[Results of chemotherapy in thyroid cancer]

Doxorubicin chemotherapy was performed in 52 patients with thyroid malignancies. Data from 47 patients could be evaluated. 16 remissions and partial remissions were seen, 15 cases had a progressive course, and in 16 patients there was no change of tumour size during the period of treatment. Results of treatment were worse in locally invasive tumour growth and reduced general state of health as well as in anaplastic carcinomas. Results were best in follicular and C-cell carcinomas. The mean survival time of patients responding to treatment was longer than in non-responders. The main indication for treatment is alleviation of tumour symptoms (bone pain, threatening fractures, pressure due to tumour); further indications are anaplastic carcinomas because of their bad prognosis and C-cell carcinomas because of their comparatively satisfactory response.

Thyroid function after bronchography with propyliodone

Thyroid function was studied in 27 subjects who underwent bronchography with propyliodone (18-70 ml, containing 30% of organic iodine). Sustained elevations of serum non-hormonal iodine were observed, indicating that significant amounts of propyliodone were absorbed from the bronchial tree and also that elimination may take several weeks. During the period of anaesthesia, there was an increase in thyroxine-binding globulin and all thyroid hormones which was transient and probably reflected vascular response to the anaesthetic. T4-T3 conversion was inhibited with a nadir of T3 and a peak of rT3 occurring on the 2nd day after propyliodone exposure. FT4 increased gradually during the 2 weeks after bronchography, but remained within the normal range. 6 out of the 27 patients developed pathologic T4 levels, 3 elevated T3 levels, and 2 an abnormal response to thyrotropin-releasing hormone; these changes might have been confused with hyperthyroidism. None of the patients developed clinical thyrotoxicosis; however, in patients with autonomous thyroid tissue, the same precautions should be taken with propyliodone as with other iodine-containing agents which are known to induce hyperthyroidism in this situation.

[Diagnostic value of FT4 concentration and T4/TBG radio--better discrimination with FT4 in marked TBG anomalies]

In 211 consecutive patients T4/TBG ratio correlated well with direct FT4 determination over a wide range of TBG concentration. However, there was a tendency to decreasing T4/TBG ratios with an increase of TBG concentration, which in consequence did lead to false results in three patients with very high TBG concentrations. Direct FT4 determination, which is not influenced by the binding protein levels, therefore is superior to T4/TBG ratio in patients with very low or high TBG concentrations.

[The Houssay phenomenon in man (author's transl)]

Marked insulin sensitivity, accompanied by unusual hypoglycaemic symptoms, was observed in three patients with juvenile diabetes mellitus. All three had anterior hypopituitarism, developing post-partum in two, a craniopharyngioma being the cause in the third. These are thus three examples of the Houssay phenomenon of which only 37 cases have previously been described.

[Pharmacokinetics of prednisolone in adrenal insufficiency ]

Prednisolone was measured in serum and urine after oral and intravenous administration of prednisone and prednisolone in 16 patients with adrenal insufficiency and after bilateral adrenalectomy. Thus, the problem of cross-reactivity with endogenous steroids, the main factor disturbing the measurement of prednisolone, was completely eliminated. Prednisolone was detected by a simple competitive protein-binding radioassay. Distribution, elimination and other bioavailability parameters were calculated from the obtained data. No significant differences between serum levels were detected after oral administration of these drugs. Peak levels were reached after 2-3 h. After 5, 7.5 and 10 mg prednisone peak serum levels averaged 11.9 +/- 2.2, 15.9+/-3.4 and 21.5+/-5.9 microgram/dl, respectively. Prednisolone was still detectable 24 h after administration of 10 mg. The plasma half-time of approximately 5 1/2 h suggests that prednisolone is present in serum far about 2 days after application of higher doses. Since prednisolone interferes in most assays for cortisol, prednisone therapie has to be stopped at least 2 days before cortisol determinations. Urinary excretion was proportional to the applicated doses. The metabolic clearance rate of prednisolone was decreased (56.0+/-7.2 1/24 h/m2) in patients with adrenal insufficiency. This can be attributed to alterations in corticosteroid metabolism, probably due to an increased transcortin production.

[Late manifestations of glycogenosis 1 in early adulthood]

Mild forms of glucose-6-phosphatase deficiency (glycogenosis type I) may remain undetected till indirect consequences of the metabolic bloc clarify the diagnosis in early adulthood. Since humoral regulation could play a decisive role in the metabolic adaption to hypoglycemia, caused by the enzyme deficiency, we studied insulin-, glucocorticoid-, catecholamine-and somatotropin-secretion in a 27 year old man with a mild glycogenosis type I. Basal and stimulated insulin release was decreased, the glucocorticoid secretion lay in the lowest part of the normal range, whereas catecholamine and somatotropin secretion showed no significant change. Thus, the humoral adaption in glucose-6-phosphatase deficiency corresponds to the hormonal regulation in prolonged starvation.

Diagnostische Wertigkeit von FT4-Konzentration und T/TBG-Quotient - Bessere Trennschärfe des FT4 bei ausgeprägten TBG-Anomalien

Bei 211 konsekutiv untersuchten Patienten erlaubte der T/TBG-Quotient über einen weiten Bereich derTBG-Konzen-tration eine zutreffende und mit der direkten Bestimmung des FT4 gut übereinstimmende Beurteilung der Schilddrüsenfunktion. Mit steigender TBG-Konzentration tendiert der T/TBG-Quotient jedoch zu niedrigeren Werten, was bei drei Patienten mit hohem TBG-Spiegel zu einer falschen Zuordnung führte. Die direkte Bestimmung des FT4, die von der Bindungsproteinkonzentration unabhängig ist, bietet deshalb bei ausgeprägten TBG-Anomalien gegenüber dem T4/ TBG-Quotienten Vorteile.

[Late manifestation of glycogenosis I in early adulthood]

Mild forms of glucose-6-phosphatase deficiency (glycogenosis type I) may remain undetected till indirect consequences of the metabolic bloc clarify the diagnosis in early adulthood. Since humoral regulation could play a decisive role in the metabolic adaption to hypoglycemia, caused by the enzyme deficiency, we studied insulin-, glucocorticoid-, catecholamine- and somatotropin-secretion in a 27 year old man with a mild glycogenosis type I. Basal and simulated insulin release was decreased, the glucocorticoid secretion lay in the lowest part of the normal range, whereas catecholamine and somatotropin secretion showed no significant change. Thus, the humoral adaption in glucose-6-phosphate deficiency corresponds to the hormonal regulation in prolonged starvation.

Iodine, thyroxine (T4), triiodothyronine (T3), 3,3',5'-triiodothyronine (rT3), 3,3'-diiodothyronine (T2) in normal human thyroids. Effect of excessive iodine exposure

20 Normal glands obtained from euthyroid subjects at autopsy were analysed for total iodine (Tl), PBl, L-thyroxine (T4), 3,3',5-triiodothyronine (T3), 3,3',5'-triiodothyronine (rT3), 3,3'-diiodothyronine (T2) after pronase hydrolysis. The mean Tl was 325.1+-47.2 micrograms/g wet tissue, giving a total iodine per gland of 10.01 mg. Pretreatment of iodine containing X-ray drugs in 8 patients did not significantly affect these results with the exception of Lipiodol. The mean T4, T3 and T2 values were 93.0+-23.1 micrograms/g, 5.25+-0.99 micrograms/g, 5.54+-1.05 micrograms/g and 0.60+-1.19 micrograms/g, respectively. In contrast to goitrous tissue, normal thyroid tissue showed no dependence of the T4/T3 ratio on the Tl. Compared with goitrous tissue PBI consisted of much more T4-l in normal tissue. The corresponding values were 47.7+-11.8% and 12.7+-3.4%, respectively. A positive relationship was found between Tl and T4, T3, rT3 but not with T2. The rT3 concentration corresponds to that of T3 in a remarkable way. The ratios of T3 or rT3 were similar, suggesting that thyroidal T3 and rT3 production is a random process. T2 represents only 0.73% of T4-l. Our results in normal thyroid tissue clearly show that the difference in iodine concentrations is only one factor among others in comparison to goitrous tissue.

Basal ganglia calcification in pseudohypoparathyroidism type II

The case history of a patient with basal ganglia calcifications found by computerised tomography is presented. Calcium and phosphorus metabolism showed a pattern suggesting lack of parathyroid hormone (PTH). Further studies revealed increased endogenous PTH levels and urinary cAMP excretion. However, endogenous and exogenous PTH could not elicit the cAMP-mediated phosphaturic response, indicating pseudohypoparathyroidism type II. The responses of prolactin to TRH and chlorpromazine was impaired. Basal ganglia calcification in pseudohypoparathyroidism type II may represent the only somatic abnormality in this disease apart from the biochemical abnormalities.

The metabolic serum clearance of GnRH. Relationship to age, sex and male puberty

The MCR of constantly infused synthetic GnRH (1.53 micrograms/min) was studied in relation to age, sex, and male sexual maturation. GnRH was determined by a radioimmunoassay using a specific GnRH antiserum and 125I-GnRH, prepared by the chloramine T technique and purified on Sephadex G 25. Serum LH and FSH were measured by RIA. The results (mean values +/- SEM) of MCR expressed here as ml/min/1.86 m2 showed a statistically significant difference: infants (6-13 yrs) 1170 +/- 79, sexually mature males (22-29 yrs) 639 +/- 28, elderly men (64-79 yrs) 520 +/- 38, sexually mature females (20-24 yrs) follicular phases: 1354 +/- 90, luteal phases: 1736 +/- 242, postmenopausal women (53-74 yrs) 598 +/- 45. We found a linear negative correlation between serum LH and MCR of GnRH in both sexes. During male puberty the MCRLH-RH decreased simultaneously to the stages of pubic hair development.

IN CONCLUSION

1) The MCR of GnRH is a function of age, sex, and sexual maturation, 2) its negative linear correlation with LH in both sexes indicates that the MCR presumably reflects endogenous GnRH levels, 3) the MCRGnRH seem to be subject to endocrine regulation.

Effects of a single high oral dose of thyroxine on the pituitary-thyroid-axis

Ten euthyroid and 9 hypothyroid volunteers were orally administered 2 mg L-thyroxine (T4) to study the interaction between substitutive and suppressive effects of a single high T4 dose. After a significant rise the serum T4 concentration for 5 days in euthyroid and for 11 days in hypothyroid patients an inhibition of basal and of TRH stimulated TSH release was observed. Maximal inhibition of the TSH response in hypothyroid patients occurred 1 to 7 days after the individual T4 peak. This interval was significantly correlated to the extent of the respective T4 rise. In euthyroid subjects TSH response was significantly inhibited for 8, in hypothyroid patients for 22 days. In all but 3 of the euthyroid patients there was a significant inhibition of the thyroidal 132I uptake on day 8. Normalization of thyroidal 132I uptake and of pituitary TSH secretion generally coincided.

[Determination of progesterone in urine by a competitive protein binding method (author's transl)]

A new method, based on the principle of competitive protein binding, is described for the determination of progesterone in urine. The sensitivity of the assay for progesterone is 0.24 micrograms/l urine. The within-assay precision, as determined by the coefficient of variation, varies between 4 and 10%, the between assay precision between 9.2 and 17%. The recovery of progesterone is 104.3%. The average urinary progesterone excretion in normal men is 0.12 +/- 0.10 micrograms/g creatinine. In the follicular phase of 17 normal women the urinary progesterone excretion is 1.4 +/- 1.1 micrograms/g creatinine, in the luteal phase 7.7 +/- 4.6 micrograms/g creatinine. In normal pregnancy the urinary progesterone excretion rises significantly (y = -11.1 +/- 1.1 x, r = 0.66, n = 175, p < 0.001) from 1.5 to 25.7 micrograms/g creatinine.