Recovery of ovulatory menstrual cycles under hydrocortisone in two amenorrheic women with isolated corticotropin deficiency

Two amenorrheic women presenting clinical signs of adrenal insufficiency were shown to have isolated corticotropin deficiency (ICD). LH and FSH were normally responsive to GnRH. The occurrence of this disease during the postpartum and the presence of autoantibodies against corticotropic cells in one case may indicate that ICD was a sequela of an autoimmune hypophysitis. The presence of amenorrhea, while the gonadotroph was not damaged, and the reappearance of ovulatory menstrual cycles under the sole effect of hydrocortisone replacement therapy suggest that cortisol deficiency may by itself alter the gonadal function.

Evidence for an increased glycation of IgG in diabetic patients

The levels of non-enzymatically glycated total plasma proteins, albumin and IgG were determined in diabetic and non-diabetic patients using affinity chromatography on boronate-agarose gels. A significant increase in both glycated albumin and IgG, and in total glycated plasma proteins was demonstrated. A good correlation between glycated albumin and glycated hemoglobin was observed, while the correlation between glycated IgG and glycated albumin (or hemoglobin) was lower. This was found probably related to wide variations of glycated IgG for diabetics patients who have high glycated hemoglobin levels. These variations were inversely correlated with total serum IgG. Determination of fructosamine or 5-hydroxymethylfurfural content of IgG showed a significant increase in diabetics. Glycated IgG was found to contain approximately one mole of glucose. The main site of glycation was determined to be present in the Fab (more precisely the Fd) part of the IgG molecule.

Insulin and HDL-cholesterol metabolism

Insulin is essential to the physiological regulation of high density lipoprotein (HDL) cholesterol metabolism. It acts directly at the hepatic level by favouring HDL2 to HDL3 conversion (by its action on hepatic lipase). In the peripheral circulation, it induces HDL2 formation by allowing triglyceride-rich lipoprotein catabolism by lipoprotein lipase (LPL) and free cholesterol esterification by lecithin acyl cholesterol transferase (LCAT). In the case of insulin deficiency or peripheral insulin resistance, there is a reduction of HDL cholesterol related to HDL2 decrease, partly due to LPL deficiency. In the case of endogenous hyperinsulinism, there is an intrahepatic disturbance of HDL metabolism partly related to excessive synthesis of VLDL-TG and leading to the decrease of HDL2/HDL3 and enhanced formation of HDL2 TG. When hepatic hyperinsulinism is associated with peripheral insulin resistance, HDL cholesterol decrease is the consequence of both intrahepatic action of insulin and diminution of its peripheric action. Optimized insulin therapy can normalize HDL cholesterol in case of true insulin deficiency. When there is preservation of insulin secretion, HDL cholesterol remains lower than controls. Insulinopenia as well as hyperinsulinism can favour atherogenic lipoprotein disturbances.

[Mechanisms of diabetic impotence. 25 cases]

Twenty-five impotent diatetics were investigated by means of nocturnal penile tumescence monitoring, hormone determinations, penile blood pressure measurement, artificial erection test and dynamic cavernosography, bulbocavernous reflex latency time measurement and cortical evoked responses from pudendal nerves. Sexological treatment was then attempted for a better evaluation of the psychogenic element. Penile blood pressure was also measured in 15 non-impotent diabetics and was found to be abnormal as often as in impotent diabetics. The results as a whole demonstrated that impotence was predominantly psychogenic in 9 cases, predominantly organic in 12 cases and mixed psychogenic and organic in 4 cases. Diabetic impotence is often due to several causative factors, as was the case in 12 of our patients. The factors most frequently responsible were psychological (present in 13 cases), neurological (present in 12 cases) and vascular factors (arterial abnormalities in 7 cases, "venous leakage" in 4 cases). Endocrine abnormalities were observed in only 2 cases.

Dopamine-secreting pheochromocytoma: an unrecognized entity? Classification of pheochromocytomas according to their type of secretion

A pheochromocytoma that exclusively secretes dopamine (DA) rather than predominantly DA among a blend of catecholamines is as yet unreported. Of the 50 patients with pheochromocytoma who have undergone surgery, 32 underwent treatment within the last 5 years (when DA assay has been available). One half of these patients (15/32) exhibited DA secretion either in mixed catecholamines (12 patients) or exclusively (three patients). All three patients with exclusive DA-secreting tumors were normotensive. Without hypertension, the clinical investigation was a diagnostic challenge (unexplained cough or flank mass with inflammatory features). All three tumors were malignant and two were ectopic. Five of the 12 patients with mixed catecholamine-secreting tumors whose secretions included DA were hypertensive. Five other patients had flank mass and one had an unexplained cough. Tumors were rather large, and three of the tumors with mixed secretion were ectopic. Of the 12 patients, seven had tumors that were judged to be malignant. Three patients exhibited a dramatic decrease in blood pressure under alpha-blockade, which was not used in subsequent cases. Predominant or exclusive secretion of DA would explain the lack of hypertension due to its antiadrenergic action that inhibits the vasoconstrictive effects of other amines. Hypertension in patients with pheochromocytoma might depend on the ratio of DA/noradrenaline + adrenaline.

A kinetic colorimetric assay of gamma-glutamyltransferase

We have explored a kinetic colorimetric method for measuring gamma-glutamyltransferase (EC 2.3.2.2) activity in serum, using L-gamma-glutamyl-3,5-dibromo-4-hydroxyanilide and glycylglycine as donor and acceptor substrates. The released product, 3,5-dibromo-4-hydroxyaniline, reacts with 2,5-dimethylphenol to produce a blue quinone monoimine in the presence of ascorbate oxidase (EC 1.10.3.3). This dye has peak absorption at 610 nm, whereas the donor substrate shows negligible absorption throughout the visible spectrum. The reaction can be run with all the reagents in a single working solution with serum as starter, or with the substrate solution as starting reagent. The sample/reagent volume ratio is 1:24. Adaptation of the method to several automated instruments gave good precision in all cases. Comparison with a method in which L-gamma-glutamyl-3-carboxy-4-nitroanilide is the donor substrate showed good correlation of results (r greater than or equal to 0.987). The dynamic range of the method exceeds the upper limits of the reference intervals for men (9-33 U/L) and women (8-25 U/L) by at least 18-fold.

A kinetic colorimetric assay of gamma-glutamyltransferase

We have explored a kinetic colorimetric method for measuring gamma-glutamyltransferase (EC 2.3.2.2) activity in serum, using L-gamma-glutamyl-3,5-dibromo-4-hydroxyanilide and glycylglycine as donor and acceptor substrates. The released product, 3,5-dibromo-4-hydroxyaniline, reacts with 2,5-dimethylphenol to produce a blue quinone monoimine in the presence of ascorbate oxidase (EC 1.10.3.3). This dye has peak absorption at 610 nm, whereas the donor substrate shows negligible absorption throughout the visible spectrum. The reaction can be run with all the reagents in a single working solution with serum as starter, or with the substrate solution as starting reagent. The sample/reagent volume ratio is 1:24. Adaptation of the method to several automated instruments gave good precision in all cases. Comparison with a method in which L-gamma-glutamyl-3-carboxy-4-nitroanilide is the donor substrate showed good correlation of results (r greater than or equal to 0.987). The dynamic range of the method exceeds the upper limits of the reference intervals for men (9-33 U/L) and women (8-25 U/L) by at least 18-fold.

Clinical and biological phenotypes in late-onset 21-hydroxylase deficiency

We analyzed data from 20 patients with late-onset 21-hydroxylase deficiency (LOHD). Three clinical phenotypes could be distinguished among the 18 women. Seven (39%) presented with clinical features suggesting polycystic ovarian disease (PCOD). However, despite androgen levels similar to those of patients with typical PCOD, high serum LH to FSH ratios were not consistently found. Seven other women (39%) presented with isolated hirsutism, suggesting idiopathic hirsutism. The remaining 4 women (22%) had no manifestations of androgen excess and were considered to have the cryptic form of LOHD. Serum 17-hydroxyprogesterone (17-OHP) and androgen levels were similar in the 3 phenotypes, suggesting that the clinical expression of LOHD in women is modulated by individual factors, such as androgen sensitivity. The 2 men were detected by family study and were clinically normal. Since clinical diagnosis of LOHD is impossible, we concentrated on hormonal data with the aim of providing guidelines for the biological diagnosis of LOHD. Assay of basal serum 17-OHD at 0800 h in both sexes and in the early follicular phase in women was sufficient to establish the diagnosis of LOHD in most patients. If doubtful results are obtained, i.e. serum 17-OHP levels between 2 and 5 ng/ml, an ACTH test must be performed. Post-ACTH serum 17-OHP levels exceeding 10 ng/ml confirm the diagnosis of LOHD. Such results should avoid confusion with heterozygotes for 21-hydroxylase deficiency, whose frequency is high within the general population and may be even higher in patients with idiopathic hirsutism or PCOD.

A double blind controlled study of the hormonal and clinical effects of bromocriptine in the polycystic ovary syndrome

Previous studies on the efficacy of bromocriptine for the treatment of patients with the polycystic ovary syndrome failed to include control groups. This study, therefore, was undertaken to determine the clinical and endocrine effects of bromocriptine and a placebo (given in a random double blind fashion) in 55 patients with PCOS. The plasma levels of estrone, estradiol, testosterone, androstenedione, dehydroepiandrosterone, dehydroepiandrosterone sulfate, 17-hydroxyprogesterone, and serum PRL and gonadotropins (LH and FSH) were measured before treatment. In addition the serum PRL response to TRH and the serum LH and FSH response to GnRH were determined. The effects of acute administration of bromocriptine (2 X 2.5 mg at 12-h intervals) on serum gonadotropins and their response to GnRH were studied to explore the possibility that this test might predict the response to chronic bromocriptine treatment. Bromocriptine then was given at an initial dose of 1.25 mg twice daily. If no clinical improvement occurred 2.5 mg were given twice daily for at least 6 months. Hormonal measurements and dynamic tests were repeated after 3 and 6 months of therapy. The endocrine profile of the two groups was not different before treatment. The clinical results were not better in the treatment group than in the placebo-treated patients: therapy was successful (restoration of ovulatory cycles of less than 35 days duration) in 12 of 28 patients taking bromocriptine vs. 8 of 27 taking placebo. Slight improvement (1 or 2 ovulations) occurred in 3 of 28 vs. 3 of 27, and failure (no clinical change) in 13 of 28 taking bromocriptine vs. 16 of 27 taking placebo, respectively. Serum PRL fell significantly in the bromocriptine group, and there was a significant fall in the serum LH response to GnRH in both groups. No hormonal measurement or response predicted the clinical response to treatment. The only significant effect of chronic bromocriptine therapy (5 mg/day) in patients with the polycystic ovary syndrome was to lower the serum PRL concentration.

Treatment of human hyperprolactinaemia with a new dopamine agonist: CU 32085 (mesulergin)

CU 38085 (mesulergin) was given at doses ranging from 0.5 to 5 mg/day to 37 patients with pathological hyperprolactinaemia of varying aetiology. The effectiveness of this drug on the suppression of hyperprolactinaemia and on the recovery of gonadal functions was equivalent to that of bromocriptine previously given to a different group of 83 hyperprolactinaemic patients. Tumour shrinkage during treatment with CU 32085 was ascertained in two cases of macroprolactinoma. Histological examination after adenomectomy revealed extensive peri-vascular fibrosis in both cases. In most patients, the efficient doses of CU 32085 were 5-fold lower than those of bromocriptine. After acute oral administration in 10 previously untreated patients, 0.5 mg of CU 32085 had a more prolonged suppressive effect on Prl levels than 2.5 mg of bromocriptine (approximately 18 vs 12 h). According to this, 0.5 mg CU 32085 once a day was sufficient to maintain Prl levels within the normal range in 16 patients. Side-effects were similar in nature and frequency to those induced by bromocriptine and seemed to be dose-dependent. They can be avoided by slowly increases of dose at initiation of treatment.

Acute effects of bromocriptine on gonadotropin secretion in polycystic ovary syndrome

Thirty-two women presenting with polycystic ovary syndrome (PCO) were studied on 3 consecutive days. On day 1, plasma androstenedione, testosterone, dehydroepiandrosterone (DHEA), DHEA sulfate (DHEA-S), 17-hydroxyprogesterone (17-OHP), estrone (E1), estradiol, serum prolactin (PRL), and PRL response to thyrotropin-releasing hormone were determined. On day 2 the patients were given two placebos at 1-hour intervals; then serum PRL, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) and the LH and FSH responses to LH-releasing hormone (LH-RH) were determined. On day 3 the patients were given two 2.5-mg tablets of bromocriptine (BRCR) at 12-hour intervals; then serum PRL, LH, and FSH and the LH and FSH responses to LH-RH were again determined. After BRCR, mean values of basal serum PRL (P less than 0.001), LH (P less than 0.05), and FSH (P less than 0.001) and the FSH response to LH-RH (P less than 0.01) fell with respect to the values determined on day 2. Our group of patients was heterogeneous regarding the effects of BRCR upon the LH response to LH-RH. Of 32 women undergoing the trial, 17 did not respond to BRCR (change of the LH response to LH-RH less than 33% with respect to day 2). They were called "nonresponders." Among the 15 who responded to BRCR, 10 decreased their LH response greater than or equal to 33% ("decreasers") and 5 increased their LH response greater than or equal to 33% ("increasers"). Decreasers had mean values of serum PRL, plasma E1, DHEA-S, and 17-OHP higher than nonresponders (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Phosphate determination by enzymatic colorimetric assay

A direct colorimetric assay for inorganic phosphate in serum is described. The system is based on utilization of the enzymes, purine-nucleoside phosphorylase and xanthine oxidase, to generate superoxide ions. The superoxide is measured in the presence of an electron mediator compound with 3-(4',5'-dimethyl-2-thiazolyl)-2,4-diphenyl-2H-tetrazolium bromide as the chromogen. The high absorbance of this chromogen between 550 and 660 nm affords useful results with a sample/reagent volume ratio as low as 1:100. A single working reagent is used, and the reaction is complete in 15 min at room temperature. The standard curve is linear for inorganic phosphate concentrations as high as 4.9 mmol/liter. Analytical recovery of phosphate in human sera averages 100%. Within-run precision study gives CV less than or equal to 1.0%. The results of this method compare closely (r greater than 0.99) with those obtained by the semidine method (recommended standard). The method lends itself to automation.

Hyperprolactinemia and sexual function in men

Male hyperprolactinemia (HPRL) is known to induce different types of sexual dysfunctions. In order to determine the incidence of HPRL among patients referred for sexual dysfunction, serum prolactin (PRL) was assayed in 1053 clinically idiopathic cases. Among 850 cases complaining of erectile impotence, 10 with marked HPRL (1.1%, PRL above 35 ng/ml) were found, of whom 6 cases were associated with a pituitary adenoma. 17 mild HPRL (2%, PRL 20-35 ng/ml) were also found. Among 124 cases with premature ejaculation, 13 (10%) mild HPRL were found. Serum PRL was normal in 51 cases complaining of an ejaculation without orgasm, and 27 patients exclusively complaining of reduced sexual desire. Our results lay stress on the fact that serum PRL must be assayed in every case of clinically idiopathic erectile impotence. Indeed, 5 of the 10 marked HPRL patients would have been misdiagnosed if we had only assayed this hormone when plasma testosterone was below the normal range. Moreover, in order to shed some light on the mechanisms by which HPRL disturbs male sexual function, the sexual behaviour of 17 markedly HPRL males was compared to their serum levels of PRL and testosterone, first before treatment, then at regular intervals during treatment. Our main conclusion is that impotence cannot be totally explained by a decrease in plasma testosterone, because this steroid hormone was within the normal range 7 of the 16 impotent patients. Moreover, when serum PRL was lowered by bromocriptine, 6 patients recovered their potency before plasma testosterone clearly increased, and in 3 of those patients before it reached the normal range.(ABSTRACT TRUNCATED AT 250 WORDS)

Medical treatment of hyperprolactinemia

The current treatment of choice for primary hyperprolactinemia is medical. This is true not only for idiopathic forms, but also for micro- and macroprolactinomas, which are the most frequent causes of this pathology. Although questioned by some authors, the slow evolution of the illness, the rarity of transformation of a microadenoma into a macroadenoma, and the possibility of spontaneous cure cause most authors to favor medical treatment, with which they observe both normalization of gonadal function and tumor regression. By retrospective analysis of 95 hyperprolactinemic patients (72 women and 23 men including 26 cases of suspected microadenoma and 44 macroadenomas) treated with 3 dopamine agonists (bromocriptine, metergoline and CU 32085) between 1975 and 1983, and with the help of large series published in the literature, we have tried to review the present knowledge of this subject. After a quick review of different medications, we will consider their prolactin-suppressing effects, their influences upon gonadal and gonadotropic functions, and their antitumoral action. More specific problems will then be discussed: side effects, resistance, possibility of cure, the evolution of the prolactinoma, the place of medical therapy relative to surgery, and contraception in association with dopaminergics.

Comparative investigations in 26 impotent and 26 nonimpotent diabetic patients

To determine the causes of diabetic impotence the same investigations were performed in 26 impotent and 26 nonimpotent diabetics. The rates of abnormalities found were almost identical in the 2 groups in regard to Doppler examination of the penile arteries, conduction velocities of the median nerves, latency times of the bulbocavernosus reflex and cystometrograms. Conversely, urine flow rates (24 of 25 versus 2 of 26 patients) and Minnesota Multiphasic Personality Inventory (14 of 23 versus 0 of 14 patients) were almost exclusively abnormal in the impotent diabetics. In addition, inadequate sex-specific attitudes were found in 60 per cent of the impotent diabetic men, which was the proportion found in a carefully selected sample of psychogenically impotent nondiabetic men. The distribution of the abnormalities found suggests that in most diabetic patients impotence results from the addition of a subtle abnormality of the autonomic nervous system in almost every case or psychological and arterial factors.

[Hormone levels, celioscopy and ovarian histology in the hirsutism-anovulation syndrome]

Among 50 women with hirsutism, spanio- or amenorrhoea and anovulation, coelioscopy and histological examination of ovarian biopsies showed that 26 had typically polycystic ovaries (PCO), 17 had "borderline ovaries" (BO)--i.e. apparently normal or subnormal but with histological abnormalities identical to those of PCO--and 7 had normal ovaries. The hormonal profiles of BO and PCO were very similar. An increase in LH or in LH response to LHRH, which is regarded as characteristic of polycystic ovarian disease, was only observed in 75% of women with PCO or BO. The PCO and BO detection value of simple basal LH determination was slightly enhanced by the LHRH test, and no further enhancement was observed after repeated LHRH injections. 38% of PCO's and 75% of BO's were associated with adrenal hyperandrogenism, as evidenced by a rise in dehydroepiandrosterone values. Thus, more than one half of hirsute and non-ovulating women have polycystic ovaries. Most of these can be diagnosed by hormonal investigations without having recourse to coelioscopy. However, some do not display, at least permanently, the hormonal profile characteristic of polycystic ovarian disease.

Enzymic creatinine assay: a new colorimetric method based on hydrogen peroxide measurement

We describe a new colorimetric method for measuring creatinine in serum and urine. Creatinine hydrolysis is catalyzed by creatinine amidohydrolase, and the creatine so produced is assayed in reactions catalyzed sequentially by creatine amidinohydrolase and sarcosine oxidase in a system that generates hydrogen peroxide. The hydrogen peroxide is measured at 510 nm in a reaction catalyzed by horseradish peroxidase, with 3,5-dichloro-2-hydroxybenzenesulfonic acid/4-aminophenazone as the chromogen. This series of reactions is complete in 30 min at room temperature. A blank sample measurement corrects for endogenous creatine. The standard curve is linear for creatinine concentrations as great as 2.21 mmol/L. Analytical recovery of creatinine in human sera and urine averaged 99.8%. Within-run and between-run precision studies gave CVs of less than or equal to 3.3 and less than or equal to 4.3% for a serum with a creatinine concentration of 69 mumol/L. Results by this method agree well (r greater than 0.99) with those by both the enzymic ultraviolet method of Wahlefeld and the fuller's earth/Jaffé method.

Enzymic creatinine assay: a new colorimetric method based on hydrogen peroxide measurement

We describe a new colorimetric method for measuring creatinine in serum and urine. Creatinine hydrolysis is catalyzed by creatinine amidohydrolase, and the creatine so produced is assayed in reactions catalyzed sequentially by creatine amidinohydrolase and sarcosine oxidase in a system that generates hydrogen peroxide. The hydrogen peroxide is measured at 510 nm in a reaction catalyzed by horseradish peroxidase, with 3,5-dichloro-2-hydroxybenzenesulfonic acid/4-aminophenazone as the chromogen. This series of reactions is complete in 30 min at room temperature. A blank sample measurement corrects for endogenous creatine. The standard curve is linear for creatinine concentrations as great as 2.21 mmol/L. Analytical recovery of creatinine in human sera and urine averaged 99.8%. Within-run and between-run precision studies gave CVs of less than or equal to 3.3 and less than or equal to 4.3% for a serum with a creatinine concentration of 69 mumol/L. Results by this method agree well (r greater than 0.99) with those by both the enzymic ultraviolet method of Wahlefeld and the fuller's earth/Jaffé method.

[Basal C peptide levels in response to intravenous tolbutamide in the detection of incorrect insulin therapy (or prolonged misuse)]

Fifty nine insulin dependant diabetics were hospitalised for a trial withdrawal of insulin: 17 patients rapidly showed signs of lack of insulin, 18 did not develop cetoacidosis but could not be stabilised on diet and oral hypoglycemic agents, 24 were stabilised without insulin. A statistical study (multifactorial analysis of correlations, plotting of ROC graphs) validated the classification of these diabetics into 3 groups. It also showed that in patients with hypoglycemia, the values of C-protein, and after intravenous injection of tolbutamide, were good predictive factors for insulin-dependance: all patients with basal C-protein less than 1,9 ng/ml could not be stabilised without insulin; when the basal C-protein greater than or equal to 1,9 ng/ml and the amplitude of response at the 5th min was greater than or equal to 0,4 ng/ml, the diabetes could be stabilised by diet and oral hypoglycemic agents in 90 p. 100 of cases. This institutes an easy, reliable and economic method of detecting abusive insulin therapy.

[Insulin and the metabolism of lipoproteins]

In normal individuals, insulin regulates lipoprotein metabolism. It increases hepatic triglycerides (TG) secretion and makes VLDL and chylomicrons post prandial removal easy by stimulating adipose tissue lipoprotein lipase (LPL). Insulin activity and cholesterol rich lipoprotein is more complicated: by its action on VLDL and chylomicrons turn-over, it influences LDL and HDL formation. It regulates cellular cholesterol pool at different levels: stimulation of LDL receptor, but also of HMG CoA reductase. Controlling LCAT, in participates in cholesterol removal by HDL. In insulin dependent diabetes, lack of adipose tissue LPL stimulation augments triglycerid-rich lipoproteins, by slowing their catabolism, resulting in a weak increase of LDL and a lowering of HDL. In non insulin dependent diabetes with hyperinsulinism, VLDL are elevated because of insulin stimulation of triglycerid hepatic production. LDL are increasing. HDL status remains discussed: HDL cholesterol is low but HDL triglycerid is high, there is no known disturbance of apo A level. In the two types of diabetes, although mechanism is different, perturbation of lipoprotein metabolism may account for the atherogenicity of this disorders.

Investigative strategy of hyperandrogenism in women

Investigative procedures in the assessment of female hyperandrogenism are reviewed. Based on their experience, the authors suggest an inexpensive investigative strategy in hyperandrogenic females consisting of the following: the first step depends upon the clinical symptoms--in cases of hirsutism with regular menstrual cycles, plasma testosterone (T) and plasma dehydroepiandrosterone sulfate (DHA-S) are assayed, and the basal body temperature chart is recorded. In cases of hirsutism with irregular or anovulatory menstrual cycles, in addition to T and DHA-S, plasma 17-hydroxyprogesterone and urinary-free cortisol are assayed. In case of anovulation without hirsutism, T and DHA-S are assayed, and the LHRH test is performed. The results of this first investigation allow to attribute to the woman one of the six following hormone profiles: (1) metabolic hyperadrenalism; (2) tumoral hyperandrogenism; (3) 21-hydroxylase defect; (4) nontumoral DHA-S increase; (5) nontumoral ovarian hyperandrogenism; (6) idiopathic hirsutism. The additional investigative procedures required in each of these groups are detailed.

[Blood prolactin in 845 cases of clinically idiopathic sexual dysfunction]

Serum prolactin levels were measured in 845 subjects presenting with clinically idiopathic sexual dysfunction, including impotence, premature or defective ejaculation and frigidity in women. Stimulation tests using thyrotrophin-releasing hormone (TRH) and sulpiride were performed in 80 men. One p. cent of impotent subjects had high serum prolactin levels associated with pituitary adenoma in 4/5 cases; 2.2% of impotent men, 10% of men with premature ejaculation and 5.6% of frigid women had moderate hyperprolactinaemia (50 ng/ml), probably not responsible for the sexual disorder. Mean serum prolactin levels were slightly below normal values (p less than 0.05) in impotent subjects. The results of stimulation tests were normal in all but one case. The mean area under the TRH response curve was moderately reduced in subject with impotence or defective ejaculation (p less than 0,05). The present study suggests that serum prolactin levels should be systematically measured in subjects with sexual impotence.

[Nutrition survey assisted by computer]

Data processing has made data banks available to the nutritionist, enabled rapid conversion of food data, and supplied detailed even commented listings of eating behaviour. Until now, however, use of the computer has remained the privilege of the dietician. A conversational data programme employing a microcomputer has been developed, enabling patients to establish a dialogue with the calculator, with storage of data concerning their food habits. A double food survey was conducted in 93 adult subjects, one of which involved the dieticians from ISTA, and the other the computer. Good correlation was found between the two estimates of calorific rations (r = 0.84, p less than 0.001) and nutriments. Deviations between the two estimates were less than 20 p. cent in the majority (80 p. cent) of cases. Psychological questioning confirmed the good reception reserved for this type of computerized survey, whatever the initial reservations held against data processing. Performances were not altered by the sociocultural level of the persons surveyed. This type of interactive programme should lead to simplification of the food anamesis, thus favorizing the communication and the counselling role of the nutritionist. It can also be of value in the framework of epidemiological surveys or education of nutrition.

Serum triglycerides determined colorimetrically with an enzyme that produces hydrogen peroxide

In this direct colorimetric procedure, serum triglycerides are hydrolyzed by lipase, and the released glycerol is assayed in a reaction catalyzed by glycerol kinase and L-alpha-glycerol-phosphate oxidase in a system that generates hydrogen peroxide. The hydrogen peroxide is monitored in the presence of horseradish peroxidase with 3,5-dichloro-2-hydroxybenzenesulfonic acid/4-aminophenazone as the chromogenic system. The high absorbance of this chromogen system at 510 nm affords useful results with a sample/reagent volume ratio as low as 1:150, and a blank sample measurement is not needed. A single, stable working reagent is used; the reaction is complete in 15 min at room temperature. The standard curve is linear for triglyceride concentrations as great as 13.6 mmol/L. Average analytical recovery of triglycerides in human sera is 100.1%, and within-run and between-run precision studies showed CVs of less than or equal to 1.6 and less than or equal to 3.0%, respectively. The method is suitable for automation.

Serum triglycerides determined colorimetrically with an enzyme that produces hydrogen peroxide

In this direct colorimetric procedure, serum triglycerides are hydrolyzed by lipase, and the released glycerol is assayed in a reaction catalyzed by glycerol kinase and L-alpha-glycerol-phosphate oxidase in a system that generates hydrogen peroxide. The hydrogen peroxide is monitored in the presence of horseradish peroxidase with 3,5-dichloro-2-hydroxybenzenesulfonic acid/4-aminophenazone as the chromogenic system. The high absorbance of this chromogen system at 510 nm affords useful results with a sample/reagent volume ratio as low as 1:150, and a blank sample measurement is not needed. A single, stable working reagent is used; the reaction is complete in 15 min at room temperature. The standard curve is linear for triglyceride concentrations as great as 13.6 mmol/L. Average analytical recovery of triglycerides in human sera is 100.1%, and within-run and between-run precision studies showed CVs of less than or equal to 1.6 and less than or equal to 3.0%, respectively. The method is suitable for automation.

[Dopamine-secreting phaeochromocytoma. A little known clinical and biochemical entity (author's transl)]

The authors have observed a case of phaeochromocytoma revealed by fever and poor general condition without hypertension. Urinary catecholamine assays showed predominant dopamine secretion. Only 13 cases of dopamine-secreting phaeochromocytoma have been published so far, including 4 with clinical symptoms resembling those of this patient. The metabolic and hormonal effects of high plasma dopamine levels were studied, and responses similar to those observed with TRH stimulation by dopamine infusions were obtained: TSH and prolactin responses were inhibited, and GH was increased. This case underlines the need for catecholamine assays, including dopamine, in patients with unexplained fever and apparently non-secretory adrenal tumour.

[Is age a prognostic factor in differentiated carcinoma of the thyroid gland? (author's transl)]

Reviewing the outcome of 82 patients with differentiated carcinoma of the thyroid gland operated upon and followed up for more than 5 years, the authors were unable to find any difference between "younger" *under 45) and "older" (above 45) patients. They wonder whether the poorer prognosis of differentiated thyroid gland carcinoma in older patients could be due to to the tumour being usually more advanced in such patients at the time of diagnosis rather than to age itself. II this were the case, there would be no need to tailor the operative procedure to the patient's age.

[Systematic or selective frozen sections during surgery for suspected malignant thyroid lesions? Results in 674 cases over a period of 6 years (author's transl)]

Results of a retrospective study of 674 frozen sections in thyroid surgery, demonstrated on over all reliability of 98.2%, when compared with final pathological findings, with 651 confirmation in 674 cases. False negatives of malignancy represented 1.6% of lesions thought to be benign, while false positives were obtained in 4.8% of lesions thought to be malignant on frozen sections. Prior to frozen sections, 221 patients had needle punctures and cytological smears studies of the thyroid lesion. When comparing the results after using the two methods, no false positive for malignancy, assessed by cytology, was found on frozen sections, which also corrected but two false negatives of malignancy given by the 177 smears affirmative of benignancy, but reduced the number of equivocal results of cytology from 36 to 1. Both pre-operative cytological examination by needle puncture and intra-operative frozen sections appear, therefore, to be very reliable methods for studying thyroid lesions. Frozen sections are complementary to cytological studies. These results suggest that, in surgical thyroid diseases, frozen sections, need perhaps not to be systematically conducted, but should be selective and reserved for cases in which pre-operative needle cytology affirms malignancy, or raises suspicion.