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PURPOSE: Accelerated rate of bone turnover and increased resorption due to primary hyperparathyroidism (PHPT) result in osteopenia and an increase in the fracture risk. However, there are no data about the relative frequency of the PHPT in the subpopulation with the low bone mass. The aim of the study was to evaluate the diagnostic power of the bone densitometry in diagnosis of PHPT. PATIENTS AND METHODS: Material consisted of 4016 new patients: 2504 women and 1512 men. Bone mineral density (BMD) in the L2 - L4 vertebra and femoral neck was measured by DEXA (LUNAR - DPX or LUNAR - EXPERT, Lunar Radiation Corp., USA). All the patients with BMD Z-score below -2.0 SD (according to the sex and age) were the subjects of further diagnostic procedures. The serum calcium and intact PTH level as well as 24-hours urine excretion was measured. RESULTS: In 451 (331 women and 120 men) out of the total 4016 patients, the measured BMD Z-scores were below -2.0 SD. Out of these 451 patients, 52 were diagnosed with PHPT. In 41 patients, diagnosis of PHPT was based on elevated serum intact PTH in the face of overt hypercalcemia. The remaining 11 normocalcemic patients with elevated PTH and coexisting vitamin D deficiency, will become hypercalcemic after vitamin D replacement. CONCLUSIONS: In the large cohort of unselected patients who presented for bone densitometry, a very high (11.5%) prevalence of PHPT was found among subjects with low bone mass (BMD Z-score less than -2.0 SD). Presented results confirm the importance of the BMD measurements in the screening of the disease.

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In the last 7 years 64 patients (48 women, 16 men, aged 25-75 yrs) with incidentally found asymptomatic adrenal tumours have been observed in the Department of Endocrinology. In 11 patients a routine clinical investigations revealed metastatic tumours at the adrenal glands. In the remaining 53 patients the diameter of the adrenal tumours was < or = 3 cm. Only two of them were treated surgically; the rest has been observed regularly and ultrasonographic examinations have been repeated every 3 to 6 months. Twenty three patients with adrenal tumours < 3 cm of diameter were treated by surgery. The macroscopical examination revealed adrenal cortical adenoma in 11 cases, adrenocortical carcinoma in seven, and pheochromocytoma in 5 patients. The investigation of the pituitary-adrenal system (urinary excretion of 17-OHCS before and during dexamethasone administration, 17-KS, "free" corticosteroids, plasma ACTH, cortisol and S-DHA levels) did not reveal any abnormality except that in 10 patients the plasma ACTH concentration was low, especially in the morning. These values were significantly lower as compared with the remaining patients and with control group. One of the possible interpretations is a pituitary suppression by only periodically increased concentrations of the corticosteroids.

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UNLABELLED: To determine the efficacy of the estrogen replacement therapy (ERT) on the bone mineral density (BMD) measured with quantitative computed tomography (QCT) in postmenopausal osteoporosis 16 women aged 46-72 were examined. They were divided into two groups: 8 women treated with conjugated estrogens (Group I) and 8 who did not received ERT (Group II). In all 16 patients the serum hormonal concentrations (LH, FSH and estradiol) were measured with radioimmunological methods. The bone densitometry was performed in all of them using the single-energy computed tomography (QCT) with the computer Picker 1200. Bone mineral density was measured in three lumbar vertebra (L1-L3) and expressed in milligrams K2HPO4 per ml. The bone mineral density (BMD) was statistically significantly higher in the estrogen treated group (Group I) in every vertebra compared with that of controls (Group II). The serum FSH concentration was statistically significantly lower in the ERT group (Group I) and a statistically significant correlation between FSH level and average BMD (Lmean) was present. IN CONCLUSION: 1. the ERT is very efficacious in preventing bone loss in postmenopausal women; 2. measurement of BMD in lumbar vertebra L1 or L3 may be a sufficiently reliable and accurate, cost-effective and time-saving method of screening for osteoporosis; 3. the serum FSH determination seems to be useful in monitoring of the estrogen therapy for postmenopausal osteoporosis.

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Endogenous opiates may be important in the control of ACTH secretion in men. The effect of opiate receptor blockade by naloxone on ACTH, beta-endorphin-like substance and cortisol release was studied in healthy women and in 9 patients with Cushing's disease. In the healthy subjects, ACTH, beta-endorphin and cortisol levels were increased in response to naloxone. However, in 3 our of the 9 patients with Cushing's disease, a paradoxical decrease in serum ACTH, cortisol and beta-endorphin concentrations was observed after naloxone administration. In the patients with a paradoxical response to naloxone, transsphenoidal microadenomectomy was ineffective.

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The aim of this study was to develop a technique for the radioimmunological determination of the activity of LH-like substances in the human prostate. The material comprised 19 specimens of prostatic tissue obtained during transbladder extirpation in patients with benign prostatic hyperplasia. Tissues of human testes and human sceletal muscle were used as controls. The method adopted for LH extraction from the membrane fraction of human prostatic tissue appeared to be sufficiently specific, accurate and sensitive for routine laboratory investigations. The concentrations of the LH-like immunoreactivity in human testicular tissue was found to be 57, 46 and 70 mU per g of the membrane fraction while those of the prostatic gland tissues ranged from 34 to 155 mU per g of the membrane fraction. However such LH-like substance was not found in human sceletal muscle tissue. It seems that the LH-type activity is an indirect proof for the existence of LH receptors in the human prostate.

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The aim of this study was to evaluate the usefulness of computed tomography in the localisation of adrenal tumors producing aldosterone and cortisol. One case each of Conn's and Cushing's syndrome are described. The diagnosis of Conn's syndrome was established by demonstrating an elevated plasma aldosterone level "at rest" and its decrease after stimulation, the absence of plasma renin activity and a lowered plasma potassium level. The diagnosis of Cushing's syndrome due to adrenal adenoma was established by demonstrating the typical clinical features, an abnormal diurnal rhythm of cortisol and ACTH secretion and an increased urine excretion of 17-OHCS without suppression by large doses of dexamethasone. The localisation and the size of the tumors as determined by computed tomography were confirmed during surgery.

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