon encodes the first 26 of the 32 amino acids of the signal peptide, and the second exon encodes the remainder of signal peptide and the apparent FAD binding site. The remaining 10 exons are clustered in a region of only 4.3 kilobases, separated from the first two exons by a large intron of about 5.6 kilobases. Two forms of human adrenodoxin reductase mRNA, differing by the presence or absence of 18 bases in the middle of the sequence, arise from alternate splicing at the 5' end of exon 7. This alternately spliced region is directly adjacent to the NADPH binding site, which is entirely contained in exon 6. The immediate 5' flanking region lacks TATA and CAAT boxes; however, this region is rich in G + C and contains six copies of the sequence GGGCGGG, resembling promoter sequences of "housekeeping" genes. RNase protection experiments show that transcription is initiated from multiple sites in the 5' flanking region, located about 21-91 base pairs upstream from the AUG translational initiation codon.

Treatment of growth hormone deficient patients with recombinant somatropin for 1 year: results of a Chinese multicentre trial

Fifty-nine patients with idiopathic growth hormone deficiency were included in a Chinese multicentre trial of recombinant somatropin, 0.5-0.7 IU/kg/week s.c. given in six or seven divided doses. The height velocity increased from 2.8 +/- 1.0 cm/year to 13.1 +/- 2.5 cm/year during 1 year of treatment, and typical catch-up growth was observed. The increase in height SDS for chronological age was significant, but the increase in height SDS for bone age was not statistically significant. No adverse reactions to the treatment were recorded. Recombinant somatropin was shown to be very effective and safe during the first year of therapy in patients with growth hormone deficiency.

Effect of acute water loading on plasma levels of antidiuretic hormone AVP aldosterone, ANP fractional excretion of sodium and plasma and urine osmolalities in myxedema

We monitored the plasma and urine osmolalities, fractional excretion of sodium, fractional excretion of chloride, plasma levels of antidiuretic hormone (ADH, AVP), aldosterone and atrial natriuretic peptide (ANP) before and after acute water ingestion in 12 patients with overt hypothyroidism. The ability of the patients to dilute and concentrate urine was found impaired and the ability of excretion of water load decreased and delayed. Acute water load test was proved to be effective in evaluating the urinary excreting function for the patients. We hypothesize that inappropriate secretion of anti-diuretic hormone and elevated plasma ANP may be homeostatic factors for abnormal urinary excretion in patients with hypothyroidism.

[Studies on the abnormal response of pituitary somatotropin to dopaminergic drugs in patients with acromegaly]

This article studies the effects of dopaminergic drugs on the pituitary GH secreting adenoma. The secretion of GH was enhanced and suppressed in 6 normal adults and 5 acromegalic patients respectively after intravenous infusion of dopamine and oral ingestion of L-dopa. Simultaneous administration of L-dopa and carbidopa (a drug that inhibits the conversion of L-dopa to dopamine in peripheral tissue) showed no suppressive or stimulatory effect on the secretion of GH in acromegaly. This result indicates that an abnormality in the GH secreting cell may be the cause of the different responses of GH to dopaminergic drugs in acromegaly.

Clinical trial with somatonorm in idiopathic growth hormone deficiency in children

This article reports the efficacy and safety of treatment with Somatonorm in 9 children with idiopathic growth hormone (GH) deficiency in China. The growth velocity increased from 2.6 +/- 0.2 cm/year before treatment to 10.7 +/- 0.5 cm/year at the end of 1-year treatment. The increment of human growth hormone (hGH) level and area under the response curve above the baseline level were larger after one injection of Somatonorm at the dose of 0.1 IU/kg sc than that of 0.17 IU/kg im. Increments of delayed bone age were not significant. There was no correlation between the increase of height growth velocities and the serum Somatomedin-C (SMC) levels during hGH therapy (r = -0.055). Blood sugar levels and blood alkaline phosphatase concentrations increased significantly after therapy. There were no significant side effects. Serum T4 levels of 3 patients dropped below normal after treatment. Serum anti-hGH antibody appeared at 3-12 month in 2 patients, but it did not attenuate the growth velocity.

Clinical and biochemical effects of incremental doses of the long-acting somatostatin analogue SMS 201-995 in ten acromegalic patients

Ten patients (seven women, three men) with active acromegaly, five previously treated and five newly diagnosed, were included in an open-label prospective trial of 3 daily subcutaneous injections of the long-acting somatostatin analogue SMS 201-995 (Sandostatin) at increasing doses in order to obtain maximum growth hormone (GH) suppression. Four patients had received surgery, radiotherapy or bromocriptine. SMS 201-995 doses were increased in a stepwise fashion from 100 micrograms every 8 h (three times daily) to 200, 300 and finally 500 micrograms three times daily at monthly intervals if mean serum GH values failed to decrease to undetectable levels in over 75% of the samples. The optimal dose was maintained for up to 28 months. Significant clinical improvement of headache, soft tissue swelling, facial features, hyperhidrosis and paraesthesia occurred in all patients. Mean 12-h GH levels were significantly suppressed in four patients and fell to normal values in four. Suppression of GH levels was not achieved in two patients. Comparison of the mean interindividual GH values shows that the optimal efficacious dose is 100 micrograms t.i.d. in 7/10 patients. Somatomedin-C (SM-C) was also significantly reduced to below 50% of pretreatment levels in nine patients in whom it was measured. The subsequent increments of SMS 201-995 up to 500 micrograms three times daily did not produce further clinically relevant GH or SM-C suppression. Pituitary tumour shrinkage occurred in five patients. Thyroid function remained normal. Impaired glucose tolerance occurred in four patients. Side-effects (diarrhoea, abdominal discomfort) were mild and transient. Asymptomatic gallstones occurred in three patients on 1500 micrograms/day and one patient on 600 micrograms/day after 6-12 months treatment. This dose-finding study shows that 100 micrograms three times daily SMS 201-995 is an effective therapy for most of the acromegalic patients we treated.