Food-dependent androgen and cortisol secretion by a gastric inhibitory polypeptide-receptor expressive adrenocortical adenoma leading to hirsutism and subclinical Cushing's syndrome: in vivo and in vitro studies

Aberrant gastric inhibitory polypeptide (GIP) receptor expression in bilaterally hyperplastic adrenals or unilateral adrenal adenomas is a rare form of adrenal hyperfunction. So far, only few cases have been described. In all these cases, cortisol was the predominant steroid released in a food-dependent manner, leading to the development of non-ACTH-dependent Cushing's syndrome. In the present study, we describe a novel case of a GIP receptor-expressive adrenocortical adenomatous nodule, detected incidentally by computed tomography scanning in a 41-yr-old lady with hirsutism but no clinical signs of Cushing's syndrome, on physical examination. Hormonal investigations in morning fasting samples showed slightly elevated androgen levels, low-normal baseline cortisol, normal suppression of cortisol after dexamethasone administration, and ACTH levels that were not suppressed and did stimulate after CRH administration. The elevated urinary free cortisol excretion, in conjunction with an atypical cortisol diurnal rhythm, raised the possibility of an aberrant stimulation of cortisol production by the adrenal tumor. Further studies demonstrated food-dependent secretion of cortisol, which was abolished by prior octreotide administration. Notably, substantial amounts of adrenal androgens were also secreted after food consumption. Removal of the tumor resulted in undetectable cortisol and androgen levels that did not respond to food consumption. Histological examination of the excised tumor revealed an adrenocortical adenomatous nodule originating from the inner zona reticularis, consisting mainly of compact cells. A steroidogenic secretory pattern, indicating the concomitant release of adrenal androgens and cortisol, was also observed in vitro from tumor cells cultured in the presence of GIP. The in vitro secretory response to GIP was higher for the adrenal androgen DHEA, compared with cortisol. The expression of the GIP receptor in tumor cells, but not in the adjacent normal adrenal, was demonstrated by RT-PCR), using specific oligonucleotide probes for this receptor. In summary, we describe a patient with a GIP-expressive cortisol and androgen oversecreting adrenocortical nodule with the unusual presentation of hirsutism and not the typical clinical signs of Cushing's syndrome. It is of note that food intake in this patient provoked a substantial increase in both adrenal androgen and cortisol levels that, together with the histological appearance of this nodule, was compatible with a zona reticularis-derived tumor. Thus, aberrant expression of the GIP receptor does not exclusively involve cells of a zona fasciculata phenotype, as previously reported, but may also occur in other types of differentiated adrenocortical cells.     

Monoclonal gammopathy in extranodal marginal zone lymphoma (ENMZL) correlates with advanced disease and bone marrow involvement

Monoclonal gammopathy is a well-recognized occurrence in splenic marginal zone lymphoma (MZL); however, its prevalence has never been reported in extranodal MZL (ENMZL). We present results of a retrospective analysis of 26 patients with newly diagnosed as well as previously treated ENMZL. Monoclonal gammopathy was detected in 7 out of 26 (27%) patients. All patients with a monoclonal gammopathy had stage IV disease, and most of them had involvement of lymph nodes and/or bone marrow (n = 6). Only 1 out of 7 patients with a monoclonal spike had stage IV disease diagnosed based on multifocal mucosal involvement. There was also a strong correlation between the involvement of bone marrow and the presence of a monoclonal spike (Fisher's exact test, P = 0.0007). Prevalence of monoclonal gammopathy is higher than previously recognized and indicates advanced disease. However, the prognostic significance of the presence of monoclonal gammopathy in this population is unknown.     

Snatch lift kinematics and bar energetics in male adolescent and adult weightlifters

AIM: The aim of the present study was compare linear kinematics and energy changes of the barbell, along with the angular kinematics of the leg movement during the snatch technique, between male adolescent and adult weightlifters. METHODS: Two S-VHS cameras operating at 60 fields per second recorded the heaviest lifts of 14 male adolescent and 9 adult top-level weightlifters under competitive conditions. The spatial co-ordinates of selected points on the body and the barbell were calculated using the direct linear transformation procedure. A low pass digital filter with 4 Hz cut-off frequency was used for the smoothing of raw co-ordinate data. The 't'-test for independent samples was used for the statistical treatment of data. RESULTS: The results revealed that there were no significant differences between the adolescent and the adult weightlifters in the majority of the kinematic variables. However, adolescent weightlifters extended their knees significantly slower (t21 = 4.211, p < 0.05) during the 1st pull and their ankles during the 2nd pull (t21 = 2.440, p < 0.05) than the adult weightlifters did. Moreover, the average relative power output was significantly greater for the adult weightlifters during both the 1st (t21 = 2.303, p < 0.05) and the snd pull (t21 = 2.611, p < 0.05). CONCLUSION: These results indicate that the adolescent weightlifters were characterised from a high level of snatch technique and differentiated from the adults predominantly at the less powerful execution of the movement.     

Fracture callus engulfing a peripheral nerve does not affect its function: an experimental study in rabbits

The fate of a peripheral nerve engulfed in fracture callus is not known. We investigated the impact of envelopment of the sciatic nerve by fracture callus using a New Zealand rabbit femoral fracture model. The sciatic nerve was mobilized and coiled around the ipsilateral femur, which was surgically fractured, shortened, and osteosynthesized. Bony union was achieved, and callus engulfed the sciatic nerve in all animals. Nerve function was evaluated clinically and by conduction studies preoperatively and postoperatively. Although the nerve function in terms of clinical evaluation, amplitude, motor latency, and spontaneous activity deteriorated immediately postoperatively, recovery was evident in the following weeks indicating that the detected nerve dysfunction was attributable to the surgical mobilization. In addition, histologic and quantitative histomorphometric analyses proved that in none of the animals did the callus compress the sciatic nerve whereas an impressive process of axonal regeneration took place despite callus maturation. Results of our study suggest that callus, engulfing a peripheral nerve, does not compress it and the nerve appears to be intact in an osseous canal. This results in preservation of the integrity and function of the nerve, which may have significant clinical applications.     

Laboratory of Microbiology and Infectious Diseases,Aristotle University,Faculty of Veterinary Medicine, 540 06 Thessaloniki,Greece

Four groups of 12 pregnant sows of the same genetic background, with similar litter size, living under the same housing conditions and having the same hygienic and nutritional standards, were used. In control animals (gC), a basic feed was provided, in which the dietary level of α-tocopherol was 20 mg/kg of feed and that of selenium (Se) was 0.45 mg/kg of feed (standard ration). Sows in the second group (gE) received basic feed supplemented with 30 mg α-tocopherol per kg (50 mg/kg of feed, in total). To those in the third group (gSe) basic feed was provided but additionally they were injected with 30 mg Se (sodium selenite) on days 30, 60 and 90 of pregnancy. For the sows in the fourth group (gESe), basic feed was supplemented with 30 mg α-tocopherol per kg. In addition they received 30 mg injectable Se (sodium selenite) on days 30, 60 and 90 of pregnancy. The experiment started on day 30 of pregnancy and lasted until weaning day (28 days post-farrowing). It was found that α-tocopherol and selenium act synergistically. Piglets born from sows in gESe had the highest immunoglobulin concentration level up to weaning day. All productive and clinical parameters (number of piglets born/litter, number of weaned piglets/litter, and piglets’ average body weight at birth and on weaning day) were greater in these piglets in comparison with the animals of the other groups. Diarrhoea problems were minimal in the piglets in gESe.