Search

In 149 cases, blood pressure response to glucagon test did not exceed 20/10 mm Hg more than the response in the cold pressor test control and was considered negative. Plasma catecholamine level increases may be seen in 95% of patients without pheochromocytomas. Among six patients with pheochromocytomas, urinary metanephrine levels were of diagnostic importance in two with isolated pheochromocytoma and in one with the multiple endocrine neoplasia of type 2 (MEN-type 2). Urinary metanephrine determinations yielded false-negative results in three patients with MEN-type 2, while vanilmandelic acid level was normal in one and nephrotomograms were positive in two of these three. These results suggest that the early diagnosis of pheochromocytoma in patients with MEN-type 2 may be difficult and may require multiple biochemical and roentgenographic investigations.

On 247 of the 1,711 scintiscans (15%), the appearance of renal or urinary tract areas differed sufficiently from normal to merit mention in interpretation. For 162 patients (195 surveys), the abnormalities noted were classified as "minor." For 39 patients (52 surveys), the abnormalities noted were classified as "major"--that is, confirmed by other means or considered of major importance to diagnosis and management. Of these, 9 were filling defects (2 each were renal cell carcinoma, simple cyst, and polycystic disease; 3 were a mass of undetermined nature) and 30 were unilateral or bilateral urinary tract obstruction indicated by hydroureter and massive retention in renal area(s). These obstructive manifestations were associated with primary pelvic or prostatic malignancy or extension of malignant disease; in nine patients, progression or remission of obstruction was noted on sequential imaging. These changes were compatible with changes in clinical status and may afford an added means of following response to therapy in appropriate patients.

A 27-year-old man with disabling adult-onset hypophosphatemic osteomalacia was studied in 1947. Because of the failure of large doses of vitamin D, with oral calcium and phosphate supplements, to induce calcium retention on prolonged metabolic balance studies, total parathyroidectomy was performed. Bone healing ensued and subsequently tetany has been easily controlled with modest doses of vitamin D. On restudy in 1968 (after vitamin D had been discontinued) both serum phosphate and renal phosphate clearance were in the range expected in hypoparathyroidism. Intravenous administration of parathyroid hormone reproduced the high phosphate clearance that had been present before parathyroidectomy. The data indicate a causal or permissive role of parathyroid hormone in the renal phosphate leak, hypophosphatemia and osteomalacia in this patient.

The effect of sex hormones on bone tissue was studied in 12 osteoporotic patients. Surfaces of bone undergoing formation and resorption were determined by quantitative microradiography of iliac crest biopsy samples before and after treatment with estrogens in 11 postmenopausal women and with testosterone in one gonadally competent man. Before treatment, bone resorption was greater than normal in all but one patient and bone formation was normal. After treatment, bone resorption decreased to within the normal range in all patients, and bone formation did not change significantly. Biochemical studies showed significant decreases in serum calcium, phosphorus, and alkaline phosphatase levels and in urinary excretion of calcium and hydroxyproline. These changes are believed to be the consequence of the effect of the hormones on bone. The data indicate that the major effect of sex hormones in osteoporosis is an inhibition of bone resorption.