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Mogens Blichert-Toft

A discussion of the physiological qualities of corticotrophin and somatotrophin is of relevance with a view to the later approach to the problems. It is not the intention to give a detailed account of these matters; this will lead far beyond the limits of the subject at issue.

HUMAN CORTICOTROPHIN

The chemical structure of corticotrophin, the regulation of secretion and its biological action are considered on the basis of an overall review of some large-scale studies by Evans et al. (1966a), Fortier (1966), Mess & Martini (1968), MacDonald et al. (1969), Harris & George (1969), Sayers & Travis (1970), and Thorn (1972).

The hormone is a peptide composed of a single, unbranched chain of 39 amino acids. The sequence of the first 24 amino acids and the last six is identical in the sheep, the ox, pig and man. The biological action resides in the 24 N-terminal amino acids

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Mogens Blichert-Toft, Lotte Hummer and Harriet Dige-Petersen

ABSTRACT

In patients with untreated Cushing's disease decreased thyroid function has been demonstrated by several investigators. An inhibiting effect of glucocorticosteroids on the release of thyrotrophin seems to be the cause. In the treated patient with remission of the disease the pituitary-thyroid function has not been studied in detail. The question is, if the hypofunction proved in the untreated state might persist in the treated patient. This might be anticipated from both clinical and experimental studies.

In the present study the pituitary-thyroid function has been determined after total adrenalectomy followed by remission in 14 patients with Cushing's disease. All patients were replaced adequately with cortisone acetate post-operatively as estimated by excretion of cortisol in urine. Levels of serum thyroxine, thyroxine-binding globulin, and serum thyrotrophin were measured. In addition, tracer studies were performed. The 131I-uptake in the thyroid gland and plasma protein-bound radioiodine were determined. After thyrotrophin-stimulation test, the thyroxine reserve and the rise in 131I-uptake in the gland were measured. TRH-stimulation test was performed to determine the TSH-reserve. A normal pituitary-thyroid function and a normal pituitary and thyroid reserve were demonstrated.

In the conclusion it can be said that decreased pituitary-thyroid function or reserve has not been found in the Cushing-patient subjected to adrenalectomy followed by remission. Thus, thyroid replacement therapy has not to be considered, when an adequate replacement therapy is planned after total adrenalectomy.

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Vagn Haas, Margaret Marley, Anders Green, John Date, Mogens Blichert-Toft and Erik F. Mogensen

Abstract. The excretion of urinary iodine was studied in a representative population sample from the county of Funen, Denmark, comprising 505 persons between 25–44 years of age, stratified according to geography, age, and sex. Urine samples were collected for 5 h during late afternoon and early evening. The 24-h iodine excretion was estimated on the basis of iodine and creatinine determinations using correlation equations determined in a pilot study of 50 men and women. The iodine excretion was significantly higher in men: 89 μg/24 h (median) than in women: 76 μg/24 h; the whole population: 85 μg/24 h. No significant differences were observed among the age groups studied. The iodine excretion was significantly higher in people living on small islands: 98 μg/24 h (median) compared with 84 μg/24 h in urban regions and 78 μg/24 h in rural districts. Median iodine excretion per gram of creatinine was 58.8 μg for the whole sample. The iodine excretion for men was 77% higher than reported in an earlier investigation performed in Funen, 1969, but still lower than internationally recommended (WHO).