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A group of 24 healthy young men were evaluated before and after serial suberythematous ultraviolet (UV) radiation: group I, control (no irradiation); groups II and III, 12 radiations in 4 weeks with two different spectra (both containing UV-B). Before the first and 2 days after the last exposure all the volunteers were given an intravenous injection of thyrotropin releasing hormone (TRH, protirelin 0.2 mg) and luteinizing hormone releasing hormone (LH-RH, gonadorelin 0.1 mg). The serum concentrations of TSH, follicle stimulating hormone, LH and prolactin were measured at 0, 20, 30, 45 and 60 min by radioimmunoassay. Neither basal nor stimulated levels of the pituitary hormones showed significant changes after UV radiation. The results showed that exposure to suberythematous doses of UV did not influence the regulation of pituitary hormones in these healthy individuals. more...

The diuretic therapy of patients with idiopathic edema is known to induce a secondary aldosteronism, which perpetuates edema formation and exacerbates the clinical symptoms. The observation of a decreased excretion of dopamine in these patients suggests that a treatment with the orally active dopamine agonist bromocriptine might be beneficial. Nine patients with typical symptoms of idiopathic edema, which had been present for several years, were treated with bromocriptine (Pravidel) 2 X 2.5 mg/die. The response to therapy was assessed clinically by the normalization of diurnal weight gain and general well-being. Seven patients showed a good response to bromocriptine, in one patient the response was only modest, and in one patient the medication had to be stopped because of nausea. Bromocriptine normalized diurnal weight gain without inducing weight loss. Both without therapy and during bromocriptine treatment electrolytes in serum, blood pressure, plasma renin activity and aldosterone are within the normal range. From the present pilot study it can be concluded that bromocriptine is an effective alternative to the traditional diuretic therapy in some patients with idiopathic edema. It remains unclear, whether the beneficial effect of bromocriptine reveals a dopamine deficiency, or whether bromocriptine is only a symptomatic treatment. more...

To investigate the influence of critical illness on plasma renin activity and aldosterone levels and to examine potential inhibitory effects of dopamine therapy on aldosterone responsiveness, we measured plasma renin activity, and potassium and creatinine in serum, as well as the responses of aldosterone, cortisol and prolactin levels to TRH 200 micrograms i.v. + Synacthen 0.25 mg i.v. in 63 unselected, critically ill patients (32 females, 31 males, aged 18-84 years). Of the patients 19 received dopamine treatment (3-13 micrograms/kg/min i.v.); 21 of the patients died in the further course of their disease. Plasma renin activity was increased in 66.7% of the patients and aldosterone levels were elevated in 90.5% of the patients. There were correlations (P less than 0.05) of lethality with plasma renin activity and cortisol levels and correlations (P less than 0.01) of aldosterone concentrations with plasma renin activity and cortisol levels. Whereas dopamine treatment had no inhibitory effect on aldosterone levels before and after stimulation, prolactin stimulation was decreased in dopamine-treated patients. Thus, dopamine does not generally lose its potency of hormone inhibition in critically ill patients, but has no influence on the secondary aldosteronism developing regularly in the early phase of critical illness, which is apparently mainly due to the stimulatory effect of ACTH (or ACTH-related pituitary peptides) and is considered an epiphenomen of the stress mechanisms acting upon the patients in this condition. more...

To induce the lacking development of puberty, a male patient with hypothalamic hypogonadism and anosmia (Kallmann's syndrome) was treated with pulsatile application of gonadotropin-releasing hormone (GnRH) to imitate the endogenous secretion of GnRH. The low-dose pulsatile GnRH treatment which was reported to be successful by various authors proved to be ineffective when administered to our patient subcutaneously as well as intravenously. Serum testosterone levels comparable to the lower normal values in adults and continuous progress of pubertal development were only achieved after increasing the dosage from 2 to 8 micrograms per pulse by subcutaneous application. The course of therapy is reported in detail. more...

A patient (19 years old) with Kallmann's syndrome was treated with gonadotropin-releasing hormone (2.5-16 micrograms) administered subcutaneously every 2 h using a portable infusion pump. During 42 weeks of treatment testosterone levels and testicular size did not increase sufficiently although no reasons for this insufficient response were detectable. Therefore the regime of controlling and changing the catheter system was intensified. By this means partial occlusions of the catheter were detected and could be corrected. Afterwards testosterone levels increased immediately and persistently to normal values. more...

As a contribution to the question if the elevated concentrations of free fatty acids in sera of critically ill patients described in literature play a role in the decrease of thyroid hormone levels in these patients, serum levels of the important free fatty acids were measured in 31 patients of our intensive care unit in the course of their disease using gas chromatography. After admission to the ward, only palmitoleic acid was significantly increased compared with 174 control persons, arachidonic acid was not different from the controls, palmitic, stearic, linoleic and linolenic acid were significantly decreased. In the course of the disease, no relevant changes were observed. The 21 patients not surviving their disease showed significantly lowered levels of palmitic, stearic and linoleic acid before death compared with the surviving patients at the end of the observation period. The hypothetical role of single free fatty acids as inhibitors of the binding of thyroid hormones to their transport proteins must be questioned because of the results. more...

Potential impairment of the efficacy of human atrial natriuretic peptide (human ANF-(99-126), hANP), the most potent endogenous natriuretic agent in healthy subjects, was examined in eight male normotensive patients with uncomplicated type 1 diabetes mellitus (aged 22-37 years). After giving informed consent, patients and eight male control subjects (aged 22-28 years) received in a random double-blind study design i.v. bolus injections of 100 micrograms hANP (Bissendorf peptide) or placebo. At base-line, patients differed from controls in elevated creatinine clearance (P less than 0.05) and in mild postprandial hyperglycemia. Whereas the responses of urinary cyclic guanosine monophosphate, the second messenger of hANP, were found to be normal in patients, the diuretic and natriuretic effects of hANP were grossly impaired when compared to controls (P less than 0.01); hANP resulted in increased plasma protein concentrations only in controls (P less than 0.05 vs patients). In both groups, creatinine clearance remained uninfluenced by hANP. There were similar decreases in plasma renin activity, aldosterone, levels, and blood pressure (systolic more than diastolic) in both groups (P less than 0.05 vs placebo). Heart rate and blood glucose remained unchanged. Thus, there is evidence for a decreased responsiveness to hANP exclusively of renal fluid, sodium, and chloride excretion in uncomplicated type 1 diabetes mellitus. The mechanisms responsible for this phenomenon remain obscure, neither a down regulation at the hANP receptor sites nor an hANP-induced shift from intra- to extravascular fluid volume are likely to be involved in its probably diabetes-specific pathogenesis. more...