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Max Rieu, Jean-Marc Kuhn, Henri Bricaire and Jean-Pierre Luton

Abstract. Twenty-one treated acromegalics with plasma GH levels ≤ 5 ng/ml were evaluated during an oral glucose tolerance test (OGTT). Serum insulin-like growth factor (IGF) levels, measured by a competitive binding assay, were high in 10, normal in 8 and low in 3 patients. Urinary calcium excretion (Ca U), measured over 24 h, was elevated in 9 of the 10 patients whose IGF levels were high, whereas only 1 of the patients with normal or low IGF levels was hypercalciuric. A paradoxical rise in GH following TRH injection was observed in 5 of the 10 patients whose IGF levels were high, whereas all patients with normal or low IGF levels showed no GH response to TRH. GH levels ≥ 10 ng/ml occurred during ornithine (ORN) administration in 6 of the 18 patients with normal or high IGF levels. The remaining 12 patients with no GH rise during ORN included 2 cases in which IGF levels were high and GH rose following TRH, and 2 cases in which IGF levels were normal and GH levels were ≥ 10 ng/ml during insulin-induced hypoglycaemia (IIH), thus excluding a GH deficiency.

These results show that acromegaly is not cured in certain treated patients with normal GH levels during OGTT. It seems that IGF and Ca U determinations are valuable indices of activity, in contrast to GH response to ORN. The GH response to TRH is also relatively useful.

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Max Rieu, Eric Revue, Rémi Bonete and Sébastien Nunez

Rieu M, Revue E, Bonete R, Nunez S. Relationships between plasma thyrotropin receptor antibodies and lipid or lipoprotein parameters in Graves' disease. Eur J Endocrinol 1996:135:77–81. ISSN 0804–4643

Functional thyrotropin receptors (TSH-R) have recently been detected in fat cells but not in liver cells from rat, and it seems that in infant adipocytes stimulatory TSH-R antibodies (TSH-R-ab) act through this receptor pathway, resulting in increased triglyceride catabolism. We investigated the relationships between plasma TSH-R-ab and free thyroxine (FT4) levels and plasma lipid or lipoprotein values in 49 untreated adult women with Graves' disease, all positive for these antibodies. A simple positive correlation (p < 0.01) was found between TSH-R-ab levels and FT4 values (r = 0.40). Simple positive correlations (p < 0.001) were found between triglyceride levels and FT4 (r = 0.51) or TSH-R-ab (r = 0.52) values. Multiple regression analysis confirmed that both FT4 and TSH-R-ab are strong (p < 0.005) predictors of triglyceride (FT4: partial r = 0.40; TSH: partial r = 0.39). Simple negative correlations (p < 0.05, at least) were found between FT4 levels and total cholesterol (TC) (r = −0.45), low-density lipoprotein (LDL)-C (r = -0.46), apoprotein (apo)-B (r = −0.31) or high-density lipoprotein (HDL)-C (r = −0.55) values. Among these lipid parameters, only HDL-C levels (r = −0.31, p < 0.05) correlated to TSH-R-ab values. However, multiple regression analysis revealed that while FT4 is a strong predictor (p < 0.005) of TC (partial r = −0.42), LDL-C (partial r = −0.43) or HDL-C (partial r = 0.47), TSH-R-ab are not. Thus, the apparent positive relationship between TSH-R-ab and HDL-C results from the positive correlation between TSH-R-ab and FT4. In conclusion, this study suggests that stimulating TSH-R-ab are involved in triglyceride metabolism. In contrast to thyroid hormones, these antibodies seem not to be related to cholesterol metabolism.

Max Rieu, Hôpital Saint Michel, 33 rue Olivier de Serres, 75015 Paris, France

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Jean Marc Kuhn, Lise Duranteau, Max A Rieu, Najiba Lahlou, Marc Roger and Jean Pierre Luton

Kuhn JM, Duranteau L, Rieu MA, Lahlou N, Roger M, Luton JP. Evidence of oestradiol-induced changes in gonadotrophin secretion in men with feminizing Leydig cell tumours. Eur J Endocrinol 1994;131:160–6. ISSN 0804–4643

To study the sex steroid-gonadotrophin relationship, plasma oestradiol (E2), testosterone and gonadotrophin-releasing hormone (GnRH)-induced (100 μg iv) gonadotrophin response were measured in 42 male partners of infertile couples with normal sperm count (group I) and in 21 men with Leydig cell tumour (LCT, group II) in which a basal evaluation was repeated after tumour removal. Plasma free α-subunit (FAS), immunoreactive α-inhibin and luteinizing hormone (LH) pulse analysis were assessed in 10 LCT before and in six of them after surgery. Testosterone was significantly (p < 0.01) lower whereas E2 was significantly (p < 0.001) higher in group II than in group I. Gonadotrophin data were similar in both groups. The mean FAS was higher in group II than in group I and α-inhibin was higher than the normal range in 6/10 LCT. In group II, E2 levels were significantly (p < 0.01) and negatively correlated with testosterone, FSH, GnRH-induced gonadotrophin rise and LH pulse amplitude but not frequency. Significant (p < 0.001) changes were observed after surgery: E2 and α-inhibin fell; testosterone, LH and FSH rose; whereas FAS did not change significantly. The LH pulse amplitude but not frequency increased significantly (p < 0.05). In conclusion E2 oversecreted by LCT decreased LH and testosterone levels concomitantly. The GnRH-induced gonadotrophin level rose and the LH pulse amplitude decreased when the plasma E2 level rose, whereas the pulse frequency remained unaffected. A concomitant increase in α-inhibin and E2 is likely to be responsible for the drop in plasma FSH levels. These data support an action of excessive amounts of E2 at pituitary level, perhaps by decreasing the sensitivity of gonadotrophs to GnRH.

JM Kuhn, Service d'Endocrinologie, Hôpital de Bois Guillaume, 147 avenue du Maréchal Juin, 76230 Bois Guillaume, France