[Endocrinological findings in endocrine orbitopathy]. / Endokrinologische Befunde bei der endokrinen Orbitopathie.

Carl-Adolph von Basedow described the typical clinical features of immune-mediated hyperthyroidism (tachycardia, proptosis, goiter) in 1840 and termed it the "Merseburg trias". Graves' disease is an autoimmune disease with thyroidal and extra-thyroidal manifestations such as endocrine orbitopathy, which is caused by a dense lymphocytic infiltrate. A genetic predisposition combined with so far unidentified environmental factors and a complex immunological process seem to be important for its pathophysiology. The pathognomonic histopathophysiological picture is characterised by the typical lymphocytic infiltration of the ocular muscles and retrobulbar connective and adipose tissues leading to the classical exophthalmus. No specific therapy is available. The goal of therapy is therefore the correction of the hyperthyroidism and inhibition of the immune-mediated orbital inflammation which can be achieved by early interdisciplinary team work of endocrinologists, ophthalmologists and radiation therapy.

[Radiotherapy for Graves' ophthalmopathy]. / Radiotherapie der endokrinen Orbitopathie.

Graves' ophthalmopathy (GO) is the most frequent extrathyroidal manifestation of Graves' disease, an autoimmune disorder of the thyroid, whereas the precise pathogenesis still remains unclear. In Hashimoto's thyroiditis the occurrence of proptosis is an extremely rare event. The therapy for middle and severe courses of GO shows in partly disappointing results, although several therapy modalities are possible (glucocorticoid therapy, radiotherapy, antithyroid drug treatment, surgery). All these therapies lead in only 40 - 70 % to an improvement of the pathogenic symptoms. An intensive interdisciplinary cooperation is necessary to satisfy the requirements for the treatment of Graves' ophthalmopathy. As a consequence of the very different results of the few of clinical studies that were accomplished with reference to this topic, treatment by radiotherapy in the management of the disease is presently controversially discussed. In the German-speaking countries the radiotherapy is, however, firmly established as a therapy option in the treatment of the moderate disease classes (class 2-5 according to NO SPECS), especially if diplopia is present. This article describes the sequences, dosages and fractionation schemes as well as the risks and side effects of the radiotherapy. Altogether, radiotherapy is assessed as an effective and sure method. The administration of glucocorticoids can take place before the beginning of or during the radiotherapy. For the success of treatment the correct selection of patients who may possibly profit from a radiotherapy is absolutely essential. By realising that GO proceeds normally over a period of 2-5 years, which is followed by a period of fibrotic alteration, the application of the radiotherapy in the early, active phase is indispensable. A precise explanation for the effects of radiotherapy in treatment of the GO does not exist at present. The determination of the most effective irradiation doses was made from retrospectively evaluated collectives. Recently the results of a national survey of all German RT departments were published, initiated by the working group of the DEGRO (German Society of Radiooncology). In the most of the German radiooncology departments irradiation with 8 to 10 x 1.8-2.0 Gy 5 x weekly to 16 or 20 Gy is standard. Two recently published prospective German studies pointed out the equivalence of the effectiveness of a short therapy in low dose ranges up to 2.4 Gy as well as of a low proportioned irradiation during a longer period in relation to a standard therapy with 20 Gy. That is why at the moment it is not possible to give a definite recommendation with reference to dosages or the fractionation schemes. In 2003 the first European group (European Group on Graves ' Orbitopathy Experience -- EUGOGO) was founded for pursuing investigations of GO in multi-centric studies, mainly to improve therapy results.

[Graves disease. An important differential diagnostic consideration for systemic lupus erythematosus]. / Morbus Basedow. Eine auch dermatologisch wichtige Differenzialdiagnose des systemischen Lupus erythematodes.

Graves disease is a frequent cause (30-40%) of hyperthyroidism. In addition to the classic clinical triad (goiter, exophthalmos and tachycardia), symptoms relating to other organ systems may be found at presentation. Cutaneous manifestations play an important role and may initially be the only clue to the endocrine disorder. A 40-year-old woman with Graves disease presented with features of systemic lupus erythematosus. She had a malar rash, as well as marked hematological changes (thrombocytopenia and leukocytopenia) and antinuclear antibodies (1:640). She also had hyperthyroidism and Graves disease-specific thyroid autoantibodies (TSIg). Her symptoms improved after initiation of antithyroid therapy. Because of overlapping clinical and laboratory criteria, Graves disease can mimic systemic lupus erythematosus. The differentiation requires careful laboratory evaluation. Moreover, both autoimmune diseases may occur in the same patient.

[Multi-modality therapy concept in metastatic follicular thyroid carcinoma with hyperthyroidism]. / Multimodales Therapiekonzept bei metastasiertem folliculären Schilddrüsencarcinom mit Hyperthyreose.

The coincidence of hyperthyroidism and thyroid carcinoma seldom occurs. Only few reports on functionally metastases of thyroid carcinoma have been published. We report a 59-year-old man who underwent subtotal thyroidectomy for toxic nodular goiter. Histological examination revealed a follicular thyroid carcinoma. After thyroidectomy and cervical lymphadenectomy the patient developed a strong hyperthyreosis. Scintigraphy showed strong radioiodine uptake in the sacrum. De-bulking resection of the metastasis followed by high-dose radioiodine treatment was performed. After radioiodine therapy the patient became euthyroid. Treatment of hyperthyreosis in metastatic thyroid cancer requires a multimodal therapeutic concept.

Multiple intracranial lipoma: a case report.

We report on a male epileptic patient, presently 27 years old, who has suffered complex-partial attacks for 19 years. Under treatment with carbamazepine the seizures were completely controlled. In addition, the patient exhibited partial hypopituitarism. CT and MRI revealed the presence of 2 lipomas, one located within the optico-chiasmatic cistern and the other one in the medial temporal lobe. To our knowledge, this combination of the generally rare lesions has not been described yet.

[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.

[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.

[Studies on the behavior of human growth hormone (HGH) level in the preparation period for the clinical test]. / Untersuchungen zum Verhalten von Wachstumshormonspiegeln (HGH) in der Vortestperiode

Behaviour of human growth hormone (HGH) during preparation for a clinical test. 172 adults and 63 children were examined for the behaviour of their HGH basic values during preparation for a clinical test. Even before the beginning of the stimulation itself 11% of the adults and 47,5% of the children showed a fluctuation of the HGH levels in the serum. Neglect of these HGH movements involves the risk of misinterpretation and thus of false diagnosis. It therefore appears to be essential, especially for judging stunted-growth forms in childhood, to make tests for "empty stomach" values for the purpose of HGH determination at least 30 minutes before and immediately at the beginning of the stimulation test. The behaviour of the basic values must be included in the assessment of the test.