GH deficiency in adults: an epidemiological approach.

OBJECTIVE: The prevalence of adult onset GH deficiency (GH-D) is poorly documented. Epidemiological data are now required to estimate the financial cost of GH treatment in adults. The aim of the present study was to estimate the prevalence of GH-D, from a cohort of 1652 adult patients with hypothalamo-pituitary diseases. DESIGN: The hormonal status of all patients presenting with pituitary diseaseand observed during the year 1994 in 15 endocrine units was retrospectively analyzed, irrespective of the date of disease onset, of the nature and date of pituitary investigations, and whether or not they included specific testing of the GH axis. Of the whole population of 1652 patients, a selected group (RG2) was chosen after exclusion of patients with active acromegaly (n=1414). RESULTS: GH stimulation tests had been performed in 549 patients of the RG2 group and a documented GH-D was found in 301. A relationship between the value of the GH peak and the number of pituitary deficits was evaluated. For instance, it was shown that 93% of patients with three deficits had GH-D. These results constituted the basis for estimating the number of GH-D in the group of untested patients. The number of GH-D deduced from the number of established GH-D (n=301) and from the number of GH-D hypothesized from other pituitary deficits (n=406) was 707 cases. Prevalence and annual incidence were calculated from data recorded in a referral center with a well-defined catchment area, Marseilles (Bouches du Rhône department). We projected a prevalence of 2638 for France and an annual incidence of 12 GH-D per million of the adult population.

Impairment of renal compensatory hypertrophy by hypothyroidism in the rat.

Renal compensatory hypertrophy (RCH) occurs in hypothyroid rate, but it is impaired when compared to RCH found in euthyroid controls. It is due to cellular hypertrophy as the DNA content does not change and the Protein/DNA ratio increases in the compensating kidney. RCH is enhanced by thyroxine (T4) with a rise in the DNA content of the compensating kidney, but the Protein/DNA ratio does not change indicating that hypertrophy is as important as hyperplasia. Corticotrophin (ACTH) given to eu and hypothyroid rats enhances RCH with an increase in the protein content of the compensating kidney without any change in its DNA content. In the hyperthyroid rats, the enhanced RCH is not further increased by ACTH and the rise in the kidney DNA content elicited by T4 is suppressed by ACTH. The Protein/DNA ratio is increased by ACTH in hypo, eu and hyperthyroid rats. The renotrophic action of ACTH is due to hyperadrenocorticism: it is related to an increased plasma testosterone level and to a disturbed Na+, K+ and glucose metabolism.

[Diabetes and estro-progestins]. / Diabete ed estro-progestinici.

PIP: The action of estrogens on glucose metabolism has been proven more than 30 years ago. Estroprogestational agents do not modify sensibly glucose metabolism in normal women, but they do have a serious diabetogenic effect on women with hereditary antecedents of diabetes. These women can use oral contraception only under strict surveillance. Estroprogestinic agents should never be administered to women with latent diabetes; they can be administered to women with diabetes only if glycemia and vascular conditions are constantly checked. It is possible that minipills can cause fewer glucose metabolism complications. Steroids used as male contraceptives have no influence on lipid and glucose metabolism. Natural estrogens administered during and after menopause can improve the glucose tolerance in diabetic patients. It is still not clear what mechanism governs the diabetogenic effects of estroprogestinic agents. The article contains a detailed review of the literature on the subject, and a very useful table listing all combined oral contraceptives available in France.^ieng

[Benefits and limitations of pancreas transplantation in insulin-dependent diabetics: a study apropos of 26 patients]. / Bénéfices et limites de la transplantation pancréatique chez le diabétique insulinodépendant: étude à propos de 26 patients.

From November 1990 to March 1995, 26 simultaneous pancreas-kidney (SPK) transplants were carried out. The recipients were uremic type I diabetic patients. After the first year of transplantation, patient survival was 96% and pancreas and kidney survival was 69% and 84%, respectively. The pancreas transplant failure was due to veinous thrombosis (two cases), and to graft rejection (71%). The most common urologic complications of bladder drainage were urethritis (61%), bicarbonate loss (42%) and urinary tract infections (100%). Fasting blood glucose (0.91 +/- 0.1 g/L), hemoglobin A1C (5.3 +/- 0.4%) and lipidic profile were found to be normal among diabetic recipients whose grafts had been functioning for 1 year. The insulin secretion of type I diabetic patients with SPK transplants (n = 13), and six non diabetic patients with kidney transplants was assessed by oral glucose tolerance tests. Only the patients with SPK transplants presented late hyperinsulinemia at 120 minutes. The quality of life for both type I diabetic patients after SPK transplants and diabetics treated by insulinotherapy (n = 6), was studied. After transplantation, the quality of life improved only because of insulin independence. In spite of chirurgical and urologic complications, pancreas transplantation in type I diabetic patients improves both metabolic control and quality of life.

[Modification of the renotrophic action of adrenal hypercorticism by nutritional factors in uninephrectomized rats]. / Modulation de l'effet rénotrophique de l'hypercorticisme surrénalien par des facteurs nutritionnels chez le rat uninéphrectomisé.

In the rat renal compensatory hypertrophy (RCH) was enhanced by hyperadrenocorticism induced by the administration of a long acting ACTH at a dose of 18 Y/100 g body weight/d. for 7 d. after uninephrectomy (UN). In the present experiments we compared the differences delta between the weight, the content in protein, RNA and DNA of the left solitary kidney and the same determinations done on the right kidney excised at UN 7 d. earlier. The rats drank freely a isotonic solution of NaCl (G1) or KCl (G2) or glucose (G3, G4). The rats of group G1, G2 and G3 received a standard solid food; the G4 rats ate a K poor diet. About half of the animals were treated with ACTH. RCH occurred in all the rats even when they lost body weight. The gain in weight of the solitary kidney was enhanced in all the rats treated with ACTH but not in the G2 rats loaded with KCl. This renotropic action of hyperadrenocorticism was most prominent in the K depleted G4 rats. The protein/DNA ratio, a marker of cellular hypertrophy, was increased by hyperadrenocorticism in the G1 and D2 rats drinking respectively the NaCl or the KCl solutions. This ratio did not change in the ACTH treated G3 and G4 rats drinking the glucose solution suggesting that, in this experimental condition, cellular hyperplasia and hypertrophy occurred at the same extent. These experiments suggest that, in the uninephrectomized rat, the renotrophic action of ACTH is modulated by nutritional factors. The enhancement of RCH by ACTH may be related to hyperglycemia, hyperinsulinism or altered handling of Na and K by the nephron.

[Influence of nutritional factors on the enhancement of renal compensatory hypertrophy by hyperadrenocorticism in the rat (author's transl)]. / Modulation de l'effet rénotrophique de l'hypercorticisme surrénalien par des facteurs nutritionnels chez le rat uninéphrectomisé.

In the rat compensatory hypertrophy (RCH) was enhanced by hyperadrenocorticism induced by the administration of a long acting ACTH at a dose of 18 Y/100 g body weight/d. for 7 d. after uninephrectomy (UN). In the present experiments we compared the differences delta between the weight, the content in protein, RNA and DNA of the left solitary kidney and the same determinations done on the right kidney excised at UN 7 d. earlier. The rats drank freely a isotonic solution of NaCl (G1) or KCl (G2) or glucose (G3, G4). The rats of group G1, G2 and G3 received a standard solid food; the G4 rats ate a K poor diet. About half of the animals were treated with ACTH. RCH occurred in all the rats even when they lost body weight. The pain in weight of the solitary kidney was enhanced in all the rats treated with ACTH but not in the G2 rats loaded with KCl. This renotrophic action of hyperadrenocorticism was most prominent in the K depleted G4 rats. The protein/DNA ratio, a marker of cellular hypertrophy, was increased by hyperadrenocorticism in the G1 and G2 rats drinking respectively the NaCl or the KCl solutions. This ratio did not change in the ACTH treated G3 and G4 rats drinking the glucose solution suggesting that, in this experimental condition, cellular hyperplasia and hypertrophy occurred at the same extent. These experiments suggest that, in the uninephrectomized rat, the renotrophic action of ACTH is modulated by nutritional factors. The enhancement of RCH by ACTH may be related to hyperglycemia, hyperinsulinism or altered handling of Na+ and K+ by the nephron.

[Lipid composition of peritoneal and follicular ovulatory fluid from patients participating in an in vitro fertilization protocol]. / Etude de la composition lipidique du liquide péritonéal et folliculaire ovulatoire chez des patientes incluses dans un protocole de fécondation in vitro.

The aim of this work is to study and compare lipid composition of peritoneal and ovulatory follicular fluid of women. The studied patients are involved in a FIV protocol. We have studied 53 peritoneal fluids and 90 follicular fluids from 33 patients. On each sample the following parameters are estimated: cholesterol, triglycerides, phospholipids, non esterified fatty acids (A.G.N.E.), HDL and LDL cholesterol, HDL and LDL phospholipids. Lipid composition of follicular and peritoneal fluids differ from these of blood plasma. The two mediums studies show no differences with regard to their lipid composition. In both cholesterol is only found as HDL cholesterol. Cholesterol arising from spermatozoa membranes may be implicated in capacitation phenomenon. HDL Cholesterol, the only form found in the studied mediums, may act as a cholesterol acceptor. Theses two points partially explain the fact that follicular and peritoneal fluids are good mediums for capacitation and survival of spermatozoa.

A student leadership model for promoting educational programs in organ donation and transplantation.

The global organ shortage is the strongest factor for the increase in transplant wait time and deaths on waitlists. Here we describe a model for involving high school students in education research around organ donation and transplantation and capitalize on the strength of a pre-existing educational program offered by the local organ procurement organization (OPO). While training in education research at Cleveland Clinic, a high school student embarked on a collaborative project with the local OPO. The project involved evaluating three educational programs, selecting the most appropriate program for administration at her school, coordinating with the student's school administration and teachers, administering an assessment tool for the effectiveness of the program, and analyzing the results. The local OPO program that was selected for implementation consisted of a video presentation entitled "Share your life, share your decision" prepared by the United States Health Resources and Services Administration (HRSA), lectures by invited speakers and an educational assessment (pre- and post-education). The assessment survey included 3 multiple choice and 7 true/false questions. Compared to the over 2500 programs administered in the last 5 years by the local OPO, this program had a higher volume of participation (n = 353 compared to an average of 150 students/day). Students correctly classified transplantation status of more organ and tissues post-education (P < .0001 for both). For 5 out of the 7 true/false questions, students correctly answered questions more frequently post-education (P ≤ .002 for all). This experience included for the first time a formal assessment of the program which will be utilized to address targeted areas for specific improvements. This student collaborative model of involving students in organ donation and transplantation related education research has the potential to promote and maximize the effectiveness of educational programs targeting their peers.

HLA and MICA polymorphism in Polynesians and New Zealand Maori: implications for ancestry and health.

Data from HLA typing studies have made significant contributions to genetic theories about the Austronesian diaspora and the health of descendant populations. To help further unravel pattern and process elements, we have typed HLA and MICA loci at high resolution in DNA samples from well defined groups of Maori and Polynesian individuals. Our results show a restricted set of HLA class I alleles compared with other well characterised populations. In contrast, the class II HLA-DRB1 locus seems to be diverse in Maori and Polynesians and both groups show high frequencies of HLA-DRB1(∗)04:03, -DRB1(∗)08:03, -DRB1(∗)09:01 and -DRB1(∗)12:01. Our survey also provides the first ever MICA datasets for Polynesians and reveal unusual distributions and associations with the HLA-B locus. Overall, our data provide further support for a hybrid origin for Maori and Polynesians. One novel feature of our study is the finding that the gene sequence of the HLA-B(∗)40:10 allele in Polynesians is a recombinant of HLA-B(∗)55:02 and -B(∗)40:01. HLA-B(∗)40:10 is in close association with HLA-C(∗)04:03, an allele identified as a hybrid of HLA-C(∗)04 and -C(∗)02. In this respect, our data resemble those reports on Amerindian tribes where inter-allele recombination has been a common means of generating diversity. However, we emphasize that Amerindian gene content per se is only a very minor element of the overall Polynesian genepool. The wider significance of HLA and MICA allele frequencies across the Pacific for modern day health is also discussed in terms of the frequency relative to reference populations of disease known to be associated with specific HLA and MICA markers. Thus, Polynesians and Maori are largely unaffected by "European autoimmune diseases" such as ankylosing spondylitis, uveitis and coeliacs disease, yet there are several Maori- and Polynesian-specific autoimmune diseases where the HLA and MICA associations are still to be determined.

[Diabetes and estrogens-gestagens (author's transl)]. / Diabetes und Ostrogene-Gestagene

The glucose tolerance of the normal woman is not disturbed by oral contraceptives, or only slightly so. In women with a hereditary diabetic taint or diabetic complications during pregnancy, however, the diabetogenic effect is intensified. Estrogens/gestagens (OE-P) are contraindicated in patients with latent diabetes because they may develop an irreversible manifest diabetes. OE-P may be given in manifest diabetes with careful supervision of the blood sugar, lipid levels and the vascular condition. The doses of insulin or oral antidiabetics must often be raised. If the diabetes is not adequately stabilized, the OE-P must be discontinued. Young diabetic women should have their children before the onset of vascular complications. If a diabetic has two living children, surgical sterilization must be given serious consideration.

[Excretion of water, sodium, and potassium during the compensatory renal hypertrophy in hypothyroid rats]. / Excrétion de l'eau, du sodium et du potassium au cours de l'hypertrophie rénale compensatrice chez le rat hypothyroïdien

Renal compensatory hypertrophy is studied in age matched euthyroid and radiothyroidectomized female rats. 7 days after uninephrectomy, the hypertrophy of the remaining kidney is equally small in both groups. But 60 days after this operation, the hypothyroid animals show only a 12% increase in the wet weight of the remaining kidney whereas the euthyroid controls increase this weight by 21%. The excretion of water, Na and K are determined in the urine excreted in 5 h after a small water load. The results are related to 1 gram of kidney wet weight. These outputs increase in all animals after uninephrectomy. They are significantly higher in the hypothyroid rats than in the euthyroid controls as well before than 60 days after uninephrectomy. The reduction in tubular Na reabsorption found in the hypothyroid rat may account for the impairment of compensatory renal hypertrophy in hypothyroidism.

[Clinical and biological patterns of hyperthyroidism in elderly patients (author's transl)]. / Les hyperthyroïdies du sujet âgé.

Aetiological, clinical and biological patterns of hyperthyroidism are studied in 22 consecutive patients over the age of 65 years. In this group the frequency of toxic multinodular goiter and Graves disease are grossly the same. A previous iodine administration could be a significant aetiologic factor in 8/22 patients. The clinical symptomatology is characterized by the predominance of cardiovascular disorders and by the mildness or absence of the other symptoms of thyrotoxicosis. The classical abnormalities of thyroid function tests are only found in 65% of our patients. The others have high total and free thyroxine (T4) and normal triiodothyronine (T3) plasma levels with a marked increase in reverse T3 (RT3) levels. These abnormalities result possibly from an impairment of the peripheral conversion of T4 to T3 as it is seen in fasting or in sick euthyroid patients. Most of our hyperthyroid patients had an associated disease and were undernourished. In the elderly patient the determination of plasma T4 by a radioimmunoassay and the T3 uptake test are the best screening methods for detecting an often hidden thyrotoxicosis.

[Inhibition of compensatory kidney hypertrophy by hypothyroidism in the rat. Measurement of the mean diameter of glomeruli and proximal tubules]. / Inhibition de l'hypertrophie rénale compensatrice par l'hypothyroïde chez le rat. Mesure du diamètre moyen des glomérules et des tubes proximaux.

The body, heart and kidney weights are reduced in the hypothyroid rat. In this animal, the diameter of the proximal tubule is significantly smaller than in euthyroid controls. The glomerular diameter is not affected by hypothyroidism. 21 days after uninephrectomy, the weight of the remaining kidney and the diameter of the proximal tubule increase significantly both in the hypothyroid and the euthyroid rats. But this compensatory renal hyperthrophy is definitely impaired in the hypothyroid animals.

[Effects of fasting and of ACTH on renal compensatory hypertrophy in the 48 hour uninephrectomized rat]. / Effets du jeûne et de l'ACTH sur l'hypertrophie rénale compensatrice chez le rat uninéphrectomisé depuis 48 heures.

Renal compensatory hypertrophy (R.C.H.) is determined 48 h. after uninephrectomy in fed and fasting rats having free access to a NaCl solution. ACTH (18 gamma/100 g BW/d/2d) enhances R.C.H. in the fed animals. R.C.H. is severely impaired by food deprivation and the remaining kidney looses weight; a normal kidney weight can be maintained if the fasted, uninephrectomized rat is treated with ACTH. These experiments suggest that the stimulation of the adrenal cortex by ACTH has a renotrophic effect. This action may be related to the elevation of blood glucose or/and to the fall of the concentration of plasma K+.