Adrenal autotransplantation after total adrenalectomy: delayed determined function.

Adrenal autotransplantation after bilateral total adrenalectomy has been utilized to eliminate the need for replacement therapy and to prevent the late occurrence of Nelson's syndrome in some patients with Cushing's disease. It is possible to follow these cases up closely today, owing to the highly developed hormonal evaluation and imaging techniques. In this study, two patients who underwent bilateral total adrenalectomy and cortex autotransplantation are presented. The autografts were found functional and the patients had not required any steroid replacement therapy.

Hirsutism due to the treatment with L-thyroxine in patients with thyroid pathology.

There are many factors involved in the aetiology of hirsutism. It is well known that some drugs may cause hirsutism as a side effect, such as phenytoin, diazoxide, minoxidil etc. In Turkey, where the endemic goiter constitutes an important health problem, the value of suppression therapy with thyroid hormone still carries a special importance. We established the increasing tendency of hirsutism in patients treated with L-thyroxine (L-T4) for various thyroid pathology. That is why we decided to evaluate the role of thyroid hormones in the aetiology of hirsutism observed in patients treated with L-T4. We determined the total and free T3, T4, TSH, TBG, Plasma Cortisol transcortin, delta-4-androstenedione, FSH, LH, prolactin, total and free testosterone, estradiol, progesterone, sex hormone-binding globulin (SHBG), dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulphate (DHEAS) and 17 hydroxyprogesterone (17 OH Pg) levels in serum or plasma in a group of female patients who were taking L-T4 daily, regularly at least for 6 months and complaining of the occurrence of hirsutism. We demonstrated in these patients SHBG, transcortin and estradiol levels significantly lower than controls (p less than 0.001, p less than 0.05 and p less than 0.05, respectively) and DHEAS level significantly higher than controls (p less than 0.001). An important correlation was found between TBG and SHBG levels (r:0.536, p less than 0.05) and also between total and free testosterone levels (r:0.952, p less than 0.001).

Asymptomatic-nonfunctional adrenal masses detected by CT.

We identified as an incidental finding "silent adrenal tumors" in 12 patients undergoing abdominal computed tomography (CT) scanning for unrelated problems. Until recently, adrenal masses came to clinical attention either from local symptoms due to massive enlargement or from manifestations of excess hormone production. With CT, small adrenal glands and neoplasms could be also visualized and diagnosed at an earlier preclinical stage. Patients with asymptomatic adrenal masses detected by CT scan must be investigated for the possibility of metastasis from another primary site, secondly screened for hormone production and should be followed-up for malignant degeneration. The investigation did not show any sound criteria for the diagnosis of malignancy except the follow-up of the masses with serial CT scans in short intervals.

The value of L-thyroxine in the supressive therapy of euthyroid nodules and in the prevention of post-thyroidectomy recurrences.

Long-term L-thyroxine (L-T4) suppression therapy was applied to 133 patients with euthyroid nodular goiter (126 females/7 males) and to 148 patients (136 females/12 males) with post-thyroidectomy recurrence between the years 1980 and 1986. The results are interpreted as "Complete Success" if the nodule disappeared, "Partial Success" if it became smaller, "Late Unresponsiveness" if the nodule first decreased then increased in volume and "Unresponsiveness" when it did not change. In the group of euthyroid nodules, complete success was obtained with 150-200 micrograms/L-T4 daily administration. But in the recurrence group the response to the same dose was lower than in the first group and most of them were partial responders. On the other hand, we found highly significant differences in the incidence of postoperative recurrences, between the group of patients subjected to a long term L-T4 suppression therapy with the recurrence and prophylactic therapy with L-T4. While postoperative recurrence was only 6.35% in the long term L-T4 receiving group, it was very high (80.95%) in the non-treated group. Furthermore, in the group of patients taking L-T4 suppression therapy only for a short period, the incidence of recurrence was 12.70%. As a result of this study, we concluded that routine long term L-T4 suppression therapy is necessary both for the treatment of selected euthyroid nodules without any suspicion of malignancy for the prevention of post-thyroidectomy recurrences.

Sodium ipodate in the treatment of toxic diffuse goiter. Short-term and long-term effects on thyrotoxicosis.

Iodinated radiocontrast medication has been successful in the treatment of thyrotoxicosis when used for short periods up to 21 days, but experience with long-term use is lacking. In the first part of this study, a group of seven patients each taking 1.5 g. sodium ipodate daily was observed for 21 days and compared to a similar group of seven thyrotoxic patients taking 400 mg. propylthiouracil (PTU) daily. Sodium ipodate brought about a more significant decrease in serum total T3 and T4 levels, and more prominent increase in reverse T3 levels in the first ten days of the treatment. In the second part, a group of seven patients with thyrotoxicosis were given sodium ipodate, 1.5 g, daily for 20 days and 0.75 g. thereafter and were compared to a similar group of seven patients who took PTU, 300 mg. daily for the first 20 days and 150 mg. daily afterwards. Serum thyroid hormone levels decreased in both groups at the end of the first month of treatment, but rose again, along with worsening of symptoms, in five patients on ipodate treatment. Therefore, sodium ipodate, an iodinated radiocontrast agent is unable to control thyrotoxicosis for longer than a month.

The differentiation between constitutional delayed puberty and hypogonadotropic hypogonadism: experience with three newly devised methods.

There is no known method that is wholly successful in differentiating between hypogonadotropic hypogonadism and constitutional delayed puberty at an early stage. We present here the results we have got with three recently suggested methods in patients with delayed and absent puberty. These methods are te LHRH test before and after 36 hour pulsatile LHRH treatment, the prolactin response to TRH, and the prolactin response to metoclopramide.

Biologically ineffective gonadotropin secretion: two cases.

Symptoms of gonadal insufficiency, in the presence of high serum levels of gonadotropins, generally indicate primary gonadal failure. An exception to this generalization is the secretion of ineffective gonadotropic hormone secretion by the pituitary. One such case was reported in 1979. However rare it may be, this disorder should still be taken into consideration when evaluating hypogonadal patients. In fact, it may not be so rare as it is supposed. In this report, two such cases are presented. They both show signs of gonadal insufficiency in the presence of high serum gonadotropin concentrations, but responding normally to exogenously administered chorionic gonadotropin.