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Gynaecomastia, or enlargement of the male breast may result from various endocrine dysfunctions and often reflects ectopic production of substances such as hCG and estradiol. We report on the case of a 30 year old man who presented with gynaecomastia and elevated plasma levels of hCG, estradiol and testosterone. As a result of several diagnostic procedures such as selective venous sampling and magnetic resonance tomography (MRT), a hCG producing tumor of the upper lobe of the left lung was found. This hormonal overproduction induced an enhanced secretion of estradiol and testosterone in the testicular tissue. Histology revealed a giant cell carcinoma with positive immunostaining for hCG. This case report further underlines the necessity of an intensive search for ectopic beta-hCG production due to malignant tumours, in particular in the adult.

Biochemical and radiological results, surgical technique and its results were critically analysed in a retrospective study of 154 operations on the adrenals in 127 patients, operated on between 1957 and 1980. There were no complications in 95 patients. In the remaining 32, both intra- and postoperative complication rate was greater after extraperitoneal than transabdominal approach to the adrenals. Postoperative mortality was 6%, but since 1967 only two patients have died in the postoperative period. Thromboembolic phenomena were the main cause of death, patients with Cushing's disease most commonly having this complication.

A patient with high-grade osteoporosis had elevated levels of ACTH, cortisol and carcinoembryonic antigen (CEA). Computed tomography demonstrated enlarged adrenal glands. Despite intensive search no ACTH-producing tumour was found. A central Cushing's syndrome was thus possible, and a radiologically normal sella turcica made a microadenoma of the hypophysis a possibility. However, a one-time hypertensive crisis with elevated catecholamines raised the suspicion of an additional phaeochromocytoma and thus provided the first pointer to a multiple endocrine neoplasia. Bilateral phaeochromocytomas, discovered at adrenalectomy, as well as raised serum-calcitonin levels, strongly suggested coexistence of a C-cell carcinoma, which previously had not been demonstrated either by thyroid scanning or fine-needle biopsy. A total thyroidectomy revealed a multifocal and metastasizing C-cell carcinoma. On extraction it contained a high concentration of calcitonin, typical for a C-cell carcinoma. An unusual finding was of ACTH in extracts of both the C-cell carcinoma and the phaeochromocytoma. It was immunologically identical with the synthetic ACTH used as a standard.

Pheochromocytoma scanning using 131J-meta-benzylguanidine was done in one patient with metastasizing paraganglioma, one patient with multiple endocrine neoplasia type IIb. No activity of tumour tissue could be demonstrated in the patient with metastasizing paraganglioma, whereas the pheochromocytoma could be clearly defined in the patient with multiple endocrine neoplasia type IIa. The female with multiple endocrine neoplasia type IIb showed a suspect space-occupying lesion of the left adrenal using computed tomography. Pheochromocytoma could be excluded by 131J-benzylguanidine scanning, selective estimation of catecholamines in adrenal venous blood as well as the glucagon stimulation and clonidine suppression.

Percutaneous transhepatic portal vein catheterisation with blood sampling from the various areas of drainage, especially the pancreatic veins, was undertaken in seven patients with insulinoma to diagnose its site. In six patients measurement of serum-insulin levels revealed an abrupt rise in the vascular area later found to drain the area of the insulinoma. Insulin measurement in one patient with insulinoma in the head of the pancreas falsely indicated an islet-cell tumour in the region of the tail of the pancreas. C-peptide concentration in serum followed the concentration of insulin, but did not show such a marked rise. The method of percutaneous transhepatic portal vein catheterisation with selective blood sampling for the measurement of hormonal concentration was superior to ultrasound, computer tomography or coeliacography for determining the site of the tumour.

From 1979 to 1986, seven patients with multiple endocrine neoplasia (MEN) type IIa and three with type IIb were treated. Nine had a C-cell carcinoma, one had C-cell hyperplasia. None had hyperparathyroidism. Three patients had multiple mucous neuromas. Six patients had proven pheochromocytoma: adrenalectomy was performed in these six (unilateral or bilateral depending on whether the tumor was uni- or bilateral). All ten patients had a total thyroidectomy--three later required neck dissection for regional lymphnode metastases. One patient died from the consequences of diffuse liver metastases of a C-cell carcinoma. Extensive family screening is necessary with patients who have MEN type II, in order to discover early any occult disease carriers. In addition, MEN type II should be excluded in all patients who have C-cell carcinoma, pheochromocytoma or hyperparathyroidism.

Plasma levels of calcitonin and carcinoembryonic antigen (CEA) were determined pre-operatively and two months postoperatively in ten patients with C-cell carcinoma as part of multiple endocrine neoplasia type II. In addition, CEA was measured in extracts from 20 different phaeochromocytomas (five from patients with multiple endocrine neoplasia type II, 15 from patients with sporadic phaeochromocytoma). In comparison, CEA concentration was determined in extracts from five C-cell carcinomas of patients with multiple endocrine neoplasia type II. When correlating pre- and postoperative calcitonin and CEA levels, there was a significant linear relationship (P less than 0.001). CEA concentration in extracts from phaeochromocytomas was at the lower level of sensitivity (4.7 +/- 12.2 pg/mg tumour wet-weight). In extracts from C-cell carcinomas they were much higher (6402 +/- 4570 pg/mg tumour wet-weight). The results suggest that it is possible, in patients with phaeochromocytoma and high calcitonin levels, to differentiate by additional CEA determination between C-cell carcinoma in the course of multiple endocrine neoplasia type II and sporadic phaeochromocytoma with ectopic calcitonin liberation.

The thymic nurse cell is a unique type of epithelial cell in the thymic cortex. It is in intimate contact with the developing thymocytes by harbouring up to 200 thymocytes in distinct vacuoles, called caveoles. This investigation is concerned with the nurse cell expression of the intercellular adhesion molecule ICAM-1, the ligand for thymocyte LFA-1. Nurse cells from young Balb/c mice were isolated in a density gradient. ICAM-1 expression was studied by using two different immunotechniques: alkaline phosphatase labelled cryosections, and immunogold electron microscopy. The specific antibody was a monoclonal rat anti-mouse ICAM-1. Immunostaining of cryosections demonstrated that ICAM-1 is expressed on the surface membrane and in the internal caveolar membranes of thymic nurse cells. Electron microscopy of immunogold labelled sections revealed ICAM-1 on the surface membrane of thymic nurse cells and on the membranes of the caveoles, the small cytoplasmic vesicles, as well as on the Golgi apparatus.

Zusammenfassung Ziel: Ziel unserer prospektiven Studie war die optimierte Bestimmung des hypophysären Somatostatin-Rezeptorstatus in der 111 -In-Pentetreotid-Szintigraphie und der intraindividuelle Vergleich mit dem pharmakologischen Effekt von Octreotid bei florider Akromegalie. Methoden: Bei n = 22 Patienten mit Wachstumshormon-(GH)-sezernierendem Hypophysenadenom wurde eine 111-In-Pentetreotid-Szintigraphie durchgeführt und die spezifische Nuklidakkumulation in der Hypophysenregion (Auswertung sowohl visuell als auch semiquantitativ mittels ROI-Technik und Berechnung verschiedener Uptake-Indizes) mit dem akuten GH-Abfall nach 100 ug Octreotid s.c. (Octreotid-Akuttest) korreliert. Ergebnisse: Der von uns vorgeschlagene Uptake-Index (Quotient zirkuläre Hypophysen-ROI : irreguläre Zerebrum-ROl, jeweils cts/pixel nach Untergrund-Korrektur im sagittalen SPECT-Schnitt mit der maximalen Hypophysendarstellung 24 h p. i.) korreliert am besten mit dem pharmakologischen Effekt (akuter GH-Abfall) von Octreotid; seine obere Normgrenze liegt im Bereich von 3,5. Schlußfolgerungen: Da sich häufig auch die normale Hypophyse szintigraphisch darstellen läßt, ist die rein visuelle Abgrenzung zum pathologischen Rezeptorstatus manchmal uneindeutig. Ein mittels standardisierter ROI-Technik berechneter, hypophysärer Uptake-Index erleichert diese Abgrenzung und hilft so, mögliche Responder für eine Octreotid-Langzeittherapie zu selektieren.

Objective The response to subcutaneous (SC) gonadotropin replacement therapy, using human chorionic gonadotropin (hCG) and human menopausal gonadotropin (hMG) or hCG alone, was evaluated in male hypothalamic hypogonadism. Design Sixteen patients with hypothalamic hypogonadism were treated with gonadotropins for induction of puberty and normalization of spermatogenesis. The results were analyzed retrospectively. Setting The study was carried out in a clinical endocrinology department providing tertiary care and in private practices of endocrinology. Patients Eight patients with idiopathic hypogonadotropic hypogonadism and eight patients with Kallmann's syndrome in prepubertal or early pubertal stages. Interventions Human chorionic gonadotropin and hMG were administered SC in individual dosages. Main Outcome Measures Increase of serum testosterone (T), testicular volume, semen volume, and sperm count were evaluated. Results Normalization of serum T and complete sexual maturation was achieved in all patients. Spermatogenesis was induced in all but two patients. Seven patients showed normal findings in semen volume and sperm count, and two patients had semen quality close to normal. In five patients sperm count remained 6 /mL. Conclusions The results obtained by SC gonadotropin replacement prove this mode of administration to be effective in stimulating steroidogenesis and spermatogenesis in hypogonadotropic males.

We report on a 30-year-old man with azoospermia, primary hypogonadism and minor dysmorphic features who carried a balanced insertional chromosome translocation inv ins (2p24;4q28.3q31.22)de novo. Molecular cytogenetic analyses of the chromosome breakpoints revealed the localization of the breakpoint in 4q28.3 between BACs RP11-143E9 and RP11-285A15, an interval that harbours the PCDH10 gene. In 4q31.22, a breakpoint-spanning clone (RP11-6L6) was identified which contains the genes LSM6 and SLC10A7. On chromosome 2, BACs RP11-531P14 and RP11-360O18 flank the breakpoint in 2p24, a region void of known genes. In conclusion, the chromosome aberration of this patient suggests a gene locus for primary hypogonadism in 2p24, 4q28.3 or 4q31.2, and three possible candidate genes (LSM6, SLC10A7 and PCDH10) were identified by breakpoint analyses.

The aim of our prospective study was to optimize the determination of the pituitary somatostatin receptor status by means of 111-In-pentetreotide scintigraphy and to compare it intraindividually with the pharmacological effect of octreotide in active acromegaly.In n = 22 patients with growth hormone (GH) secreting pituitary adenoma, 111-In-pentetreotide scintigraphy was performed, and the specific radionuclide accumulation in the pituitary area (evaluation visually as well as semiquantitatively by means of ROI technique and calculation of various uptake indices) was correlated with the acute drop of GH after administration of 100 micrograms octreotide s. c. (octreotide acute test).The uptake index we propose (cts/pixel-ratio circular pituitary ROI: irregular cerebrum ROI after background correction in the sagittal SPECT slice with maximum pituitary uptake 24 h p.i.) correlates best with the pharmacological effect (acute decrease of GH levels) of octreotide; its upper normal limit amounts of 3.5.As often the normal pituitary gland can be visualized scintigraphically, the purely visual differentiation between a normal and a pathological receptor status sometimes is equivocal. A pituitary uptake index, calculated by means of a standardized ROI technique, facilitates this discrimination and so contributes to select possible responders for a treatment with octreotide.

Gynaecomastia, or enlargement of the male breast may result from various endocrine dysfunctions and often reflects ectopic production of substances such as hCG and estradiol. We report on the case of a 30 year old man who presented with gynaecomastia and elevated plasma levels of hCG, estradiol and testosterone. As a result of several diagnostic procedures such as selective venous sampling and magnetic resonance tomography (MRT), a hCG producing tumor of the upper lobe of the left lung was found. This hormonal overproduction induced an enhanced secretion of estradiol and testosterone in the testicular tissue. Histology revealed a giant cell carcinoma with positive immunostaining for hCG. This case report further underlines the necessity of an intensive search for ectopic beta-hCG production due to malignant tumours, in particular in the adult.

Grey level was measured in 93 ultrasonic scans of the thyroid gland in order to quantify hypoechogenicity in diffuse inflammatory thyroid disease. Using a modern ultrasound device (256 grey-scale steps and 7.5-MHz parallel scan), grey levels were measured in normal thyroid glands and euthyreotic goiters as well as in thyroiditis or Graves' disease using a programmed setting of the device. Highly significant differences were found between normal thyroid glands and thyroiditis or Graves' disease. Sensitivity of the method was 65% in discriminating Graves' disease and 91% in discriminating thyroiditis; specificity was 95%. The clinical value of the method for follow-up studies in inflammatory diseases of the thyroid gland still has to be established.

Bechterew's disease is a chronic-inflammatory condition of the spine, with a tendency toward stiffening and relatively frequent involvement also of the hip, knee and shoulder joints. Contrary to most other rheumatic diseases, drug therapy plays a rather minor role. The focus is on movement, in line with the motto that "Bechterew patients need movement". The sports therapy concept of the Münster University Bechterew group as well as initial experience are set out.

The aim of this study was to clarify the extent of bone mineral deficiency in patients with Klinefelter's syndrome on the premise that testosterone substitution could prevent this deficiency. Bone mineral density was measured by single-photon absorptiometry in 42 patients with Klinefelter's syndrome, (21 patients without therapy, 10 with testosterone substitution before the age of 20 and 11 patients with testosterone substitution beginning after the age of 20). We found significantly lower bone mineral density in patients without therapy and in patients when the therapy began later compared to normal individuals. Patients with early therapy showed a high proportion of normal values of bone mineral density. We found a positive correlation between bone mineral density and plasma testosterone and a negative correlation between plasma testosterone and age for patients without therapy. These findings suggest that low testosterone levels before or during puberty cause inadequate bone development and low bone mineral density in Klinefelter's syndrome. Only early testosterone substitution may prevent bone mineral deficiency. Later substitution no longer affects bone mineral density.

The aim of the study was to investigate the influence of 40 mg of the beta-blocker penbutolol (Betapressin TM; Hoechst Ltd., Frankfurt/Main) in comparison to placebo on the insulin consumption on the blood sugar profile in twelve insulin-dependent diabetes (IDDM) patients. The patients were treated with penbutolol and placebo for a period of three days, and then were examined with the help of the glucose-controlled insulin infusion system. The blood sugar profile and insulin consumption over a 24 hour period was not affected by either penbutolol or placebo, nor could any changes be measured in these parameters when measured after food intake. After a submaximal exercise load on the bicycle ergometer (1 watt per kg body weight) following an evening meal, no difference could be observed between penbutolol and placebo in the above-mentioned parameters. The same was also true for hormonal parameters as STH, ACTH, cortisol, and catecholamines. These findings demonstrated that medication of penbutolol over a three-day period has no influence on the baseline blood sugar profile and insulin consumption or on insulin consumption after food intake during rest and physical exercise.

Bekannte Komplikation der Epiphysenfraktur vom Typ 3 und 4 nach Salter und Harris [10] ist ein partieller Wachstumsfugenverschlus mit konsekutiver Achsenfehlstellung und Beinverkurzung. Die Blount-Klammerung zur Behebung der Achsendeformitat ist bei der geschadigten Wachstumsfuge obsolet; Beinverlangerungsmasnahmen und Korrekturosteotomien sind aufwendig. Die einfache Resektion der Knochenbrucke erweist sich stets als erfolglos, da die Knochenhohle zwischen den spongiosen Resektionsflachen stets schnell wieder knochern uberbaut. In der Behandlung des Fehlwachstums empfahl Langenskjold [6, 7] nach der Resektion der Knochenbrucke die Fettgewebeinterpositionsplastik, die die unerwunschte Knochenneubildung erfolgreich verhindere. Wir berichten uber die Behandlungsergebnisse von 7 Patienten.

Zwischen 1979 und 1987 wurden an der Chirurgischen Universitatsklinik „Bergmannsheil“ Bochum 53 Kinder und Jugendliche mit 93 ligamentaren Verletzungen des Kniegelenkes operativ versorgt und nachuntersucht. Das durchschnittliche Alter betrug zum Unfallzeitpunkt knapp 15 Jahre.

In a retrospective study of 31 patients with suspected pheochromocytoma we examined the preoperative results of 131I-metaiodobenzylguanidine (131-I-MIBG) scintigraphy and a fluorimetric urine catecholamine determination test. An additional radioenzymatic plasma catecholamine determination test was performed in 25 patients. In 14 of the 31 patients the diagnosis of pheochromocytoma was later histologically confirmed. In the remaining 17 patients the suspected diagnosis was finally rejected after a clinical decision had been made on the basis of clinical history, symptoms, laboratory and imaging tests. 131-I-MIBG scintigraphy apparently had a very high specificity (no false-positive results among the patients with rejected diagnosis), but showed the least sensitivity (3 of 14 tumours were not detected). Urine catecholamines showed two false-negative and three false-positive results. Plasma catecholamines had the highest sensitivity and gave only one false-positive result. Because of its high pathognomonic value 131-MIBG scintigraphy can be helpful not only for localization, but also for confirmation of diagnosis when catecholamine determination tests are contradictory. On the basis of our experience with false-positive results after interfering medication therapy, urine and plasma catecholamine determination tests should only be carried out after purification with thin layer chromatography or high performance liquid chromatography.

Xylitol has been suggested as a potentially useful sweetener in the diabetic diet. In 14 insulin-dependent diabetics a standard diabetic diet regimen was compared with diets in which starch was isocalorically exchanged in the breakfast meal by either 30 g xylitol or 30 g sucrose. Insulin requirement and blood glucose were measured using a glucose-controlled insulin infusion system. The results following breakfast with xylitol were similar to those after starch breakfasts. Sucrose, in contrast, induced a greater post-prandial rise in blood glucose levels despite counter-regulation by the glucose-controlled insulin infusion system. Insulin requirement after sucrose significantly exceeded (p less than 0.01) that after xylitol or starch during the first 60 min and 2 h respectively. No short-term side effects of xylitol were found.

Bei sechs Patienten mit adrenalem Phaochromocytom erfolgte die Lokalisationsdiagnostik durch Ultraschalluntersuchung, Phlebographie der Nebennieren und selektiver Katecholaminbestimmung im Blut der Vena cava sowie der Nebennierenvenen. Durch die selektive Katecholaminbestimmung konnten alle Phaochromocytome lokalisiert werden, durch die Ultraschalluntersuchung funf, durch die Phlebographie vier. Ein Phaochromocytom von 1,5 g Gewicht, das nur durch die selektive Katecholaminbe-stimmung, nicht aber durch Ultraschall oder Phlebographie lokalisiert wurde, konnte computertomographisch dargestellt werden.

Gonadotropin-releasing hormone (GnRH) and some potent long-acting GnRH analogs, applied by different routes of administration, were tested in six healthy human males. The effects on gonadotropin secretion were compared with the one after intravenous (i.v.) bolus injection of 25 microgram of GnRH. The net increase of luteinizing hormone (deltaLH) in serum produced by 25 microgram of GnRH i.v. was matched by subcutaneous (s.c.) injection of 100 microgram of GnRH, dissolved in 20% gelatin or without gelatin; 5 microgram of D-Ser (TBU)6-des-Gly10-GnRH-ethylamide i.v.; 5 microgram of D-Leu6-des-Gly10-GnRH-ethylamide i.v.; and 50 microgram of D-Trp6-des Gly10-GnRH-ethylamide given pernasally (p.n.). D-Leu6-des-Gly10-GnRH-ethylamide, 50 microgram p.n., produced one-half such increase as did also multiple p.n. administrations of 200 microgram of GnRH every 2 hours. With 100 microgram of GnRH and all analogs, elevation of serum LH lasted for about 7 to 9 hours. The longest elevation was observed with GnRH dissolved in gelatin and with D-Ser (TBU)6-des-Gly10-GnRH-ethylamide, as reflected by the greatest areas under the curves of net increase. The longer the duration of the action of LH secretion, the higher was the observed increase in follicle-stimulating hormone (FSH). Correlation between effect on LH secretion and testosterone secretion was not found. By infusion of 1 microgram/kg/hour od D-Leu6-des-Gly10-GnRH-Ethylamide in two men over a period of 15 hours, a plateau of gonadotropin levels was reached within 7 to 9 hours. These plateau levels, especially of FSH, were higher than after bolus injection or p.n. application.

Fifteen patients with a total of 16 islet-cell tumors 7-20 mm in diameter (average, 12 mm) were examined preoperatively by computed tomography (CT) and ultrasound. Seven out of 16 tumors were detected by CT and 9 out of 15 by ultrasound. Marked contrast enhancement was seen on dynamic CT scans following a bolus injection, while a circumscribed, hypoechoic mass was seen on ultrasound. Tumors of the tail of the pancreas and those outside the pancreas were difficult to detect. Ultrasound is recommended as the initial step for locating islet-cell tumors, followed by CT; angiography and transhepatic venous sampling should be restricted to tumors which are not detectable by other methods. Intraoperative ultrasound was successful in 3 patients and may facilitate the operative search.

Long-acting analogs are of special interest in long-term treatment with gonadotropin-releasing hormone (GnRH). However, inhibitory effects of agonist analogs on gonadotropin secretion or on reproductive processes have been observed in rats as well as in human males. Since these inhibitory effects seem to be dose-related, we checked the findings for d-Leu 6 -des-Gly 10 -GnRH-ethylamide within the dose range proposed by us for treatment. In six eugonadotropic human males, a significant decrease of luteinizing hormone and follicle-stimulating hormone responsiveness to a standard dose of GnRH and significant decrease of testosterone basal secretion were observed after 2 and 4weeks of subcutaneous administration of 5μg of d-Leu 6 -des-Gly 10 -GnRH-ethylamide twice daily. In two eugonadotropic males, these effects could not be observed under pernasal administration of 50μg of the substance for 4weeks. In two postmenopausal women, subcutaneous long-term administration of 5μg of the substance produced a marked decrease of basal serum levels and decreased responsiveness of both gonadotropins within 2weeks of application. In one of the women, reversibility of the changes was tested 3months after treatment and could be confirmed. The findings are of great importance for therapeutic trials with d-Leu 6 -des-Gly 10 -GnRH-ethylamide and other GnRH analogs. They show that investigations are still necessary to find the optimal therapeutic regimens for this substance.

Plasmin noradrenaline concentration after bicycle exercise (200 W for 2 min), compared with base line concentration, was used as an index of sympathetic responsiveness in patients with essential hypertension. Atenolol (JCI 66082, a "cardioselective" beta-blocker) was given in a daily dose of 200 mg to 16 patients for five weeks. This caused a decrease in supine blood pressure of 37/23 and, on standing, of 36/25 mm Hg compared with the placebo period. There was a significant correlation between the ratio of the increase in plasma noradrenaline concentration on exercise over its base line concentration and the subsequent fall in mean arterial pressure (r=0.840; P less than 0.001). There was a less significant correlation between plasma renin concentration and subsequent decrease in mean arterial pressure (r=0.542; P less than 0.05). Administrations of atenolol caused a rise in plasma noradrenaline both on lying and after exercise (P less than 0.0125), and a fall in plasma renin concentration (P less than 0.01). The results suggest that the antihypertensive effect of atenolol is related to the responsiveness of the sympathetic nervous sytem. Adrenergic activity is apparently an important determinant of blood pressure response to beta-blockade.

The diagnosis of phaeochromocytomas is based on the clinical features and on the hormone findings in the peripheral blood. Localisation, however, depends on radiological methods. Pneumoperitoneum was abandoned, because of its low accuracy, in favour of arteriography; lately, suprarenal phlebography has been available for the localisation of phaeochromocytomas. Our experience in nine patients with operatively confirmed phaeochromocytomas is described. Together with venous sampling from the caval system and the suprarenal veins for catecholamine estimations, it was possible to localise all tumours correctly. One tumour lying in the sympathetic chain in the thorax was correctly localised by hormone estimation. Our experience suggests that suprarenal phlebography represents a reliable method for localising phaeochromocytomas which carries a low risk and is to be preferred to arteriography.

In 10 insulin dependent maturity onset diabetics we found elevated basal C-Peptide levels (4.78 +/- 0.5 ng/ml. Normal range 1.1--3.6 ng/ml), which could be suppressed by insulin injection to the same extent as in sulfonylurea treated diabetics could be demonstrated. C-Peptide immunoreactivity in these patients therefore seems to be newly secreted rather than accumulated material. Since adrenalectomized patients could be suppressed in the same way, it is likely, that catecholamines are not the major factor in the mechanism of suppression. Therefore only decrease of bloodsugar levels seems to be accountable for the decrease of C-Petide levels. High C-Petide levels in insulin dependent maturity onset diabetics which cannot be stimulated but suppressed may be explained by a loss of glucoreceptor molecules.

In normotensive subjects an inverse correlation was observed between an index of sympathetic nervous activity (the plasma-noradrenaline concentration during physical exercise) and reactivity to exogenous noradrenaline. This relationship was invariably disturbed in age-matched patients with essential hypertension. Multiple-regression analysis revealed a highly significant correlation between the combination of both factors and the height of mean arterial blood-pressure ( r =0·91). The findings suggest that sympathetic nervous activity and pressor response to noradrenaline together form an important determinant of the arterial blood-pressure level. An inverse relationship could be demonstrated between plasma-renin concentration and pressor response to angiotensin II in normotensives, and this relationship was unchanged in hypertensive patients. Therefore angiotensin II does not appear to contribute directly to high blood-pressure.

Of 29 patients examined operation revealed a malignant tumor in 9 and a benign insulinoma in 18, 2 insulinomas were not found. The problems of preoperative tumor localization were limited to small insulinomas (size 7-35 mm). Ultrasound detected all of 3 insulinomas as low echogenic structures (size 7, 8, 17 mm). Computed tomography demonstrated 4 of 5 insulinomas (size 7, 8, 15, 17 mm) due to contrast enhancement following bolus injection. Arteriography localized 12 of 18 insulinomas preoperatively and 14 of 18 retrospectively. Selective transhepatic venous sampling for insulin assay identified 7 of 8 tumors. Real-time ultrasound and dynamic CT are promising in the diagnostics of insulinomas over 7 mm and should precede arteriography. Selective transhepatic venous sampling as the last diagnostic step is a major procedure and most specific, but not always without problems in interpretation.

In two double-blind studies 66 insulin-dependent diabetic subjects pretreated with pork insulin were changed to human insulin (recombinant DNA) or a purified pork insulin preparation (regular and NPH insulin). Sixty-five patients previously pretreated with beef insulin were transferred, in a randomized, double-blind fashion, to human insulin and purified beef insulin of the same preparations (regular and NPH insulin). Patients’ metabolic control, as demonstrated by fasting and 1-h postprandial blood glucose, HbA1c, and daily insulin dosage, over 4 mo was unchanged in our four groups compared with the values before changing insulin preparation. No severe hypoglycemic attacks or skin reactions were reported.

Urinary catecholamines and urinary excretion of vanillylmandelic acid confirmed the diagnosis of phaeochromocytoma in ten patients. In two of seven a modified glucagon test significantly aided confirmation of the diagnosis. In all patients the tumour was localised both by catecholamine determination in blood from the vein draining into the inferior vena cava (IVC) and by adrenal phlebography. Site of the adrenal tumour was definitively determined by the high catecholamine level in the adrenal veins and by phlebography. Three extra-adrenal tumours, a thoracic and two abdominal ones, were localised by high catecholamine levels in blood from other veins draining into the IVC. Vanillylmandelic acid determinaion was unreliable in the diagnosis of small phaeochromocytomas.

In six insulin-dependent diabetic subjects, we investigated whether differences between biosynthetic human insulin (BHI) and pork insulin are present as measured by an automatic glucose controlled insulin infusion system (GCIIS) (Biostator). The parameters measured were basal insulin requirement and food-dependent insulin requirement, as well as the blood sugar-lowering and insulin-saving effect of standardized physical work. The results show that BHI does not reveal any differences with regard to the basal food-independent and food-dependent insulin requirement compared to pork insulin in insulin-requiring diabetic subjects. Delayed food-dependent initial rise in blood sugar and insulin during physical work, which was observed with BHI, does not show any differences in the integral over 180 min. These investigations confirm the results found in vitro and in animal experiments. At the same time, they indicate discrete differences in the activity spectrum.

Tumour weight was compared with maximal vanillylmandelic acid and catecholamine excretion in 24-hour urine in 21 patients with phaeochromocytoma. The tumour weight correlated both with vanillylmandelic acid (r = 0.805, P less than 0.001) as well as urinary catecholamine levels (r = 0.725, P less than 0.001). Normal vanillylmandelic acid excretion was found in seven patients; urinary catecholamine levels were abnormal in all patients. The Katecult test was additionally performed in ten patients, with nine positive results.

Empirically obtained data could be verified and the basis for assessment of total insulin requirement, circadian distribution of insulin doses and contents of single insulin portions of old and delayed-action insulin could be established in a prospective study in 13 insulin-dependent diabetics. Assessment of insulin requirements was done after a 36-hour investigation period with the artificial endocrine pancreas using standardised conditions. Readjustment was complemented by dietary advice and rearrangement of total calory input and distribution of carbohydrates during the day. Therapeutic success in 55 patients justifies this procedure. Adjustment of insulin-dependent diabetics was thus obtained more rapidly, better and at less cost.

In 55 poorly controlled insulin-dependent diabetics, we tried to discover criteria for an improvement of metabolism by means of the "artificial beta-cell" (Biostator). To this end, during the first 24 h of hospitalization, blood glucose was monitored continuously under conventional insulin therapy (monitoring period). Insulin requirement was determined during the next 24 h by the artificial beta-cell (feedback period). Corrections of diabetes regimen were made with reference to the insulin consumption during the feedback period and to the extent of the postprandial blood sugar increases and decreases during the monitoring period. The resulting new diabetes regimen led to a significant improvement of the daily blood sugar profiles.

Die differentialdiagnostische Abgrenzung endokriner Orbitopathien, insbesondere bei einseitiger Protrusio bulbi von retrobulbaren Tumoren und anderen Orbitaerkrankungen ist sehr aufwendig und schwierig. Normale Schilddrusenfunktionstests schliesen eine endokrine Orbitopathie nicht aus, da auch im aktiven Stadium der endokrinen Orbitopathie nicht selten die Schilddrusenfunktion durch Schilddrusenhormone supprimierbar ist (Solomon et al., 1977). In neuerer Zeit wurden daher zwei weitere Untersuchungsverfahren in der Orbitadiagnostik eingefuhrt, die Ultraschalldiagnostik und die Computertomographie. Seit aus den Untersuchungen von Kroll u. Kuwabara (1966) und von Werner (1971) bekannt ist, das die Vergroserung und Verdickung der auseren Augenmuskeln eines der charakteristischsten Symptome der endokrinen Orbitopathie ist, erhoffte man, mit den genannten Verfahren die anscheinend auch bei gering ausgebildeter endokriner Orbitopathie bestehenden extraocularen Muskelveranderungen erkennen zu konnen. So konnten Forrester u. Mitarb. 1977 mit Hilfe der Ultraschalldiagnostik in allen untersuchten Fallen von Hyperthyreose mit Augenveranderungen eine Vergroserung der auseren Augenmuskeln feststellen, bei den Patienten mit Hyperthyreose ohne klinische Augensymptome konnten sie in 63% extraoculare Muskelveranderungen nachweisen. Enzmann u. Mitarb. (1976) fanden mit Hilfe der Computertomographie in der uberwiegenden Zahl der Patienten mit endokriner Orbitopathie extraoculare Muskelveranderungen; die Starke der Augenmuskelveranderungen korrelierte mit der Schwere des klinischen Bildes, wobei Patienten mit gering ausgebildeter endokriner Orbitopathie und Patienten mit Hyperthyreose ohne klinische Augensymptome keine computertomographischen Veranderungen zeigten.

In der Diabetesdiat werden in letzter Zeit Susungsmittel nur noch mit Vorbehalt verwendet. So sind alle mit Saccharose gesusten Speisen aus der Diabetesdiat ausgeschlossen, die synthetischen Susungsmittel Sacharin und Natriumcyclamat sind nur bedingt zur Susung von Speisen geeignet und werden wegen ihres bitteren Nachgeschmackes bei bereits geringer Uberdosierung von vielen Diabetikern abgelehnt (Forster, 1978). Andererseits sind nach einer Befragung bei Diabetikern (Mehnert, 1971) nur weniger als 20% alIer Diabetiker bereit auf die Geschmacksrichtung sus zu verzichten. Einen Ausweg bieten die Zuckeraustauschstoffe Sorbit, Fructose und Xylit. Xylit hat dabei, wie orale und intravenose Belastungen an StoffTwechselgesunden wie an Diabetikern gezeigt haben, den Vorzug, das Xylit weder eine Hyperglycamie noch einen Insulinmehrbedarf induziert (Lang, 1968; Mehnert, 1964). Ziel der vorliegenden Untersuchung war zu prufen, ob diese Eigenschaften des Xylit auch dann nachweisbar sind, wenn Xylit in die Diabetesdiat eingebaut verabreicht wird.

We studied the insulin requirements of seven insulin-dependent diabetics applying a glucose controlled insulin infusion system. The data were transformed into individually programmed and rectangular profiles. The MAGE, a measure of blood sugar fluctuations, was significantly lower when individually programmed step profiles were used (P less than 0.005) than it was when rectangular profiles were applied: 57.7 +/- 24.8 mg/dl vs 89.0 +/- 42.9 mg/dl. The average of measured blood glucose levels was significantly lower in individually programmed infusion profiles (P less than 0.025). The combination of individually programmed profiles and preprandial insulin bolus significantly reduced the postprandial blood glucose level and increase (P less than 0.001). Our investigations suggest that individually programmed insulin infusion profiles are able to smooth blood glucose fluctuations. When combined with an initial insulin bolus they may lead to a reduced insulin consumption after meals.

Report of the result of CT and venography in 12 patients with suspected adrenal disease, venography being combined with selective blood sampling for hormone analysis. In one patient CT showed a 1.6 cm big pheochromocytome in the left adrenal gland, not demonstrated by venography, but proven by analysis of the blood sample. Both methods showed hyperplasia of both adrenals in one patient with Cushing Syndrome with elevated Cortisol levels found in the analysis of the blood smples. Of 3 patients with hyperaldosteronism, venography was able to demonstrate 2 Conn adenomas, not seen on CT; whereas CT showed the third 2 X 1.5 cm big Conn adenoma hidden in an enlarged adrenal gland. Hormone analysis was helpful in 2 of these cases, while in the third it was misleading. The authors believe that both methods should be employed to localise over adrenal disease with endocrine activity.

Slightly to moderately increased plasma norepinephrine levels thought to reflect increased sympathetic tone have been observed in a proportion of patients with essential hypertension (1–3). However, some authors have also reported on normal- plasma norepinephrine levels in essential hypertension (4, 5).

From 1979 to 1986, seven patients with multiple endocrine neoplasia (MEN) type IIa and three with type IIb were treated. Nine had a C-cell carcinoma, one had C-cell hyperplasia. None had hyperparathyroidism. Three patients had multiple mucous neuromas. Six patients had proven pheochromocytoma: adrenalectomy was performed in these six (unilateral or bilateral depending on whether the tumor was uni- or bilateral). All ten patients had a total thyroidectomy--three later required neck dissection for regional lymphnode metastases. One patient died from the consequences of diffuse liver metastases of a C-cell carcinoma. Extensive family screening is necessary with patients who have MEN type II, in order to discover early any occult disease carriers. In addition, MEN type II should be excluded in all patients who have C-cell carcinoma, pheochromocytoma or hyperparathyroidism.