Evaluation of hypothalamic-pituitary-adrenocortical hormones and inflammatory cytokines in patients with persistent vegetative state.

Hypothalamic-pituitary-adrenocortical hormones, i.e. prolactin (PRL), human growth hormone (hGH), thyroid stimulating hormone (TSH), and Cortisol and plasma levels of cytokines, i.e. tumor necrosis factor-alpha (TNF-alpha), interleukin 1 beta (IL-1 beta), and interleukin-6 (IL-6), were assessed in 27 patients with persistent vegetative state (PVS) and in 16 outcome patients. In comparison with normal parameters, plasma levels of TSH were not significantly altered, while elevated basal hGH concentrations in 48.1% of PVS subjects and depressed cortisol levels in all PVS individuals and in patients who emerged from coma (outcome patients), respectively, were observed. In addition, higher TNF-alpha plasma levels in PVS subjects than in outcome patients and in healthy donors were found, while IL-1 beta plasma levels were elevated in both groups of patients in comparison with healthy controls. Of interest, in 55% PVS male patients hyperprolactinemia was observed, whereas in outcome patients more than six months these values were within normal range. In four patients, who emerged from coma in the course of this study, prolactin plasma levels were followed-up and increased basal values progressively fell to normal range within six months.

Cyclic Cushing's syndrome due to ectopic ACTH secretion by an adrenal pheochromocytoma.

Pheochromocytoma is a rare cause of ectopic Cushing's syndrome. We report on such a patient in whom ectopic ACTH secretion displayed a cyclic pattern. A 35-year-old woman was referred to us with a diagnosis of ACTH-dependent Cushing's syndrome. A 3.3 cm left-sided adrenal mass was noted at abdominal computerized tomography. At admission, clinical and hormonal data were unrewarding, so it was decided to continue to observe the patient. Four months later, she became symptomatic with hypertensive and psychotic crises and glycemic decompensation. By that time, a full-blown Cushing picture was evident. Severe hypercortisolism was documented with urinary free cortisol ranging 1500-2200 micrograms/24 h, serum cortisol 143-160 micrograms/dl and plasma ACTH 167-218 pg/ml. Neither ACTH nor cortisol values were significantly modified after high-dose dexamethasone, oCRH or metyrapone. Urinary catecholamine and vanilyl mandelic acid excretion were moderately elevated. Chest CT and total body MIBG scan were negative and magnetic resonance of the sella region was inconclusive. No center to periphery ACTH gradient was observed by inferior petrosal sinus catheterization, whereas a significant left to right gradient was found on selective adrenal vein catheterization. A left adrenalectomy was performed and a 4 cm medullary neoplasia was removed. The cells were immunostained for ACTH, neuron-specific enolase and A chromogranin. Signs and symptoms of Cushing's syndrome resolved with normalization of basal and dynamic endocrine evaluations.(ABSTRACT TRUNCATED AT 250 WORDS)

[Hormonal evaluation in the diagnosis of obesity associated with "primary empty sella"]. / Valutazione ormonale nella diagnosi di obesità associata a "primary empty sella".

To determine whether obesity associated with "primary empty sella" (PES) had a characteristic hormonal pattern, we evaluated the hormonal profile in 24 simple obese and 19 obese-PES women. The latter group showed a significant delta-GH and LH impaired levels as well as plasma beta-EP significantly higher. Hence, the beta-EP measurement could be used to predict the hormonal response in these women.

Detection of tsh binding inhibiting antibodies (TBI-ab) and thyroid adenylate cyclase stimulating antibodies (TS-ab) in sera of patients with Graves' disease.

In the sera of patients with Graves' disease have been demonstrated the immunoglobulins able to inhibit the binding of TSH to the human thyroid membrane (TBI-Ab) and the immunoglobulins stimulating the thyroid adenylate cyclase (TS-Ab). The present study was performed in 75 hyperthyroid Graves' patients to ascertain the pathophysiological significance of these immunoglobulins. TS-Ab and TBI-Ab prevalence appeared to be much higher in the untreated and in relapsing patients than in subjects in remission. When the results of TBI-Ab and TS-Ab were compared in each group of patients no correlation was found between the two activities. We conclude that the TBI-Ab and the TS-Ab are the markers of hyperthyroidism in Graves' disease but the two activities are not equivalent and probably reflect a different phenomenon concomitantly produced.

[Determination of glycemia with a new reflex photometer (glucometer)]. / Determinazione della glicemia con un nuovo fotometro a riflessione (glucometer).

The introduction on the market of small sized (easy to use) reflectance photometers for determination of blood glucose levels offers a new possibility in the monitoring homeostasis of glucose in diabetic patients. An evaluation of the system has been performed comparing the results with those obtained by spectrophotometer methods. Results by the two methods are quite comparable. A wide use of this system for blood monitoring should be encouraged especially among the diabetic patients in order to allow them to achieve a higher autonomy, particularly in emergency situations.

A degradation product of circulating luteinizing hormone (beta-hCG subunit) in human semen.

Levels of beta-human chorionic gonadotropin (beta-hCG) were detected in semen under basal conditions. No significant correlation to levels of luteinizing hormone (LH) in blood was found. The beta-hCG level did not increase within 3-7 days after a 5000 IU dose of hCG was injected intramuscularly. Human chorionic gonadotropin was detected in semen only after injection. beta-Human chorionic gonadotropin in the semen represents a degradation product of circulating LH.

[Chronobiological aspects of TSH secretion in control subjects and in subjects with primary hypothyroidism]. / Aspetti cronobiologici della secrezione del TSH in soggetti controllo e con ipotiroidismo primario.

The circadian rhythm in plasma TSH concentration was demonstrated in euthyroid subjects and in treated hypothyroid patients. Our results suggest that two hypothalamic areas, involved in TRH secretion, are responsables in basal as well impulsive pituitary TSH dismission.

[Various types of reducing diets]. / I vari tipi di diete dimagranti.

It must be readily understood that the only possibility of fighting obesity is by bringing about a reversal in the energy balance so that inputs are smaller than outputs. At least theoretically, then, obesity's special quality is that it does not present any therapeutic problem. Restriction in food intake is currently the treatment of choice; to be effective, food intake must be cut so that the energy provided is below the obese person's daily consumption, on average below 1200 calories per day, while at the same time holding a comparatively high intake of indispensable elements (proteins, vitamins, certain minerals and oligo-elements). The physician has a choice of various possibilities represented by fasting, a variety of free or controlled diets, protein diets or diets with low carbohydrate content and with a variable fat content; dissociated, zig-zag, one food diets etc. Substantially all these tend to limit the total quantity of glycides and boost the feeling of satiety by increasing the total volume of good while keeping total calories unvaried. It is clear that each of them has specific indications and clear-cut contraindications. The aim is to produce a calory shortfall, not cause denutrition. The diet must therefore be suited to the individual directed during subsequent stages of weight loss in relation to the patient's specific requirements (number of meals, etc.).

[Urinary excretion of catecholamines in obese subjects and in diabetics (author's transl)]. / Excretion urinaire des catécholamines chez les sujets obèses et chez les diabétiques

95 obese subjects, 40 diabetics and 22 normal controls were investigated. The weight of all obese subjects was at least 20% higher than the ideal weight. Catecholamine excretion was determined a few days after hospitalization to minimize the influence of environmental changes. Spectrofluorimetric estimation of adrenaline and noradrenaline in the urine was carried out according to the method of von Euler and Lihajko. Statistical analysis of the results showed a significant increase in both adrenaline and noradrenaline excretion in the group of obeses subjects compared with the diabetics. The increased catecholamine excretion may represent the response of the adrenal medulla to the stress of the disease. Such an increase may be responsible for perpheral insulin resistence and hence acts as a diabetogenic factor. The results obtained emphasize the influence of catecholamines on insulin responsiveness, possibly constituting a major contribution to the diabetic state.