Oestradiol-(E2) levels in serum were significantly higher in a group of 91 males with gynaecomastia than in a control group. The levels were highest in patients with testicular tumour, hyperprolactinaemia and idiopathic gynaecomastia. In gynaecomastia of puberty and primary or secondary hypogonadism, the E2 level was within normal limits, but the testosterone/oestradiol ratio was significantly reduced. Tamoxifen, at a daily dose of 20 mg, was administered over 2-4 months to 16 patients with gynaecomastia. Of twelve patients with painful gynaecomastia ten became painfree. Gynaecomastia regressed partially or completely in 14 patients, in only 2 was it unchanged. There was no recurrence of gynaecomastia after discontinuing tamoxifen. Side-effects did not occur. It is concluded that tamoxifen is a promising alternative to the surgical treatment of gynaecomastia.

Drug Prescribing for Patients with Chronic Kidney Disease in General Practice: a Cross-Sectional Study

Background: Multiple endocrine neoplasia type 1 (MEN-1) is an autosomal dominant predisposition for tumors of the parathyroid glands, anterior pituitary and pancreatic island cells. We report of a 59 year old patient with MEN-1 who underwent partial resection of abdominal metastases of gastrinoma 5 years ago and is treated with Octreotid LAR since then. The patient now presented for his annual staging examination. Past medical history: MEN-1 had been diagnosed with the patient in 1999, following workup of primary hyperparathyroidism. The patient had undergone resection of four hyperplastic epithelial bodies as well as resection of a mediastinal mass, emerging to be a thymus carcinoid. Furthermore, a macroprolactinoma was found, being treated with cabergolin since then. High gastrin levels as well as a history of gastrointestinal ulceration raised suspicion of gastrinoma in the context of MEN-1. Somatostatin receptor scintigraphy with indium-octreotide confirmed three sites of enhanced storage intraabdominally. Patient underwent explorative laparotomy. Two sites of metastatic infiltration of a then confirmed gastrinoma could be resected totally, a third site was only partially resected. Diffuse metastatic peritoneal infiltration was found. Pancreas itself presented free of tumor manifestation. Being treated with Sandostatin LAR, the patient showed no symptoms of Zollinger-Ellison-syndrome the following years and needed to take PPI only occassionally. History of present workup: The patient now presented for an extended staging to clarify the indication for re-operation. Parathyroid hormone, calcium and phosphate as well as prolactin, testosterone and LH/FSH were found normal; gastrin secretion was low under therapy with Octreotide. Somatostatin receptor scintigraphy with indium-octreotid found the well-known abdominal storage site being constant in size. Also in the pancreatic region storage enhancement was found, a finding which had not been described in prior szintigraphies. However, retrospective analysis of former examinations showed discrete storage enhancement in this region, representing the primary tumor site. Abdominal CT scanning showed two intrapancraetic contrast agent storing lesions in the early arterial phase. Endoscopic ultrasound confirmed two lesions in the corpus/cauda region.

BACKGROUND:Substitution of pituitary insufficient patients with recombinant human growth hormone (rhGH) in addition to the conventional substitution with glucocorticoids, L-thyroxine and sex hormones has been approved by the regulatory authorities in 1995 with the imposition to conduct surveillance studies to monitor drug safety.RESULTS:24% of all patients were within their 2nd treatment year, 15% within their 4th year, maximum treatment period was 6 years. There were 2 peaks within the patients age distribution: 30 to 39 years (24%) and 50 to 59 years (24%). The causes for pituitary disease were as follows: pituitary adenomas (47%), idiopathic (16%), craniopharyngeomas (16%) and others (21%). Mean GH dose was 1.5 IU/d s.c. (range 0.4 to 4 IU/d). Serum-IGF-1 increased by 159 and 192% in females and males. Waist circumference decreased by 2% and serum cholesterol was lowered by 5.5% in males. There were 2 cases with new carcinomas, 1 diabetes mellitus II and 1 death. Adverse events (AEs) within KIMS were compared to those of the treatment (GH) and placebo (PI) groups of the previous admission trials (in percent): edema: KIMS 10, GH 37, Pl 3; arthralgia: KIMS 8, GH 19, Pl 2; muscle pain: KIMS 3, GH 16, Pl 3; dizziness: KIMS 2, GH 1, Pl 3; headache: KIMS 2, GH 3, Pl 2; others: KIMS 2, GH 22, Pl 13. The reported incidence of AEs in KIMS was lower than in previous clinical trials. There might be 3 reasons for this: 1. under-reporting, particularly those AEs not likely to be related to GH treatment; 2. doses used in trials were 2-fold higher than in KIMS; 3. dose titration for individual patients.CONCLUSION:Surveillance programs are important for monitoring of drug long-term efficacy and safety.

Background: Substitution of pituitary insufficient patients with recombinant human growth hormone (rhGH) in addition to the conventional substitution with glucocorticoids, L-thyroxine and ses hormones has been approved by the regulatory authorities in 1995 with. the imposition to conduct surveillance studies to monitor drug safety. Results: 24% of all patients were within their 2nd treatment year, 15% within their 4th year, maximum treatment period was 6 years. There were 2 peaks within the patients age distribution: 30 to 35) years (24%) and 50 to 59 years (24%). The causes for pituitary disease were as follows: pituitary adenomas (47%), idiopathic (16%), craniopharyngeomas (16%) and others (21%). Mean GH dose was 1.5 IU/d s. c. (range 0.4 to 4 IU/d). Serum-IGF-1 increased by 159 and 192% in females and males. Waist circumference decreased by 2% and serum cholesterol was lowered by 5.5% in males. There were 2 cases with new carcinomas, 1 diabetes mellitus II and 1 death. Adverse events (AEs) within KIMS were compared to those of the treatment (GH) and placebo (P1) groups of the previous admission trials (in percent): edema: KIMS 10, GPI 37, Pl 3; arthralgia: KIMS 8, GH 19, Pl 2; muscle pain: KIMS 3, GH 16, Pl 3; dizziness: KIMS 2, GH, P1 3; headache: KIMS 3, GH 3, P1 3; others: KIMS 3, GH 22, P1 13. The reported incidence of AEs in KIMS was lower than in previous clinical trials. There might be 3 reasons for this: 1. under-reporting, particularly those AEs not likely to be related to GPI treatment. 2. doses used in trials were 2-fold higher than in KIMS; 3. dose titration for individual patients. Conclusion: Surveillance programs are important for monitoring of drug long-term efficacy and safety.

OBJECTIVE To compare pulsatile gonadotropin-releasing hormone (GnRH) therapy with gonadotropin therapy in male patients with idiopathic hypothalamic hypogonadism. DESIGN Prospective study. Patients had free choice between the two forms of therapy. SETTING Patients were treated on an outpatient basis in our department. PATIENTS Eighteen patients of matched age (mean [+/- SD] age: 21.1 +/- 3.0 years and 23.6 +/- 7.3 years) and similar testicular volume were treated in each group. INTERVENTIONS Pulsatile GnRH therapy was started with 4 micrograms GnRH subcutaneously every 2 hours using a portable pump and gonadotropin therapy with 3 x 2,500 IU human chorionic gonadotropin (hCG) weekly injected intramuscularly. After 8 to 12 weeks of hCG treatment, 150 IU human menopausal gonadotropin two to four times weekly were added. RESULTS Testosterone (T) and estradiol (E2) levels increased significantly higher (T: P less than 0.03; E2; P less than 0.001) in the gonadotropin group than in the GnRH group (T: 22.5 +/- 8.1 versus 16.8 +/- 5.5 nmol/L; E2: 150 +/- 70 versus 88. +/- 59 pmol/L). Five patients developed gynecomastia during gonadotropin therapy. The rise of testicular volume was significantly more pronounced (P less than 0.001) in the GnRH group (delta testicular volume = 8.1 +/- 2.0 mL) than in the gonadotropin group (delta testicular volume = 4.8 +/- 1.8 mL). Ten patients of the GnRH and 8 of the gonadotropin group had positive sperm counts, ranging from 1.5 to 26 x 10(6) spermatozoa/mL. The latter was achieved more rapidly in the GnRH group (12 +/- 1.6 versus 20 +/- 2.3 months: P less than 0.02). CONCLUSIONS Endocrine and exocrine testicular function can be normalized by both forms of therapy. Gonadotropin therapy has more side effects. Gonadotropin-releasing hormone leads to a higher testicular volume and a more rapid initiation of spermatogenesis compared with gonadotropin therapy.

To investigate relationships between hyperthyroidism and behavior, 45 formerly hyperthyroid patients (now euthyroid) and 51 control subjects were investigated by (a) a semi-structured psychiatric examination, (b) self-rating scales to assess mood states and personality, and (c) neuropsychological tests. Patients with "subclinical" or "remitted" hyperthyroidism showed more abnormalities than the controls in all dimensions investigated. Forty-three percent of patients (10% of controls) complained of "seriously reduced" well-being with feelings of fear, hostility, and inability to concentrate. While a fearful-agitated syndrome dominated in the initial phase of the illness, a mainly depressive syndrome was characteristic after a longer period of remission. More than 25% of the patients (2% of controls) showed "markedly impaired" neuropsychological functioning. Patients with a relapse within 2.5 years exhibited the most abnormal results. Even after a longer period of hormonal remission, there was no complete psychopathological and neuropsychological normalization. A thorough follow-up of hyperthyroid patients is recommended.

TRH-induced stimulation of hGH secretion before and after operation or radiotherapy and during bromocriptine treatment was tested in 188 patients with acromegaly. A normal hGH level (basal level less than 5 ng/ml) was achieved after operation in 106 patients (58%). Postoperatively persisting elevated hGH levels were reduced to normal by bromocriptine in 39%, by radiation in 22% and by combined radiation and bromocriptine in 48%. In cases with additional hyperprolactinaemia a response to bromocriptine occurred in 47%. Pre- and postoperative TRH-induced stimulation of hGH secretion was not correlated with the rate of either normalization nor recurrence and thus has no prognostic significance.

Drug Prescribing for Patients with Chronic Kidney Disease in General Practice: a Cross-Sectional Study

Neue radioimmunologische Methoden erlauben den Nachweis zahlreicher gastrointestinaler Hormone wie Insulin, Glukagon, Somatostatin, pankreatisches Polypeptid, gastrisches inhibitorisches Peptid, Neurotensin, Cholezystokinin, Pankreozymin, Sekretin, Motilin, Serotonin und Gastrin. Die endokrinen Zellen des Gastrointestinaltraktes enthalten mindestens soviel aktive Hormone, wie alle anderen endokrinen Organe zusammen [1]. Andererseits sind Erkrankungen dieses Systems selten und stehen in der Regel nicht im Vordergrund differentialdiagnostischer Überlegungen. Neben einer charakteristischen Symptomatik sind solche Erkrankungen aber gekennzeichnet durch eine typische Symptomatik und die Möglichkeit einer medikamentösen und chirurgischen Therapie.

Infiltrate hämatologischer Systemerkrankungen im Hypothalamus-Hypophysen-Bereich sind seltene Komplikationen dieser Erkrankungen. Infolgedessen sind solche Infiltrate unter den zahlreichen pathologischanatomischen Ursachen hypothalamisch-hypophysärer Krankheitsbilder (3) eine selten zu sichernde Differentialdiagnose. Wir berichten hier über die Diagnostik und Verlaufsbeobachtung eines suprasellären Infiltrates bei einem Patienten mit einem Morbus Hodgkin.

Untersucht wurden 11 gesunde Personen, fünf Typ I und ein Typ II Diabetiker. Nach einer 12stündigen Fastendauer wurde Caerulein (20 ng/kg) i.v. injiziert und 60 Minuten später eine orale Glukosebelastung mit 100 g bei den Gesunden und 25 g Glukose bei den Diabetikern durchgeführt. Blutdruck, Puls, Blutglukose, Serum-Insulin, Glucagon, Prolaktin und Wachstumshormon wurden während der gesamten Testdauer von 240 min in regelmäßigen Abständen gemessen und mit den Werten einer Kontrolluntersuchung bei den gleichen Personen ohne Caerulein verglichen. Caerulein führte zu keiner signifikanten Änderung einer der gemessenen Parameter. — Während Caerulein die exokrine Pankreasfunktion stark stimuliert, hat dieses Decapeptid keinen Einfluß auf Glukosetoleranz und Funktionen des endokrinen Pankreas und der Hypophyse.

Fifty-seven male patients with hyperprolactinemia have been investigated. Macroadenomas were found in 49 patients of whom 24 had received pituitary surgery before elevated PRL levels were discovered. In 8 patients radiology of the pituitary fossa revealed either evidence of microadenoma or a completely normal sella turcica. Prolactin levels ranged from 582 to 498 000 microU/ml. All patients with macroprolactinomas, including those who had undergone previous surgery, had PRL levels above 5000 microU/ml. Disturbances of libido and sexual potency were prevalent in the majority of patients, less frequently accompanied by gynacecomastia and galactorrhea. However, visual disturbances were the reason for the first visit to the doctor in the majority of patients. Pituitary surgery led to improvement of visual field defects, though prolactin levels were never normalized. Postoperative radiotherapy had no significant influence on PRL levels. In contrast, bromocriptine therapy led, in the majority of patients, not only to improvement of hypogonadal symptoms but also to normalization of PRL levels.