Showing papers by "Nelson B. Watts published in 1989"

Reversible impairment of gonadotropin secretion in critical illness. Observations in postmenopausal women.

Abstract: • Gonadotropin levels were measured in 65 postmenopausal women admitted to the intensive care unit. Sixteen patients (25%) were hypogonadotropic as measured by luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels of 5 IU/L or less, and only 20 patients (31%) were found to have gonadotropin levels within the expected postmenopausal range (≥30 IU/L). No significant differences in prolactin or free thyroxine levels were found, but the cortisol level was higher and the total thyroxine level lower in the hypogonadotropic group. The patients in the hypogonadotropic group also seemed more seriously ill, with a longer duration of hospitalization, an increased total number of days in the intensive care unit, an increased number of days in the intensive care unit before gonadotropin sampling, a higher incidence of parenteral hyperalimentation, lower serum albumin levels, and higher mortality. Stimulation of the gonadotropin-releasing hormone performed on 10 patients showed a blunted response in patients with baseline LH and FSH levels of 10 IU/L or less. Of 10 patients followed up sequentially, 6 showed a rise in gonadotropin levels that paralleled recovery, 1 died with low gonadotropin levels, and 3 continued to have low gonadotropin levels 17, 34, and 82 days, respectively, after initial screening. Critically ill postmenopausal women may exhibit a marked fall in gonadotropin, LH, and FSH levels. This disease in gonadotropin levels in response to illness is reversible and results from pituitary unresponsiveness to gonadorelin hydrochloride. ( Arch Intern Med. 1989;149:1637-1641)

Use of a Sensitive Thyrotropin Assay for Monitoring Treatment With Levothyroxine

Abstract: • To determine if a sensitive assay for thyrotropin (thyroid-stimulating hormone [TSH]) would be useful as a primary test to determine optimal doses of levothyroxine, an enzyme immunoassay for TSH that discriminated hyperthyroid from euthyroid subjects with no overlap was compared with radioimmunoassays for TSH and thyroxine (T4) and the calculated free thyroxine index (FTI) in 100 patients receiving stable doses of levothyroxine The basal TSH level, determined with the sensitive assay, predicted the TSH response to thy rotropinreleasing hormone (TRH); all patients whose basal TSH level was less than 035 mU/L had absent or subnormal responses, and all patients with TSH levels of 035 mU/L or greater had normal responses In patients with normal TSH levels, the T4level and FTI were superfluous (normal) or misleadingly high; conversely, 65% of patients with low TSH levels had normal T4levels or FTIs, or both An assay for TSH with sufficient sensitivity to discriminate between abnormally low values and the low range of normal can be used as the primary test for monitoring levothyroxine treatment The T4or FTI measurements are not needed if the TSH level is normal, but they should be done in patients with low TSH levels (Arch Intern Med1989;149:309-312)

The Pituitary Gland

Abstract: This book is an ambitious effort: 21 chapters, 48 figures, 105 tables, and almost 1500 references. A book on the pituitary gland should contain information on anatomy and imaging, normal function, and endocrine and nonendocrine aspects of pituitary diseases, with strategies for diagnosis and treatment. The author, a clinical endocrinologist, is at his best discussing normal function and endocrine aspects of pituitary diseases, but with shortcomings even there. The other topics are covered in bits and pieces rather than specific sections, making it hard to get a clear understanding. The organization of the book into its many chapters leads to a moderate amount of distracting redundancies, while the detail in each chapter makes it difficult to find specific items. Testing strategies are described in generalities rather than specifics, several useful protocols are not mentioned (hypertonic saline infusion for diabetes insipidus, overnight metyrapone test rather than the two-day test), and some