Intrasellar or pituitary abscess

✓ Two patients, each of whom had an isolated intrasellar (pituitary) abscess, are described. A short survey is given of recorded cases.

Nyctohemeral growth hormone levels in children with growth retardation and inflammatory bowel disease

Short stature is a common complication of inflammatory bowel disease. Recently McCaffery, Nasr, Lawrence, and Kirsner (1970) concluded, from blood growth hormone (GH) levels obtained during insulin-hypoglycaemic provocation, that GH deficiency contributed to the retardation in growth observed in subjects with inflammatory bowel disease. Although it was not possible to eliminate the possibility of partial hypopituitarism, this study does not confirm the existence of GH deficiency in six subjects with short stature complicating inflammatory bowel disease. The nyctohemeral (night and day) serum GH is described, and the insulin and glucose levels in these subjects and normal sleep-related GH rises in all are demonstrated. This finding is not compatible with growth hormone deficiency. In one subject the response to arginine provocation was blunted. Three subjects manifested hyperinsulinism and evidence for ;insulin resistance'. These findings are unexplained but suggest that insulin resistance may contribute to a blunted GH response to insulin-induced hypoglycaemia. Blunted GH response to both arginine and insulin-induced hypoglycaemia may also result from continuous secretion and reduced pituitary storage of growth hormone. This possibility is suggested by the pattern of raised blood GH levels in one of the subjects.

Studies on the activity of the pituitary-gonadal axis in the XYY syndrome

Results are presented of pituitary gonadotrophic and testicular steroid hormone assays carried out on 11 phenotypic males with a 47, XYY karyotype. These results are compared with those from a control group of normal ambulant males and a group of patients with a 46, XY karyotype who were detained in a maximum security hospital.

Disorders of growth hormone and corticotropin regulation in patients with empty sella

✓ Endocrine functions in seven cases of primary empty sella were studied. No clinical features of endocrine disturbances were apparent. Urinary excretion of gonadotropins, and thyroid and adrenal functions were normal. Plasma human growth hormone (HGH) concentration was also normal but did not increase after insulin-induced hypoglycemia in four patients, after arginine in one, and after a glucose load in six. Urinary excretion of 17-hydroxycorticosteroids (17-OHCS) increased normally in all patients after metyrapone administration, while plasma 17-OHCS did not increase in three subjects after insulin-induced hypoglycemia or in one after lysine-vasopressin. Two patients showed exaggerated responses to lysine-vasopressin. These results indicate an impairment of the hypothalamic HGH and corticotropin regulation in patients with empty sella. Since in chromophobe adenomas comparable changes were seen, the differential diagnosis between empty sella and chromophobe adenoma is impossible on the basis of endocrinological data alone. The only reliable diagnostic method is accurate radiological study including air contrast tomoencephalography.

Pituitary gonadotrophins and 17-ketosteroids in patients with the XYY syndrome

The urinary excretion of pituitary gonadotrophins and 17-ketosteroids was studied in nine males with karyotype 47,XYY and the serum testosterone in five such patients. We found a comparatively low urinary excretion of pituitary gonadotrophins as well as of dehydroepiandrosterone. The conclusion of the study combined with previous results is, however, that there are no indications of any pronounced abnormality in the urinary excretion of pituitary gonadotrophins or 17-ketosteroids and normal concentrations of serum testosterone in males with the XYY syndrome, in spite of the abnormality of the testis found in a high proportion of such patients.

Urinary gonadotrophins in nine fertile eunuchs

Urinary total hypophyseal gonadotrophins (HG), follicle stimulating hormone (FSH) and luteinizing hormone (LH) were measured by specific bioassays in nine so-called »fertile eunuchs« with an age range of 14–27 years, mean 20.8 years. All the patients but one were extremely eunuchoid with testes of varying size but all larger than infantile testes. The excretion of androgen metabolites was low, those of gonadal origin as revealed by a dexamethasone suppression test (DXM) being extremely low. A biopsy of the testes was performed in 2 cases showing full spermatogenesis in some of the tubules and no mature Leydig cells. Five of the patients had almost normal sperm counts after treatment with testosterone or human chorionic gonadotrophin (HCG). The mean excretion of HG was 6.3 MUU/day but the individual values varied widely (95% limits 0.5–84.9) and of FSH 4.7 IU/day (95% limits 1.6–13.1) which is not significantly different from that of normal men. The mean LH was 2.1 IU/day, the 95% limits being 0.8–5.4 which is significantly lower than that of normal men (t = 5.5, P < 0.0005). Thus LH deficiency appears to be an important feature of the syndrome.

Hypergonadotrophic hypogonadism with anosmia

A 58 year old male with anosmia and primary testicular failure is described. The presence of anosmia did not preclude the secretion of elevated levels of gonadotrophin suggesting that in hypogonadotrophic hypogonadism with anosmia (Kallmann's syndrome) the hypogonadotrophism is not the result of anosmia alone, but that other, probably hypothalamic, factors are involved. The patient described phenotypically resembled Klinefelter's syndrome, but no chromosomal abnormality was detected. To our knowledge, hypergonadotrophic hypogonadism associated with anosmia has not previously been reported, and thus may represent a heretofore unrecognized clinical entity.

The effect of clomiphene on urinary gonadotrophins in infertile men

In order to study the effect on urinary hypophyseal gonadotrophins as measured by specific bioassays, 19 infertile men aged 26 to 47 years, average 30.8, were treated with clomiphene citrate (Clomivid®) 50 mg daily for 30 days. During the last 8 days of treatment 24 hour urine samples were collected daily for the determination of total hypophyseal gonadotrophins (HG), follicle stimulating hormone (FSH) and luteinizing hormone (LH). HG, FSH and LH rose equally to an average of 3 times the control values, the increase being highly significant statistically (P < 0.001). The most pronounced increase was observed in the cases with the lowest control values. Only one patient failed to respond. No side effects due to the drug were observed.

The occurrence of the syndrome of anorexia nervosa in male subjects

A syndrome characterized by the psychopathological features of anorexia nervosa occurs in male subjects. There have been 25 cases previously reported in the literature which appear to be fairly typical of the condition and the present paper adds the case histories of another six patients. Endocrine investigation on these patients reveals a disorder of urinary excretion levels of testosterone and of total gonadotrophic activity, which is comparable to the disturbance of sex hormones that accompanies the menstrual disturbance of female patients with anorexia nervosa. The exact nature of the endocrine disturbance in the male, however, is still less well understood than that in the female.