The enterohormones

In this review, the origin of endocrinology has been traced to the discovery of the first hormone, secretin, a gut hormone, by Bayliss and Starling 70 years ago. Since then gastro-enterological endocrinology has flourished with the discovery of a host of new hormones, including glucagon, enteroglucagon, gastrin, cholecystokinin-pancreozymin (CCK-PZ), gastro-intestinal inhibitory peptide (GIP), vasoactive intestinal peptide (VIP), motilin, and many others are awaiting discovery. There is extensive overlap in the biological and immunological activity of these hormones which may be related to similarities in primary structure, a common ancestral molecular origin or relative non-specificity of the receptor sites in various target organs. Administered gut hormones have proved useful in the diagnosis of many endocrine and non-endocrine disorders, and provide scope for the medical management of conditions hitherto considered to be primarily surgical. Measurements of circulating levels have given us a deeper understanding of physiological and pathophysiological processes, and in many instances are the simplest and most rapid means of diagnosing certain disease processes. The review was intended to assist the busy practitioner to keep abreast of a rapidly-advancing field where new ideas and concepts appear at such a breathtaking rate that only the individual intimately concerned can keep pace. The author hopes to have at least achieved this objective.S. Afr. Med. J. 48, 359 (1974)

Preliminary trial of a powerful new sulphonylurea in maturity-onset diabetes-HB419 (Glibenclamide)

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Prevalence of diabetes, glycosuria and related variables among a white population in Cape Town

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Prevalence of glycosuria and diabetes among Indians and Bantu

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Serum Gastrin levels in Pigs

Serum gastrin levels were measured in 11 young pigs during starvation and one and two hours after feeding. The mean basal value was 57 -+- 16 pg/ml and was not affected by anaesthesia. Gastrin levels' at one and two hours after feeding were significantly higher than the basal levels. However, the rise was much less than that noted in humans, suggesting a species difference

Somatostatin in human pancreatic and gastric juice

Considerable amounts of IRS are secreted after secretin injection in human pancreatic juice collected during endoscopic retrograde cholangiopancreatography. The mean IRS levels in the pancreatic juice of non-diabetic patients were 79+/-10 (SE) pg/ml. The IRS levels in NIDDM were considerably higher, the mean value being 1635+/-313 (SE) pg/ml. The mean IRS level in IDDM were 312+/-151 (SE) pg/ml. In IDDM, those patients whose blood glucose levels were well controlled by insulin showed low pancreatic juice IRS ranging from non-detectable to 46 pg/ml. On the other hand, those with uncontrolled hyperglycemia showed IRS levels ranging from 452 to 1047 pg/ml. Gel-filtration profiles of IRS in pancreatic juice extracts were not consistent in all cases. Some showed IRS peaks eluting with SS14 and SS28, while others contained IRS species that were eluted in more retarded fractions. The retarded IRS fraction exhibited biological activity indistinguishable from that of SS14 as indexed using a quantitative cytochemical method.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/24539/1/0000818.pd

Plasma gut hormone levels in 37 patients with pheochromocytomas

Pheochromocytomas are usually recognized by the effects of overproduction of catecholamines, but there are clinical features that cannot be ascribed to catecholamine excess that may be due to vasoactive peptides. We, therefore, measured blood levels of vasoactive intestinal peptides (VIP), substance P, somatostatin (SS), and motilin in 50 instances in 37 patients with pheochromocytomas-21 malignant, 10 benign intra-adrenal, and 6 ectopic (5 paracardial and 1 perirenal). Hormone levels were considered raised if the level was more than 3 S.D. above the mean value found in 52 healthy subjects. Of the 37 patients, 20 (54%) had an abnormality in 1 or more gut hormone levels. The most common abnormality was a raised SS in 9/37 (24%). In addition to these, however, 3 (8%) others had raised VIP, 5 (13.5%) raised motilin, and 3 (8%) raised substance P. Patients with benign adrenal adenomas had raised levels of SS and substance P. Ectopic pheochromocytomas produced only SS in addition to catecholamines, but malignant pheochromocytomas could secrete all 4 peptides, and more than 1 in the same patient. We conclude that pheochromocytomas may secrete multiple vasoactive peptides, and they are more likely to do so if malignant. Somatostatin is the most commonly secreted peptide and is found with benign adrenal and ectopic (paracardiac) tumors. If the level of more than 1 peptide is elevated, the likelihood of malignancy is significantly increased . Les phéochromocytomes sont généralement déceléspar les effets dûs à la surproduction de catécholamines, mais certains troubles ne peuvent être attribués à ce phénomène et relèvent peut être de l'action de peptides vasoactifs. Les auteurs se sont donc attachés à doser dans le sang le VIP, la substance P, la somatostatine (SS), et la motiline. Ces dosages furent pratiqués 50 fois chez 37 malades porteurs de phéochromocytomes: 21 malins, 10 bénins et 6 ectopiques (5 paracardiaque et 1 péri-rénal). Les taux des hormones furent considérés comme élevés lorsque leur niveau fut supérieur à plus de 3 fois le taux de 52 sujets sains. Sur les 37 malades 20 (54%) présentaient un excès d'une ou de plusieurs hormones digestives. L'anomalie constatée la plus fréquente fut l'élévation de la SS (9 fois sur 37 soit 24%). Ajoutée à ce fait fut l'élévation de la VIP chez 3 sujets (8%), de la motiline chez 5 (13.5%) et de la substance P chez 3 (8%). Les phéochromocytomes bénins surrénaliens présentaient à la fois une élévation du taux de la SS et de la substance P. Les phéochromocytomes ectopiques en revanche présentaient seulement une élévation de la SS. Les phéochromocytomes malins pouvaient sécréter les 4 peptides ou plus d'un chez le même malade. En conclusion les phéochromocytomes peuvent secréter de multiples peptides vasoactifs et plus particulièrement lorsqu'ils sont malins. La SS est la substance qui est la plus souvent secrétée et elle est trouvée dans les tumeurs bénignes surrénaliennes ou ectopiques. Si plus d'une de ces substances est produite en excès les risques de malignité de la tumeur sont significativement plus importants. Los feocromocitomas generalmente son diagnosticados por los efectos del exceso de producción de catecolaminas pero hay características clínicas que no pueden ser atribuidas al exceso de catecolaminas y que pueden ser más bien manifestación de péptidos vasoactivos. Hemos establecido los niveles sanguíneos del péptido intestinal vasoactivo (VIP), de la sustancia P, de la somatostatina (SS), y de la motilina en 50 determinaciones en 37 pacientes con feocromocitomas; 21 malignos, 10 benignos intra-adrenales, y 6 ectópicos (5 paracardiales y 1 perirrenal). Se consideró que los niveles hormonales estaban elevados cuando el nivel era de más de 3 de desviación estandar sobre el valor promedio en 52 individuos normales. De 37 pacientes, 20 (54%) presentaron un valor anormal en 1 o más determinaciones del nivel de hormonas intestinales. La anormalidad más común fue la elevación de la SS en 9/37 (24%). Además de esto, sinembargo, otros 3 (8%) presentaban elevación de VIP, 5 (13.5%) elevación de sustancia P. Los adenomas suprarrenales benignos exhibieron niveles elevados de SS y de sustancia P. Los feocromocitomas ectópicos demostraron producción sólo de SS además de catecolaminas, pero los feocromocitomas malignos demostraron ser capaces de secretar todos los 4 péptidos, y más de 1 en el mismo paciente. Hemos llegado a la conclusión de que los feocromocitomas pueden secretar múltiples peptidos vasoactivos y que ésto tiende a ocurrir cuando son malignos. La SS es el péptido más frecuentemente secretado y se lo encuentra en los tumores suprarrenales benigno y ectópico (paracardiacos). Si se encuentran niveles elevados de más de 1 péptido, la posibilidad de malignidad aparece significativamente aumentada.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41274/1/268_2005_Article_BF01655534.pd

Recovery on rewarming after hypothermic hyperglycaemia

Severe hypothermia may lead to hypo- or hyperglycaemia. We report two cases of the latter, less common, condition in which the blood glucose levels were 638 and 580 mg/l00 ml. The glucose levels in both cases fell rapidly on rewarming, without any exogenous insulin and despite one patient being an insulin-requiring diabetic. The glycaemic status in hypothermia appears to result from the relative contributions of reduced hepatic glucose production, leading to hypoglycaemia and reduced glucose uptake by the liver and peripheral tissues, causing hyperglycaemia. Rewarming alone appears to normalise glucose homeostasis by facilitating glucose utilisation.S. Afr. Med. J., 48, 1617 (1974