SUMMARY In a consecutive series of 41 hirsute women clinically classified as benign androgen excess, only 34 %were found to have elevated plasma 'total' testosterone (T), 22 %having subnormal sex hormone binding globulin (SHBG). When expressed as the ratio T jSHBG ('free androgen index'), 85 % of the patients had values above the normal range. It is concluded that this index is more reliable than total testosterone in assessing androgen status in female patients.Total testosterone (nmol/l) x 100 SHBG (nmol DHTII) 24·9 years, range 20-35). Neither group of subjects was receiving the contraceptive pill or other form of medication known to interfere with androgen metabolism. None of the hirsute patients showed evidence of virilism and all were provisionally diagnosed as having 'benign androgen excess'.Plasma total testosterone was measured by the radioimmunoassay of Collins et a[6 using an antiserum donated by Mr Mike Mansfield (Chelsea Hospital for Women). Plasma SHBG was assayed by the two-tier column method of Iqbal and Johnson"; results are expressed in terms of the uptake of 51X-dihydrotestosterone (DHT). Free androgen index (FAl) was calculated as the ratio:
ResultsStatistical analysis of results employed Student's t test. Results of grouped data are expressed as the mean ± 1 SEM.
Patients and methodsThe results are presented in the Figure. Normal ranges (mean ± 2 SD), calculated from the results obtained in the control group, were as follows: Testosterone 0·8-3·2 nmol/l: SHBG 25-121 nmol DHT/I: FAIl·3-4· 5. Of the 41 hirsute women, only 14 (34 %) had a plasma testosterone which fell outside the normal range, although the group mean Forty-one consecutive premenopausal women (mean (2·5 ± 0·18 nmol/l) was significantly higher than age 27·4 years, range 19-50) referred to the Depart-that of the controls (2·0 ± 0·09 nmol/l)(p
SUMMARY Sera from 91 patients with hereditary angioedema were screened for thyroid antibodies. The results for the 77 patients more than 17 years old were compared with previously published data for the prevalence of thyroid disease in a large community (Whickham). Of the female patients with hereditary angioedema, the prevalence of thyroglobulin antibodies (TGA) was 14-0%, higher than the expected 3% (p < 0 001). The prevalence of thyroid microsomal antibodies (TMA) was 20%, also higher than the expected 7-6% (p < 0-01). The age distributions of the females in both groups differed: in the group with hereditary angioedema there was a greater proportion of younger patients which should have resulted in a lower prevalence of thyroid antibodies. Adjusting for related patients with hereditary angioedema, there was still an increased prevalence of TGA (p < 0 01) and TMA (p < 0 01).
SUMMARY. The cortisol responses to hypoglycaemia (insulin tolerance test, ITT) and tetracosactrin (short Synacthen test, SST) were compared after hypophysectomy to evaluate the SST for the assessment of hypothalamo-pituitary-adrenocortical (HPA) axis function in the immediate post-operative period. In 12 patients who were tested a mean of 21 months postoperatively (range 1-96) peak plasma cortisol in the SST correlated with that in the ITT (r=0·9O). Correlation was also seen in 12 patients tested a mean of 9 days (range 4-18) after hypophysectomy (r = O' 73). Basal-peak cortisol increments did not correlate. The peak plasma cortisol response in each test was classified by comparison with a reference value of 550 nmollL. On this basis there was a notable discrepancy between the ITT and SST results in only one patient who was tested 4 days after hypophysectomy.The close correlation between ITT and SST responses after pituitary surgery extends into the immediate post operative period and indicates that the latter test can be used to screen HPA axis function at this time. Additional key phrases: hypophysectomy; function; hypoglycaemia; tetracosactrin; cortisolPituitary surgery can cause inadequacy of adrenocorticotrophic hormone (ACTH) secretion and secondary hypocortisolism. Patients are tested to identify those who need replacement therapy. The insulin tolerance test (ITT) is regarded as the standard test of hypothalamo-pituitaryadrenocortical (HPA) axis function. It is inconvenient and potentially dangerous and not beyond criticism. The safer and simpler short Synacthen test (SST) directly tests adrenocortical function and indirectly also assesses integrated HPA axis function on the basis that deficiency of endogenous ACTH causes involution of the adrenal cortex and reduced response to exogenous ACTH. 1The adrenocortical response to exogenous ACTH has been shown to correlate closely with that to surgical and hypoglycaemic stress.':"The ITT and SST results might be expected to differ in circumstances of acute impairment of Correspondence: Dr R S Jackson, Department of Chemical Pathology, The Ipswich Hospital, Heath Road, Ipswich, Suffolk IP4 SPD, UK. 46ACTH secretion, for example after hypophysectomy, if performed before adrenocortical function has declined. However, the time lag for reduction of adrenocortical responsiveness in the SST secondary to acute reduction of ACTH may be short" and direct comparison of SST and ITT has not been made close to this time, for example after pituitary surgery. Accordingly, the ITT is still frequently used in the immediate postoperative period to determine the need for cortisol replacement therapy. The possibility of using the SST instead is attractive? and indeed the SST has been performed as early as 8 days postoperatively, but without ITT for comparison." A larger study of paired SSTs and ITTs excluded patients within 15 days of pituitary surgery." The aim of this study was to compare the results of paired SSTs and ITTs in this immediate postoperative period. PATIENTS AND MET...
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