Thyroid hormones affect plasma ghrelin and obestatin levels.

Using radioimmunoassay, the effects of thyroid hormones on plasma total ghrelin (Gh) and obestatin (Ob) concentrations were evaluated in thyrotoxic patients with an excess of thyroid hormones and in hypothyroid patients lacking endogenous thyroid hormones. 24 patients with thyrotoxicosis, 25 hypothyroid patents after total thyreoidectomy performed due to thyroid cancer, and 17 control subjects were examined. Compared with the controls, the ghrelin and obestatin were elevated in hypothyroidism, while they were decreased in thyrotoxicosis. The plasma Gh and Ob levels differ depending on the thyroid function. In thyroid hormones deficiency, plasma Gh and Ob are increased, while in patients with excess of thyroid hormones, the levels of both Gh and Ob are definitely lower. Gh/Ob ratio is higher in hypothyroidism than in control subjects and thyrotoxic patients.

Chromogranin A as a useful neuroendocrine marker in patients with autoimmune Addison's disease.

BACKGROUND: Antiparietal cells antibodies (APC-Ab) are commonly found in patients with autoimmune Addison's disease (AAD), usually pointing to autoimmune atrophic gastritis and pernicious anemia. The autoaggression to the gastric proton pumpmay result in a long-term hypergastrinemia, which predisposes to enterochromaffin-like cell hyper/dysplasia and gastric carcinoids. AIM: We evaluated the clinical utility of assessing serum chromogranin A levels in patients with AAD. MATERIAL AND METHODS: Serum chromogranin A, gastrin, and gastric APC-Ab levels were determined in 40 patients with AAD using commercially available kits. RESULTS: Serum chromogranin A and gastrin levels were found to be elevated in 27.5 and 22.5% of patients with AAD, respectively. The Addison's patients with elevated APC-Ab had significantly higher chromogranin A and gastrin levels, as compared to individuals with normal APC-Ab (chromogranin A: 128.00+/-123.08 vs 57.68+/-36.50 ng/ml, p=0.0036; gastrin: 141.38+/-191.43 vs 49.50+/-75.36 muU/ml, p=0.003). Additionally, the patients with AAD and coexisting elevated serum APC-Ab, contrary to those with normal levels, showed a significant correlation between the chromogranin A and gastrin concentrations (r=0.52, p=0.0092 vs r=0.211, p=0.43). Serum chromogranin A appeared also significantly correlated with APC-Ab levels (r=0.431, p=0.005). CONCLUSIONS: In patients with autoimmune Addison's disease hyperchromograninemia and hypergastrinemia occur with a prevalence of 27.5 and 22.5%, respectively. Addison's patients with coexisting elevated gastric APC-Ab, particularly with elevated gastrin levels, are at risk of enterochromaffin-like cells hyper/dysplasia. Serum chromogranin A assessment may complement histology for the early diagnosis of gastric carcinoid in these patients.

Pneumadin in the rat ventral prostate and its hormonal regulation.

Pneumadin (PNM) is a decapeptide originally isolated from mammalian lungs, and exerts a potent antidiuretic action by stimulating arginine-vasopressin release. We have recently developed a sensitive and specific radioimmunoassay (RIA) for rat PNM and detected high concentrations of PNM--not only in the rat lungs, but also in the prostate. Hence, we investigated whether prostate PNM content is regulated by sex hormones. Male adult rats were orchidectomized or sham-operated and given a subcutaneous injection of testosterone or estradiol (40 and 5 mg/kg), respectively. The animals were decapitated one week after surgery, and their ventral prostates were promptly removed and weighed. PNM concentration and localization in the prostate were investigated by RIA and immunocytochemistry (ICC). Orchidectomy resulted in significant decreases in the prostate weight and PNM concentration, and testosterone administration prevented these effects. Estradiol administration to sham-operated rats caused prostate atrophy without changing PNM concentration. ICC localized PNM immunoreactivity (IR) exclusively in the epithelial cells of the ventral prostate. Orchidectomy markedly reduced PNM-IR concentration, while testosterone abolished this effect. Estradiol did not modify PNM-IR concentration in the atrophic prostate of sham-operated rats. We conclude that PNM content of rat prostate is dependent on the presence of adequate levels of circulating testosterone. The possibility that PNM plays a key role in the maintenance of the prostate growth is unlikely since estradiol-induced gland atrophy is not associated with any decrease in PNM concentration. The localization of PNM in the epithelial cells could suggest that this peptide may be involved in the regulation of some testosterone-dependent secretory functions of the rat prostate.

[Detection of pituitary autoantibody in patients with pituitary tumors and hypopituitarism]. / Wykrywanie autoprzeciwcial przysadkowych u chorych z gruczolakami przysadki i w niedoczynnosci przysadki.

UNLABELLED: In 80 patients, 73 cases of pituitary tumours and 7 cases of hypopituitarism, we performed pituitary autoantibodies assays in serum samples because in our previous studies we had found a high prevalence of pituitary autoantibodies in several autoimmune endocrine disorders. To detect the presence of pituitary autoantibodies we applied 2 methods, radioimmunoassay (RIA) and immunoblotting. The RIA was performed by solid phase technique in human pituitary microsome-coated polyethylene tubes. Following incubation with diluted sera of the patients labelled 125I-protein A was added to the tubes to detect the retained antibodies. In the sera of 33 patients we detected the presence of antibodies; in the other 47 patients no antibodies were found. The majority of the patients with positive antibody results were previously treated by pituitary irradiation. To evaluate the molecular weights of pituitary autoantigens the microsomal proteins were separated on SDS PAGE, then electrophoretically transferred to nitrocellulose membranes and reacted with diluted sera of 30 antibody-positive patients. The nitrocellulose strips were incubated with labelled 125I-protein A and autoradiographed. Using immunoblotting, 13 out of these 30 patients we found autoantibodies reacting with pituitary microsomal antigens of different molecular weights, most frequently reacting with a 68 kDa autoantigen. CONCLUSIONS: The prevalence of pituitary autoantibodies in patients with pituitary diseases is 41% lower than in autoimmune endocrine diseases. Pituitary autoantibodies usually appear in patients after pituitary irradiation or after neurosurgery followed by irradiation, but occur rarely in untreated patients with pituitary adenomas.

[Bone mineral density in primary hyperparathyroidism]. / Gestosc mineralna kosci w pierwotnej nadczynnosci przytarczyc.

UNLABELLED: Skeletal complications of advanced hyperparathyroidism include clinically bone pains, muscle weakness, bone deformities and fractures. X-ray studies reveal subperiosteal bone resorption, atrophy of the cortex of long bones, cysts, brown tumours and calcifications of soft tissues; these changes appear in the late period of the disease. In recent onset of hyperparathyroidism bone changes may be detected by X-ray absorptiometry. Thus the aim of our study was to evaluate bone mineral density with the use of dual energy X-ray absorptiometry (DEXA) at two sites: in lumbar vertebral bodies consisting mainly of the trabecular bone and in 1/3 distal part of the radius composed predominantly of the cortical bone. Twenty-three patients with primary hyperparathyroidism were included in our study. Hypercalcemia (ionized calcium above 5.4 mg/100 ml, total calcium above 10.6 mg/100 ml) and increased serum PTH, above 100 pg/ml, were detected in all patients. Isotope scintigraphy using 99mTc-MIBI revealed the presence of a parathyroid adenoma; this was confirmed at surgery and histopathologically. In bone densitometry we found greatly reduced bone mineral density (BMD) in 1/3 distal part of the radius amounting to 66.8 +/- 12.0% of the age-matched range and markedly smaller bone loss in lumbar spine, BMD was 91.7 +/- 14.6%. In 10 patients control densitometry, performed 6-24 months after parathyroid adenomectomy, revealed a marked 10 to 22% increase in bone density of lumbar vertebral bodies in the first year. BMD of the 1/3 distal part of the radius increased to a smaller degree 6.3% per year. CONCLUSIONS: 1. Bone densitometry in primary hyperparathyroidism reveals pronounced decrease in bone mineral density in the 1/3 distal part of the radius and much smaller decrease of the lumbar spine density. 2. Parathyroid adenomectomy leads to a rapid increase in density of the trabecular bone L1-L4 vertebral bodies and much smaller increase in the cortical bone of the radius. 3. Pronounced differences in bone mineral density of cortical bone and trabecular bone surpassing 20% are characteristic of hyperparathyroidism as they do not occur in other types of osteoporosis.

[Markers of bone formation and resorption in primary and secondary hyperparathyroidism]. / Markery tworzenia i resorpcji kosci w pierwotnej i wtórnej nadczynnosci przytarczyc.

Hyperparathyroidism, both primary and secondary in chronic renal failure, leads to pathologic changes in the bones. Newly introduced markers of bone metabolism enable to biochemically detect and evaluate these changes. The aim of our studies was to perform determinations of serum osteocalcin as a marker of bone formation, and C-terminal telopeptide of collagen I (ICTP) as a marker of bone resorption in patients with excessive secretion of parathyroid hormone (PTH). Our studies comprised of 15 patients with primary and 24 patients with secondary hyperparathydroidism. In all patients serum PTH, osteocalcin and ICTP were detected by radioimmunoassay; the correlations between PTH and osteocalcin as well as between PTH and ICTP were also performed. Serum PTH was elevated in both, primary and secondary hyperparathyroidism. In primary hyperparathyroidism serum osteocalcin was moderately or definitely elevated, similarly serum ICTP was high. Following surgical removal of a parathyroid adenoma, concomitantly with a drop in serum PTH there was a rapid normalization of serum osteocalcin and ICTP. Secondary hyperparathyroidism in uraemia was characterised by markedly elevated serum osteocalcin and ICTP which surpassed the concentration of these markers in primary hyperparathyroidism. There was a positive correlation between serum PTH and osteocalcin levels, and a lower correlation between PTH and ICTP. From our studies it is concluded that excessive secretion of PTH in primary and secondary hyperparathyroidism stimulates bone formation and to higher degree--bone resorption.

[Primary hyperparathyroidism--diagnostic problems]. / Pierwotna nadczynnosc przytarczyc--problemy diagnostyczne.

Parathyroid imaging with 99m Tc-MIBI, introduced at the beginning of the 90's seems to be a promising method for parathyroid adenomas localization. The aim of the study was to assess the efficacy of parathyroid imaging with 99m Tc-MIBI for preoperative localization of parathyroid adenomas and to compare that method with the high-resolution ultrasonography. Thirteen patients with primary hyperparathyroidism of duration from 2 to 25 years were included in the study. The presence of parathyroid adenomas was confirmed by histopathology in all patients. The sensitivity for scintigraphy and ultrasonography was 92.8% and 78.5%, the number of false positive results was 0 and 2 and false negative-0 and 1, respectively. Parathyroid imaging with 99m Tc-MIBI is a useful method for parathyroid adenomas localization, and in contrast to ultrasonography its sensitivity does not decrease if a parathyroid adenoma is located ectopically. Nevertheless, because of the greater accessibility, lower costs and its simplicity ultrasonography should be used as a screening modality for parathyroid adenoma localization.

[Comparison of calcitonin tolerance after intramuscular or intranasal administration in treatment for postmenopausal osteoporosis]. / Porównanie tolerancji kalcytoniny podawanej domiesniowo lub donosowo w leczeniu osteoporozy pomenopauzainej.

The aim of the study was to compare the tolerance of synthetic salmon calcitonin applied in two different ways, intramuscularly or intranasally, in 50 patients with postmenopausal osteoporosis with bone fractures. Thirty patients were treated with calcitonin in intramuscular or subcutaneous injections, whereas in 20 cases calcitonin was applied in nasal spray. In the first group several side effects were observed, like nausea, vomiting, abdominal pains, skin rush, headaches, dropping blood pressure, symptoms of bronchial spasm. Finally in 13 cases it was necessary to stop calcitonin therapy. On the other hand the patients receiving calcitonin in nasal spray did not manifest any severe side effects.

[Outcome of treating hypothyroidism with thyreoideum]. / Wyniki leczenia niedoczynnosci tarczycy preparatem thyreoideum.

The results of hypothyreosis therapy with thyroideum (dried thyroid gland) were assessed in 40 patients. The study aimed at establishing proper dosage and assaying blood serum T4, T3, and TSH levels. Daily dose of 1 tablet (0.2 mg of iodine) improved clinical status but did not cover the daily requirement of the body for thyroid hormones. An increase in daily dose to 2 tablets (0.4 mg of iodine) produced nearly complete compensation of hypothyreosis. However, such a daily dose was often associated with adverse reactions, especially in patients with arterial hypertension or atherosclerosis. Thyroid hormones assay has shown that dried thyroid gland administered in daily dose of 0.4 mg normalizes serum T3 levels whereas serum T3 levels remained constantly low, and TSH increased as in non-treated disease. An increase of the daily dose to 0.6 mg of iodine produces excessive increase in serum T3 levels with clinical symptoms of T3 toxicity.

Polyendocrine autoimmunity in thyroid diseases.

Anti-adrenal and anti-pituitary autoantibodies have been determined in 45 patients with autoimmune diseases of the thyroid, including 25 patients with Graves' disease and 20 patients with hypothyroidism of autoimmune origin. The determinations were carried out with the use of solid-phase RIA methods previously developed by us, involving polyethylene tubes coated with the solubilized microsomal fractions obtained from human adrenal and pituitary glands. In the majority of patients with autoimmune diseases of the thyroid the presence of both anti-adrenal and anti-pituitary autoantibodies was detected. In 13 among 20 patients with hypothyroidism of autoimmune origin, the presence of anti-adrenal autoantibodies, and in 12 the presence of anti-pituitary autoantibodies was found. Among 25 patients with Graves' disease, 19 had both anti-adrenal and anti-pituitary autoantibodies. In the majority of patients with autoimmune diseases of the thyroid the titers of autoantibodies of both types were high but in no case were the clinical symptoms of adrenal or pituitary hypofunction observed. Our studies indicate that the thyroid diseases of autoimmune origin can be regarded as manifestation of some more generalized autoimmunization process.

[Monitoring of treatment for hypothyroidism with L-thyroxine]. / Monitorowana terapia niedoczynnosci tarczycy L-tyroksyna.

The study was aimed at the evaluation of treatment of hypothyroidism with L-thyroxine administration monitored by the determination of T3 and T4 concentrations. The investigations were carried out in a group of 57 patients with hypothyroidism including 37 patients with autoimmune etiology of hypothyroidism, 12 patients after strumectomy and 8 patients after treatment with 131J. The administration of L-thyroxine at a dose of 2 micrograms/kg/day effectively eradicated all symptoms of the disease and led to the normalization of blood serum T3 and T4 values in the majority of patients with autoimmune hypothyroidism. So the majority of women required the daily dose of L-thyroxine of 100-150 micrograms, and the majority of men 125-175 micrograms. Lower dosage of L-thyroxine (50-100 micrograms daily) was required to attain euthyroid state in some patients with postoperative or postradiation hypothyroidism. Monitoring of the therapy by the determination of blood serum T3 and T4 concentrations greatly facilitated the proper choice of the therapeutic dose of L-thyroxine as the return of the thyroid hormone concentrations to normal usually brought about the complete remission of symptoms of the disease. The exception from this rule was only in the case of patients with arterial hypertension and coronary disease in whom, because of the side-effects, lower dosage of L-thyroxine (usually 50 micrograms daily) must have been applied to attain the optimal improvement. The treatment with L-thyroxine caused much less side-effects as compared to the therapy using the dessicated thyroid preparations (Thyroideum).

[Method for detection of antitubulin antibodies. Results of assays in autoimmune thyroid diseases]. / Metoda wykrywania autoprzeciwcial antytubulinowych. Wyniki oznaczen w autoimmunologicznych chorobach tarczycy.

A cytoskeletal protein--tubulin was isolated from the cerebral tissue by the sequential microtubule polymerization and depolymerization technique described by Schelansky. The purity of the isolated protein was verified by SDS polyacrylamide gel electrophoresis. The binding reaction with monoclonal antibodies against various cytoskeletal proteins confirmed the presence of pure tubulin. The isolated tubulin was used as reactant in a solid phase radioimmunoassay for the detection of antitubulin antibodies in tubulin-coated plastic tubes. Antitubulin antibody assays were performed in 20 cases of hypothyroidism and 56 cases of Graves' disease. In 70 percent of cases of hypothyroidism and 50 percent of cases of Graves' disease the levels of antitubulin autoantibodies were elevated. The highest titres of antibodies had some patients with Graves' disease. The antitubulin autoantibodies were of the IgM class.

[Radioimmunologic determination of pituitary autoantibodies in patients with Addison's disease]. / Radioimmunologiczne oznaczanie autoprzeciwcial przysadkowych w chorobie Addisona.

The occurrence of pituitary autoantibodies was investigated in 34 patients, 25 females and 9 males, with Addison's disease of autoimmune origin and in 10 patients with tuberculous etiology of the disease. In both groups adrenal autoantibodies were also determined. Autoantibodies were determined by radioimmunoassay using solid phase technique in tubes coated with proteins of human adrenal and pituitary microsomal fractions. Pituitary autoantibodies were detected in 28 of 34 patients (20 females and 8 males) with autoimmune Addison's disease but only in 3 patients (2 females and one male) with nonimmune etiology of the disease. Both antipituitary and antiadrenal antibodies remain present in the circulation for many years as they were detected in autoimmune Addison's disease even after 10 or more years after the onset of the disease. There was a close relationship between the occurrence of pituitary antibodies and adrenal autoantibodies: they both appeared in the same patients and high titres of pituitary autoantibodies were associated with high titres of adrenal autoantibodies. This suggests a close similarity or identity of pituitary and adrenal autoantigens.

[Glycoprotein hormone alpha subunit as a marker of pituitary adenoma]. / Podjednostka alfa hormonów glikoproteinowych jako znacznik gruczolaków przysadki.

Blood serum FSH, LH, prolactin and testosterone as well as urinary excretion of 17KS and 17-OHCS were determined in 8 patients with chromophobe pituitary adenomas treated by transphenoidal microsurgical removal or craniotomy with or without subsequent telecobalt therapy. It was found te disease tends to recur in the majority of patients despite the type of therapy. Recurrence is accompanied by gonadotropins hyposecretion, increase in prolactin secretion, secretory disorders in the gonads and adrenals; an increase in prolactin secretion is proportional to the intensity of the compression symptoms. Bromocriptine in a daily doses ranging from 5.0 to 7.5 mg decreases prolactin levels in the recurrent chromophobe pituitary adenomas and does not affect their proliferation.

Echocardiographic abnormalities in acromegalic patients.

UNLABELLED: The aim of our study was the evaluation of the cardiac size and left ventricular function in 26 patients with acromegaly and 20 control subjects using echocardiography. The following parameters were evaluated: systolic and diastolic ventricular dimensions, diastolic posterior wall and interventricular septal thickness, left ventricle ejection fraction and left ventricular mass, amplitude of the posterior left ventricular wall movement, speed of the circular fibres shortening area of the left ventricular muscle and left ventricular contractility index. RESULTS: In 91% of patients with acromegaly echocardiographic abnormalities were found. The most frequent were: concentric thickening of the left ventricular posterior wall in 38%, interventricular septal thickening in 54% and increased left ventricular mass in 84.6% of acromegalic patients. Left ventricular dimensions were increased: diastolic in 65.4% and systolic in 92% of patients. In 46% of cases the ejection fraction was decreased. There was no correlation between extent of the left ventricular hypertrophy and other echocardiographic abnormalities, serum growth hormone concentration, choice of therapy and duration of the disease.

[Growth hormone-releasing factor (GRF) stimulation test in the diagnosis of pituitary adenomas]. / Testy stymulacji neurohormonem GRF w gruczolakach przysadki.

The studies aimed at evaluation of pituitary reserve of growth hormone following stimulation with GRF have been carried out in a group of 33 patients (11 women and 22 men, of age between 25 and 62 years) with pituitary tumors. The studied material included cases with pituitary adenoma characterized by excessive secretion of growth hormone (somatotropinoma), prolactin (prolactinoma) or alpha subunits of glycoprotein hormones (alphoma), and those with hormonally inactive adenoma. The GRF stimulation tests were carried out in hospitalized patients after overnight fast between 8.00 and 10.00 a.m. Blood samples for hormonal determinations were taken before the test, and after 15, 30, 60, 90 and 120 minutes following intravenous administration of 100 micrograms of GRF 1-29. Besides growth hormone, also the blood serum concentrations of other pituitary hormones were determined in the patients studied, both in the basal state and during the dynamic tests. In patients with acromegaly the results of the determinations of growth hormone following stimulation with GRF showed considerable individual variability. In 5 cases there was an increase in blood serum growth hormone concentration. No response to GRF was noted in the remaining 8 cases. In adenoma cases of prolactinoma type, growth hormone concentration began to rise already at the 15-th minute of the test in most cases. In three cases of prolactinoma associated with acromegaly no response to GRF was observed. The cases of alphoma-type adenoma were usually characterized by the secretion of pituitary hormones other than growth hormone.(ABSTRACT TRUNCATED AT 250 WORDS)