An unusual case of isolated ACTH deficiency with coexisting chronic thyroiditis in a 53-year-old man is reported.The patient was admitted with a 2-year history of generalized fatigue, a 13-kg weight loss, muscular weakness, and frequent hypotensive and hypoglycemic attacks. On admission serum thyroxine and triiodothyronine were significantly elevated. Basal TSH concentration was not detected and TSH showed no response to TRH, but one month after replacement therapy with hydrocortisone it was shown that serum T3, T4 and TSH response were all within normal limits. Thyroid antibodies were positive and biopsy of the thyroid gland showed chronic thyroiditis.Arginine and 1-Dopa provoked a subnormal rise in GH with a maximum of 5.6 ng/ml and 5.0, respectively. One month after treatment with hydrocortisone, GH response to 1-Dopa and arginine increased to the normal range. Prolactin response to TRH was normal and FSH response to LHRH was also normal. LH showed an exaggerated response to LHRH, although a normal response was revealed after treatment with hydrocortisone. We also presented a summary of 44 Japanese cases, 23 males (mean age; 46 yrs old) and 21 females (mean age; 48 yrs old), with isolated ACTH deficiency.
Plasma GH responses to TRH were investigated in 50 cancer patients.Out of 50 cancer patients, 33 were found to be responders.At 15, 30 and 60 min after TRH injection, the mean values GH for cancer patients was significantly higher than the corresponding value for normal controls and the base-line level following saline injection in cancer patients (p<0.001).Our results suggests that a possible alteration of hypothalamic-pituitary function regulating GH secretion may occur in patients with cancer.
We have demonstrated the sex difference with respect to the dopaminergic modulation of serum TSH secretion in patients with primary hypothyroidism. Ten patients, 4 men and 6 women, with hypothyroidism were given 10 mg of Domperidone (Domp) iv, a very potent and specific dopamine receptor blocking agent, which could not readily cross the blood brain barrier. There was a significant rise in the TSH level after Domp iv in female patients with primary hypothyroidism, from basal values at zero time at 74.4 +/- 33.8 (M +/- SE) microU/ml to 171.2 +/- 94.9 at 30 min (p less than 0.001), 159.6 +/- 100.5 at 60 min (p less than 0.001). In contrast, no significant change in serum TSH values after Domp iv occurred in male patients with primary hypothyroidism, from basal values at zero time of 181.1 +/- 39.9 microU/ml to 171.4 +/- 31.1 at 30 min, 180.7 +/- 33.2 at 60 min and 172.7 /+- 31.0 at 90 min. After thyroid hormone therapy, max delta TSH values and the change from basal to peak values were significantly related to basal TSH values in female patients with primary hypothyroidism (r = +0.93, p less than 0.001), while max delta TSH in male patients was inversely related to basal TSH values within the limited concentrations (r - =0.78, p less than 0.02). It was conjectured from our results that maximum TSH responses to intravenous administration of domperidone in male and female hypothyroid patients were observed in respectively different basal TSH values, that is, less than 100 microU/ml in males and more than 100 microU/ml in females. Our findings provided evidence of sex difference in dopaminergic modulation of TSH secretion in primary hypothyroidism.
It was demonstrated that thyrotropin-releasing hormone (TRH) elicited a paradoxical increase in basal GH levels in cancer patients.Out of 94 cancer patients, 50 were found to be GH responders and this phenomenon was more frequently recognized in female than in male cancer patients.In cancer patients under 59 years of age, the GH response to TRH was significantly greater in females than in males, although there was no sex difference in the GH response in patients above 60 years of age. In female cancer patients, the GH response to TRH was significantly greater in patients under 59 years of age than in patients above 60 years of age, while there was no age difference in the GH response in male cancer patients.It was concluded that paradoxical responses of serum GH to TRH were recognized in 53 per cent of cancer patients and were more frequently observed in female than in male cancer patients.
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