Determinations of cardiac output and oxygen consumption simultaneously with measurements of glomerular filtration rate and renal plasma flow were performed before and after hypophysectomy in two cases of acromegaly, two cases of metastatic mammary carcinoma, one case of diabetes mellitus and in one case of chromophobe adenoma. After hypophysectomy evidence of adrenocortical insufficiency was present in all but one subject and these patients were on substitution therapy with cortisone (17,21-dihydroxy-pregn-4-ene 3,11,20-trione) at the time of the postoperative studies. In two patients at least, postoperative hypothyroidism could not be demonstrated. In all cases, however, hypophysectomy was followed by a marked and roughly parallel reduction in cardiac output and oxygen consumption. A substantial decrease in glomerular filtration rate, renal plasma flow and renal blood flow following hypophysectomy was also found while no or only slight changes in mean brachial arterial blood pressure were observed. The changes in renal function did not always parallel the reduction in cardiac output.
In a prospective study, 68 hospitalized patients were diagnosed as having giant cell arteritis. Temporal artery biopsy was performed in all patients and showed histologic evidence of arteritis in 42 (62%). Twenty-six patients had a negative biopsy but met the clinical criteria for the diagnosis. Four different clinical pictures were recognized. Thirteen patients (19%) had symptoms of localized temporal arteritis without muscular discomfort. The polymyalgia rheumatica syndrome without signs of localized arteritis was seen in 33 patients (49%). Seventeen (25%) had symptoms of both polymyalgia rheumatica and temporal arteritis. Five patients (7%) had general symptoms only, such as fever, anorexia, and fatigue, without muscular or arteritic symptoms.
Clearances of inulin and para-aminohippuric acid as well as renal extraction of para-aminohippuric acid were studied in six hypophysectomized patients, in one case of craniopharyngioma and in two cases of chromophobe adenoma. All subjects showed evidence of adrenocortical insufficiency and received substitution therapy with cortisone (17,21-dihydroxy-pregn-4-ene-3,11,20-trione) at the time of this investigation. Thyroid insufficiency was demonstrated in only four cases. Glomerular filtration rate and renal plasma flow were decreased to a varying extent, the reduction being most marked in the hypothyroid subjects. Irrespective of the degree of reduction in glomerular filtration rate and renal plasma flow a normal renal extraction of para-aminohippuric acid was found.
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