Addison\u27s Disease in Half-Siblings

In this only reported incidence of Addison\u27s disease in half-siblings, the adrenal failure is postulated to be a sex-linked recessive character. Adrenocortical antibodies were not detected

Prolonged Remission of Cushing\u27s Disease Following Bromocriptine Therapy

A 33-year-old woman developed hypercorticism of fulminant onset following delivery of a full-term, normal child. An ectopic hormone-producing neoplasm was excluded by extensive studies. Pituitary dependent hypercorticism of intermediate lobe origin was suggested on the basis of onset following pregnancy, failure of Cortisol suppression by high-dose dexamethasone, hyperresponsiveness of prolactin to thyrotropin-releasing hormone stimulation, and reduction in adrenocorticotropin titers following oral administration of bromocriptine. Initial remission of disease achieved with bromocriptine was followed by recurrence on discontinuation of the agent. However, complete remission which occurred following a prolonged course of bromocriptine has persisted for a total of 22 months

Cushing\u27s Disease: Dilemmas of Diagnosis and Management

Determining the cause of Cushing\u27s disease and correcting the abnormality presents a continuing challenge to the clinician despite remarkable advances in diagnostic and therapeutic techniques. We present seven cases to illustrate 1) the classic disorder cured by pituitary adenomectomy: 2) persistence of the disease after adenomectomy: 3) Cushing\u27s disease manifesting in the puerperium and remitting with dopamine agonist therapy: 4) a patient whose disease relapsed at least five times during 20 years of treatment by adrenalectomy, pituitary radiation, mitotane, and pituitary adenomectomy; 5) the Nelson syndrome; 6) the ectopic adrenocorticotropic hormone (ACTH) syndrome in a patient with dexamethasone suppressible urinary cortisol who had a pituitary adenoma which stained positively for ACTH hut who was not cured by total hypophysectomy; and 7) a patient whose ACTH-secreting tumor proved fatal despite repeated surgical, radiologic, and pharmacologic measures

Hypophyseal Growth Hormone II. Interaction with Other Hormones

Growth hormone (GH) synthesis and release is controlled by hypothalamic GH releasing factor. Thyroid hormones, androgens and estrogens in physiologic concentrations enhance GH secretion but a controlling role for glucagon and vasopressin in GH release is not established. Under stress, ACTH directly facilitates GH release while the similar action of the catecholamines is mediated by the a-adrenergic receptors. Though physiologic doses of glucorticoids and progestins do not affect GH liberation, prolonged administration of medroxyprogesterone acetate or of glucocorticoids in high dosage will decrease blood levels or blunt Gti responsiveness. GH enhances the release of insulin. A shift in adrenal steroid biosynthesis from the glucocorticoid to the androgenic pathway may also be an effect of GH administration. Prolonged elevated GH levels decrease serum thyroid binding globulin but increase the turnover of free thyroxine. Decreased thyroidal iodine uptake is probably secondary to these changes in thyroxine metabolism. In hypothyroidism and severe Cushing\u27s syndrome GH release is blunted. In most cases of acromegaly as well as in hyperthyroidism GH is nonsuppressible, while in diabetes its response to stimuli other than hypoglycemia is exaggerated

Pregnancy Following Sequential Bromocriptine Therapy in a Hyperprolactinemic Subject

Regular menses were maintained in a 26-year-old woman with a prolactinoma by sequential bromocriptine therapy given for either five or 14 days of the menstrual cycle. She conceived promptly when desired

Recurrent Klebsiella Meningitis Following Trans-sphenoidal Hypophysectomy for Nelson\u27s Syndrome: Chloramphenicol resistance during relapse

Three episodes of meningitis due to Klebsiella pneumoniae occurred in a young man following cerebral surgery. The patient had the features of Nelson\u27s syndrome, and a chromophobe adenoma was removed by trans-sphenoidal resection. Intravenous chloramphenicol was effective in producing a temporary clinical response during the first episode of meningitis, but the organism became resistant to chloramphenicol during the second episode. Combined parenteral and intralumbar administration of gentamicin resulted in temporary improvement only. Subsequently, the subcutaneous cerebrospinal fluid (CSF) reservoir of Ommaya provided a safe, convenient way to administer prolonged intraventricular therapy which, combined with a definitive procedure to correct the cerbrospinal fluid rhinorrhea, ultimately cured the infection