Summary The mean total serum oestradiol level was found to be significantly increased in 8 male patients with carcinoma of the breast when compared with 8 healthy reference subjects matched for race, sex and age. The calculated mean free oestradiol index was also higher in these patients. There were no significant differences, however, between the levels of LH, FSH, prolactin, DHEA-S, testosterone and SHGB in the 2 groups. The patients showed a significantly increased LH response to GnRH while there was no difference in the FSH response. Only 1/7 patients had a tumour devoid of steroid hormone receptors. It may be that an increased level of circulating oestradiol-17,B is an important factor in the aetiology of hormone-dependent male breast cancer.
The thyroid status of twenty-seven African patients with gestational trophoblastic neoplasia (GTN) was studied. Fifteen patients were found to be biochemically hyperthyroid (eight patients with choriocarcinoma; seven with hydatidiform mole). Of these fifteen patients, nine were clinically thyrotoxic. The most serious complication of thyrotoxicosis was life-threatening acute pulmonary oedema with associated cardiac failure. It was found that when serum levels of the human chorionic gonadotrophin (hCG) reached a level of about 0.1 X 10(6) iu/1, thirteen of sixteen patients were biochemically hyperthyroid; at serum levels of 0.3 X 10(6) iu/1 of hCG most patients were clinically thyrotoxic. A feature of hyperthyroidism associated with GTN is that whereas T4 is invariably raised the T3:T4 ratio tends to be low (0.015 +/- 005); rT3:T3 ratios were high in this group. TSH levels were not increased.
Eight patients with symptomatic porphyria (porphyria cutanea tarda symptomatica, PCT) were treated with smalt doses of chloroquin sulphate over periods ranging from 2 to 16 weeks. A good clinical and biochemical response was obtained in all but one patient, who relapsed after initial improvement. Manifestations of acute untoward reaction were seen in one patient only. It is concluded that low dose chloroquine therapy is both safe and effective in PCT.Studies in porphyric rats indicate that the mechanism of action of chloroquine in PCT is probably not related, as has been suggested, to the formation of a chloroquine-porphyrin complex which damages liver cells and thereby leads to a reduction in hepatic porphyrin stores.Chloroquine therapy led to increased urinary iron excretion and an increase in the desferrioxamine-chelatable iron in patients with PCT. It is suggested that the prolonged beneficial effects of chloroquine treatment may be related to reduction in a specific pool of liver iron.
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