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Hypothyroidism and amenorrhea due to hypothalamic insufficiency. A study in four young women
Extractable acidic nuclear antigen Sjagren’s syndrome Sicca complex Rheumatoid arthritis
Amenorrhea
Thyrotropin
Hypothalamic insufficiency tuteinidng hormone
I
Alpha,-antitrypsin phenotypes Chronic bronchitis
Arrhythmia Atropine
Tritcheostomy
rhythmias.
ii
CA
I.
Cardiac arrhythmias during wakefulness and sleep in 15 patients with sleep-induced obstructive apnea and the effect of atropine and tracheostomy on these arrhythmias were studied by continuous overnight Halter electrocardiographic, respiratory and electroencephalographic recordings. Sleep was characterized by marked sinus arrhythmia, extreme sinus bradycardia, asystole. second degree atrioventrlcular block and ventricular arrhythmias. Arrhythmias duing wakefulness were limited to premature ventricular beats. The administration of atropine was partially and tracheostorny highly effective in preventing the majority of these arrhythmias during sleep. Marked sinus arrhythmia during sleep is characteristic of the syndrome of obstructive s!eep apnea and Is frequen!!y accompanied by po?en!ially life-threatening tachy- and bradyar-
Tilkian AG, Guilleminault C. Schroeder JS, Lehrman KL, Simmons FB, Dement WC: Sleep-induced apnea syndrome. Prevalence of cardiac arrhythmias and their reversal after tracheostomy. Am J Med 63: 346358, 1977.
Sleep apnea Obstructive apnea
III a matched pair study of 114 patients with chronic obstructive pulmonary disease (COPD) and 114 cantrol subjects and their families, COPD was found two to three times as often in brothers and sisters of patients than in those of the control subjects. Parents of index patients were also more often affected than parents of control subjects but that difference was not significant. Three patients with Pi2 phenotype and nine (7.9 per cent) with a PiMZ phenotype were found in the group of index patients. There were no subjects with PiZ and six subjects (5.3 per cant) with Mi! phenotypee in the control group; the prevalence of the MZ phenotype in the general white population is approximately 2.3 per cent. The prevalence of the PIMZ phenotype was significantly (P
Kueppers F, Miller RD, Gordon H, Hepper NG, Offord K; Familial prevalence of Chronic obstructive pulmonary disease in a matched pair study. Am J Med 63: 336-342, 1977.
Z and MZ phenotypes
Chronic obstructive pulmonarydisease Airway disease
Continuedon page A103
inappropriately low thyrotropin levels, with a normal thyrotropin response to thyrotropin-releaeing hwmone in three. and absence of a pituitary lesion. Nevertheless, menses did not resume after adequate replacement with thyroid hwrone. Investigation of the pituitary-gonadal axis revealed a normal increase in both luteinizing hormone and follicle-stimulating hormone following the intravenous administration of gonadotropin-releasing hormone. Three subjects received 100 mg clomiphene citrate a day for five days, but a normal menstrual cycle was not induced. It is concluded that amenorrhea was not due to thyroid hormone deficiency but, like the hypothyroidism, to a hypothaiamic abnormaiity invoiving secretion of the appropriate reteasing hoimone.
Four women were evaluated for secondary amenorrhea of 12 to 36 months’ duration. All were considered to have hypothalamic hypothyroidism on the basis of low thyroxine concentrations,
Woolf PD: Hypothyroidism and amenorrhea due to hypothalamic insufficiency. A study in four young women. Am J Med 63: 343-347, 1977.
Hypothyr6idism Thyroxine
The presence of a precipitating antibody to an extractable nuclear antigen, termed Ha. was examined by i~iffusion in gel in three subpopufationsof patients with Sj@ren’s syndrome (SS): (1) those with sicca complex alone, (2) those with SS and rheumatoid arthritis (SS-RA) and (3) those with SS and systemic lupus efythamatosus (SS-!XE). Control populations included petients with rheumatoid arthritis (RA) alone and systemic lupus erythematosus (SLE) alone, and normal age-matched blood donors. The results demonstrate the high incidence of anti-Ha antibody in siccacomplex(68 percent) versus the low incidence of the antibody in SS-RA (5 per cent) (p <0.005). In addition, there was a markedly increased incidence of the anti-Ha antibody in SSSLE (73 per cent) when compared with that in SLE (2 per cent) (p
Kassan SS, Akiruki M, Steinberg AD, Reddick RL, Chusad TM: Antibody to a soluble acidic nuclear antigen in Sjijgren’s syndrome. Am J Med 63: 328-335, 1977.
Systemic lupuserythematosus
I
Amenorrhea
Thyrotropin
Hypothalamic insufficiency tuteinidng hormone
I
Alpha,-antitrypsin phenotypes Chronic bronchitis
Arrhythmia Atropine
Tritcheostomy
rhythmias.
ii
CA
I.
Cardiac arrhythmias during wakefulness and sleep in 15 patients with sleep-induced obstructive apnea and the effect of atropine and tracheostomy on these arrhythmias were studied by continuous overnight Halter electrocardiographic, respiratory and electroencephalographic recordings. Sleep was characterized by marked sinus arrhythmia, extreme sinus bradycardia, asystole. second degree atrioventrlcular block and ventricular arrhythmias. Arrhythmias duing wakefulness were limited to premature ventricular beats. The administration of atropine was partially and tracheostorny highly effective in preventing the majority of these arrhythmias during sleep. Marked sinus arrhythmia during sleep is characteristic of the syndrome of obstructive s!eep apnea and Is frequen!!y accompanied by po?en!ially life-threatening tachy- and bradyar-
Tilkian AG, Guilleminault C. Schroeder JS, Lehrman KL, Simmons FB, Dement WC: Sleep-induced apnea syndrome. Prevalence of cardiac arrhythmias and their reversal after tracheostomy. Am J Med 63: 346358, 1977.
Sleep apnea Obstructive apnea
III a matched pair study of 114 patients with chronic obstructive pulmonary disease (COPD) and 114 cantrol subjects and their families, COPD was found two to three times as often in brothers and sisters of patients than in those of the control subjects. Parents of index patients were also more often affected than parents of control subjects but that difference was not significant. Three patients with Pi2 phenotype and nine (7.9 per cent) with a PiMZ phenotype were found in the group of index patients. There were no subjects with PiZ and six subjects (5.3 per cant) with Mi! phenotypee in the control group; the prevalence of the MZ phenotype in the general white population is approximately 2.3 per cent. The prevalence of the PIMZ phenotype was significantly (P
Kueppers F, Miller RD, Gordon H, Hepper NG, Offord K; Familial prevalence of Chronic obstructive pulmonary disease in a matched pair study. Am J Med 63: 336-342, 1977.
Z and MZ phenotypes
Chronic obstructive pulmonarydisease Airway disease
Continuedon page A103
inappropriately low thyrotropin levels, with a normal thyrotropin response to thyrotropin-releaeing hwmone in three. and absence of a pituitary lesion. Nevertheless, menses did not resume after adequate replacement with thyroid hwrone. Investigation of the pituitary-gonadal axis revealed a normal increase in both luteinizing hormone and follicle-stimulating hormone following the intravenous administration of gonadotropin-releasing hormone. Three subjects received 100 mg clomiphene citrate a day for five days, but a normal menstrual cycle was not induced. It is concluded that amenorrhea was not due to thyroid hormone deficiency but, like the hypothyroidism, to a hypothaiamic abnormaiity invoiving secretion of the appropriate reteasing hoimone.
Four women were evaluated for secondary amenorrhea of 12 to 36 months’ duration. All were considered to have hypothalamic hypothyroidism on the basis of low thyroxine concentrations,
Woolf PD: Hypothyroidism and amenorrhea due to hypothalamic insufficiency. A study in four young women. Am J Med 63: 343-347, 1977.
Hypothyr6idism Thyroxine
The presence of a precipitating antibody to an extractable nuclear antigen, termed Ha. was examined by i~iffusion in gel in three subpopufationsof patients with Sj@ren’s syndrome (SS): (1) those with sicca complex alone, (2) those with SS and rheumatoid arthritis (SS-RA) and (3) those with SS and systemic lupus efythamatosus (SS-!XE). Control populations included petients with rheumatoid arthritis (RA) alone and systemic lupus erythematosus (SLE) alone, and normal age-matched blood donors. The results demonstrate the high incidence of anti-Ha antibody in siccacomplex(68 percent) versus the low incidence of the antibody in SS-RA (5 per cent) (p <0.005). In addition, there was a markedly increased incidence of the anti-Ha antibody in SSSLE (73 per cent) when compared with that in SLE (2 per cent) (p
Kassan SS, Akiruki M, Steinberg AD, Reddick RL, Chusad TM: Antibody to a soluble acidic nuclear antigen in Sjijgren’s syndrome. Am J Med 63: 328-335, 1977.
Systemic lupuserythematosus
I