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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A patient in whom Cushing syndrome had been diagnosed at the age of 23 was found 14 years later to have subclinical diabetes mellitus, subcutaneous calcified fat tissue necroses, and hypergastrinemia suggesting Zollinger-Ellison syndrome. Histopathologic investigation revealed pancreatic adenomatosis of the glucagon producing A2-cells with accompanying B-cell hyperplasia, and hyperplasia of the adrenal cortex. The origin of the increased serum gastrin concentration in this patient is not yet known. The significance of A2-cell proliferation in Zollinger-Ellison syndrome and and in multiple endocrine adenomatosis is discussed.
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PMID:[Glucagon producing adenomatosis of Islands of Langerhans with polyendocrine symptoms]. 1 53

The risk of systemic effects of high doses of potent topical corticosteroids was evaluated in 6 psoriatics with lesions on more than 50% of the body surface. Before the examinations the patients had been treated for 3-4 months with 35-65 g fluorinated corticosteroids daily. General clinical examination, plasma cortisol determinations, and tetracosactrin tests were carried out. One patient showed clinical signs of Cushing's syndrome including diabetes mellitus, another had a slight Cushingoid appearance. The plasma cortisol levels were depressed in 5 of the 6 patients on the first post-treatment day. A subnormal plasmacortisol response to tetracosactrin stimulation was noted in 3 of the patients. In these cases the potent corticosteroid therapy was discontinued. One month later a follow-up was performed, which showed a clinical and laboratory normalization except for the tetracosactrin test in one case. The study emphasizes the risk of serious systemic effects of the absorbed corticosteroids, if high doses are used for long periods.
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PMID:Systemic effects of local treatment with high doses of potent corticosteroids in psoriatics. 8 83

Locally recurrent, poorly differentiated carcinoma of the prostate was associated with hypokalemic alkalosis, marked hypernatremia, diabetes mellitus of recent onset, and hyperosmolar syndrome. These findings, with mild hypertension, in the absence of clinical features of Cushing's syndrome, suggested an ectopic ACTH syndrome. Plasma ACTH and cortisol levels were markedly elevated, and failed to suppress in response to either low or high-dose dexamethazone administration. The patient's condition deteriorated rapidly. Autopsy findings included carcinoma extensively infiltrating the prostate with extension to the urinary bladder, and metastases confined to the pelvic nodes and soft tissues. The adrenal glands weighed 23 g and showed diffuse hyperplasia. Extract of the prostatic tumor was analyzed for ACTH and showed approximately 40 times normal plasma levels (or about 4,010 pg/g of tissue); ultrastructural features showed secretory granules consistent with ACTH content of the tumor cells. Such cells were positive when stained for ACTH by peroxidase-tagged immunochemical methods. The case fulfills all established criteria for relating excess corticosteroid production and nonpituitary tumors.
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PMID:Ectopic ACTH, prostatic oat cell carcinoma, and marked hypernatremia. 19 43

Glucagon is secreted not only by A2-cells of the pancreatic islets but also by A cells in the gastric fundus and duodenum. Several reports have demonstrated that the glucagon plasma concentration is increased in genetic diabetes as well as in many conditions associated with a decreased glucose tolerance such as hepatic cirrhosis, myocardial infarction, infectious diseases, burns, taumatic shock, glucagonomas, acute pancreatitis, acromegaly, pheochromacytoma and Cushing's syndrome. Hyperglucagonemia is particularly important in diabetic ketoacidosis and in non-ketotic hyperosmolar coma. The mechanisms responsible for the diabetic's hyperglucagonemia remain controversial. According to several authors, the increased glucagon secretion is, for its main part, secondary to a prolonged defect in insulin secretion and thus relatively insensitive to an acute insulin administration. According to others, the A cell abnormality is of primary origin, independant from insulin deficiency and its effects are cumulative with those of the insulin lack. Several reports dealing with induced or spontaneous experimental diabetes are in favor of the first or the second hypothesis. It appears likely that glucagon plays a role in the metabolic derangments of diabetes. Indeed, hepatic glucose production is closely related to the ratio of molar concentrations of insulin and glucagon. Finally, in insulin-dependant diabetics, somatostatin infusion reduces plasma glucagon concentration and blood glucose and prevents the development of ketosis after withdrawal of insulin therapy. These results illustrate the contribution of glucagon in the pathogenesis of hyperglycemia and ketosis. Several arguments have been accumulated in favor of the following concept: diabetes hyperglycemia results both from glucose under-utilization secondary to insulin lack and from hepatic glucose over-production due to glucagon excess. Although controversial, the role of glucagon in ketogenesis appears likely.
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PMID:[The role of glucagon in hyperglycemia. A review (author's transl)]. 79 28

Effect of successful treatment on plasma glucagon response to arginine was studied in patients with diabetes mellitus, Cushing's syndrome and hypothyroidism. Exaggerated response of plasma glucagon to arginine infusion in diabetic subjects was normalized in those successfully treated with sulfonylureas and significantly improved in those treated with insulin. Patients with Cushing's syndrome and hypothyroidism also exhibited excessive responsiveness of plasma glucagon, which were completely normalized following treatment. The results suggest that the metabolic derangement is a main etiologic factor in inducing hyperresponsiveness of plasma glucagon to arginine in these disorders.
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PMID:Alteration of plasma glucagon response to arginine after treatment in patients with diabetes mellitus, cushing's syndrome and hypothyroidism. 84 89

Subnormal plasma 11-deoxycortisol (compound S) responses to metyrapone were found in patients with adrenal insufficiency or with Cushing syndrome caused by adrenal tumors and in those receiving long-term glucocorticoid or diphenylhydantoin sodium therapy. High normal or exaggerated responses were seen in women receiving oral contraceptives, patients with Cushing syndrome caused by adrenal hyperplasia, and those with untreated hypothyroidism. Diabetes mellitus, hypoglycemia, congestive failure, and obesity also were associated with exaggerated responses. Subnormal plasma S responses were observed in 15 patients who responded normally to a repeat test or to the standard metyrapone test. The abnormal response resulted from insufficient metyrapone, administration at the wrong time, or delay in obtaining the blood sample. The single-dose metyrapone test may be the procedure of choice in screening for adrenal insufficiency.
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PMID:Single-dose metyrapone test: review of a four-year experience. 105 66

Analysis of 16 486 obstetric and neonatal case histories of the years 1963--1972. 30.7% of all neonates of Austrian (A) mothers showed one or more signs of placentar insufficiency. Pronounced prenatal dystrophy (p.d.) occurs in similar numbers in women with or without EPH gestosis, but has other important causes as well. In p.d. excentric umbilical cord insertion is more common than in neonates without dystrophy (56.4 : 52.4). Very young mothers often have neonates with p.d. During the ten year period p.d. increased considerably until 1967. After that it decreased slightly but not to the numbers at the start. These changes in frequency apply to all maternal age groups equally. Pronounced and highgrade p.d. in foreign workers' (f.w.) children is significantly more common than with A mothers (p 0.0001). Cushing's syndrome as a symptom of fetal disease due to diabetes has become rarer by over 50% owing to more intensive preventive measures; at the same time still-births of those weighing 4000 g or more have disappeared. The frequency of Cushing's syndrome rises according to the age of the mother from 0.8% to 3.5%. In Austrian mothers the number of previous abortions has decreased during these 10 years, just as has the number of births. The chances of actual pregnancies are the worse the higher the number of previous abortions. In f.w. mothers previous artificial abortions are far more numerous, but the outcome of pregnancy does not deteriorate with an increase in previous abortions. In A mothers the effects of previous premature or still births are the same as after abortions but much more pronounced. The percentage of normal births following premature births has fallen somewhat in A mothers during the ten year period, also after one miscarriage from 86% to 71%, probably owing to effective prevention of late abortions. Of 173 pairs of twins the first-born was heavier than the second in 71 instances. It is confirmed that the second twin is still-born almost twice as often as the first-born and this in twins of whom the second is heavier than the first. 11% of individual twins weith more than 3000 g and 28% between 2501 and 3000 g. The heavier the twins the lower the average age of the mother (from 30.8 to 26.6). The mothers whose first twin weighs more than 2500 g, the second less, appear to be younger than those with an inverse ratio (27.6 : 30.7).
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PMID:[The influence on the outcome of pregnancies of sociologic and medical changes during 1963--1972. II. Special section: prenatal dystrophy, diabetogenic fetal disease, the impact of previous miscarriages and twins (author's transl)]. 117 91

Two patients with acromegaly have been treated with hypophysectomy. Because the disease was still active, the patients were reoperated. No pituitary tissue could be found at the second operations. Besides the acromegaly, one of the patients had diabetes mellitus (appeared after the first operation), Cushing's syndrome, probably ACTH-dependent, and evidence of thyrotoxicosis. In both patients extopic pituitary tissue was suspected. One of the patients reacted with a normal fall in plasma growth hormone to growth hormone releasing-inhibiting hormone. Ectopic pituitary function should be suspected, if the pituitary function is retained after a hypophysectomy.
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PMID:Ectopic pituitary function. 118 87

A rare case of pancreatic exocrine carcinoma with an endocrine component secreting adrenocorticotropic hormone (ACTH) is reported and discussed in relation to other cases previously published. The patient initially presented with a severe form of diabetes, which was treated accordingly. Persistence of hyperglycemia, along with other metabolic alterations and marked hypokalemia, led to the suggestion of abnormal ACTH secretion. In this patient, however, a florid Cushing's syndrome was not observed. The patient also developed hematological alterations, mainly leukopenia and thrombocytopenia, whose origins were unclear. At autopsy, a poorly-defined mass was discovered between the body and tail of the pancreas. Standard histology showed a moderately-differentiated adenocarcinoma. Immunohistochemical analysis of the tumor specimen demonstrated the presence of some neoplastic cells immunoreactive for chromogranin A, neuron-specific enolase and ACTH. These findings are consistent with the existence of an endocrine component within the exocrine carcinoma with ACTH differentiation.
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PMID:Pancreatic exocrine carcinoma producing adrenocorticotropic hormone. 131 74

A 57-year-old obese woman with hypertension, diabetes mellitus, osteoporosis, and a 40-year history of secondary amenorrhea was diagnosed with corticotropin-dependent Cushing's syndrome. Dynamic endocrine testing and radiological evaluation did not reveal definitively the source of the excess corticotropin. Bilateral adrenalectomy was performed with resolution of the signs and symptoms of hypercortisolism. Four years later, the patient was noted to have rising serum corticotropin levels and an enlarging pituitary mass; hyperprolactinemia also was documented. A diagnosis of Nelson-Salassa syndrome was made, and she underwent a transsphenoidal adenomectomy. A histological examination of the specimen revealed two distinct, albeit contiguous, adenomas: a corticotroph adenoma and a lactotroph adenoma. Postoperatively, the serum prolactin and corticotropin levels decreased significantly. Although the stalk section effect resulting from compression by a pituitary adenoma can raise serum prolactin levels, a concurrent lactotroph adenoma should be considered in patients with nonfunctional or functional pituitary adenomas of other types associated with significantly elevated prolactin levels. The mechanisms underlying simultaneous adrenocorticotropic hormone and prolactin excess are discussed.
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PMID:Coexisting corticotroph and lactotroph adenomas: case report with reference to the relationship of corticotropin and prolactin excess. 131 62


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