Objective To study the effect of levels of 24-hour mean blood pressure(BP)and blood pressure diurnal rhythm on renal function of patients with chronic renal failure(CRF).Methods 24-hour blood pressure monitoring was obtained in patients with CRF(117cases),the GFR was determined periodically.Results The rate of decline of GFR in patients with CRF to a target blood pressure was slower than in patients with CRF not to a target BP(P

Objective To study the clinical characteristic of the central hyperthyroidism due to thyrotropin-secreting pituitary adenoma. Methods 5 patients with TSH-secreting pituitary adenoma (4 male and 1 female) among 1500 pituitary adenomas were summarize between 1992 and 2006, and clinical characteristics of the 5 patients were analyzed retrospectively. Results 5 patients represented 0.33% of all pituitary adenoma patients were seen during the same period. The mean age of the patients was 39.8 years old, and mean duration 5.84 years. All patients were presented with thyrotoxicosis. 3 patients were previously considered as suffering from primary hyperthyroidism and were treated with anti-thyroid drug for 6 to 16 years, and one of them subsequently underwent hypothyroid operation twice. None of them had visual field defect. Hyperthyroidism was determined in all patients by means of elevated total or free thyroid hormone levels while serum TSH levels varied between 3.94?54.7mU/L. TRH provoked an increase in serum TSH concentration greater than 30 mU/L from the baseline level in one patient, whereas no response was observed in two patients. MRI showed pituitary macroadenomas in four patients, while microadenomas in remaining patient. Four patients underwent transsphenoidal adenomectomy and followed by radio therapy in three patients. This resulted in normalization of all hormone parameters in all patients 1-2 weeks after operation. Conclusion Central hyperthyroidism due to thyrotropin-secreting pituitary adenoma should be considered in patients with elevated thyroid hormone and non-suppressed serum TSH level. Combined treatment (transsphenoidal adenomectomy and radiotherapy) is the choice for thyrotropin-secreting pituitary adenoma.

Objective To study the characteristics of clinical and laboratory findings in patients with adrenocorticotropic hormone(ACTH)independent macronodular adrenocortical hyperplasia(AIMAH).Methods The clinical and laboratory findings of 7 cases of AIMAH admitted between 1997 and 2005 were reviewed retrospectively.Results 5 of the 7 patients showed typical clinical features of Cushing's syndrome,including moon face,central obesity,hypertension,etc.A part of patients had hypokalemia(43%)and secondary diabetes mellitus(71%).There was lowering of plasma ACTH levels,and an increased cortisol secretion or disturbance in or circadian rhythm.In 6 patients,a low dose or high dose of dexamethasone suppression tests failed to suppress cortisol secretion.CT scan showed bilateral macronodular adrenal hyperplasia.Pituitary MR imaging for pituitary was negative in 6 patients.Unilateral total adrenalectomy was performed in 2 cases.4 cases were treated by bilateral adrenalectomy.One patient died of stroke before operation.5 cases received glucocorticoid replacement therapy after operation.Pathologic examination showed diffuse yellow or brown nodules measuring 0.3 cm～7.0 cm in diameter in all the specimems of 6 patients who undement operation.There was no recurrence in all the patients ofter surgery during the follow-up period.No Nelson syndrome occurred in these 6 patients postoperatively.Conclusion AIMAH is a rare cause of Cushing's syndrome with unique clinical,CT image and pathological findings.Bilateral adrenalectomy in one stage or in stages,or unlateral adremectomy is indicated on the basis of clinical and CT findings.

Ovotestis is a rare disorder of sexual differentiation in which the gonads have both ovarian and testicular elements. The patients always present with ambiguous external genitalia, and there are usually with serious disorder between chromosomal sex, gonadal sex, social sex, and psychological sex. The definite diagnosis and gender confirmation, appropriate surgery in internal genitalia and orthomorphia in external genitalia, as well as psychological support are essential for a multidisciplinary medical group in managing this disease. The medical data of two children with ovotestis who were reared as boy or girl respectively were analyzed.

Objective To describe a case of female sexual abnormality with 46, XX caused by an androgen-producing adrenocortical tumor and to explore the mechanism of abnormal androgen secretion from the tumor. Methods The tumor tissues as the experimental group were compared with the normal adrenal tissue. The LH/human chorionic gonadotropin ( hCG) receptor was determined by immunohistochemisty, the activity of 3β-hydroxysteroid dehydrogenase ( 3β-HSD ) , 17α-hydroxylase ( CYP17 ) , and 17β-hydroxysteroid oxidoreductase ( 17β-HSD ) by enzyme linked immunosorbent assay(ELISA) and the expression of mRNA of 3β-HSD2, 17β-HSDB3, CYP17, and LH/hCG receptor by real-quantitative polymerase chain reaction ( RQ-PCR ) . Results The immunohistochemisty results showed that the LH/hCG receptor was negative in the experiment group, but positive in control. The activity of 3β-HSD and CYP17 of the experiment group was higher than that in the control (P<0. 01), while the activity of 17β-HSD was lower(2 638. 798±70. 551 vs 9 148. 174±382. 836, P<0. 01) according to ELISA results. The relative contentof3β-HSD2mRNAoftheexperimentgroupwashigherthanthatinthecontrol(P<0.05),andtherelative content CYP17 mRNA of the experiment group was much higher than that in the control (P<0. 01). However, the relative content of 17β-HSDB3 mRNA and LH/hCG receptor mRNA were much lower than those in the control ( P<0. 01) by RQ-PCR. Conclusion Sexual abnormality and virilization could be caused by the excessive androgen secreted by androgen-producing adrenocortical tumor, which is an extremely rare disease. The mechanism of the secretion of androgen from the tumor remains unknown so far. It may be related to the increased activity of 3β-HSD and CYP17, but has no relationship with the expression of LH/hCG receptor.

Hyperthyroidism and acromegaly formed an unusual association.An acromegaly patient with a toxic thyroid adenoma was reported here,including clinical features,treatment,and final outcomes.The association of thyroid disease with acromegaly was reviewed.

With the continuous glucose monitoring system, daily blood glucose profiles were compared in type 2 diabetic patients treated with glargine or neutral protamine hagedorn (NPH) at bedtime for 12 weeks. The blood glucose levels in these patients were previously not well controlled with sulfonylureas. The results suggested that combined treatment with glargine before bedtime showed less nocturnal hypoglycemia and more stable blood glucose profile with less excursion when fasting blood glucose levels were well controlled.

Thirty cases of pituitary stalk interruption syndrome were divided into normal height (group 1) and short stature (group 2).There was no significant difference in growth hormone or insulin-like growth factor-Ⅰ levels between two groups(P＞0.05).Expected height and body mass index in group 1 were higher than those in group 2,while testosterone,cortisol,and FT4 were lower.Height were positively correlated with age,expected height,birth weight,and body mass index.The height of patients with pituitary stalk interruption syndrome depended on both genetic factors and the hormones from pituitary-target gland.

Objective To assess the pituitary function in patients with pituitary adenoma after transsphenoidal ectomy of hypophysoma.Methods Data of 106 patients with pituitary adenoma who were admitted in endocrine department and underwent the operation in PLA General Hospital from January 1993 to January 2010 were collected.Assessments of pituitary function were made before and after surgery.Results Total 23.6％ and 16.0％ of 106 patients underwent pituitary function evaluation by 1 week and 3 months after surgery,respectively.23.5％ and 5.9％ of patients with hyopituitarism before surgery underwent pituitary function evaluation by 1 week and 3 months after surgery respectively,and the respective figures in those without hypopituitarism were 23.6％ and 20.8％.The incidences of new onset of hypopituitarism among 106 patients that underwent surgical procedure were 48.0％ within 1 week after surgery and 35.3％ by 3 months after surgery.Conclusion The rate of re-evaluation of pituitary function by 1 week and 3 months after pituitary surgery was low.Probably,many patients were missed the diagnosis of hypopituitarism after pituitary surgery.

Objective To investigate the effect of leukemia-related protein-16 (LRP16) gene on cell glucose uptake and its molecular mechanism.Methods LRP16 over-expression cell lines were made via translating LRP16 gene expression vector pcDNA3.1-16 and control plasmid pcDNA3.1 into 3T3-L1,C2C12,and HepG2 cell.The effect of LRP16 gene on cell glucose uptake was detected using 2-deoxy-[~3 H]-D-glucose.Western blot was used to detect the effect of LRP16 gene on the expression levels of PPARγ,GLUT-4,and GLUT 2 protein.Results Cell lines with over-expression of LRP16 gene were successfully established,the expression level of LRP16 was two fold higher than control cells.The insulin-stimulated glucose uptakes in control 3T3-L1,C2C12,and HepG2 cells were higher than cells with over-expression of LRP16 gene(P＜0.01).The expression levels of PPARγ and GLUT-4 or GLUT-2 protein in control cells were higher than cells with over-expression of LRP16 gene (P＜0.05).Conclusion LRP16 inhibits cell glucose uptake via decreasing the expression of PPARγ protein.