Ketoconazole, an imidazole derivative known to inhibit cytochrome P450-dependent adrenal enzymes was given to a patient with a functioning adrenal rest tumor of the liver in preparation for surgery. The drug was administered in a stepwise manner for 42 days starting with 400 mg and reaching 1 g the last 4 weeks of the trial. Clear clinical improvement was evident early in the trial and was associated with evidence of amelioration of her hypercortisolism and striking changes in serum and urinary levels of steroid hormones and metabolites. Sex steroids in serum and urine fell dramatically from the first day to the end of the trial. Urinary 17-ketosteroid excretion fell from a basal average of 139 mg/24 h to near normal levels within a week of therapy; serum testosterone fell from a basal level of 2.4 to 0.18 ng/ml; serum 17 beta-estradiol fell likewise from 1096 to 150 pg/ml. In contrast, cortisol levels in serum and urine increased in the first 2 weeks of the trial and subsequently fell to values below the basal levels. Similarly, serum 17 alpha-OH-progesterone levels increased 63% above the basal levels by day 6 of the trial and declined afterwards. Nine months after successful tumor resection the patient is apparently cured as judged by steroid hormone levels and physical appearance. We conclude that ketoconazole was effective in blocking tumoral steroidogenesis which resulted in clinical benefit.

In order to study the interaction between vasopressin (VP) and hypothalamic corticotropin releasing factor (CRF) on the release of ACTH, VP and CRF were administered separately and in combination to normal cycling women. The combined hormones raised plasma ACTH levels higher than the sum of the separate responses and 5 times more than CRF alone. This study reveals for the first time synergism between VP and CRF in their ACTH releasing effects in humans.

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Objective: This study examines the relationship between the results of in vitro determinations of carbohydrate digestion rates and the glycemic index. Subjects: Ten healthy non smoking men, aged between 21 and 24-y-old, were selected to participate in the study. Methods: Six different meals with similar lelvels of carbohydrates were assayed at breakfast in ten subjects and blood samples were obtained at 0, 15, 30, 60 and 120 min to determine glucose levels. The Englyst's enzymatic method was used in the in vitro study. The six meals were based in cereals (rice or spaghetti); legumes (lentil soup and beans with spaghetti); and potato (potato stew with meat and vegetables). Results: The meals showed different glycemic indices: rice and spaghetti based meals had lower values (mean value 31.4 and 42, respectiively); the intermediate values corresponded to lentil soup and the bean dish (49.3, and 76.8 respectively) and the higher glycemic index was shown by the potato based meal (82). Conclusions: A significant correlation was observed when the ratio of rapid carbohydrate digestion rate and the lente carbohydrate digestion rate was correlated with the glycemic index of the meals, but not when only the rapid carbohydrate digestion rate was considered. These results demonstrate a useful, simple and inexpensive method to estimate the biological response of high carbohydrate meals. Sponsorship:

insulin sensitivity in our patients exhibited a discontinuous distribution, implying that PCOS is a heterogeneous disorder possessing subpopulations regarding IR.