Endocrine Aspects of Sarcoidosis (concluded)

Our plain-English summary of Endocrine Aspects of Sarcoidosis (concluded), by J.L. Winnacker, K.I. Becker, S. Katz (1968).

The study

• Authors: J.L. Winnacker, K.I. Becker, S. Katz
• Published: The New England Journal of Medicine 278(9):485-492 February (1968)
• Type of article: Journal article
• Our copy: from Johns-Manville's own medical library. The article is still under copyright, so we describe it here rather than post it.

In plain English

This article was the concluding part of a review by the authors of published medical reports on sarcoidosis affecting hormone-producing glands. It did not concern asbestos. It covered the pituitary gland and hypothalamus, thyroid, parathyroid, adrenal glands, pancreas, genital organs and pregnancy. From their literature survey, the authors counted about 60 reported cases of presumptive or definite diabetes insipidus due to sarcoidosis. In 19 randomly selected published cases in which pituitary function had been adequately evaluated, they found diabetes insipidus in 14 and a deficiency of one or more anterior pituitary hormones in 17. They judged that earlier reports had probably understated such deficiency because of inadequate laboratory testing. In 41 randomly selected pregnant patients with sarcoidosis, chest x-ray reports showed less hilar adenopathy or lung infiltration on the later film in 23, although the earlier appearance often returned after delivery. The authors concluded that all patients with presumptive or definite sarcoidosis of the hypothalamus or pituitary should be given a trial of corticosteroids. They noted that the value of these drugs had not been demonstrated.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Review of published literature (concluding installment of a 'Medical Progress' review), including the authors' own tallies of selected published cases
• Who was studied: Published case reports and series of patients with sarcoidosis involving the hypothalamus, pituitary, thyroid, parathyroid, adrenal glands, pancreas and genital organs, and pregnant patients with sarcoidosis, drawn from literature since 1909
• Main results:
  • The authors' literature survey found approximately 60 reported cases of presumptive or definite diabetes insipidus due to sarcoidosis since 1909
  • Among 19 randomly selected published cases of sarcoidosis with adequately evaluated pituitary function, diabetes insipidus was found in 14
  • Among the same 19 cases, deficiency of one or more anterior pituitary hormones was found in 17
  • In order of decreasing frequency, the deficiencies were of gonadotropin, TSH and ACTH
  • The authors considered it probable that the low frequency of hypopituitarism in earlier reports was due to inadequate laboratory evaluation of anterior pituitary function
  • In 41 randomly selected pregnant patients with sarcoidosis, chest x-ray reports at or shortly after term showed a decrease in hilar adenopathy or pulmonary infiltration in 23, compared with films from before or early in pregnancy
  • In this pregnancy group, the x-ray appearance frequently reverted to the initial appearance later in the post-partum period
• The authors' conclusion: The authors concluded that, because progressive sarcoidosis of the hypothalamic-pituitary axis has serious consequences, all patients with a presumptive or definite diagnosis of sarcoidosis of these organs should be given a therapeutic trial of corticosteroids
• Limitations the authors state:
  • The authors noted that corticosteroid use in hypothalamic-pituitary sarcoidosis had been limited to a small group of patients, most of whom were seriously ill, and that its value had not been demonstrated
  • The authors noted that in many earlier reviews diabetes insipidus was diagnosed solely from unexplained polyuria, polydipsia and hyposthenuria, so the accuracy of some conclusions might be questioned
  • The authors noted that the specific effects of ovarian and placental hormones on the activity of sarcoid granulomas had not yet been investigated

Topics

Medical terms in this study, explained in our Lexicon: Chest X-Ray.

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