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Bei Erkrankungen der Nebennieren bestehen charakteristische korperliche Veranderungen infolge der Hormonstorungen, durch Druckgefuhl im abdominellen Bereich oder durch Schmerzen aufgrund der vergroserten erkrankten Drusen. Die Diagnose last sich mit Hilfe entsprechender Hormonbestimmungen und des lokalen Untersuchungsbefundes stellen (Abb. 22.1).

A deficiency of thyroxine-binding globulin (TBG) has been recognized in euthyroid subjects but has not been reported in conjunction with a depressed thyroidal I131 uptake. We have studied a 35-yr-old Indonesian male physician who lacked TBG but showed the normal localization of thyroxine (T4) binding in the albumin and prealbumin serum protein fractions. No physical abnormalities were present and mild serum hepatitis was the only prior illness of note. The subject had a consistently low protein-bound iodine (PBI), an increased red blood cell (RBC) uptake of triiodothyronine, and a normal basal metabolic rate (BMR) and serum cholesterol. The thyroidal I131 uptake was markedly low but showed a 7-fold increase after thyroidstimulating hormone (TSH); an abnormal release of trapped I131 was not induced by KSCN. The half-life of radioiodinated thyroxine (T4-I131) was shortened and the turnover rate was increased with a proportionally reduced extrathyroidal organic iodine pool. These findings imply a no...

The complex aspects of androgen steroid metabolism make it important to investigate the relationship between the production rate of testosterone from analysis of a urinary metabolite and the production rate of steroid in the plasma. The plasma production rate of testosterone was estimated by the product of metabolic clearance rate (M. C. R.) and mean plasma concentration and this was compared with the urinary production rate by analysis of specific activity of a urinary metabolite, testosterone glucuronoside. The M. C. R. following single injection of tritiated testosterone calculated according to the method of Tait was 980 1/d S.D.±120 in 5 normal males and 760 and 840 1 in 2 females. The product M. C. R. and mean plasma testosterone indicates a plasma or inner pool production rate of 6.9 mg/d in normal male and maximum 0.8 mg/d in adult female. The urinary production rate was determined by injection of tritiated testosterone, enzyme hydrolysis of urine, chromatographic isolation of testosterone and its oxidized derivative, and determination of the cumulative specific activity. The urinary production rate was 6.5 mg S. D. ±1.9 in male and 1.9 mg/d S. D. ± 0.9 mg in normal female. 1 % of injected tracer was excreted as testosterone glucuronoside. The plasma production and urinary production rates in the male were quite similar, however the discrepancy in the female suggests that approximately 1 mg of testosterone precursor is converted to testosterone in a second compartment not in equilibrium with plasma testosterone.

During the first month after removal of a unilateral aldosterone-producing adenoma, sodium conservation is poor and restriction of sodium intake may result in adrenal insufficiency. The excretion of aldosterone is reduced and does not increase in response to stimulation by administration of corticotropin, angiotensin, and by restriction of sodium intake. Chronic hypervolemia in patients with primary aldosteronism can result in selective suppression of the ability of the adrenal gland to secrete normal amounts of aldosterone immediately after removal of an aldosterone-secreting tumor.

Cushing's syndrome, an unusual group of disorders characterized by hypercortisolism, must be considered in the differential diagnosis of such common clinical problems as hirsutism, menstrual irregularity, hypertension, diabetes mellitus, and obesity. Its distinct forms--pituitary-dependent Cushing's syndrome (Cushing's disease), adrenal tumor and ectopic ACTH syndrome--must be identified correctly so that specific therapy can be administered. In the majority of cases, use of a relatively simple diagnostic sequence will provide accurate and rapid diagnosis. However, in our experience with more than 60 patients, diagnostic difficulties may arise from a variety of conditions (e.g., drug interference, alcohol ingestion, and depression). In addition, unusual circumstances, such as unexpected responses to dexamethasone, may complicate the diagnosis. Our approach to these problems is illustrated through a report of seven cases, and we emphasize that the proper management of Cushing's syndrome mandates a thorough marshalling of all the available data.

Nine normal subjects ingested 100 gm. glucose, fructose, and sucrose on separate days after an overnight fast. Plasma glucose, fructose, insulin, glucagon, growth hormone, and triglyceride levels were then measured over the following 5 hr. Plasma glucose and insulin peaks were both significantly lower after fructose ingestion as compared with glucose and sucrose. Plasma glucagon suppression was significantly less after fructose. Growth hormone showed a late stimulation after glucose and sucrose but did not rise after fructose intake. Triglyceride levels were significantly increased at 3 to 5 hr. after fructose ingestion.

Seventy-five morbidly obese patients underwent jejunoileal bypass between December 1968 and October 1975. The average weight of 45 patients who had had the bypasses for over two years stabilized at 62.4% of the maximum preoperative value. Postoperative complications included recurrent diarrhea in 11% (8/74) and serum electrolyte deficits in 64% (48/75), most of which were transient. Potassium and calcium deficiencies were usually correctable by oral supplementation, but hypomagnesemia persisted in 23% (16/71) despite supplementation. Nine percent (4/43) had biopsy-proved hepatic cirrhosis after one year. Other complications were polyarthralgia, bone demineralization, renal stones, and vasculitis. Three patients required reanastomosis to original bowel continuity; all rapidly regained weight. One died of vasculitis and hepatic failure attributable to the bypass. Jejunoileal bypass is suitable only in morbidly obese patients with particularly high motivation, whose risk factors outweigh those risks incurred through bypass.

Plasma glucose and glucagon responses to standard meals containing carbohydrate, fat, and protein as in normal diets were studied in 12 subjects with insulin-dependent diabetes and 12 normal subjects. Diabetics had two to three times greater glucagon responses than did normal subjects. Fifteen units of insulin injection did not normalize these excessive glucagon responses, although postprandial hyperglycemia was reduced. Infusion of somatostatin at a dosage of 500 mug/hr prevented glucagon responses and diminished postprandial hyperglycemia by 60%. The combination of insulin and somatostatin caused a progressive fall in plasma glucose levels despite meal ingestion. Somatostatin and insulin, administered subcutaneously in the same syringe, also abolished postprandial hyperglycemia. These studies indicate that excessive glucagon secretion participates in the genesis of diabetic postprandial hyperglycemia. Somatostatin, an inhibitor of glucagon secretion, may thus prove useful as an adjunct to insulin in the treatment of diabetes mellitus.

Cushing's syndrome due to nodular adrenal hyperplasia comprises a clinically and biochemically heterogeneous group of disorders whose pathogenesis is unclear. We describe two patients with atypical steroid dynamics and large unilateral adrenal nodules who had pituitary ACTH-dependent disease. In the differential diagnosis of Cushing's syndrome, we recommend repeated ACTH measurement and selective venous sampling-particularly in those patients with impaired dexamethasone suppressibility and abnormal findings on computerized tomography.

Growth hormone assays were performed before and after androgen administration in a 12-year-old boy with unexplained growth retardation. A subnormal growth hormone secretion in response to a standard hypoglycemic stimulus was demonstrated, and it was corrected by androgen pretreatment. After that, a normal serum growth hormone level and a temporary growth spurt were demonstrated.