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Procalcitonin is a biomarker for estimating the likelihood of a bacterial infection. Procalcitonin-guided antibiotic therapy can reduce antibiotic overuse in respiratory tract infections. The differential diagnosis of water-electrolyte imbalances is challenging. Copeptin is co-secreted with arginine vasopressin (AVP) and is a reliable surrogate of plasma AVP. Copeptin may become a useful diagnostic tool in patients with polydipsia-polyuria syndrome and hyponatremia. Copeptin is also known to mirror different levels of stress. It appears to have an interesting potential as a new prognostic biomarker in patients with ischemic stroke. Biomarkers should not be used without the clinical context. They are meant to complement clinical judgment based upon a synthesis of available clinical and laboratory features in each patients.

The estimated prevalence of anorexia nervosa is highest in teenagers and probably increasing in prepubertal girls, while morbidity rates in female adults remain constant. Childhood and adolescent AN often take a chronic and disabling course with severe consequences for somatic and mental health in adulthood and an eventually high mortality. Besides a reduced growth, diminished reproduction rate and an increased risk of osteoporosis a prolonged course of the disorder may impact on the development of the adolescent brain, probably by hormonal dysfunctions such as those of the corticoid and gonadal system and by severe changes in neuropeptides such as leptin. Thus, besides a genetic disposition, longer lasting effects of starvation on brain development might explain the high prevalence of mental disorders in adulthood of former AN patients. Neuropsychological findings resembling those in obsessive-compulsive disorder and autism spectrum disorders are of growing importance because they might contribute to more effective and specific interventions in both adolescent and adult eating disorders.

Hyperglycemia and insulin resistance are frequently observed during critical illness. The underlying pathophysiology is not yet fully understood, although hyperglycemia predicts post-surgical morbidity and mortality. Apparently perioperative insulin resistance has a complex pathophysiology and tissue-specific differences have to be considered. Multiple causative factors and intracellular signalling pathways have been identified driving the development of systemic perioperative insulin resistance. This review will focus on mechanisms involving the classical insulin signalling cascade., (© Georg Thieme Verlag Stuttgart · New York.)

Hormones and their imbalances have significant effects on the morphology and physiology of the skin and influence various skin functions, especially wound healing and lipogenesis. With increasing age, the concentrations of important circulating hormones, including growth hormone and sex-related steroids, decrease continuously. As a result, physiologic processes are negatively influenced and various age-associated disorders may develop. As the population aged 80 and over is expected to rise in the next decades, the understanding of the molecular mechanisms accompanying skin aging and disease prevention will become even more important and play a role in preventing disease.

Disturbances of the hormonal regulation of critically ill patients are known since many years. In the last years, two topics received a lot of attention since a single intervention led to a mortality benefit: the intensive blood glucose control in surgical intensive care patients and the low dose hydrocortisone therapy in sepsis. These results were quickly incorporated in guidelines. However, large multi-center studies failed to support the initial results in several points. This review discusses these and other disturbances of endocrine regulation of critically ill patients., (Georg Thieme Verlag KG Stuttgart, New York.)

Background and Objective: Treatment of type 1 diabetes mellitus (DM) aims to prevent complications by strictly optimizing blood glucose levels. Although physical exercise is an important part of metabolic control, endurance sports are considered hazardous for patients with type 1 diabetes because of the extreme physiological stress they represent. To further elucidate the metabolic challenge this form of exercise presented we investigated the performance of triathlon competitors with type 1 diabetes., Patients and Methods: Ten patients (32-61 years) with type 1 diabetes (disease duration 2-35 years) were followed for three years, during which each year they participated in one triathlon long-distance competitions (2.4 miles swimming, 26.2 miles running and 112 miles cycling; Ironman Germany 2005-2007). Glucose, cortisol, aldosterone, renin, thyroid hormones, testosterone, growth hormone and catecholamines were measured in blood and saliva. Five non-diabetic competitors served as controls., Results: The performance equalled those of age-matched healthy athletes. Several participants experienced hyperglycemia early in the bike leg, whereas all of them developed low blood glucose levels during the marathon leg. Basal insulin supply was reduced up to 50 % on race day. Hormone levels in athletes with type 1 DM and healthy controls were similar., Conclusions: Patients with type 1 DM can successfully sustain extreme endurance challenges. Physiological alterations of the metabolic state complicated by type 1 DM can readily be compensated by adapting intensified insulin therapy and nutritional modifications. Thus 1 DM should not be regarded a contraindication to participating in high endurance sports.

Many studies have concentrated on investigating the effects of short and medium term hypobaric conditions in people living at low altitudes. In contrast, only little is known about long term or genetic adaptations to chronic hypobaric conditions in people living at high altitudes. A small number of phenotypic characteristics have been defined in these people so far, comprising hormonal functions, oxygen saturation of hemoglobin, skeletal growth, muscular morphology and function, cardiovascular functions, and fluid and electrolyte changes. Several of these characteristics have been attributed to genetic adaptations. However, so far, no specific genes coding for any of the specific phenotypes found in high altitude dwellers have been detected.

The clinical relevance of drug-induced weight changes is due to the development of obesity, increased rates of morbidity and reduced treatment compliance, even if the psychopharmacological treatment is effective. Possible underlying causes of weight gain in patients treated with antipsychotic drugs are the psychiatric disorder itself, and changes in the neurotransmitter, cytokine and hormone systems. Clinical management of psychopharmacologically induced weight gain includes diet, behavioral and pharmacological therapy. Possible add-on strategies - based on case reports and small studies - are ephedrine, sibutramine, orlistat, topiramate, nizatidine, naltrexone, metformin, amantadine, and reboxetine.

The function and fission properties of every cell in the organism follow a distinct rhythm. The synchronization of all these peripheral rhythms is controlled by a superordinate "master-clock", which is located in the nucleus suprachiasmaticus of the hypothalamus. Endocrine systems, aside from the autonomic nervous system, serve as efferent signals to transmit the rhythm to peripheral organs. The measurement of time-dependent changes in circulating hormone concentrations allows conclusions concerning the functionality of circadian rhythms and therefore represents a central approach in endocrine research. Regarding the interpretation of diurnal changes, one has to keep in mind that apart from the light/dark cycle other factors like the sleep/wake cycle or food intake also clearly influence the secretory activity of many endocrine organs. The dissociation of intrinsic circadian rhythms from other influencing factors requires the performance of costly and well-controlled experimental studies. Moreover, because of the complex interactions between hormones it is necessary to assess diurnal changes in activity of various endocrine systems in parallel. Only such an approach enables to understand the impact of endocrine rhythms on the complexly regulated homeostasis of e.g. glucose metabolism or the immune system.

The endocrine system of aging males reveals changes of more or less unknown significance for estrogens, dehydroepiandrosterone (DHEA), melatonin and growth hormone. The difference between physiological changes and clear hormone deficiency is not really understood and the clinical relevance of the observed changes needs to be investigated. Estrogens do not show any changes, but DHEA, melatonin or growth hormone show several changes in their concentrations concomitant with increasing age, without validated clinical significance. According to the guidelines of the ISSAM, the significance of changes in DHEA, DHEAS, melatonin, growth hormone and IGF-1 are not well enough understood to justify routine examination when investigating late-onset hypogonadism in aging men. There is no indication for treatment with these hormones (with the exception of, e.g., estrogens in prostate cancer or male-to-female-transsexualism), as the assumed positive effects as well as negative side effects are not clearly understood and need further investigation.

Hypopituitarism is usually caused by tumours of the hypothalamus-pituitary region, but may also arise as the consequence of pituitary inflammation, infiltration or hypoperfusion. Tumour mass reduction by surgical intervention or following drug treatment may improve pituitary function. However, neurosurgical tumour resection and radiation therapy may lead to a permanent manifestation of hypopituitarism. Diagnosis is established by endocrine testing, revealing the characteristic low serum concentrations of both peripheral hormone and associated regulatory hormone of pituitary origin. Hypopituitarism may involve from one to all endocrine axes regulated by the pituitary (in order of frequency: growth hormone deficiency>secondary hypogonadism>secondary hypothyroidism>secondary adrenal failure). The treatment of permanent hypopituitarism consists of replacement of the peripheral hormones (hydrocortisone, DHEA, thyroxine, testosterone or oestradiol, growth hormone). Quality of life is impaired in a considerable number of patients with hypopituitarism and mortality is increased, mostly due to cardiovascular and cerebrovascular causes, but also as a consequence of recurrent respiratory infections. Long-term care and monitoring of patients with hypopituitarism requires the experienced endocrinologist.

Objectives: The study was undertaken to compare different anaesthetic techniques for scheduled or urgent caesarean section with respect to maternal circulatory parameters, maternal and fetal endocrine stress response, fetal vitality parameters and further clinical parameters such as recovery and analgesic demand., Methods: After ethical approval,patients scheduled for general anaesthesia were randomly allocated to the esketamine group ( n=21; induction with 0.5 mg/kg BW esketamine and 1.5 mg/kg BW methohexitone, ventilation until cord cutting with FiO(2) 1.0) and the sevoflurane-group ( n=21; induction with 1.5-2.0 mg/kg BW methohexitone, ventilation until uterotomia with N(2)O/O(2) [FiO(2) 0,5] and endtidal sevoflurane concentrations about 1.0 vol%). After fetal development, all patients received 2.5 microg/kg BW fentanyl and sevoflurane (about 1.0 vol% endtidal) during ventilation with N(2)O/O(2) (FiO(2) 0.33). As a further control, a group with spinal anaesthesia ( n=22; 2.6-3.0 ml isobaric bupivacaine 0.5 %) was investigated. Maternal circulatory and endocrine plasmatic stress parameters were investigated at five time points and fetal parameters once after development.alpha< or =0.05 was considered significant., Results: Biometric data were comparable in all groups. Systolic arterial pressure was higher in the esketamine group ( p=0.008), whereas the heart rate was lower during spinal anaesthesia ( p<0.001). Plasma noradrenaline decreased in all collectives ( p<0.001) and mean group levels of noradrenaline ( p=0.04) and adrenaline ( p<0.001) were lower during spinal anaesthesia. In all groups, antidiuretic hormone (ADH) remained within the normal range or was slightly increased. Adrenocorticotropic hormone (ACTH) initially increased in all groups and decreased in later time course ( p<0.001). Cortisol increased in all groups ( p<0.001) but group levels were lower during spinal anaesthesia ( p<0.001). In the groups with general anaesthesia, no significant differences in recovery times were obvious, and neither recall nor dream reactions were observed. Postoperative hypoxic incidents (psaO(2) <90%) were comparable between the groups. After spinal anaesthesia, first analgesic demand was later than in the controls ( p=0.001), and the total amount of piritramide was lower ( p=0.02). Nausea and vomiting were more frequent during spinal anaesthesia ( p=0.03). All patients were content with their regimen. Apgar scores, pH-values and adrenaline, noradrenaline and cortisol in plasma were comparable in all groups of children (69 children, 5 gemini). The fetal concentration of esketamine (251 ng/ml) was lower than the corresponding maternal values (493 ng/ml)., Conclusions: When compared with methohexitone, sevoflurane and N(2)O for caesarean section, initial total intravenous anaesthesia with esketamine and methohexitone mediated specific antinociception without negative maternal or fetal effects and not taking invasion kinetics or elimination between uterotomia and cord cutting into consideration. Avoidance of N(2)O allows optimal oxygenation of the fetomaternal unit. Stress protection and hemodynamic responses were well balanced, and intraoperative recall or negative dream reactions were lacking. Superior postoperative pain protection was advantageous after spinal anaesthesia, but in contrast, nausea and vomiting were more frequent in this group.

The classification of functional hyperandrogenism (FHA) presented in this paper is based on well known clinical experience supported by recent data of molecular biology. Functional hyperandrogenism is composed of various organ system-specific entities with consequently differential diagnostic and therapeutic strategies. The term polycystic ovary syndromes (PCOS) is misleading and should be replaced by adequate descriptions. Inspite of intense discussions and progress in molecular biology are with the exception of the here described FHA III-group the etiological consequences unresolved in terms of diagnostic and therapeutic procedures. Based on recent findings on the human genome genetic screening methods (Microarrays) may be available in the near future to allow a better understanding of the underlying pathophysiology.

Purpose: The emergency transport in an ambulance can be a considerable physical and psychological stress for the patient. In this article we report on a stress test with 23 volunteers transported in an emergency helicopter., Methods: We determined the hemodynamic and endocrinological values of 23 volunteers after a standardised 15-minute transportation in a helicopter type EC 135., Results: During the take-off we registered an increase of the heart rate of 18% and endocrinological parameters were elevated up to 51%. All the registered values were within the physiological tolerance level. Psychological tests showed a feeling of fear and agitation before take-off, but after the flight the volunteers reported less stress than expected., Conclusion: The stress situation is caused by fear of the flight, that cannot be objectively justified. The relatively low stress induction by helicopter transportation might be an indication that there should be more patient transport with modern helicopters, especially for non-trauma patients. This subject deserves further investigation.

The pilot study included serum analysis of ionized calcium, copper, zinc, various hormones and amino acid profiles from dogs affected with panosteitis, as well as protein electrophoresis performed on bone biopsies. Results of these analyses are as follows: ionized calcium, copper, zinc and hormones (parathyroid hormone, IGF-1, T3 and T4) were within reference ranges. Eleven of 23 serum amino acids from panosteitis-affected dogs were found to be significantly increased (P = 0.05). SDS-polyacrylamide gel electrophoresis performed on bone biopsies, which were pretreated with SDS, resulted in a double band of 39,000 D molecular weight in all panosteitis-affected dogs. Similar studies in control dogs resulted in a single band in this region. Attempts at amino acid sequencing from the N-terminal of the proteins in this double band region were unsuccessful. A chemical interference at the N-terminal end of these proteins was suspected. The composition of this double band is as yet unknown. The etiology of panosteitis could therefore not be definitively verified. However, it does appear that protein- or amino acid metabolism is affected in dogs with panosteitis.

Forty-eight-hour rapid cycling is a rare subclass of affective disorders and entails a regular periodic change of moods. The following case study describes the symptoms, therapy, and outcome of a patient suffering from daily switching between mania and depression along with neurobiological findings correlated to the affective cycles. We found alternating reduction and prolongation of sleep duration during manic and depressive days as well as differences in the amount of REM sleep. Cortisol secretion was regularly increased during depressive days. Regarding thyroid-stimulating hormone (TSH) secretion, the circadian rhythm was absent on depressive days. However, the glucose metabolic rate as measured by positron emission tomography (PET) did not differ on manic and depressive days. The patient reached almost complete remission under treatment with lithium.

During male ageing serum levels of testosterone, free testosterone, DHEA, growth hormone and maltonin decrease in contrary to the increase of FSH, LH, SHBG. Estradiol, Prolaktin and dihydrotestosterone show no significant changes. The terminus "andropause" is not correct, because there is no sudden decrease in sexual hormones, which is seen in the female (menopause). We should characterize the hormonE changes as "partial endocrine variations of the ageing male" or "partial androgen deficiency of the ageing male". Wether hormone replacement therapy leads to delay of ageing or increase of well being in ageing males can only be demonstrated in long term studies over ten years. Otherwise an evidence is required to demonstrate that long time hormone replacement therapy will not lead to tumour induction or increase of tumour growing.

Objective: This study was undertaken to investigate simultaneously the influence of coinduction with propofol and midazolam on sympathoadrenergic and hemodynamic reactions and stress response during the extended induction period of TIVA., Methods: 2 x 20 patients over the 60th year of life with major visceral surgery were investigated in a prospective randomized design. All patients received about 0.1 mg/kg BW midazolam for oral premedication. In the midazolam-group, induction of TIVA was undertaken with 0.05 mg/kg BW midazolam, 2.5 micrograms/kg BW fentanyl and 1.0 mg/kg BW propofol (1 min later). Controls received 2.5 micrograms/kg BW fentanyl and 2.0 mg/kg BW propofol. After muscle relaxation with 0.1 mg/kg BW vecuronium, TIVA was conducted in both groups with 8-5 mg/kg BW/h propofol and bolus injections of fentanyl with respect to clinical demands. Beyond consumption of anesthetics and recovery, sympathoadrenergic and hemodynamic reactions and SEF90 were investigated at 6 time points before induction of anesthesia and at skin incision. Plasma levels of ADH, ACTH and cortisol were measured twice before induction and at skin incision., Results: Biometric data of both groups were comparable, and mean age was over 65 years. In the midazolam-group, co-induction with a mean dosage of 3.8 mg midazolam halved the induction dose of propofol and reduced the propofol demand during the following course of anesthesia as well, achieving a significant over all reduction of 200 mg propofol (p = 0.04). With respect to recovery from anesthesia more than 90 min later, no significant differences were found. Plasma concentrations of noradrenaline and adrenaline dropped significantly in both groups (p < 0.0001), as well as mean arterial pressure and heart rate (Fig. 1 and 2). For ADH, ACTH, cortisol and SEF90, no statistical differences were observed. Plasma-concentrations of midazolam were significantly higher in the midazolam-group., Conclusion: In elderly patients, co-induction with 0.05 mg/kg BW midazolam halved the induction dose of propofol and led to a further dose reduction with maintained hypnotic potency. However, the halvage of propofol induction dose had no effect on the reduction of the sympathoadrenergic tone with decrease of blood pressure and heart rate. The overall moderation of the stress response was comparable as well. Thus, both induction regimens investigated in this study cannot be recommended in patients with severe hemodynamic disorders like hemorrhagic or cardiac shock. The propofol reduction should be primarily considered under economic aspects.

Breeding animal transports between parts of our institute were used assessing effects of age of animals, of breed, of their functional state and of individual specificity of reaction patterns using peripheral venous blood samples. Increased mean values of Hb, Hk, body temperature, total protein, albumin, FT4, T4, FT3, T3, cortisol, adrenaline and decreased ones of body weight, Pa, Fe, noradrenaline were found after transport stress. Comparing age matched groups of DSB and HF breed higher concentrations of total protein, creatinine, lactate, cortisol, FT4, T3 and FT3 and lower ones of albumin, blood urea and Fe could be observed in animals of DSB breed before and after transport. Strong correlations existed on 14 variables within animals before and after transport stress meaning there could be individual specificity of some blood parameters.

ANAESTHETICS, ENDOCRINE SYSTEM, AND STRESS: The effects of anaesthetics on the nervous system are invariably associated with endocrine reactions, which are of great importance for the general characterization of anaesthetics or anaesthetic regimens. In this context, the endocrine stress response is mainly represented by adrenaline (A), noradrenaline (NA), antidiuretic hormone/vasopressin (ADH), adrenocorticotropic hormone (ACTH), and cortisol. PHARMACOLOGICAL PROFILE AND ANAESTHETIC ACTION OF KETAMINE: The pharmacological profile of ketamine is characterized by the term "dissociative anaesthesia." At the present time, the anaesthetic action of ketamine cannot be explained by a single mechanism. Its overall action might be due to different central and peripheral factors, and stereospecific effects are obvious. ENDOCRINE RESPONSES TO RACEMIC KETAMINE AND S(+)-KETAMINE: In contrast to stereospecific differences in the anaesthetic action of racemic ketamine and S-(+)-ketamine, the endocrine reactions to the S-(+) isomer and the racemic mixture are very similar. When S(+)-ketamine is used as the sole anaesthetic, significant activation of the sympathoadrenergic system with increases in plasma levels of A and NA can be observed. This effect is mitigated by midazolam. In combination with propofol, sympathoadrenergic responsiveness is preserved without overwhelming effects. In contrast to monoanaesthesia with S(+)-ketamine, during combination with midazolam and propofol significant increases in plasma ADH levels are observed, which might be due to suppressed sympathoadrenergic reactivity. In addition, surgical stress activates the pituitary-adrenocortical system with increases in ACTH and cortisol. Effects of midazolam and propofol on this effect are similar. SYNOPSIS AND CLINICAL ASPECTS: S-(+)-ketamine as a monoanaesthetic has significant sympathomimetic properties, which are beneficial during induction of patients in shock and patients with asthma. The combination of S-(+)-ketamine and midazolam has weaker sympathomimetic and general endocrine-stimulating properties, and can be used for analgosedation in patients with cardiovascular instability and exogenous catecholamine requirements. In combination with propofol, the sympathomimetic and general endocrine-stimulating effects of S-(+)-ketamine are less pronounced because of contrasting properties of both drugs. This combination might be useful in patients with endocrine deficits and for analgosedation, when rapid recovery is necessary and negative circulatory effects should be avoided.

The occurrence of hormonal disorders in 1.4 to 9.7% of the patients of andrology units justify a corresponding hormone analysis. Besides helping to make the differential-diagnosis of a disease hormone results are important for the description of preservation of spermatogenesis in cases of aspermia or azoospermia. Indications of a rest-spermatogenesis or a spermatozoon-pool could be crucial for assisted reproduction. Spermatological and testis-histological data of 2 independent collectives (n1 = 138; n2 = 110) were correlated with basal levels of FSH, LH, PRL, T, free T, and E2. Serum FSH appears with a sensitivity of 88.8% and a specification of 94.1% as good, but not absolutely certain discriminator of preserved or disturbed spermatogenesis. The inclusion of testis volume improves the diagnostic reliability only negligibly--the critical size is 16 ml. Because of its low diagnostic sensitivity the serum LH alone gives not much information but it can indicate together with serum testosterone causally relevant disorders in androgen metabolism (i.e. androgen resistance syndrome. Klinefelter-syndrome). PRL, T, free T, and E2 gave no conclusion of occurrence of disturbed or preserved spermatogenesis. For indication of performing testis biopsy because of diagnosis and therapeutic considerations further factors of spermatogenesis are required.

Total intravenous anaesthesia with ketamine-propofol offers distinct advantages over a TIVA with an opiate, including less cardiovascular and respiratory depression and an altered neuroendocrine and immunological stress response pattern. The effects of the more active stereoisomer S-(+)-ketamine in combination with propofol on the circulatory, endocrine and metabolic responses to abdominal surgery were compared with those of alfentanil-propofol. Twenty-four patients scheduled for elective hysterectomy participated in this study which had the approval of our institution's ethics committee. Anaesthesia was induced with 2 mg/kg S-(+)-ketamine or 0.05 mg/kg alfentanil, followed by 1 mg/kg propofol. Tracheal intubation was facilitated with 0.06 mg/kg vecuronium. Anaesthesia was maintained with 1 mg/kg per h S-(+)-ketamine or 0.0125 mg/kg per h alfentanil and propofol at an initial rate of 15 mg/kg per h which was reduced to 5 mg/kg per h after 30 min. Blood samples for catecholamines, cortisol and metabolites were drawn at predetermined times from before induction to 6 h postoperatively. Adrenaline and noradrenaline concentrations decreased preoperatively in the ketamine group (K) from 55 to 29 pg/ml and 166 to 39 pg/ml, respectively, and then increased to postoperative maxima of 193 or 315 pg/ml. A similar pre and postoperative course was seen in the alfentanil group (A) with slightly lower (P < 0.05) intraoperative concentrations in A. Cortisol concentrations increased in K from 12 micrograms/dl to 34 micrograms/dl intraoperatively and further to a maximum of 42 micrograms/dl postoperatively. The intraoperative increase was attenuated in A and the difference between the groups was significant (P < 0.0001). The initial ketamine bolus and tracheal intubation caused a marked, transient increase of mean arterial blood pressure from the baseline value of 105 mmHg to 120 mmHg with a subsequent decrease to 88 mmHg prior to skin incision and a gradual return to baseline during surgery. TIVA with ketamine-propofol had little effect on the perioperative courses of the endocrine parameters, which behaved as they do under anesthesia with isoflurane-nitrous oxide. Plasma catecholamine concentrations were not elevated in the period between induction of anaesthesia and skin incision.

The hemodynamic and neurohumoral effects of single and multiple doses of intravenous quinaprilat were assessed and compared with placebo in a double-blind design. The study group included 50 patients aged between 33 and 76 years with NYHA Class III and IV heart failure. The patients were randomized into three treatment groups to receive low (0.5 and 1.0 mg), medium (1.0 and 2.5 mg), or high (5.0 and 10.0 mg) intravenous doses of quinaprilat or placebo on day 1, and, based on the responses, q6h on two further days. The hemodynamic parameters were determined by right-heart catheterization. Quinaprilat is the active metabolite of quinapril, an ACE inhibitor with high affinity for the angiotensin converting enzyme, which is formulated for oral application. Compared with placebo, single and multiple doses of quinaprilat increased cardiac index by 25% (p < 0.05) and simultaneously decreased both peripheral vascular resistance by 25% (p < 0.05) and left ventricular filling pressures by 33% (p < 0.05). There was a dose-related decrease in mean right atrial pressure by 47% (p < 0.05) without significant heart rate changes (-3-5 bpm). The mean artery pressure showed a dose-related maximum decrease of 4-9 mm Hg 45-60 min after single-dose quinaprilat and of 7-10 mm Hg (p < 0.05) after repetitive dosing. Maximum changes were observed 15-90 min after drug application. The hemodynamic changes after multiple-dose quinaprilat were similar to those observed following single doses and generally persisted during the total observation period of 6 h. Compared with placebo, quinaprilat reduced ACE activity and angiotensin II and aldosterone concentrations, and increased plasma renin activity. There were no significant changes with regard to plasma catecholamines and the atrial natriuretic factor, although a slight decrease could be observed. The study results obtained in patients with advanced heart failure support both the safety and favorable hemodynamic and neurohumoral effects of intravenous quinaprilat over an observation period of 3 days.

Calves from the dairy herd and from the mother cow herd and their dams were investigated just after parturition and the calves at the first two days of life and between fifteen and twenty days and than at ninety days of life as well using whole day heart rate and video recording, results of venous blood sample analysis and body growth and health criteria. The great variation of physiological variables in calves can partly be explained by maturity, degree of adaptation, gender, time of day and the birth course. Relationships between physiological variables and the adaptability, body growth performance and the degree of adaptation to specific rearing condition could be pointed out.

Background: In 1987, a pilot trial (HIT 88/89) was initiated by GPOH to investigate the effectivity and toxicity of intense preradiation chemotherapy. The aim of this study was to improve the treatment of children with malignant brain tumors, but provided no standardized recording of auxological and/or endocrinological parameters. In 1993 a sub-project, "Endocrinological late effects", was started during the ongoing study to examine the late effects of treatment, and a retrospective evaluation was performed in order to standardize parameters., Patients: We considered auxological and hormonal data from those patients (n = 133; 78 m, 55 f) who were alive at the time of the survey, and had completed tumor therapy., Results: Analysis of the growth pattern of the children after the end of therapy indicate impaired growth. Group 1 (n = 77, CA < 10 yrs): Mean height SDS at tumor diagnosis was +0.32 (n = 77), and fell constantly after completion of therapy to -0.75 (n = 16) after 3-4.5 yrs. Group 2 (n = 56, CA > 10 yr): Height SDS-CA fell from +0.24 (n = 45) at the time of diagnosis to -0.62 (n = 14) after 3-4.5 yrs. Unfortunately, only body height and weight were recorded regularly, data on sitting height, pubertal stage and bone age were incomplete. Endocrine evaluation after end of therapy was insufficient., Conclusions: A standardization of endocrinological follow up is necessary as soon as possible, for an adequate description of the endocrinological late effects.

Different changes in neurotransmitters were observed in patients with fibromyalgia. The aim of the study was to confirm the diagnosis fibromyalgia by determination of several of these substances. In 60 patients, who met the ACR classification criteria for fibromyalgia and in 20 sex and age matched controls the following estimations were made: serotonin (EIA), somatomedin C (RIA), calcitonin (RIA), prostaglandin E2 (EIA), oxytocin (RIA), ACTH (RIA), substance P (EIA), TSH (LIA), prolactin (LIA). In comparison to healthy controls, patients with fibromyalgia revealed significantly decreased levels of serotonin, somatomedin C, calcitonin, prostaglandin E2 and a significantly increased level of prolactin. No significant differences were found in the levels of ACTH, substance P and TSH. These results suggest that the diagnosis of fibromyalgia can be confirmed by various biochemical parameters, but further investigations must be carried out to value the diagnostic relevance of these findings.

Unlabelled: Cytokines and Endocrine System: Is it Meaningful to Monitor More than the Thyroid Gland?, Aim: It was the aim of this study to evaluate the occurrence, the degree, and clinical relevance of immunological phenomena in endocrine and non-endocrine organs as seen under therapy with interferon-alpha (IFN-alpha) and/or interleukin-2 (Il-2)., Patients and Methods: In 61 patients (age: 50.2 +/- 12.8 years) receiving cytokines as treatment for hepatological or hemato-oncological diseases, parameters of the thyroid gland, the gonadal system, the adrenal gland the pituitary gland, parameters of water and electrolyte-balance, and of bone metabolism were measured. All patients were treated with interferon in a mean dosage of 15.3 +/- 10.5 mio U subcutaneously per week. Additionally, 15 patients were treated with interleukin-2 (36.5 +/- 22.3 mio U subcutaneously per week). Among other assays, patients "sera were screened for the existance of autoantibodies against 30 different antigenic substrates using an indirect immunofluorescence technique (IIF)., Results: Pts, treated with IFN-alpha and IL-2 (n = 13) showed a significant induction of thyroid antibodies against thyroglobulin (anti-TG): 61 +/- 82 U/ml vs. 1000 +/- 2352 U/ml (p < 0.05) and against thyroid-peroxidase (anti-TPO): 162 +/- 538 vs. 468 +/- 1071 U/ml (p < 0.05). In pts, only treated with IFN-alpha (n = 26), the increase of anti-TG from 69 +/- 97 to 134 +/- 178 U/ml and of anti-TPO from 20 +/- 21 to 21 +/- 19 U/ml was insignificant. Patients with a combined treatment of IFN-alpha and Il-2 were mainly affected: 2 patients developed hypo- and 5 hyperthyroidism. Thus, regular controls of thyroid function during the entire duration of therapy is justified. We were unable to show any influence of the duration of treatment or dosage of cytokines on the endocrine and non-endocrine parameters investigated. In addition, 8 different AAB (against smooth/striated muscles, parietal cells, nuclear parts, myelin, keratin, endothel, and neuroendothel) were detected by IIF which did not change under therapy. Two patients newly developed AAB during therapy, however none of them suffered from clinical symptoms. AAB against endocrine organs other than the thyroid gland were not detected. No other endocrine system showed alterations of its function., Conclusion: Based on the data of this study we conclude that the thyroid gland should be regularly monitored for immunological and functional changes during cytokine therapy. The results do not support a general recommendation for a routine screening of other, non-thyroidal endocrine systems for autoimmune phenomena and alterations of function in each patient.

The influence of gender on the prevalence of rheumatoid arthritis (RA) is well known. We examined 40 female patients with RA to show the possible influence of androgen hormones on inflammation and immune system. We measured blood count, blood sedimentation rate, C-reactive protein routinely and free and bound testosterone, dehydroepiandrosterone-sulfate (DHEA-S), prolactin, insulin like growth factor-1 (IGF), IgA-rheumatoid factor (IgA-RF) and the monocyte marker CD 14 of radioimmunoassays and enzymeimmunoassays. The female patients with RA had lower androgen levels correlating with higher inflammatory markers which are not rising significantly with higher age. The significantly raised IgA-RF with abnormal low testosterone levels points out a poor prognosis for developing joint erosions. The simultaneously reduced levels of prolactin may be rather caused by cytokines and could have additional connections to the anemia in RA. Somatomedin correlated inversely to the degree of inflammation, measured by BSR, CRP and CD 14, a fact which could indicate a reduced, Somatomedin-induced, synthesis in matrix and collagen of cartilage in "active" RA. The results point to the existence of a reciprocal connection of the endocrine system with the immune system.

In this prospective, randomized study, two regimens of total intravenous anaesthesia (TIVA), with propofol and S(+)-ketamine (S-ketamine) and with propofol and alfentanil, were compared with reference to endocrine stress response, circulatory effects and recovery. METHODS. The investigation was conducted in two groups of 20 ASA I-III patients over 60 years of age who were scheduled for endoprothetic orthopaedic surgery. After oral premedication with midazolam, patients received a TIVA with body-weight-adjusted doses of propofol, and S-ketamine or alfentanil as the analgesic component. For CPPV (PEEP 5 mbar), air and oxygen (FiO2 33%) were used. For muscle relaxation, patients of both groups received vecuronium in body-weight-adjusted doses. Blood samples were taken through a central venous line at seven time points before induction of anaesthesia and on the first morning after the operation also for analysis of epinephrine, norepinephrine (by HPLC/ECD), and ADH, ACTH and cortisol (by RIA). In addition, SAP, HR, arterial oxygen saturation, recovery from anaesthesia and side effects were observed. RESULTS. The two groups had comparable group mean values for age (S-ketamine group 71 years, alfentanil-group 70 years), other biometric data, and duration of anaesthesia and operation (Table 1). Plasma levels of epinephrine, norepinephrine (Table 2, Fig. 1), ADH (Table 2, Fig. 2) ACTH and cortisol (Table 2, Fig. 3) were higher in the S-ketamine-group (P < 0.05) owing to the intraoperative course of these endocrine parameters. Before induction, and on the first morning after the operation, levels were comparable between the groups. 5 min after the induction of anaesthesia, SAP and HR (Table 3) were significantly lower in the alfentanilgroup (P = 0.001). Recovery from anaesthesia (orientation with respect to person and location) was faster in the alfentanilgroup (16 vs 39 min, P = 0.001). An arterial oxygen saturation below 90% was observed in 7 patients in the S-ketamine- and 13 patients in the alfentanilgroup (P = 0.03). Four patients with S-ketamine reported dreams, and 1 dream was judged negative. Postoperative emesis was found in 6 patients in the S-ketaminegroup and 12 patients in the alfentanilgroup (P = 0.03). All patients said they would agree to undergo the same anaesthetic technique again. CONCLUSIONS. Considerable differences were found in the endocrine stress response of the two groups. With respect to endocrine response and circulation, TIVA with propofol and S-ketamine had sympathomimetic properties with positive circulatory effects and led to moderate endocrine stimulation. This should be kept in mind in patients with hypotension, hypothyrosis, or adrenocortical insufficiency; because "eustress" might be beneficial in this group of patients. On the other hand, TIVA with propofol and alfentanil showed sympatholytic properties, with negative circulatory effects and a remarkable reduction of endocrine stress response. This might be beneficial in patients with hypertension and states of endocrine hyperfunction. Both regimens were accompanied by such typical side effects as dreams, delayed recovery, reduced ventilation, and emesis, which should also be considered.

The effects of an antidepressant sleep deprivation on humoral systems and neurotransmitter systems are reviewed (cortisol, endorphins, thyroidea, growth hormone, prolactin, catecholamines, sexual hormones, melatonin, serotonin). The main results are: Depressed patients have a physiological response similar to controls with some differences between responders and nonresponders (responders are more similar to controls). TSH is more activated in responders than in nonresponders. The dopamine system is more activated in responders than in nonresponders and less activated in responders before sleep deprivation. The glucocorticoid-axis in more activated in responders after sleep deprivation. In conclusion, patients who profit from sleep deprivation can activate systems correlated with arousal or stress.

In geriatric patients symptoms of endocrine disorders easily can be regarded to be due to the patient's old age. This is demonstrated in a case of an 80-year-old woman suffering from the combination of adrenal insufficiency and hypothyroidism. Early recognition of typical clinical signs and adequate, simply performed replacement therapy results in a significant improvement of the patient's quality of life.

Pancreatic polypeptide (PP) can be used as a marker for endocrine active tumors originating from the pancreas. After intravenous administration of secretin, individually divergent increases in plasma PP concentration can be observed hampering interpretation of the stimulation test. Under certain circumstances elevated basal PP concentrations can be observed. Besides age, renal insufficiency and diabetes, hypoglycemia can cause high PP levels. We therefore inquired whether in patients with atypically high increase of PP after secretin this increase could be caused by hypoglycemia during the secretin stimulation test. In order to test this hypothesis we prospectively determined the plasma glucose and insulin concentrations in addition to the routinely measured gastro-intestinal hormones in 19 patients referred for secretin provocation test. In the 16 patients in whom the increase of PP was not due to an endocrine active tumor or renal insufficiency, PP rose to 170 +/- 57 pmol/l (+/- SEM) 2 minutes after secretin administration. In parallel, plasma insulin concentration increased to 365 +/- 51 pmol/l 2 minutes after secretin. The maximal insulin concentrations correlated significantly with the PP concentrations observed at the same time (R = 0.73, p < 0.01). The mean glucose concentration, however, remained constantly between 4.8 +/- 0.3 and 5.2 +/- 0.3 mmol/l and there was no correlation between the peak plasma PP concentrations after secretin and the plasma glucose concentrations (R = 0.07). The minimal glucose concentrations observed were 3.3 mmol/l in three patients (30 minutes after secretin in 2 patients and 45 minutes after secretin in one). The mean plasma glucagon concentration rose to 22.5 +/- 4.1 pmol/l 10 minutes after secretin.(ABSTRACT TRUNCATED AT 250 WORDS)

Pulsatile secretion of hormones are observed in many endocrine systems. Here we discuss the significance of pulsatile patterns of hormone secretion for the regulation of endocrine target tissues in physiology and pathophysiology. New approaches to analyze endocrine rhythms are introduced that may enable to better define the temporal patterns of secretion relevant for the regulation of distinct processes in complex in vivo systems. This may lead to improved diagnostic and therapeutic strategies of endocrine diseases.

Objective: Growth factors (human growth hormone, HGH; insulin-like growth factor I, IGF-I) and insulin were evaluated concerning their pathogenetic significance in patients with polycystic ovary syndrome (PCOS)., Methods: Twenty-eight women with signs of PCOS were examined; 24 women without signs of PCOS served as controls., Results: Women with PCOS showed significantly increased androgen, IGF-I, insulin and glucose levels, higher glucose concentrations in the oral glucose tolerance test and a higher body mass index. The concentration of HGH, the HGH/IGF-I ratio and the number of insulin receptors on red blood cells were significantly decreased in women with PCOS. The insulin receptor affinity, the maximum binding and the insulin-receptor complex were increased in PCOS patients., Conclusion: A decreased number of insulin receptors, a disturbed insulin receptor binding, the resulting hyperinsulinemia as well as high levels of IGF-I are to be considered as important factors in the pathogenesis of PCOS.

Unlabelled: In a retrospective case finding study we collected data from patients with polyglandular autoimmune syndrome type II (PGAS Type II) who had been treated in our endocrine outpatient clinic between 1975 and 1989. 31 adult patients (25 females and 6 males) fulfilled the criteria for PGAS Type II (association of autoimmune endocrine disease with at least one other--usually endocrine--autoimmune disease or autoantibodies against another organ). Among these patients, 18 had hypothyroidism due to autoimmune thyroiditis, 8 were hyperthyroid (Graves' disease), and 4 had silent autoimmune thyroiditis (without thyroid dysfunction). Insulin dependent (type I) diabetes mellitus (IDDM) was seen in 11, Addison's disease in 7, primary hypogonadism in 5, vitiligo in 6 and pernicious anemia in 5 cases. The presence of antiparietal cell antibodies was demonstrated in 21 of 30 investigated patients. These patients also showed other evidence of autoimmune gastritis, such as increased gastrin (in 10 out of 13), diminished vitamin B12 levels (6 out of 13), atrophic gastritis (9 out of 9), pernicious anemia (6 out of 30) and funicular myelosis (2 out of 30)., Conclusion: The most common endocrine diseases in our patient group were autoimmune thyroid diseases (97%) followed by IDDM (35%) and Addison's disease (23%). A high percentage (70%) of our subjects had elevated titers of antiparietal cell antibodies. Polyglandular autoimmune syndrome must be suspected in all patients with autoimmune endocrine disease, especially in the presence of relatives suffering from PGAS. Patients at risk should be screened regularly by measuring thyrotropin (ultrasensitive assay), fasting blood glucose levels, and by checking red blood count and antiparietal cell antibodies.(ABSTRACT TRUNCATED AT 250 WORDS)