985
regions where these cancers are unusual than from of study hordes of patients in regions where these cancers abound. From the African continent are reported some of the lowest incidences of gastric and colonic cancer in the world. A patient there who has such a cancer is a rarity and worthy of detailed study. Britain in the past generously supported cancer studies in Africa which revealed these and other features of cancer there. Judicious investment in that continent might pay rich dividends of knowledge.
cancer
in
the
Department of Pathology, Albany Medical College, Albany, N.Y. 12208, U.S.A.
SIR,-Williams’ has suggested that alcohol may induce an increased secretion of prolactin, thyroid-stimulating hormone (T.S.H.), and melanocyte-stimulating hormone (M.S.H.) from the anterior pituitary gland which may influence breast and thyroid cancer and malignant melanoma. However, alcohol may not affect T.s.H. or thyrotrophin-releasing hormone (T.R.H.) induced T.S.H. release in normal men,2 and Ylikahri et al.3 found a diminished T.R.H.-induced prolactin response during alcohol-induced hangover in healthv volunteers. These studies suggest that alcohol does not stimulate T.s.H. and prolactin secretion in normal men. We gave T.R.H. (0-5 mg 4 times daily) to 22 chronically alcoholic men, 12 during acute alcohol withdrawal, and 14 during complete remission after withdrawal. 4 were tested on both occasions. Injections were given after an overnight fast when the patients were recumbent. Blood was collected, and serum preserved and assayed for prolactin, T.S.H., and growth hormone (G.H.) exactly as described elsewhere.4 A control group of 12 normal male volunteers were also given T.R.H. and samples were taken under the same conditions. At baseline, prolactin was significantly lower during alcohol withdrawal (see table). T.S.H. was also lower but not significantly so. In the post-withdrawal state, both hormone concentrations were normal. Prolactin response to T.R.H. was lower during withdrawal but not significantly so. The T.s.H. response was significantly lower during withdrawal but tended to recover in the postwithdrawal state. 4 men in withdrawal and 3 in the post-withdrawal state had blunted T.S.H. response, which we have also found in mental depression.5 The most exact test of Williams’ hypothesis’ would require a study of patients during chronic excessive alcohol intake but to our knowledge this has not been done. The predicted changes, however, did not occur in acutely intoxicated men’ -
Williams, R. Lancet, 1976, i, 996. Leppaeluoto, J., Rapeli, M., Varis, R., Ranta, T. Acta physiol. scand. 1975, 95, 400. 3. Ylikahn, R. H., Huttunen, M. O., Harkönen, M. Lancet, 1976, i, 1353. 4. Prange, A. J., Jr., and others. Unpublished: 5. Loosen, P. T., Prange, A. J., Jr., Wilson, I. C., Lara, P. P. Pharmac. bio1
2.
1976, 5, suppl. 1, p. 95.
MEAN
(AND S.E.)
Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina 27514, U.S.A.
J. N. P. DAVIES
ALCOHOL AND ANTERIOR-PITUITARY SECRETION
chem. Behav.
and now we have failed to find them either 2 days or 7 days after chronic intoxication. Chronic alcohol abuse may induce the changes in hormone secretion proposed by Williams, but our findings imply that if these changes do occur, there must be a compensating depression of secretion when alcohol consumption stops. P. T. LOOSEN A. J. PRANGE,
MEDICAL-SCHOOL ENTRY
SIR,-Dr Connolly (Oct. 1S, p. 832) comments that a number of candidates for medical-school entry have had to resit their A levels in order to obtain the requisite grades, and he asks "Is this singleminded tenacity an adequate substitute for outstanding academic ability as a criterion for medical school admission?" The introduction of increasingly high academic requirements for medical-school entry may be an understandable device as an objective criterion for selection from a great number of applicants. It has been claimed that raising the academic standards of entry requirements has improved the passrate in final examinations; this may well be true. However, when medicine offers such a wide range of careers, with differing emphasis upon intellectual, technical, and social skills, there are, I think, many who question whether such emphasis upon academic prowess is wise. Measuring competence in passing examinations is relatively easy; measuring competence as a doctor, in all the varied aspects of clinical practice, is not. I do not think that I am alone in wishing to rephrase Dr Connolly’s question to: "Is outstanding academic ability necessarily the pre-eminent criterion for medical-school admission?" Holly Bush Lane, Sevenoaks, Kent TN13 3UN 8
ALAN GILMOUR
PREGNANCY AND DELIVERY UNDER BROMOCRIPTINE THERAPY
SIR,-The reports by Dr Jiirgensen and Dr Taubert (July 23, p: 203) and Dr Modena and Professor Portioli (Sept. 10,
558) prompt us criptine therapy.
p.
to
describe
a
33-week pregnancy
on
bromo-
A 26-year-old, nulliparous female presented with acromegaly, galactorrhoea, and secondary amenorrhcea. Plasmagrowth-hormone was 95 ng/ml, serum-prolactin was >50 ng/ml, and follicle-stimulating hormone and luteinising hormone concentrations were low. She was given bromocriptine (25 mg 4 times daily for 20 days, then 35 mg in 4 doses daily). During therapy, the plasma-growth-hormone and serum-pro-
lactin diminished and she started to menstruate. After 485 days therapy, the patient was found to be pregnant. Bromocriptine was continued at 35 mg daily. The pregnancy was normal until the 33rd week, when the patient went into labour,
SERUM-PROLACTIN AND SERUM-T.S.H. CONCENTRATION IN ALCOHOLICS AND NORMAL
*P
regions where these cancers are unusual than from of study hordes of patients in regions where these cancers abound. From the African continent are reported some of the lowest incidences of gastric and colonic cancer in the world. A patient there who has such a cancer is a rarity and worthy of detailed study. Britain in the past generously supported cancer studies in Africa which revealed these and other features of cancer there. Judicious investment in that continent might pay rich dividends of knowledge.
cancer
in
the
Department of Pathology, Albany Medical College, Albany, N.Y. 12208, U.S.A.
SIR,-Williams’ has suggested that alcohol may induce an increased secretion of prolactin, thyroid-stimulating hormone (T.S.H.), and melanocyte-stimulating hormone (M.S.H.) from the anterior pituitary gland which may influence breast and thyroid cancer and malignant melanoma. However, alcohol may not affect T.s.H. or thyrotrophin-releasing hormone (T.R.H.) induced T.S.H. release in normal men,2 and Ylikahri et al.3 found a diminished T.R.H.-induced prolactin response during alcohol-induced hangover in healthv volunteers. These studies suggest that alcohol does not stimulate T.s.H. and prolactin secretion in normal men. We gave T.R.H. (0-5 mg 4 times daily) to 22 chronically alcoholic men, 12 during acute alcohol withdrawal, and 14 during complete remission after withdrawal. 4 were tested on both occasions. Injections were given after an overnight fast when the patients were recumbent. Blood was collected, and serum preserved and assayed for prolactin, T.S.H., and growth hormone (G.H.) exactly as described elsewhere.4 A control group of 12 normal male volunteers were also given T.R.H. and samples were taken under the same conditions. At baseline, prolactin was significantly lower during alcohol withdrawal (see table). T.S.H. was also lower but not significantly so. In the post-withdrawal state, both hormone concentrations were normal. Prolactin response to T.R.H. was lower during withdrawal but not significantly so. The T.s.H. response was significantly lower during withdrawal but tended to recover in the postwithdrawal state. 4 men in withdrawal and 3 in the post-withdrawal state had blunted T.S.H. response, which we have also found in mental depression.5 The most exact test of Williams’ hypothesis’ would require a study of patients during chronic excessive alcohol intake but to our knowledge this has not been done. The predicted changes, however, did not occur in acutely intoxicated men’ -
Williams, R. Lancet, 1976, i, 996. Leppaeluoto, J., Rapeli, M., Varis, R., Ranta, T. Acta physiol. scand. 1975, 95, 400. 3. Ylikahn, R. H., Huttunen, M. O., Harkönen, M. Lancet, 1976, i, 1353. 4. Prange, A. J., Jr., and others. Unpublished: 5. Loosen, P. T., Prange, A. J., Jr., Wilson, I. C., Lara, P. P. Pharmac. bio1
2.
1976, 5, suppl. 1, p. 95.
MEAN
(AND S.E.)
Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina 27514, U.S.A.
J. N. P. DAVIES
ALCOHOL AND ANTERIOR-PITUITARY SECRETION
chem. Behav.
and now we have failed to find them either 2 days or 7 days after chronic intoxication. Chronic alcohol abuse may induce the changes in hormone secretion proposed by Williams, but our findings imply that if these changes do occur, there must be a compensating depression of secretion when alcohol consumption stops. P. T. LOOSEN A. J. PRANGE,
MEDICAL-SCHOOL ENTRY
SIR,-Dr Connolly (Oct. 1S, p. 832) comments that a number of candidates for medical-school entry have had to resit their A levels in order to obtain the requisite grades, and he asks "Is this singleminded tenacity an adequate substitute for outstanding academic ability as a criterion for medical school admission?" The introduction of increasingly high academic requirements for medical-school entry may be an understandable device as an objective criterion for selection from a great number of applicants. It has been claimed that raising the academic standards of entry requirements has improved the passrate in final examinations; this may well be true. However, when medicine offers such a wide range of careers, with differing emphasis upon intellectual, technical, and social skills, there are, I think, many who question whether such emphasis upon academic prowess is wise. Measuring competence in passing examinations is relatively easy; measuring competence as a doctor, in all the varied aspects of clinical practice, is not. I do not think that I am alone in wishing to rephrase Dr Connolly’s question to: "Is outstanding academic ability necessarily the pre-eminent criterion for medical-school admission?" Holly Bush Lane, Sevenoaks, Kent TN13 3UN 8
ALAN GILMOUR
PREGNANCY AND DELIVERY UNDER BROMOCRIPTINE THERAPY
SIR,-The reports by Dr Jiirgensen and Dr Taubert (July 23, p: 203) and Dr Modena and Professor Portioli (Sept. 10,
558) prompt us criptine therapy.
p.
to
describe
a
33-week pregnancy
on
bromo-
A 26-year-old, nulliparous female presented with acromegaly, galactorrhoea, and secondary amenorrhcea. Plasmagrowth-hormone was 95 ng/ml, serum-prolactin was >50 ng/ml, and follicle-stimulating hormone and luteinising hormone concentrations were low. She was given bromocriptine (25 mg 4 times daily for 20 days, then 35 mg in 4 doses daily). During therapy, the plasma-growth-hormone and serum-pro-
lactin diminished and she started to menstruate. After 485 days therapy, the patient was found to be pregnant. Bromocriptine was continued at 35 mg daily. The pregnancy was normal until the 33rd week, when the patient went into labour,
SERUM-PROLACTIN AND SERUM-T.S.H. CONCENTRATION IN ALCOHOLICS AND NORMAL
*P
