Clinical features of three patients with Werner's syndrome, one male and two females, of different pedigrees, were presented with special emphasis on the results of endocrinological examinations of these patients. All the patients fulfilled the somatic characteristics of Werner's syndrome, such as thin extremities, cataracts, early graying of hair, scleroderma-like skin atrophy and intractable ulcerations of the feet. Cardinal findings of endocrinological examinations were summarized as follows.
Growth hormone response to insulin-induced hypoglycemia was decreased in all the three patients. Thyroid function evaluated by conventional laboratory tests was considered to be almost within normal ranges in all the patients, but in one case hyperresponse of serum TSH to the TRH stimulation was observed.
As to the ACTH-adrenocortical axis, basal levels of plasma 11-OHCS and urinary 17-OHCS were almost normal and plasma 11-OHCS responses to the rapid ACTH stimulation were normal. However, diurnal rhythm of plasma 11-OHCS was impaired in two patients and Metyrapone test gave no or weak response of urinary 17-OHCS in two patients, suggesting possibility of certain defect of the hypothalamo-pituitary function. The male patient had hypogonadism with low serum LH and FSH. In testicular biopsy, however, marked atrophy of the seminiferous tubules and hyperplasia of the interstitial cells, being not compatible with secondary hypogonadism were found. Therefore. the authors cannot deny at all possibility of primary disoder of the testis. The role of parathyroid glands on the pathogenesis of calcium deposits in soft tissue and/or osteoporosis was not demonstrated in our cases. All the three patients showed various degrees of glucose intolerance with plasma IRI hyperresponses, but plasma IRI responded normally to tolbutamide in two cases examined. The results suggest the existence of insulin resistance in the peripheral tissues. No consistent change in the plasma renin activity and its response to furosemide were detected.
Above-mentioned abnormalities in endocrinological tests were essentially similar to those as having been described in the past, though there were some discrepancies among the data obtained.
From our data in the present cases and the previous literature of endocrinological studies on Werner's syndrome, it is difficult to explain the pathogenesis of the syndrome based on a monitical aspect that hormonal disturbance(s) primarily participate in “early aging phenomenom” of Werner's syndrome. Moreover, it should be pointed out that most hormonal changes found in the syndrome were different from those in the seniles.
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