Reduced diurnal variation of blood pressure in non-insulin-dependent diabetic patients with microalbuminuria.

In essential hypertension reduced diurnal blood pressure (BP) variation is associated with an increased prevalence of target organ damage. We have examined diurnal BP variation in 25 microalbuminuric (MA) and 19 normoalbuminuric (NMA) patients with non-insulin-dependent diabetes and related albumin excretion rate (AER) to diurnal BP variation in the microalbuminuric group. There were no significant differences in age, body mass index (BMI), renal function, diabetic control, clinic or daytime ambulatory BP between the groups.

Lithium inhibits the action of fludrocortisone on the kidney.

A patient with autoimmune Addison's disease treated with hydrocortisone and fludrocortisone became mineralocorticoid-deficient whilst taking lithium carbonate for a bipolar illness. During an in-patient metabolic balance study she required 1.0 mg fludrocortisone daily and dietary sodium supplementation to make plasma renin activity and serum potassium normal, and to abolish postural hypotension.

Relation between the urinary cortisol:creatinine ratio and hypoglycaemia.

The relationships between (i) urinary free cortisol and urinary creatinine concentrations and (ii) the urinary cortisol/creatinine ratio (UCCR) and various glycaemic levels were studied in three groups--normal, insulin-stressed and insulin-treated diabetic subjects. In non-hypoglycaemic subjects, there was a significant positive linear correlationship between urinary free cortisol and urinary creatinine excretion, but in the presence of hypoglycaemia, this relationship was lost. The highest mean urinary cortisol/creatinine ratio (UCCR) was found in subjects after an insulin tolerance test (ITT).

Impaired ACTH and glucagon response to hypoglycaemia in an insulin-treated diabetic.

A 32-year-old woman who had been diabetic for 24 years presented with frequent, oligosymptomatic episodes of hypoglycaemia. Investigations showed that she had attenuated adrenocortical and pancreatic A-cell response to hypoglycaemia. Her plasma ACTH response to hypoglycaemia was also impaired but there was normal adrenocortical response to the injection of synthetic ACTH.

Plasma insulin, C-peptide and glucagon concentrations in patients with insulin-independent diabetes treated with chlorpropamide.

The effect of chlorpropamide on blood glucose, plasma insulin, C-peptide and glucagon levels was studied in 21 patients with insulin-independent diabetes. A metabolic profile of these parameters was obtained throughout a normal day in seven newly-diagnosed diabetic patients (group A), before, and 3 to 8 weeks after treatment with chlorpropamide was established, and in 14 patients on longterm therapy with chlorpropamide (seven taking less than 250 mg. chlorpropamide--group B; seven taking 250-375 mg.

Changes in glycosylated haemoglobin after poor control in insulin-dependent diabetics.

Glycosylated haemoglobin (HbA1) was measured in seven insulin-dependent diabetic patients before, during, and after a seven-day period of monitored poor control. There was considerable individual variation in the pattern and degree of change in HbA1 concentration induced by poor control and the time when it occurred. Greater increases in HbA1 were seen during the period of metabolic derangement than in the subsequent two months.

Hypothalmic-pituitary adrenal responsiveness to dexamethasone-insulin tolerance test in acromegalic patients before and during treatment with bromocriptine.

Insulin tolerance tests were carried out in 10 acromegalic patients after 1 mg dexamethasone had been given the previous evening (DEX-ITT). Nine patients showed a rise in plasma 11-OHCS and four patients showed a rise in plasma growth hormone (GH) levels. These responses were unaltered after treatment with bromocriptine 10 mg daily for two months.

Effect of propranolol on glucose tolerance in hyperthyroidism.

Glucose tolerance tests were performed on six hyperthyroid patients in the morning and afternoon before, and at the end of treatment with propranolol for 2 weeks. All six subjects showed normal glucose tolerance with a normal diurnal rhythm before treatment and this remained normal in five during treatment with propranolol, while one patient developed abnormal glucose tolerance and the diurnal variation was abolished. No change in insulin levels was noted in any of the patients either before or during treatment.

Growth hormone, insulin, and prolactin secretion in anorexia nervosa and obesity during bromocriptine treatment.

We studied secretion of growth hormone (GH), insulin, and prolactin in eight women with anorexia nervosa and nine women with refractory obesity before and during treatment with bromocriptine, 10 mg/day. In the anorexic patients the raised plasma GH concentrations occurring during an oral glucose tolerance test fell significantly while on bromocriptine treatment, but there was no change in plasma insulin or blood glucose concentrations. In the obese patients, however, plasma GH concentrations remained low during the oral glucose tolerance test, and were not modified by bromocriptine.