To the Editor: Salivary testosterpne levels are a good index for the assessment of the true values of free serum testosterone (l, 2). Nevertheless, the correlation between saliva and serum testosterone levels in the follow-up after the treatment of several clinical situations (3,4) is not well studied. We studied salivary and serum testosterone by an RIA method in: a) 10 women affected by hirsutism, aged 16 to 36 years, treated with ethinyloestradiol and laevonorgestrel during three consecutive months, b) samples from 4 patients, aged 61 to 71 years, affected by prostatic carcinoma and treated with flutamide and leuprolide and one of them with diethylstilboestrol during 2 consecutive days, each for two hours, c) 44 boys aged 7 to 15 years with unl· or bilateral cryptorchidism, who had undergone surgical treatment. The correlations between salivary and serum testosterone levels in these different groups were: hirsute women r = 0.57 (p < 0.01); patients with prostatic carcinoma r = 0.62 (p < 0.001); boys with cryptorchidism r = 0.70 (p < 0.001). Our results show that: 1) in the group affected by hirsutism the use of two dnigs that act through different mechanisms of action, such as hormone transport, can hamper the correlation between both parameters, 2) in the patients affected by prostatic carcinoma, in spite of the use of diethylstilboestrol, can modify the sex hormone binding globulin (SHBG), the correlation fouind was significant, 3) in the cryptorchidism group the better correlation found between salivary and serum testosterone levels can be explained by the absence of medication. Salivary and serum testosterone levels in the follow-up of medical treatment in hypoand hyperandrogenic states must be treated with caution.
Summary— Testosterone concentrations in saliva were measured in 13 patients with prostatic carcinoma after surgical or medical (diethylstilboestrol or Estracyt) orchiectomy. The salivary testosterone values in these patients were significantly lower than in normal males but not significantly different from those in normal females. The salivary testosterone concentrations were measured for 6 consecutive months and did not vary significantly from month to month. The results suggest that the measurement of salivary testosterone concentrations could be useful in evaluating the androgenic function of patients with prostatic carcinoma after medical or surgical orchiectomy.
The history, physical and radiologic findings, treatment and pathology in five unusual cases of hyperparathyroidism is presented. The hyperparathyroidism was caused by a large (113 grams) mediastinal adenoma in the first patient, who is alive 25 years after surgery. A parathyroid carcinoma with compression of the esophagus was documented in the second patient. This patient is alive and normocalcemic 23 years after surgical treatment. A third patient with hyperplasia returned with hypercalcemia 20 years postsurgery requiring reoperation. A fourth patient with advanced bone findings was found to have a parathyroid adenoma. The fifth case is a patient with tertiary hyperparathyroidism secondary to hypophosphatemic rickets.
PTHrP has had an unidentified role in medicine since 1930, when Albright described a patient with renal cortical cell carcinoma with hypercalcemia. Since then hypercalcemia has been recognized as the most common paraneoplastic syndrome. At that time the concept of "ectopic PTH syndrome" was introduced, and remained in literature until the true etiology was finally described. In the early 1970's Roof and Benson presented evidence that PTH in humoral hypercalcemia differed from "authentic" PTH. This marked the starting point for researchers to try identifying the molecule that mimicked PTH action and structure. This molecule, named parathyroid-related peptide, has been associated to hypercalcemia seen with solid tumors, such as squamous cell carcinoma of the lung and renal cortical cell carcinoma. PTHrP has been demonstrated to have similar actions to PTH but to differ in decreasing osteoblastic activity while increasing osteoclastic activity. The more fascinating finding was the presence of the PTHrP genes throughout the body, mostly the lactating breast as well as the heart, lungs and skin among others. Despite its identification, finding its physiological roles on normal tissue still remains to be clarified.