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Volume 67 (1991)
- Issue 12 Pages 1295-
- Issue 11 Pages 1231-
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- Issue 9 Pages 14-
- Issue 8 Pages 811-
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- Issue 6 Pages 655-
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Volume 67, Issue 1
Displaying 1-6 of 6 articles from this issue
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Shieri MIYAZAKI, Takatoshi NISHIMIYA, Youichi TAKAGI, Izumi YAMAJI, Ka ...1991 Volume 67 Issue 1 Pages 1-7
Published: January 20, 1991
Released on J-STAGE: September 24, 2012
JOURNAL FREE ACCESSMetoclopramide (MCP), a dopamine antagonist, was recently used as the pharmacological test for the diagnosis of pheochromocytoma. There have been no reports involving false negative cases in the MCP test. We experienced a rare case of pheochromocytoma which showed a negative MCP test, and it caused a failure of the diagnosis.
A 51 -year-old man visited our hospital with a sudden onset of headache and palpitation. Blood pressure was 218/98mmHg at another hospital. When he came to our hospital, blood pressure returned to normal (120/80mmHg), and both serum adrenaline (E) and noradrenaline (NE) were within normal limits. A computed tomography, magnetic resonance imaging, and angiography demonstrated a 1.8×1.8cm right adrenal mass. No changes in blood pressure and plasma catecholamine were observed following the injection of 10mg of MCP.
The pathologically resected right adrenal gland contained a typical pheochromocytoma which was 1.0×1.0cm in size and weighed 8g.
The detailed mechanism of the negative MCP test in this case was not known but might be related to the small size of the tumor.View full abstractDownload PDF (3822K) -
Yoshiyuki FUWA, Keigo YASUDA, Kayoko ADACHI, Eiichi GOSHIMA, Noriyoshi ...1991 Volume 67 Issue 1 Pages 8-22
Published: January 20, 1991
Released on J-STAGE: September 24, 2012
JOURNAL FREE ACCESSTo determine the pharmacokinetic changes of prednisolone associated with an alternate-day regimen, 12 patients with various diseases were studied longitudinally. There were 9 patients (6 with systemic lupus erythematosus, 2 with sarcoidosis and one with polymyositis), who were treated with prednisolone (daily period) and subsequently put on an alternate-day regimen (alternate-day period). In 2 of the other patients (one with systemic lupus erythematosus and one with multiple sclerosis), the alternate-day regimen was preceded by the daily regimen, and subsequently an intermittent regimen consisting of 4 consecutive days on therapy and 3 days off therapy was followed. In the remaining patient with systemic lupus erythematosus, the treatment with the alternate - day regimen was initiated and followed throughout the treatment period. The mean duration and the mean total administered dose during the study were 1.1 months and 1.9g in the daily period, and 7.8 months and 7.7g in the alternate-day period. The test was done and blood was drawn for 6 hours after an intravenous administration of 20mg prednisolone (0.36mg/kg on the average) at the end of the respective regimen periods. In the daily period and the on-day of the alternate-day regimen, the pharmacokinetic study of iv prednisolone injection was done before the ingestion of oral prednisolone. The off-day test was done the next morning of the on-day. Plasma total and free prednisolone concentrations were measured by RIA. On-day and off-day tests in the alternate-day period were performed during the same week.
The mean half life of both total and free prednisolone was prolonged significantly in the daily period and during the on-day and off-day of the alternate-day regimen compared with the pretreatment values. The mean metabolic clearance rates (MCR) of both total and free prednisolone decreased significantly in the daily period and during the on-day and off-day of the alternate-day period in comparison with the pretreatment values. No significant difference was found between either mean half life or MCR during the on-day and off-day of the alternate-day period. These findings were in contrast with our previously observed prednisolone pharmacokinetics during the intermittent regimen (4 days on therapy and 3 days off therapy within one week), in which pharmacokinetic parameters during the on-day (after 3 days of prednisolone ingestion) and off-day (after 3 off-days of prednisolone ingestion) periodically changed and were similar to those in the pre-treatment period and during the daily therapy period, respectively. Clinically, the side effects such as infections and cushingoid appearance observed during the daily period were not always reduced by the shifting to the alternate-day regimen.
These findings may suggest no marked differences in pharmacokinetic indices between the alternate-day and the daily periods.View full abstractDownload PDF (1696K) -
Naoki ITOH, Yoshiaki KUMAMOTO, Keigo AKAGASHI, Hiroshi MARUTA, Taiji T ...1991 Volume 67 Issue 1 Pages 23-32
Published: January 20, 1991
Released on J-STAGE: September 24, 2012
JOURNAL FREE ACCESSRecently, it has been concluded that measurement of the serum free testosterone level is crucial for evaluating male gonadal function. However, the extent of the decline of serum free testosterone levels with aging and the actual levels in male infertility have not yet been clearly defined. In this study, the clinical significance of serum free testosterone levels was evaluated in a total of 248 subjects, including 120 healthy adult males (54 males aged 20-39, 26 males aged 40-59 and 41 males aged more than 60), 94 infertile males, 28 male hemodialysis patients, and 6 patients with Klinefelter's syndrome.
Since the serum free testosterone levels correlate significantly with serum LH and FSH levels among 120 normal adult males, it appears that free testosterone has a biological action on the organ.
In the subjects aged over 60, serum free testosterone levels were significantly decreased compared with the decrease of serum total testosterone. Thus, biologically active androgen levels decreased with aging. Serum free testosterone levels tended to decrease significantly from 40 years onwards.
In infertile males, serum total testosterone levels were equal to those in normal adult males, but their serum free testosterone levels were significantly lower. This decrease of serum free testosterone may be one of the causes of their hypospermatogenesis.
In male hemodialysis patients, serum total and free testosterone levels were not lower than in normal adult males.
It is considered that the decline of percentage of serum free testosterone levels in aged males and infertile males was caused by increased serum sex hormone binding globulin (SHBG) levels. Several workers have shown that the production of SHBG is regulated by sex steroid hormones. In this study, however, serum SHBG levels were not correlated with the E2/T ratio.
We concluded that measurement of the serum free testosterone level is of value in the endocrinological evaluation of male gonadal function.View full abstractDownload PDF (849K) -
Yukihiro NAGAI, Hisatsugu MIYAKOSHI, Yasuhiko IEKI, Yukihiro BANDO, Ri ...1991 Volume 67 Issue 1 Pages 33-41
Published: January 20, 1991
Released on J-STAGE: September 24, 2012
JOURNAL FREE ACCESSWe report a case of Klinefelter' s syndrome who developed a decrease of serum gonadotropin levels, particularly LH, after CyA treatment for complicated focal glomerulosclerosis (FGS). A 38-year-old man suffering from general malaise and pretibial edema was diagnosed FGS by renal biopsy in October 1988, and was referred to our hospital for further evaluation and treatment for FGS in December 1988. He was not married, and closer anamnesis revealed that he had had impaired seminal ejaculation from the age of 30. The physical examination showed 37% obesity, scanty body hair, pretibial edema and small bilateral testes (3.0×1.5cm). Laboratory findings included marked proteinuria (5.3g/day) and mild renal dysfunction (serum creatinine 1.3mg/dl, glomerular filtration rate 57.2ml/min). Endocrinologically, high basal levels of LH and FSH (133.6mIU/ml and 93.7mIU/ml, respectively) and the hyperresponses of LH and FSH to LH-RH stimulation were found, but the other pituitary hormone levels, thyroid and adrenal status, were in the normal range. In testicular biopsy, nodularly proliferated Leydig cells and no seminal tubules could be seen. The chromosome analysis showed 47,XXY karyotype, which confirmed the diagnosis of Klinefelter's syndrome in this patient. From 9 January 1989, CyA (6mg/Kg. day) was orally administered for 4 weeks in order to treat for FGS. After CyA administration, basal levels of LH and FSH remarkably decreased, particularly LH, and their decrease lasted for at least 6 weeks after cessation of CyA (final levels; LH 28.2mIU/ml, FSH 69.8mIU/ml). On the other hand, serum testosterone level was low normal or slightly under normal, and no apparent changes could be seen during CyA treatment. LH-RH test that was done three times (i. e., 2 days, 2 weeks and 6 weeks) after cessation of CyA showed the lower responses of both gonadotropins, but the percent of peak values to baseline levels was no different before and after CyA administration. Renal function, serum total protein, and hepatic function did not change during the clinical course. These results suggest that CyA induces the decrease of serum gonadotropin levels in a case of Klinefelter' s syndrome. The suppression of LH-RH release from the hypothalamus or direct injury to pituitary cells by CyA may be indicated, and further study should define the site of CyA.View full abstractDownload PDF (1681K) -
The Influence of Hypothyroidism on the Metabolism of AcetohexamideYuhei SHIBUTANI, Toshihiko YOKOTA1991 Volume 67 Issue 1 Pages 42-49
Published: January 20, 1991
Released on J-STAGE: September 24, 2012
JOURNAL FREE ACCESSProlonged, hypoglycemia induced by acetohexamide (AH) in a patient with non-insulin dependent diabetes mellitus accompanied by primary hypothyroidism was presented.
A 74-year-old man who had been treated with AH (500mg, daily) for diabetes mellitus since 1973 was admitted to our hospital in Oct. 1988 because of hypoglycemic coma. On admission, the level of blood glucose was 20mg/dl. Continuous intravenous administration of 10 per cent glucose solution led to improvement in the mental state on the second day. However, the level of blood glucose remained between 30 to 45mg/dl for four days after admission. On the fifth day, a fasting blood glucose level finally reached 75mg/dl. In a thyroid function test, the serum levels of thyroid hormone showed the following decreases: T3 68ng/dl, T4 2.8μg/dl, free T4 0.3ng/dl, while basal TSH levels increased to 50.3μU/ml. Since anti-thyroid microsomal antibody was positive and thyroid 99mTc-pertechnetate uptake was slightly elevated, the hypothyroidism in this patient was considered to be caused by chronic thyroiditis. Urinalysis was positive for protein. In a renal function test, the blood urea nitrogen was 26.7mg/dl and creatinine 1.7mg/dl, and creatinine clearance decreased to 22ml/min. After thyroid function returned to euthyroid, creatinine clearance improved (41ml/min).
To clarify the relationship between hypothyroidism and the metabolism of AH, the serum levels of AH and its metabolite hydroxyhexamide (HI) following oral administration of AH (500mg) were evaluated before and after thyroxine replacement therapy. The blood glucose level before therapy was lower than that after therapy, and hypoglycemic symptoms were observed early in the second and third morning after AH administration. There were no changes in the serum levels of AH between the pre-and post-replacement treatment. In contrast, the biological half time of HH before and after treatment was 16 hrs and 13 hrs, respectively. The serum levels of HH decreased more slowly before treatment than after treatment. However, compared to normal subjects, the biological half time of HH in this patient was exceedingly long in both conditions which seemed to arise from renal dysfunction caused by diabetic nephropathy.
These findings suggest that prolonged hypoglycemia in this patient was related to the delayed clearance of HH caused by renal insufficiency associated with hypothyroidism.View full abstractDownload PDF (699K) -
Aldosterone System in Patients with Anorexia, NervosaMitsue FUJITA, Hajime TAMAI, Osamu MIZUNO, Tetsuya NAKAGAWA1991 Volume 67 Issue 1 Pages 50-55
Published: January 20, 1991
Released on J-STAGE: September 24, 2012
JOURNAL FREE ACCESSPatients with anorexia nervosa frequently demonstrate dehydration, electrolyte imbalance and low blood pressure that are secondary to starvation. Hyperactivity of the Renin-Aldosterone system and insensitivity to the pressor effects of exogenous angiotensin II are observed in Pseudo-Bartter syndrome caused by the abuse of diuretics or laxatives and self-induced vomiting, however, little information about the Renin-Aldosterone system has been reported in patients with anorexia nervosa.
This study was designed to investigate the secretory function of the Renin-Aldosterone system in anorexia nervosa. The subjects were 13 patients with anorexia nervosa and 6 normal controls.
Experiment 1: Angiotensin II infusion test was performed. Blood pressure was measured every 5 minutes, and the samples for plasma renin and serum aldosterone analysis were taken every 15 minutes during infusion test.
Experiment 2: Plasma renin activity and serum aldosterone concentration were measured before and after one-hour walking. The results were as follows;(1) Basal plasma renin activity and serum aldosterone concentration in patients were not significantly higher than those in normal subjects.(2) Hypertensive response with elevation of the diastolic pressure during angiotensin II infusion in patients similar to that of normal subjects was observed.(3) Responses of plasma renin activity and serum aldosterone concentration after one-hour walking were significantly greater in patients than in normal subjects.(P<0.01)
These results suggest that (1) no impairment of production of the Renin-Aldosterone system is found in patients with anorexia nervosa, and that (2) the secretion of the Renin-Aldosterone system in patients with anorexia nervosa is not as stimulated as in those with Pseudo-Bartter syndrome since the loss of body fluids in anorexia nervosa is chronic.View full abstractDownload PDF (526K)
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