The use of thyroid function tests in the diagnosis of hypopituitarism: definition and evaluation of the TSH Index.

Background: TSH secretion in hypopituitary patients may be decreased due to TSH deficiency but it also remains under feedback inhibition by free thyroxine (fT4). We propose a TSH index (TSHI), as 'fT4-adjusted TSH', that corrects for any physiological TSH suppression, to provide a true estimate of pituitary thyrotroph function and any pathological pituitary suppression.

Methods: A total of 9519 thyroid function tests (TFTs) (Bayer Immuno-1) in 4064 patients of our institution were examined, including 444 patients investigated for hypopituitarism.

GH sensitivity of GH-deficient adults is dependent on gender but not timing of onset.

Background: Females secrete 2-3 -fold greater amounts of GH compared with males despite maintaining similar IGF-I levels. IGF-I generation tests in healthy subjects suggest this discordancy results from relative resistance to GH in females. In GHD females the presumed relative insensitivity to GH is reflected by a lower basal IGF-I and the need for higher GH maintenance doses during replacement.

Medical treatment of Charcot neuroosteoarthropathy.

The cornerstone of treatment of acute Charcot neuroosteoarthropathy is immediate effective offloading, typically with total contact casting, and reduction in weight bearing. The targets of pharmacological intervention are inhibition of excess osteoclast activation and suppression of an excess proinflammatory cytokine response. Antiresorptive therapy, especially with bisphosphonates, has been used in randomized trials.

IGF-I measurements in the monitoring of GH therapy.

Growth hormone replacement therapy has been used regularly in adult Growth hormone deficiency since the availability of recombinant GH in the 1980's. GH replacement improves quality of life, bone turnover markers, cardiovascular risk markers and adverse body composition. Originally, GH doses in replacement regimes were determined by weight and surface area and dose increases based on body composition outcomes analogous to pediatric practice.

Prospects for the development of long-acting formulations of human somatropin.

In healthy humans, growth hormone (GH) is secreted in distinct pulses with an underlying nyctohemeral pattern. Current forms of somatropin replacement are unable to closely mimic such a release pattern, but are still able to exert the beneficial action of GH. A limited number of short-term studies in rodents and humans suggest that longitudinal growth may be superior when somatropin is given with a pulsatile mode of administration, whereas hepatic insulin-like growth factor-I generation and beneficial changes in body composition appear to be equal or even enhanced with continuous somatropin administration.

Adult growth hormone replacement therapy and neuroimaging surveillance in brain tumour survivors.

Objective: Systematic collections of neuroimaging data are nonexistent in brain tumour survivors treated with adult growth hormone replacement therapy (AGHRT). We present our surveillance data.

Design: In 1993, our unit implemented a policy of performing brain scans on every brain tumour survivor before starting AGHRT, with repeat neuroimaging at least once after 12-18 months' treatment.

A new sustained-release preparation of human growth hormone and its pharmacokinetic, pharmacodynamic and safety profile.

Objective: Adult GH replacement is currently given by daily subcutaneous (sc) injections. Recently, sustained-release (SR) preparations of GH have been developed, the preparations being characterized by a dominant early release, resulting in supraphysiological early GH peaks, and a rapid decline thereafter. We present data on a new SR GH preparation.