Cushing's syndrome and hypothalamic-pituitary adrenal axis suppression induced by medroxyprogesterone acetate

The referral of a patient with features of Cushing's syndrome but with suppressed plasma cortisol and adrenocorticotrophic hormone concentrations prompted us to study the effect of medroxyprogesterone acetate (MPA) therapy on the adrenal axis. 11 women (aged 54-82 years) who were receiving 200-400 mg/day MPA were studied. Of these, four had subnormal plasma cortisol responses to a short synacthen test, and two more had borderline responses (30 min post-synacthen plasma cortisol results of 411 and 511 nmol/L). We conclude that suppression of the adrenal axis occurs relatively frequently in patients on MPA and that such patients should be checked for evidence of suppression before MPA therapy is withdrawn.

Cigarette smoking, blood pressure and the control of blood glucose in the development of diabetic retinopathy

We have investigated the relationship between diabetic retinopathy and cigarette smoking, blood pressure, control of blood glucose, duration of diabetes and insulin requirement in a cross sectional study of 193 adult patients attending 2 diabetic follow-up clinics. Multiple discriminate analysis demonstrated that the duration of diabetes was closely related to the development of retinopathy in both sexes. Cigarette smoking was related to retinopathy in men but not in women, although in that group the prevalence of smoking was low. The average blood glucose whilst attending the clinic was weakly related to retinopathy in men only whereas the presence of hypertension was weakly related in women only. Cigarette smoking in men at least may be an aggravating factor for diabetic retinopathy.

Fetal hyperthyroidism: experience of treatment in four siblings

The outcomes of four pregnancies in a woman previously made hypothyroid by partial thyroidectomy for hyperthyroidism are reported. During the first two pregnancies she had no antithyroid therapy; the first resulted in late intrauterine death of a fetus with features compatible with fetal hyperthyroidism and the second in a child with skull deformities probably due to uncontrolled fetal hyperthyroidism. During the third and fourth pregnancies the mother received carbimazole to control fetal hyperthyroidism; both babies were euthyroid at birth and thrived. In mothers at risk of having hyperthyroid infants the fetal heart rate should be measured routinely to enable hyperthyroidism to be diagnosed and treated in utero.

Clinical trials of an antiplatelet agent, ticlopidine, in diabetes mellitus

At present there is no simple, reliable and non-invasive method for monitoring progression and improvement in diabetic microangiopathy. However, some diabetic patients with severe microvascular complications show a fairly specific pattern of impaired left ventricular function (abnormal relaxation, cavity filling and wall thinning) and abnormalities of haemorheology (increased viscosity, erythrocyte rigidity and beta-thromboglobulin and decreased threshold for platelet ADP aggregation). A single-blind, 6-months' crossover study of an antiplatelet agent, ticlopidine, was conducted in 20 diabetics with clinical evidence of microvascular disease. Response to therapy was monitored by digitised M-mode echocardiographic analysis of left ventricular diastolic function and haemorheology. All patients had abnormal basal values with no significant change during the 3-month placebo run-in period but, although significant alterations in viscosity, erythrocyte deformability, beta-thromboglobulins and ADP threshold were observed, no change in left ventricular function was detected. It is concluded that, while it may be possible to alter abnormal haemorheology in diabetes, there was no change in one parameter of microvascular end-organ damage.

Primary hyperparathyroidism: changes in the pattern of clinical presentation

207 hypercalcaemic patients, discovered in an urban area of 1 million people over a period of 5 months, were examined to determine the current incidence and mode of presentation of primary hyperparathyroidism. Primary hyperparathyroidism was diagnosed in 111 patients and those most at risk were women over the age of 70 (55% of all patients). In 57% of all patients the initial indication of primary hyperparathyroidism was hypercalcaemia found unexpectedly on biochemical screening of the serum. The next most common mode of presentation was an acute hypercalcaemic syndrome in elderly patients, characterised by confusion and dehydration (14% of all patients). Modern diagnostic methods and routine estimations of serum calcium can be expected to yield at least 250 new cases of primary hyperparathyroidism per million population per year.

Histological detection of oestrogen receptor in human breast carcinomas

Histological (immunocytochemical and cytochemical) methods for demonstrating oestrogen receptor within breast-cancer cells gave a positive reaction in 29 (83%) of 35 breast carcinomas. Oestrogen receptor could be demonstrated in cytoplasm and nucleus in 15, cytoplasm only in 10, and nucleus only in 4. 24 (68.5%) of the carcinomas had detectable oestrogen receptor by the dextran-coated charcoal method, and all of these were positive by histological methods. The cytochemical method gave much better results than the immunocytochemical method and showed that carcinomas contain variable proportions of oestrogen-receptor-positive and oestrogen-receptor-negative cells.

Tumour markers in breast cancer

The clinical usefulness of 8 potential tumour markers has been evaluated in 69 patients with Stage I and II breast cancer and 57 patients with Stage III and IV. Serum CEA concentrations were raised in 13% of patients with local and 65% of those with advanced breast cancer. In patients with clinical evidence of progression or regression of tumour, serum CEA levels changed appropriately in 83% of cases. Taking 4 of the markers (carcinoembryonic antigen (CEA), lactalbumin, alpha subunit and haptoglobin) serum concentrations of one or more were raised in 33% of patients with local disease and 81% of those with advanced breast cancer. However, marker concentrations were often only marginally raised, and are unlikely to provide sensitive guide to tumour burden. CEA, lactalbumin and alpha subunit were detectable in 68%, 43% and 40% respectively of extracts of primary breast cancers.

Blindness after treatment for malignant hypertension

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Birmingham Medical Research Expeditionary Society 1977 Expedition: the diuresis and related changes during a trek to high altitude

Continuous 24-hr urine collections were made by 17 subjects during a trek to 5400 m. Fluid intake was recorded by diary. Weight and fat folds were measured daily. The results were compared with daily measurements of packed cell volume (PCV) and reticulocyte count. Early fluid retention was matched by a fall in PCV. There was a diuresis with negative fluid balance towards the end of the ascent and again early in descent. There was a slight trend for fluid retention to occur in those most affected by acute mountain sickness but the effect was not marked.

Predictive classification of human breast carcinomas based on lactalbumin synthesis

The milk protein lactalbumin was found in the cytosol fraction of 20 of 53 human breast carcinomas. Oestrogen receptor (E.R) was detected in 36 of the tumours. The presence of lactalbumin was closely associated with the presence of E.R.; in tumours containing both, there was a positive linear correlation between concentrations of lactalbumin and E.R. Synthesis of lactalbumin by a mammary carcinoma seems to indicate an intact oestrogen receptor mechanism and may therefore be useful in identifying tumours responsive to endocrine therapy.