Erol Cerasi and Rolf Luft
In a previous paper it was shown that 15 out of 85 healthy subjects with a normal intravenous glucose tolerance demonstrated a low plasma insulin response to glucose infusion which was similar to that obtained in diabetic subjects. In the present paper it has been shown that the type of insulin response to glucose infusion was the same when the test was repeated.
Low insulin responders to glucose infusion, as a group, also showed low insulin response to intravenous tolbutamide and oral glucose. This indicates that the type of insulin response is characteristic for a given subject irrespective of the stimulation used.
There seemed to be no difference in the occurrence of diabetes in the family history of the groups of low and high insulin responders.
ROLF LUFT and BJÖRN SJÖGREN
Simmonds' disease denotes a clinical syndrome, caused by a decrease in all the functions of the adenohypophysis. It has also been called panhypopituitarism. This name is not entirely satisfactory as it also includes a decreased activity of the neurohypophysis. We have preferred to introduce the term panhypoadenopituitarism in our case, as no histological examination could be made, and no signs of deranged function of the neurohypophysis could be found.
In animals the most important effects of hypophysectomy
1) The desoxycorticosterone acetate and testosterone propionate used in this work was Percorten and Perandren, and was kindly put at our disposal by Ciba Produkter A. B., Stockholm.
2) This case was kindly referred to us for treatment by Dr. Gustaf Myhrman, director of the medical department of the military hospital of Boden.
can be eliminated by the administration of pituitary extracts. In cases of panhypoadenopituitarism different types of pituitary
EGON DICZFALUSY and ROLF LUFT
Adrenal cortical tumours are sometimes capable of elaborating excessive amounts of oestrogens both in males and females (Burrows, Cook & Warren, 1936, Mason & Kepler, 1945, Roholm & Teilum, 1947). However, in the majority of cases the nature of the oestrogens excreted was incompletely studied. Since in the present case preliminary bioassays indicated a daily excretion of several thousand mouse units of oestrogenic substances, we have attempted to measure the excretion of oestradiol, oestrone and oestriol using the counter current distribution technique and fluorimetric analysis.
Case report. — Male patient born 1895. Since 1949 anemia, a tumour mass in the left upper abdomen and gynecomastia. At operation in March 1950 a large adrenocortical adenoma was extirpated. The patient died in November 1950, and at autopsy a diffuse spreading mass from an adrenocortical carcinoma was found. A detailed report on this case will be published by Arner, Diczfalusy,
Bernt Hökfelt and Rolf Luft
The effect of distorsion of the hypothalamus on the hormone production by the adrenal cortex was studied in ten patients, nine of whom had tumours involving the suprasellar region.
The spontaneous urinary excretion of 17-ketosteroids, 17-ketogenic steroids and Porter-Silber chromogens was normal in six out of the nine patients with suprasellar tumour, as well as in two without suprasellar involvement.
The diurnal rhythm in 17-hydroxy-corticosteroids in plasma was absent in four out of seven patients with suprasellar tumour, and present in three such cases. Normal diurnal rhythm was also found in the patient without distortion of the hypothalamus.
The capacity to increase steroid production on intravenous administration of ACTH was not impaired in any of the patients studied. The ability to increase ACTH secretion following depression of cortisol production by an 11β-hydroxylase inhibitor was present in five out of six patients with suprasellar tumour. The exception was a patient with clinical evidence of panhypopituitarism including low values for steroid hormones in blood and urine.
Aldosterone was excreted by all patients, but six out of eight with suprasellar tumour failed to increase aldosterone excretion following salt restriction.
Denis Ikkos and Rolf Luft
The demonstration of a species specificity of growth hormone (GH) made it possible to examine the metabolic action of this hormone in man by the use of human growth hormone preparations. The results obtained in our trials will be presented under the subheadings: protein metabolism, calcium metabolism, sodium and chloride metabolism, fat metabolism, ketogenesis, and finally carbohydrate metabolism.
Protein metabolism. Human GH caused protein anabolism as shown by retention of nitrogen, phosphorus and potassium in proportions similar to those found in protoplasm. Retention of these elements appeared promptly upon GH administration and persisted during the whole treatment period. Upon withdrawal of GH the balances of nitrogen, phosphorus and potassium became negative, but the losses during the post-treatment period were smaller than the gains under GH. Previous pathological creatinuria disappeared, and NPN concentration in blood decreased on GH administration.
Calcium metabolism. Increased calciuria appeared in all instances and the calcium balance
ROLF LUFT and BJÖRN SJÖGREN
Disturbed water and salt metabolism is a cardinal symptom in Addison's disease. It causes dehydration of the patient, as well as hypotension and, to some extent, asthenia.
The disturbed fluid balance is manifested by an incapacity to respond in the normal way to rapid changes in the fluid supply. When a fairly large quantity of fluid is administered, e. g., in a water test or with Kepler's test, this is excreted more slowly than normal and the urine does not undergo maximal dilution (Robinson et al., 1941, Levy et al., 1946).
Talbott et al. (1942), in cases of adrenal cortical insufficiency, found a reduced glomerular filtration rate and renal plasma flow, the filtration being proportionately more reduced. These authors also discuss the earlier literature on this subject. Recently Waterhouse & Keutmann (1948) demonstrated a marked reduction of glomerular filtration and renal plasma flow in their cases of Addison's disease.
Rolf Luft and Erol Cerasi
ROLF LUFT and BJÖRN SJÖGREN
In a recent paper (Luft, Santesson & Sjögren, 1948) the authors described the hypertensive effect of DCA and sodium chloride in a case of postural hypotension. In a second paper (Luft & Sjögren, 1948), the therapeutic effect of DCA and sodium chloride was demonstrated in postural hypotension and arterial orthostatic anemia, the most common type of postural reaction.
Postural hypotension is a term used in the present work to describe a condition reported by Bradbury & Eggleston in 1925. Arterial orthostatic anemia denotes a clinical condition that has been described chiefly by the Swedish investigators Bjure & Laurell (1927), and corresponds to what Schellong (1936) called »hypotonic regulatory disturbance«. The latter is a type of postural reaction, frequently observed, and common in asthenic persons with poor tone of muscles and tissues.
1) The DCA used in the present study, viz. Percorten Ciba, was kindly supplied by Ciba Produkter A. B.,
Erol Cerasi and Rolf Luft
The insulin response during a standardized glucose infusion (GIT) was studied in a group of 13 monozygotic twin pairs previously registered as consisting of one diabetic/one non-diabetic member. At the time of the study three of the non-diabetic subjects had developed overt diabetes and three decreased glucose tolerance only.
Of the non-diabetic members all but one (with diabetes due possibly to chronic pancreatitis in the sibling) showed an insulin response similar to that seen in diabetic subjects, and in healthy subjects previously assumed to be potential diabetics. The present study therefore supports our earlier suggestion that a low insulin response characterizes potential diabetes.
There was a striking similarity between the insulin curves in the twin pairs, irrespective whether diabetes occurred in one, in both or in none of the members.
It is suggested as a working hypothesis that the type of insulin response to glucose infusion is genetically determined, and that a low insulin response is a prerequisite for the development of diabetes mellitus.