JOURNAL OF ENDOCRINOLOGICAL INVESTIGATION Official Journal of the Italian Society of Endocrinology Volume 12 March 1989 Number 3 CONTENTS Thyroid function tests in acute viral hepatitis: relative reduction in serum thyroxine levels due to T4-TBG binding inhibitors in patients with severe liver cell necrosis M.C. Pagliacci, G. Pelicci, D. Francisci, C. Giammartino, L Fedeli, G. Stagni, and I. Nicoletti 149 Insulin resistance in acromegaly: evaluation by studies of insulin binding to erythrocytes A.C. Lerario, W. El-Andere, B.L Wajchenberg, L.Y. Ohnuma, M.H. Rocha, and A. Andriolo 155 Intravenous dexamethasone and subsequent ACTH test in comparison with dexamethäsone oral test in the diagnosis of Cushing's Syndrome: a report of 20 cases S. Gämbardella, G. Tamburrano, A. Giaccari, S. Frontoni, A. Lala, V. Spallone, A. Barini, M.G. Felici, and G. Menzinger 163 Melatonin effects on prolactin secretion in pituitary-grafted female rats A.l. Esquifino, M.A. Villanua, C. Agrasal, R.J. Reiter, and J.A.F. Tresguerres 171 Immunoreactive thyroglobulin in sera and saliva of patients with various thyroid disorders: role of autoantibodies AJ. Van Herle, P.D. Rosenblit, TL. Van Herle, P. Van Herle, M. Greipei, and K. Kellett 177 CASE REPORTS Possible association of aldosterone producing adenoma and non-functioning adrenal tumor R. Sorna, I. Miyamori, A. Nakagawa, T. Matsubara, H. Takasaki, T. Morise, I. Kon-i, R. Takeda, and T. Kobayashi 183 Partially compensated hypoadrenalism presenting with persistent skin pigmentation EM Whitehead, A.B. Atkinson, D.R. Hadden, J. Weaver, and B. Sheridan 187 Male pseudohermaphroditism due to 17-hydroxylase deficiency A. D'Alberton, E. Reschini, T Motta, and A. Catania 193 Cyproheptadine may act at the pituitary in Cushing's disease: evidence from CRF Stimulation J.R. Tucci, K.J. Nowakowski, and I.M.D. Jackson 197 COMMENT Inductive effects of progestogens on aromatase activity in stromal cells of human uterine endometrium T. Yamamoto, K. Shiroshita, J. Kitawaki, and H. Okada 201 SHORT COMMUNICATION Raised plasma levels of atrial natriuretic peptides in Addison's disease F.P. Cappuccio, N.D. Markandu, M.G. Buckley, A.L. Sugden, G.A. Sagnella, and G.A. MacGregor 205 II CONTENTS (continued) REVIEW ARTICLE Goiter and iodine deficiency in Europe. The European Thyroid Association report as updated in 1988 R. Gutekunst and P.C. Scriba 209 ANNOUNCEMENTS IV International Congress of Andrology 154 XXXII Symposium of the Journees Internationales Henri-Pierre Klotz d'Endocrinologie Clinique on Peptide Hormone Secreting Tumors 154 Giornate Endocrinologiche Pisane 162 International Symposium on Circulating Regulatory Factors and Neuroendocrine Function 162 IV Congress of the European Neuroendocrine Association 192 XIV European Symposium on Hormones and Cell Regulation 192 International Workshop on Multiple Endocrine Neoplasia, Type 2 208 International Symposium "Thyroid Gland, Environment and Autoimmunity 1989" 208 Satellite Meeting on Iodine and the Thyroid 208 IV J. Endocrinol. Invest. 12: 209-220, 1989 REVIEW ARTICLE Goiter and iodine deficiency in Europe. The European Thyroid Association report as updated in 1988. R. Gutekunst and P.C. Scriba Department of Internal Medicine, Medical University Lübeck, Federal Republic of Germany INTRODUCTION country. For the older literature, the reader is referred This review is based on the report of the subcommit- to references (3, 4, 15, 18-31). tee for the study of endemic goiter and iodine defi• Albania: ciency of the European Thyroid Association (1-4). Epidemiologie information on the prevalence of goi• No information is available. ter and alimentary iodine supply is scanty for most Austria: European countries. Although regional data are Iodine Prophylaxis has been mandatory since 1963. available, these do not necessarily reflect the Situa• Due to this, endemic cretinism had disappeared. tion throughout the country from which they origi• The incidence of hypothyroidism of newborn is nale. The regional data give relatively good informa• 1:4600, goiter prevalence in 6 years old 1.1-1.5%. tion concerning the population sample studied; Goiter prevalence rises with growing age up to however, it is frequently difficult to conclude which 13.4% in 18 years old. Up to 1 /3 of the adult popula• part of the whole population of a given area is re- tion have a goiter. Iodine exeretion in 2262 patients presented by the sample studied and which percen- from 5 cities show an iodine exeretion slightly below tage of the total inhabitants of the country live in the 100 jug iodine/g Creatinine. In Graz and Oberwölz, areas studied. Most surveys have used the Standard iodine exeretion is still below 70 ng iodine/g Creati• Classification of goiter size aecording to Pan Ameri• nine, though aecording to the decrease of radioio- can. Health Organization from 1974 (5), which is dine uptake from 52.4% in 1972 to 30.5% in 1981 associated with a signifteant risk of overestimation in (32) iodine intake must have improved. In Sicheldorf, children and underestimation especially in older a mean iodine exeretion of 132.6 iodine/g Creatinine adults as Sonographie volumetry has shown (5, 6-9). was found. Compared with the epidemiological data Daily urinary iodine exeretion or iodine exeretion before 1963, the Situation had drastically improved, from spot urine samples have widely been aeeepted however, a rise of potassium iodide from 10 mg to 20 as a satisfactory index of iodine intake (10, 11). mg/kg salt has been recommended and is in legisla• Since Europe, except one Spanish region (12), is not tive planning (33-37). considered to suffer from protein malnutrition, the urinary iodine/creatinine ratio is acceptable (13). Belgium: Hardly any data are available about potential effects A prevalence of goiter of 1.8% had been noted in of dietary goitrogens (14-16). Limitations of the study over 50.000 male army recruits in 1956 (18). A study of endemic goiter and iodine deficiency are partly on the seasonal Variation of stable iodine in non-tox- due to legal obstacles for epidemiology and the wide- ic goiter indicated a mean exeretion of 50 jLtg io• spread disinterest in iodine supplementation pro- dine/g Creatinine. Data from the 1960th indicate grams of European health administrations (17). similar figures (19, 38-42). In 1986, the median Information on goiter prevalence (Fig. 1), iodine urinary iodine concentration (jug/dl) in 196 healthy supply (Fig. 2) and supplementation programs (Ta• full-term infants born in Brüssels was 4.8 and thus ble 1) is listed in alphabetic order for each European lowerthan in Helsinki, Finland (11.2), but higherthan in Göttingen, FRG (1.5) (43). New and methodologi- cally reliable data on goiter prevalence and iodine supply are urgently needed. Key-words: Goiter, endemic goiter, iodine deficiency, thyroid. Bulgaria: Correspondence: Dr. Rainer Gutekunst, Dept. Internal Medicine. Medical University Lübeck Ratzeburger Allee 160. D-2400 Lübeck 1. West Ger• In 1957 a survey of 1 million schoolchildren revealed many. a goiter prevalence of 19.2%. First, iodized salt be- 209 R. Gutekunst and P C. Scriba came mandatory only locally (20 mg Kl/Kg salt). GOITER PREVALENCE % Meanwhile, iodized salt is generally used in the whole country. In 1974, a reduetion of the regional goiter prevalence from 55 to 12% was reported for adults (44). In schoolchildren, goiter prevalence de- creased to 8.5% in the district of Gabrovo and to 10.7% in Sofia in 1983 (45). One tablet containing 0.5-1.0 mg iodine is given weekly to every youngster up to the age of 18 years in endemic areas. Czechoslovakia: The prevalence of goiter of 50% (m) and 70% (f) was observed in more than 370 persons examined be- tween 1947 and 1953 (45), before the introduetion of iodine Prophylaxis. Correlation to low iodine exere• tion and to thioeyanate from brassica (16), respec- tively, was shown. Detailed data on the prevalence of diffuse and nodular goiters and of different sizes of goiters in men and women aecording to old districts during the years 1949 to 1953 have been published (46, 47). Iodine Prophylaxis was started in 1947 in some selected areas only, but since 1953 it was introduced in the whole territory. At that time, the content of potassium iodide was 12 mg/kg, but in some areas 25 mg/kg were used. Since 1965,18 mg Fig. 1 - Goiter prevalence in percent; updated map of the ETA (2). l/kg salt is used in the whole territory. It is being Regional values are denoted by brackets. considered to increase the level up to 35 mg/kg after 1985. In 1966, follow-up studies in 100.000 subjects showed urinary iodine values having in- creased to 100 /^g/24 h and age-dependent de- Table 1 - Status of iodine Prophylaxis No endemic goiter Intermediate Belgium V Austria m Denmark n Bulgaria m Finland m Czechoslovakia» m Iceland — Hungary m Ireland V Netherland m Norway V Poland m Sweden m Switzerland m United Kingdom n Yugoslavia m Endemic goiter No information FR Germany V Albania — France V Luxemburg — German DR m Soviet Union — Greece V Italy V Portugal V Romania _ Spain V Turkey — Fig. 2 - Urinary iodine exeretion (fJtg/g Creatinine); updated map of m = mandatory or used by the vast majority; v = voluntary; n = none; — = no the ETA (2). Regional values are denoted by brackets. information. 210 Goiter and iodine deficiency in Europe creases of goiter prevalence reported as an RT- Federal Republic of Germany: value of 110, which Stands for relative thyroid weight In 1984, thyroid size of more than 3000 school child- given in percent with RT=100 being normal (48). ren and more than 3000 adults from 25 and 10 The iodine Prophylaxis was interrupted for almost 7 German towns respectively were measured by so- years in 2 districts, which clearly showed and in- nography.