Our results indicate that the finding of low DHEAS levels can be considered a marker of the adrenocortical origin of an adrenal incidentaloma, provided adrenal failure has been excluded.
Antithyroid drugs may be proposed as the firstline therapy for hyperthyroidism due to Graves' disease since some patients undergo prolonged remission after drug withdrawal. On the other hand, some studies, though controversial, indicated that methimazole (MMI) has some immunomodulating activity. We retrospectively analyzed 384 consecutive patients newly diagnosed with Graves' disease in the years 1990-2002 to ascertain whether long-term therapy with low doses of MMI may prevent relapse of thyrotoxicosis. Two hundred and forty-nine patients were included in our study. The date of reduction of MMI dose to 5 mg/day was considered time 0 for survival analysis. In 121 MMI was discontinued in less than 15 months after time 0 (group D), while in the remaining 128 a daily MMI 2.5-5 mg dose was maintained (group M). One hundred and thirty-five patients were excluded for inadequate response to MMI, relapse of thyrotoxicosis that could be related to an improper withdrawal or reduction of MMI, inadequate or too short followup, iodide contamination, steroid or interferon therapy, pregnancy or post-partum. D and M groups did not differ for clinical and hormonal parameters except age, which was lower in D (p=0.019). Age > vs < 35 yr was relevant in survival analysis; therefore patients were divided in 2 groups according to this age cut-off. In younger patients relapse of thyrotoxicosis occurred in 15 patients of group D 2.4-39.6 months (median 19.0) after time 0, and 8 M after 5.9-40.0 (21.3) months, while 14 D and 5 M maintained euthyroidism until the end of the observation after 31.8-95.3 (56.6) months and 30.4-62.1 (46.5) months, respectively. Survival analysis indicated that the risk of relapse was similar in group D and M. In older patients relapse of thyrotoxicosis occurred in 40 patients of group D after 8.2-65.8 (25.4) months and 29 M after 5.8-62.5 (22.4) months, while 52 D and 86 M maintained euthyroidism until the end of the observation, 20.1-168.0 (46.7) months and 24.1-117.4 (53.4) months respectively. Survival analysis indicated that the risk of relapse was increased in group D. Therefore long-term treatment with low doses of MMI seems to prevent relapse in Graves' disease in patients above 35 yr of age. This should be confirmed in a prospective study.
Four cardiovascular tests exploring autonomic nervous function (Deep Breathing, 30 : 15 ratio, Lying to Standing, Hand Grip) have been performed in 38 diabetic patients with erectile failure (mean age 53.2 years, range 34.5-60.5) and in 35 diabetic subjects without sexual dysfunctions (mean age 52.8 years, range 45-60.5). In our study Deep Breathing test was abnormal in 21 patients with erectile failure (55.3 O/o) and in 9 patients without sexual dysfunction (25.7 Yo) (P < 0.05). Seven patients with sexual impotence (18.4 O/ o) and 2 subjects without sexual dysfunction (5.7 O/o) showed abnormal results of 30 : 15 ratio test. The Lying to Standing test was not abnormal both in impotent and in non impotent subjects, while the Hand Grip test was abnormal in 7 patients with impotence (18.4 O/o) and in 8 patients without sexual dysfunction (22.9 O/o).Results obtained from Deep Breathing test were significantly lower (P <0.01) in impotent (10.25 f 6.10 beatslmin) than in non impotent patients (14.63 f 6.85 beats/ min) .Lower 30 : 15 ratios were also found in patients with erectile failure (1.09 f 0.10 vs 1.12 f 0.09).The tests exploring the sympathetic function did not show any difference between the two groups of patients.The present study confirms the major role of parasympathetic impairment in the pathogenesis of sexual dysfunctions in diabetic men.Cardiovascular tests can be a first-step diagnostic tool in the assessment of diabetic impotence. Zusammenfassung: Es wurden vier cardiovasculare Tests fur die Untersuchung der autonomen Nervenfunktion (Tiefatmung, 30:15 Verhaltnis, Liegen zu Stehen, Handgriff) verwendet bei 38 Mannern mit Diabetes mellitus und Erektionsstorungen sowie bei 35 Kontrollpersonen ohne Erektionsstorungen aber mit Diabetes. Es ergab sich, daB der Tiefatmungstest bei 21 Mannern (553 O/o) der Gruppe mit Erektionsstorungen positiv war und bei 9 Patienten (25,7 O/o) der Kontrollgruppe ebenfalls. 7 Patienten mit einer sexuellen Impotenz (18,4 Yo) und 2 ohne sexuelle Storungen (5,7 O/ o) zeigten abnormale Resultate beim 30 : 15-Test. Impotence in diabetes 347 Der Liegen zu Stehen-Test war in keiner Gruppe positive; der Handgrifftest dagegen war bei 7 Mannern mit Impotenz (18,4 O/o und bei 8 Mannern ohne sexuelle Storungen (22,9 Yo) positiv. Die Ergebnisse des Tiefatmungstests waren signifikant niedriger in der Gruppe der Impotenten (10,25 -t. 6,lO Schlage/min) (p < 0,001) gegeniiber den nichtimpotenten Miinnern (14,63 -t.6,85 Schlage/min.). Beim 30 : 15 Test ergaben sich ebenfalls geringere Werte bei den Mannern mit Erektionsstorungen (1,09 f 0,lO vs 1,12 f 0,09).Die Tests zur Untersuchung der sympathischen Funktion zeigten keine Differenz zwischen den beiden Gruppen. Damit bestatigt die vorliegende Studie die bedeutende Rolle der parasympathischen Verschlechterung in der Pathogenese der sexuellen Dysfunktionen der diabetischen Mannern. Die cardiovascuraren Tests konnen ein erster diagnostischer Schritt bei der Beurteilung der diabetischen Impotenz sein.
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