A Predominantly Adrenaline-secreting Phaeochromocytoma

A 61-year-old woman who presented with diabetes, nausea, weightloss and sweating was found to have a phaeochromocytoma secretingadrenaline, with a small amount of N-methyIadrenaline. Therewas no significant increase in noradrenaline secretion. Shewas normotensive, and developed profound hypotension in responseto the -adrenergic antagonist phenoxybenzamine. These featuresare unusual in phaeochromocytoma, but similar features occurredin the very few previous reported cases of pure adrenaline-secretingphaeochromocytoma. We conclude that it is important to identifysuch patients, so that they should not be given -adrenergicantagonist drugs.     

SITE VARIABILITY IN A MULTISITE GERIATRIC DEPRESSION TRIAL

We studied differences in outcome and characteristics among 29 clinical sites of a multisite, double-blind antidepressant trial for geriatric depression. Six hundred and seventy-one outpatients aged 60 years or older (mean±SD=67.7±5.7) met DSM-III-R criteria for unipolar major depression, had baseline 17-item Hamilton Depression Rating Scale (HAMD₁₇) scores ≥16 and were randomized to fluoxetine (20 mg daily) or placebo. Effect sizes (ESs, expressed as mean differences between effects divided by the pooled standard deviation of the differences) were calculated for each site using selected outcome measures. ES ranged from 1.84 (favoring fluoxetine) to −0.91 (favoring placebo) for incidence of remitters (endpoint HAMD₁₇ total score of ≤8). A large, positive ES favoring fluoxetine for remission rates (ES≥0.65) was found at only six sites, moderate ES (0.35–0.64) at eight and small ES (0–0.34) at seven; ES favored placebo (<0) at eight of 29 sites. Private clinics showed an overall HAMD₁₇ ES for change scores more than twice that of university sites. These results suggest that individual practitioners may have vastly different clinical experiences in large, multisite trials for geriatric depression. Interrater reliability, subject selection, recruitment, inadequate or fixed dosing, few patients per site, brief study duration, heterogeneity of geriatric depression, financial incentive and characteristics of individual sites may contribute to response variability.     

Steroid Hormone Metabolism in Chronic Myelogenous Leukemia

Individual metabolites of steroid hormones were isolated and measuredfrom the urine of patients with chronic myelogenous leukemia. The resultswere compared with earlier studies of patients with chronic lymphatic leukemia, men with prostatic cancer, women with breast cancer and normalmen and women. The metabolites of hydrocortisone were in the normal rangefor the patients with chronic myelogenous leukemia but the amount of tetrahydrocortisol was generally greater than that of tetrahydrocortisone. Therewas no evidence for a sex difference in the production of these metabolites.The tentative conclusion was drawn that metabolites of the "adrenal androgens" were also in the normal range in chronic myelogenous leukemia. Theseresults contrast with those in chronic lymphatic leukemia patients where asex difference in production of hydrocortisone was evident and the metabolitesof "adrenal androgens" were at low levels in both sexes.

Submitted on August 13, 1964 Accepted on September 20, 1964