Kallmann's syndrome and anorexia nervosa: a diagnostic dilemma.

Kallmann's syndrome is a rare cause of primary amenorrhea, with impairment of release of gonadotropin-releasing hormone and anosmia. We present a case in which Kallmann's syndrome had been diagnosed, but who also fulfilled the diagnostic criteria for anorexia nervosa. We discuss the diagnostic dilemma.

Regulation of two members of the steroid-inducible cytochrome P450 subfamily (3A) in rats.

Monoclonal antibodies have been successfully isolated which are isozyme-specific for cytochrome P450p (3A1) or P4501 (3A2), two members of the steroid-inducible cytochrome P450 subfamily exhibiting 89% amino acid sequence homology, and these antibodies show less than 5% cross-reaction with 11 other cytochromes P450 (P450a-P450k). A library of 28 purified monoclonal antibodies was established and characterized as to epitope specificity. Appropriate antibodies were selected and utilized to investigate the regulation of expressed cytochrome P450p and P4501 proteins as a function of age, sex, and treatment of rats with various inducing agents.

Eating Behavior, Physical Symptoms and Psychological Factors Associated with Weight Reduction Following the Scopinaro Operation as Modified by Gazet.

Sixteen morbidly obese patients (12 females, four males) underwent the Scopinaro operation according to Gazet. Profound weight loss occurred, along with marked improvements in eating patterns, mood and psychosocial functioning which were reported retrospectively 1 year and repeated 2 years after surgery. Continued binge eating, comfort eating and 'eating sensibly/making up in private' were associated with reduced weight loss, suggesting that a therapeutic cognitive behavioral program to correct eating problems in association with the Scopinaro operation may increase weight loss.

Inactivation of cytochrome P450 and inhibition of ferrochelatase by analogues of 3,5-diethoxycarbonyl-1,4-dihydro-2,4,6-trimethylpyridine with 4-nonyl and 4-dodecyl substituents.

Cytochrome P450- and heme-destructive effects of the 4-nonyl and 4-dodecyl analogues of 3,5-diethoxycarbonyl-1,4-dihydro-2,4,6-trimethylpyridine (DDC) were determined using hepatic microsomal preparations obtained from untreated, beta-naphthoflavone-treated, and phenobarbital-treated chick embryos. The 4-nonyl analogue of DDC was less efficacious than 4-ethyl DDC and 4-hexyl DDC, but more efficacious than 4-dodecyl DDC with respect to cytochrome P450-destructive activity. In all hepatic microsomal preparations, cytochrome P450 destruction by 4-nonyl DDC was accompanied by loss of microsomal heme.

Pre-menarchal bulimia nervosa.

Although pre-pubertal anorexia nervosa has been well described, pre-pubertal bulimic behaviour in the context of this disorder appears to be uncommon. There have been no published reports of pre-pubertal bulimia nervosa occurring independently. Of 323 patients with bulimia nervosa attending an eating disorders research clinic between 1980 and 1989, the authors identified six patients who described pre-menarchal binge eating in the absence of a concurrent history of anorexia nervosa or massive obesity.

Anorexia nervosa in a patient with XY gonadal dysgenesis.

This is the first report of a case of anorexia nervosa in a woman with XY gonadal dysgenesis. Anorexia nervosa is a potential complication of gonadal dysgenesis, stemming not only from the disorder itself but from its investigation and treatment.

Polycystic ovary syndrome and bulimia.

One hundred fifty-three patients classified as suffering from polycystic ovarian syndrome (PCOS) and 109 patients who were suffering from a clear organic disorder or endocrinopathy received the bulimia investigation test (Edinburgh) (BITE) questionnaire for abnormal eating behaviors. Patients with PCOS showed a significant increase in their mean BITE score for approximately a third had abnormal eating patterns, and 6% have scores suggestive of clinical bulimia compared with only 1% of women in the group with organic endocrinopathies. The work suggests that women with PCOS should be screened for abnormal eating behaviors and raises the possibility that treatment by psychological means should be considered when abnormal eating behaviors are present.

Evidence for the stereoselective inhibition of chick embryo hepatic ferrochelatase by N-alkylated porphyrins.

3,5-Diethoxycarbonyl-1,4-dihydro-2,6-dimethyl-4-ethylpyridine and its 4-propyl analogue were administered to phenobarbital-pretreated rats. The N-alkylprotoporphyrins (N-alkylPPs) that were isolated from rat livers, viz., N-ethylPP and N-propylPP, were found to have greater ferrochelatase-inhibitory potency than the corresponding synthetic N-alkylPPs.

Interaction of chemicals with cytochrome P-450: implications for the porphyrinogenicity of drugs.

Our studies lead us to suggest that in order for an organic chemical to cause porphyrin accumulation in chick embryo hepatocyte culture, it must be: 1. lipophilic; 2. resistant to biotransformation by phase I or phase II reactions to compounds which are devoid of biological activity; and 3.

Alcohol education courses for offenders: an update on U.K. services.

Current service provision for offenders through Alcohol Education Courses (AECs) was examined. Information from fifty-five British agencies was collected, showing differences between AECs offered with respect to clients, teaching components and evaluation. More agencies now collect post-intervention follow-up data on clients' drinking/offending behaviour.

Regulation of heme biosynthesis in chick embryo liver cells.

According to current evidence heme controls the heme biosynthetic pathway primarily by controlling translocation of inactive pre-ALA-S from the cytosol into the mitochondrion, where ALA-S is active. A secondary mechanism involves inhibition by heme of transcription of the ALA-S gene. Porphyrinogenic drugs act by lowering a regulatory "free heme pool" by three different mechanisms: (a) by mechanism-based inactivation of cytochrome P-450 resulting in N-alkylprotoporphyrin formation and ferrochelatase inhibition, (b) by mechanism-based inactivation of cytochrome P-450 resulting in continuous heme destruction, (c) by enhanced generation of active oxygen species which interact with an endogenous substrate to form an inhibitor of uroporphyrinogen decarboxylase.

Disruption of hepatic heme biosynthesis after interaction of xenobiotics with cytochrome P-450.

Heme biosynthesis in hepatocytes is controlled by a free heme pool, which regulates delta-aminolevulinic acid synthase. Porphyrinogenic chemicals deplete the regulatory free heme pool by interacting with cytochrome P-450 thereby inhibiting heme biosynthesis and/or causing heme breakdown. Recent developments allow us to predict which groups of chemicals are likely to be porphyrinogenic.

Differential inhibition of hepatic ferrochelatase by regioisomers of N-butyl-, N-pentyl-, N-hexyl-, and N-isobutylprotoporphyrin IX.

A series of analogues of 3,5-diethoxycarbonyl-1,4-dihydro-2,4,6-trimethylpyridine (DDC), viz. 4-butyl DDC, 4-pentyl DDC, and 4-hexyl DDC was administered to phenobarbital-pretreated rats. The N-alkylprotoporphyrins (N-alkylPP) isolated from the rat livers were separated into regioisomers by means of high performance liquid chromatography; the NB or NA (NB/A) regioisomers constituted 19-26% of the total regioisomers.

Isolation of an N-alkylprotoporphyrin IX from chick embryo livers following the administration of 3,5-diethoxycarbonyl-1,4-dihydro-4-ethyl-2,6-dimethylpyridine.

The ferrochelatase-lowering activity of 3,5-diethoxycarbonyl-1,4-dihydro-2,4,6-trimethylpyridine (DDC) analogues in chick embryo hepatocyte culture has been assumed to be due to the formation of an N-alkylprotoporphyrin IX. This assumption required confirmation. For this reason the 4-ethyl analogue of DDC was administered to phenobarbital-pretreated 19-day-old chick embryos.

Patterns of porphyrin accumulation in response to xenobiotics. Parallels between results in chick embryo and rodents.

Our objective was to determine whether patterns of porphyrin accumulation produced by chemicals in chick embryo hepatocyte culture would indicate which enzyme of heme biosynthesis was inhibited. The ferrochelatase-inhibitory potency and porphyrin patterns produced by DDC, TTMS, and their analogues were studied. The protoporphyrin:coproporphyrin ratio observed was found to correlate with ferrochelatase-inhibitory activity.

Ferrochelatase-inhibitory activity and N-alkylprotoporphyrin formation with analogues of 3,5-diethoxycarbonyl-1,4-dihydro-2,4,6-trimethylpyridine (DDC) containing extended 4-alkyl groups: implications for the active site of ferrochelatase.

The ferrochelatase-inhibitory activity, porphyrin-inducing activity, and cytochrome P-450- and heme-destructive effects of a variety of analogues of 3,5-diethoxycarbonyl-1,4-dihydro-2,4,6-trimethylpyridine (DDC) were studied in chick embryo liver cells. The ferrochelatase-inhibitory activity of the 4-butyl, 4-pentyl, 4-hexyl, and 4-cyclopropylmethyl analogues of DDC was considered to be due to the formation of the corresponding N-alkylporphyrins. These N-alkylporphyrins were isolated from the livers of phenobarbital-pretreated rats following administration of the corresponding DDC analogues.

Properties of 17- to 19-day-old chick embryo liver microsomes. Induction of cytochrome P-450, effect of storage at low temperature, and resistance to lipid peroxidation.

Maximal hepatic cytochrome P-450 levels were induced in the 17-day-old chick embryo (four to five times control) with a dose of sodium phenobarbital of 6 mg/egg/day for 2 days. Similar levels of hepatic cytochrome P-450 were induced with a dose of propylisopropylacetamide of 4 mg/egg/day for 1 day. Chick embryo hepatic microsomes from phenobarbital-pretreated or from untreated chick embryos could be stored for periods of 14 days at -70 degrees C without a decrease in cytochrome P-450 levels.

Comparison of the effects of 3-ethoxycarbonyl-1,4-dihydro-2,4-dimethylpyridine and 3,5-diethoxycarbonyl-1,4-dihydro-2,4,6-trimethylpyridine on ferrochelatase activity and heme biosynthesis in chick embryo liver cells in culture.

3-Ethoxycarbonyl-1,4-dihydro-2,4-dimethylpyridine (EDP) was shown to lack the ferrochelatase-lowering activity of 3,5-diethoxycarbonyl-1,4-dihydro-2,4,6-trimethylpyridine (DDC) in chick embryo liver cells in culture. This was attributed to the inability of EDP to cause destruction of the heme moiety of cytochrome P-450 with concomitant formation of N-methylprotoporphyrin IX. EDP was less potent as a porphyrinogenic agent than DDC and caused the accumulation of uroporphyrin, heptacarboxylic porphyrin, and coproporphyrin in contrast with DDC which caused primarily protoporphyrin to accumulate.