[Organic hyperinsulinism. Clinical aspects--diagnosis--therapy]. / Organischer Hyperinsulinismus. Klinik--Diagnostik--Therapie.

It is reported on the clinical experiences in the care of 19 patients with insulinoma. The relatively simple proof of the existence of an insulinoma which is possible by the determination of insulin is performed by the recognition of a pathognomonic insulin--blood glucose--quotient in fasting state and in the fasting test, respectively. Stimulation tests are less evident and do not lead to any further clinically relevant information. The difficulty of the diagnosis consists in the localisation of the tumour. Without clinically urgent necessity an operation without localisation of the tumour should not be performed.

[Incidence of hyperthyroidism in the Halle area before and after introduction of general preventive iodine treatment]. / Hyperthyreoseinzidenz im Bezirk Halle vor und nach Einführung der allgemeinen Iodprophylaxe.

With an average frequency of more than 10% the former GDR is an endemic area of struma with an iodine insufficiency of second to third degree. After an effort for many years we succeeded in introducing the gradual prophylaxis with iodine preparations with the help of the action of an interdisciplinary iodine commission. After an initial addition of 25 mg of potassium iodide to the kilogram kitchen salt beginning with 1986 an iodination with 32 mg KJO3/kg was established for circa 85% of the so-called packet articles. At the same time an iodination of the mineral mixtures for the animal feed was performed. From the supplementation altogether resulted a daily iodine uptake of about 135 microgram. Apart from a reduction of strumata of newborn to lower than 1% further provable effects of the supplementation of iodine developed. Among others the losses of animals could be diminished and the production of meat and milk could be improved. In the animal production the annual losses in a value of more than 180 million GDR mark were eliminated. As the only side-effect foreseen an increase of the hyperthyroidisms by a factor between 2 and 3 appeared. It concerned both immunogenic and autonomy-caused overfunctions and is to be compared to the success of iodination known from other countries, egg. Tasmania. The cases of hyperthyroidism are transitory, in the course moderate and concern only already preformed, so-called latent form.(ABSTRACT TRUNCATED AT 250 WORDS)

Interdisciplinary aspects of iodine prophylaxis in German Democratic Republic.

Endemic goiter still occurs in several European countries. Alimentary iodine deficiency could be proved as the main cause of endemic prevalence. Extensive epidemiologic surveys showed the great medical and economical impact of this matter for the GDR. Over 200 million Marks might be spent for diagnosis and treatment of thyroid patients per year. Also in the field of veterinary medicine and animal production iodine deficiency plays an important role. Under the conditions of iodine deficiency the fodder containing nitrate and glucosinolates (e.g. bruised rape extraction) results in additional goitrogenic effects (so-called indirect or relative iodine deficiency). Due to iodine deficiency disorders considerable losses of yields in cattle, pigs and sheep occurred. The content of iodine in animal products used for human nutrition was subsequently low. Considering the ecological implication of these problems an Interdisciplinary Iodine Commission within the Society for Endocrinology and Diseases of Metabolism of the GDR was established. Together with the governement authorities it worked out corresponding recommendations for the prophylaxis and control of its efficiency. In 1986 the iodination of most of the packed salt (32 mg KIO3/kg = = 19 mg I/kg) and the administration of iodinated mineral mixtures for the animal production were started for pigs in the whole territory of GDR and for cattle in the southern counties of the GDR only. These activities have been accompanied by information of TV as well as in the newspapers and medical journals. Thus, an improved supply of iodine to the population through iodinated table salt and animal products can be taken into account. The efficiency of these prophylactic measures is controlled interdisciplinarily.(ABSTRACT TRUNCATED AT 250 WORDS)

[Thyroid diseases in pregnancy]. / Schilddrüsenerkrankungen in der Schwangerschaft.

Knowledge about the physiology of the fetal and maternal regulating circle of the thyroid gland is the prerequisite for the right valuation of thyroidal parameters and for a risk-poor treatment of diseases of the thyroid gland during pregnancy. The conditions of the passage at the fetoplacental unit require particular attention in the use of thyroid depressants. Hyperthyreoses as well as bland strumae may be increased in their distinction by a pregnancy. Maternal hyperthyroidism has often a mild course. While thyreostatic drugs must be applied in their least effective dosage, for the substitution with thyroid hormones there is a higher demand than in non-pregnant women. Fetus and newborn as well as the mother need a narrow-mashed control which should be performed interdisciplinarily in a special consulting.

[Ontogenetic changes in the circadian rhythm of plasma insulin and its correlation to food intake]. / Ontogenetische Anderungen der Tagesmuster der Plasmainsulin-konzentration und ihre Beziehung zur Nahrungsaufnahme.

In experiments with laboratory mice of different age (3, 9, 13, 18, 31 and 52 weeks old) directed changes of the daily pattern of plasma insulin concentration depending on the development stage of the animals could be quantified. The circadian acrophase undergoes a negative shift from the end of dark/beginning of light period in 3-weeks-old mice to the end of light/beginning of dark period in adults. The amplitude decreases up to an age of 9 weeks, whereas the amount of ultradian components is high, and increases during further development. Similar changes could be obtained for the daily pattern of feeding activity, occurring however some weeks earlier. The result is a temporary desynchronisation. In adult animals the phase correlations are relatively stable. The plasma insulin concentration reaches its maximal value before the maximum of feeding activity, thus stimulating a high food consumption and utilisation rate.

[Hiob syndrome. A case report of multiple endocrine neoplasia]. / Das Hiob-Syndrom. Ein kasuistischer Beitrag zur multiplen endokrinen Neoplasie.

It is reported on a now 48-year-old male with a multiple endocrine neoplasia (MEN I). The most impressive symptomatology issued from a relapsing organic hyperinsulinism the cause of which were multiple islet cell tumours. Up to now the hyperparathyroidism was not mastered by the removal of two adenomas of the parathyroid gland. As third fact in this clinical picture, called also Hiob syndrome, the hypophyseal manifestation developed in form of a space occupation with a hypersomatotropism, the course and final clarification of which are still open.

[Taste perception in fasting overweight patients]. / Schmeckvermögen im Hungerzustand bei Ubergewicht.

In 20 patients with a heavy overweight in the course of a fasting cure at 5 different moments gustation tests were carried out: in satiated state, in the acute fasting state and during the building-up phase. It could be proved that the thresholds in the acute fasting state are significantly lower than in the satiated state. Also in the building-up phase this tendency is pointed at. An efferent influence on the receptors evoked by hunger is discussed as cause. A direct relation between the change of the gustation sensitivity and individual metabolic parameters did, however, not develop under the experimental conditions given.

Thyroid status during pregnancy and post partum in regions of iodine deficiency and endemic goiter.

During pregnancy the thyroid is subjected to increased demands which is associated with a tendency to endogenous iodine deficiency. Under the conditions of insufficient iodine supply in the GDR the pathophysiological changes result in: 1. prevalence of goiter in about 60% of pregnant women; 2. enlargement of the extent of neck in more than 50% of all pregnant women examined only returning to the prepregnant status in 25%-40%; 3. prevalence of goiter in newborn with 5%; 12.8% of 1948 stilborn had macroscopically an enlarged thyroid gland, the highest weight being 45 g. More than 53% of the stilborn examined by autopsy had a thyroid weight of over 3 g; 4. in contrast to the regions with sufficient iodine supply renal iodine excretion was steadily decreasing during pregnancy and post partum, changing the iodine deficiency from grade II to grade III; 5. low iodine excretion in newborn: 1.3 +/- 0.2 microgram I/day in goitrous (1.2 +/- 0.2 nmol I/mmol creatinine) 2.2 +/- 0.4 micrograms I/day in non-goitrous (2.0 +/- 0.4 nmol I/mmol creatinine); 6. according to ETR more than 50% of the pregnant examined showed a hypothyroid tendency. The pathophysiological changes during pregnancy caused by insufficient iodine supply can be met efficiently by careful thyroid hormone treatment or by the administration of 150 micrograms I daily. A mandatory iodine salt prophylaxis is demanded.

[Blood glucose and serum insulin levels in newborn infants of diabetic mothers during feeding with an oligosaccharide mixture]. / Blutglucose- und Seruminsulinspiegel von Neugeborenen diabetischer Mütter bei Ernährung mit einem Oligosaccharidgemisch.

Macrosome newborns from mothers with an insulin-bound diabetes mellitus and also from mothers with a gestational diabetes show in the cord blood nearly always insulin levels additional to increased glucose values, which, compared with the normal controls are ten-fold higher in some cases. During the first three hours of life the blood glucose values decrease extremely. To prevent central injuries, caused by stronger hypoglycaemia, the early supply of oligosaccharides by continuous gastric infusion has proved as the most careful procedure. Stronger increases of blood glucose do not occur by this method and the insulin levels show a continuous tendency to normalisation.

[Desynchronization of the circadian rhythm of plasma insulin levels and feeding schedules after inversion of periodicity]. / Desynchronisation des Tagesrhythmus der Plasmainsulinkonzentration von der Futteraufnahme nach Zeitgeberverschiebung.

In experiments with laboratory mice a desynchronisation of daily rhythms in plasma insulin concentration and feeding after inversion of the light-dark periodicity is documented. Whereas the feeding rhythm follows the exogenous Zeitgeber (differences concern above all the quantity of food which decrease after inversion), the acrophase of the hormone rhythm is stable in relation to astronomic time. The daily mean, however, is reduced and the main maximum is split into three components. The results support the hypothesis that rhythms of the two investigated parameters are generated by separate oscillators.

[Initial results of a combined sonographic and cytologic diagnosis of scintigraphically remarkable thyroid changes using real-time visual puncture]. / Erste Ergebnisse einer kombinierten sonographischen und zytologischen Diagnostik szintigraphisch auffälliger Schilddrüsenveränderungen unter Anwendung der Real-Time-Sichtpunktion.

The combination of sonography and biopsy in the diagnostics of the thyroid gland results in a reliability of 100%. Thus the routine application effective diagnostics and therapy is justified. The course control after emptying of the cyst is simplified, the therapeutic effect of the puncture can be revealed. It can be attracted as evident method which is poor in risk for the confirmation of an indication to operation. This form of examination is possible also then, when no sonographic device with a puncture is at our disposal.

Thiol-protein disulfide oxidoreductase and peptidase activities in insulinoma tissue.

An islet cell tumor, characterized by proinsulin level significantly elevated above normal human pancreas, has been found to contain insulin- and glucagon-degrading activity. Examination by chromatography on Sephadex G-75 of the degradation products formed from insulin showed A chain, and B chain rich-A chain aggregate as previously found with rat pancreatic islets. There was, however, little conversion of A chain to low molecular weight components indicating that insulinoma peptidase that has been found to degrade glucagon at about pH 6.8 degraded that A chain to a markedly lower rate. In contrast to the insulin-degrading activity, which was activated by glutathione in the presence of EDTA, the peptidase activity was not affected by the thiol compound. The activity of the peptidase was markedly inhibited by chelating agents, i.e., EDTA and o-phenanthroline, whereas chymotrypsin and trypsin inhibitors, i.e., TOS-PheCH2Cl, TOS-LysCH2Cl, soybean and pancreas trypsin inhibitor were found to have no effect.

[The value of growth hormone stimulation tests]. / Zur Wertigkeit von Wachstumshormonstimulationstests.

In 142 test persons the insulin hypoglycaemia test as well as the glucagon propranolol test were performed under the interrogation of a hyposomatotropism. The combination of these tests proved as suitable for the answers to this inquiry. The insulin hypoglycaemia test led in 29%, the propranolol glucagon test only in 6% to the false indication of a hyposomatotropism. Thus the propranolol glucagon test has the higher diagnostic certainty. Insulin hypoglycaemia test and propranolol glucagon test seem to have a different effect.

[Incidence of goiter in the Naumburg district]. / Untersuchungen zur Strumahäufigkeit im Kreise Naumburg.

10% of the inhabitants of the district of Naumburg were examined for their state of the thyroid gland. The average morbidity of struma was 25.2%. Above all the struma stages I and II were found. The maxima of frequency were in the age groups of the 20--29-year-old persons with 68% in the females and 27.4% in the males. Of the 585 inhabitants of the village Grossjena (85% of the total population) 32.9% has a struma. The patterns of distribution corresponded, apart from a second peak in the females at the time of the climacterium, to the patterns found in the whole region of Naumburg. The average iodine excretion in the urine of 19.9 micrograms/g creatinine was still undercut by the 12- to 15-year-old pupils of this village with 14.8 micrograms/g creatinine. The relation of female to male carriers of struma was on an average at 2.5 : 1. In individual age groups the sex-conditioned differences were eliminated. Relation of sex, excretion of iodine and frequency of struma confirm the endemic character of the struma disease in the district of Naumburg and confirm an iodine deficiency of IInd to IIIrd degree. The results intensely emphasize the necessity of a centrally regulated iodate prophylaxis.

[The radioiodine test for the evaluation of iodine deficiency in the district of Karl-Marx-Stadt and in East Germany]. / Der Radiojodtest zur Beurteilung des Jodmangels im Bezirk Karl-Marx-Stadt und in der DDR.

The values of the per cent 24 h radioiodine uptake in the GDR are above 60--70% and speak for a low alimentary intake of iodine or renal excretion of iodine below 40 micrograms J/d. Like the struma prevalences they show a tendency increasing from north to south and characterize the whole European situation of iodine deficiency including its decrease from west to east. The mean values of radioiodine uptake of 71.7 +/- 13.2% (n = 110) in euthyroids of the district of Karl-Marx-Stadt correspond to the iodine deficiency as it occurs approximately in the districts of Erfurt, Dresden, Munich or Freiburg/B. The alimentary iodine intake of 38.4 +/- 17.2 micrograms J/d and the renal iodine excretion of 29.9 +/- 16.1 micrograms J/d, calculated from the 24 h radioiodine accumulation values of 40 euthyroid persons by means of a mathematical model developed by Oddie and co-workers were low. The latter only slightly differed (P less than 0.05) from its chemically estimated excretion of iodine in the urine: 23.1 +/- 16.9 micrograms J/g creatinine (n = 73). Between the calculated and chemically estimated excretion of iodine there was a relatively strict correlation of r = 0.68 (n = 26; P less than 0.001). The introduction of an iodine prophylaxis is regarded as an urgent necessity. Later on a new estimation of the regional "normal values" is necessary for the per cent radioiodine uptake.

[Peripheral thyroid function and TRH-TSH test in patients with acromegaly]. / Periphere Schilddrüsenfunktion und TRH-TSH-Test bei Patienten mit Akromegalie.

In 11 patients with acromegaly the peripheral thyroid hormones were determined and a TRH-TSH-test was carried out. Depending on the result of the determination of the growth hormone the patients were classified into two groups (active and inactive acromegaly). The serum thyroxin level and the T3-binding capacity were normal. Only in a few patients decreased triiodotyronine levels were found. Independent of the degree of activity of the acromegaly positive as well as negative TRH-TSH-tests were found. The struma in patients with acromegaly which is frequently to be observed seems to be in a causal connection with this disease. The examination show altogether that the control of the function of the thyroid gland and the TRH-TSH-test do not deliver an essential contribution for the diagnostics of acromegaly itself.

[Growth hormone secretion in growth retarded children and adolescents]. / Untersuchungen zur Wachstumshormonausschüttung minderwüchsiger Kinder und Jugendlicher.

In 119 children and adolescents with restricted growth whose secretion of growth hormone (hGH) was investigated in the insulin hypoglycaemia test, different hGH-secretion patterns were found. 52.1% of the investigated persons showed a prestimulatory stress-conditioned hGH-secretion. There were no relations to age or to sex. The hypoglycaemia-conditioned secretion of hormone following this spontaneous release has quantitatively no relation to the size of the decrease of blood sugar. However, it is also determined by the trend of secretion in the pretest-phase. Different modes of synthesis and release are the cause for this behaviour. High spontaneous hGH-levels decrease the hypoglycaemia effect of the intravenously applied insulin. In 33.9% of the cases the levels of the growth hormone are lower during the proper test phase or only as high as in the preparation time. Twelve times the poststimulatory values simulated a hyposomatotropism. The eventual importance of the secretion patterns remains up to now unclear for the longitudinal growth.