884 The first sample group consisted of 19 females and 83 males, age 40.6 years, and in the second series there were 43 females and 67 males, mean age 40-7. The greater proportion of females in the second series is unlikely to be the explanation for the difference in mean T4 value because in neither series was there a statistically significant difference between T4 concentrations for males and females. T was measured by radioimmunoassay, based on the method of Ratcliffe et al.,6 with an antiserum developed in our laboratory. The procedure was identical for both groups and the same person did all the analyses. A quality-control serum analysed during both periods of study showed no significant difference in mean value (first period 89.2+0.8 [s.E.M.] nmol/1; second period 9L4±0-61;f=l. 58, P> 0 - 1). This study was not designed to detect seasonal changes, and the observation was incidental to other work. Many factors will need to be investigated before cause-and-effect can be claimed. The difference, however, is quite striking and if it is due to seasonal variation this would have important consequences for the interpretation of plasma-thyroxine values in clinical diagnosis. We plan to pursue this matter further during the coming Australian winter and subsequent summer. mean
together with
those obtained after three months treatment are shown below. There was no significant decrease in either calcium or P.T.H. concentrations in the intervening period (see
table).
,
Although a histological diagnosis was lacking in our patients the evidence for primary hyperparathyroidism was strong and the results suggest that propranolol is ineffective in this condition.
J. P. MONSON Department of Metabolism London Hospital,
and
M. BEER B. J. BOUCHER R. D. COHEN
Endocrinology,
London E1 1BB
CELL-MEDIATED IMMUNITY TO EPSTEIN-BARR VIRUS IN NASOPHARYNGEAL CARCINOMA
SIR,-An association between Epstein-Barr Virus (E.B.v.) and nasopharyngeal carcinoma (N.P.C.) is well documented. Patients with N.P.c. have high antibody titres to E.B.v.-associated antigens’ and E.B.V. viral genome has been found in
We thank Dr M. Davey of the Red Cross Blood Transfusion for supplying the blood specimens.
G. H. MCLELLAN
Department of Biochemistry, Royal Perth Hospital,
W. J. RILEY C. P. DAVIES
Perth, Western Australia
PROPRANOLOL IN PRIMARY HYPERPARATHYROIDISM
SIR,-A chance finding suggested that propranolol may have been lowering calcium and parathyroid hormone (P.T.H.) concentrations in a patient with many features of primary hyperparathyroidism.’ In addition a retrospective survey of patients with renal osteodystrophy, both on and off propranolol, demonstrated a possible P.T.H.-lowering effect of the drug,2 presumably due to blockade of sympathetic stimulation of the
parathyroid glands. We have investigated the effects of propranolol on calcium and’P.T.H. concentrations in two patients with probable priPLASMA CALCIUM, PHOSPHATE, AND P.T.H. VALUES BEFORE AND AFTER THREE MONTHS OF PROPRANOLOL THERAPY
I
I
I
* Corrected to plasma-albumin 46 g/1 (0 - 02 mmol/1 per g albumin). For calcium 1 mmol/1 4 mg/dl ; for phosphate 1 mmol/1 =3-1 1 mg/dl.
mary hyperparathyroidism but in whom neck exploration had been unsuccessful. Both patients had persistent mild-to-moderate hypercalcaemia of at least eighteen months’ duration, hypophosphat2emia, increased P.T.H. concentrations, and ratios of tubular maximal capacity for phosphate to glomerular filtration-rate of 0.44 and 0 -7 mmol/l. Each patient was given propranolol 10 mg four times a day increasing to 40 mg four times a day over seven days. Fasting plasma calcium, phosphate, and P.T.H. concentrations were measured weekly for a month and again at two and three months after the start of therapy. Plasma-p.T.H. was assayed by a modification of the method of Berson et al. with M.R.C. antiserum AS/211/32 kindly supplied by the National Institute for Biological Standards and Control. The initial results 6. Ratcliffe, W.
A., and others. Clin. Endocr. 1974, 3, 481. Caro, J. F, Besareb, A., Lancet 1978, i, 827. 2 Caro, J. F, Besareb, A., Burke, J. F., Glennon, J. A. ibid. 1978, ii, 451. 3. Berson, S. A., and others Proc. natn Acad Sci U.S.A. 1963, 49, 613. 1.
10"
10"
EBV
10’
(particles
10"
per mU
curve of lymphocytes from 30 N.P.C. patients and from 20 controls against E.B.V. virion antigen as assessed by thymidine-uptake assay.
Dose-response
cells.2 High antibody titres to E.B.v. viral capsid antigen and early antigen have been associated with poor prognosis whereas high antibody titres as measured in the antibodydependent lymphocyte cytolysis assay are associated with good prognosis.3-s It has been suggested that high E.B.v. antibody titres may be the result of depressed cell-mediated immunity
N.P.C. tumour
(C.M.I.).6 Since newly diagnosed N.P.C. patients have depressed general C.M.I. it is important to assess C.M.I. to E.B.v. antigens in these patients. C.M.I. to sucrose-gradient-banded E.B.V. virion anugen 1. Henle, W., and others J. natn. Cancer Inst. 1970, 44, 2. zur Hausen, H., and others Nature, 1970, 228, 1056.
225.
together with
those obtained after three months treatment are shown below. There was no significant decrease in either calcium or P.T.H. concentrations in the intervening period (see
table).
,
Although a histological diagnosis was lacking in our patients the evidence for primary hyperparathyroidism was strong and the results suggest that propranolol is ineffective in this condition.
J. P. MONSON Department of Metabolism London Hospital,
and
M. BEER B. J. BOUCHER R. D. COHEN
Endocrinology,
London E1 1BB
CELL-MEDIATED IMMUNITY TO EPSTEIN-BARR VIRUS IN NASOPHARYNGEAL CARCINOMA
SIR,-An association between Epstein-Barr Virus (E.B.v.) and nasopharyngeal carcinoma (N.P.C.) is well documented. Patients with N.P.c. have high antibody titres to E.B.v.-associated antigens’ and E.B.V. viral genome has been found in
We thank Dr M. Davey of the Red Cross Blood Transfusion for supplying the blood specimens.
G. H. MCLELLAN
Department of Biochemistry, Royal Perth Hospital,
W. J. RILEY C. P. DAVIES
Perth, Western Australia
PROPRANOLOL IN PRIMARY HYPERPARATHYROIDISM
SIR,-A chance finding suggested that propranolol may have been lowering calcium and parathyroid hormone (P.T.H.) concentrations in a patient with many features of primary hyperparathyroidism.’ In addition a retrospective survey of patients with renal osteodystrophy, both on and off propranolol, demonstrated a possible P.T.H.-lowering effect of the drug,2 presumably due to blockade of sympathetic stimulation of the
parathyroid glands. We have investigated the effects of propranolol on calcium and’P.T.H. concentrations in two patients with probable priPLASMA CALCIUM, PHOSPHATE, AND P.T.H. VALUES BEFORE AND AFTER THREE MONTHS OF PROPRANOLOL THERAPY
I
I
I
* Corrected to plasma-albumin 46 g/1 (0 - 02 mmol/1 per g albumin). For calcium 1 mmol/1 4 mg/dl ; for phosphate 1 mmol/1 =3-1 1 mg/dl.
mary hyperparathyroidism but in whom neck exploration had been unsuccessful. Both patients had persistent mild-to-moderate hypercalcaemia of at least eighteen months’ duration, hypophosphat2emia, increased P.T.H. concentrations, and ratios of tubular maximal capacity for phosphate to glomerular filtration-rate of 0.44 and 0 -7 mmol/l. Each patient was given propranolol 10 mg four times a day increasing to 40 mg four times a day over seven days. Fasting plasma calcium, phosphate, and P.T.H. concentrations were measured weekly for a month and again at two and three months after the start of therapy. Plasma-p.T.H. was assayed by a modification of the method of Berson et al. with M.R.C. antiserum AS/211/32 kindly supplied by the National Institute for Biological Standards and Control. The initial results 6. Ratcliffe, W.
A., and others. Clin. Endocr. 1974, 3, 481. Caro, J. F, Besareb, A., Lancet 1978, i, 827. 2 Caro, J. F, Besareb, A., Burke, J. F., Glennon, J. A. ibid. 1978, ii, 451. 3. Berson, S. A., and others Proc. natn Acad Sci U.S.A. 1963, 49, 613. 1.
10"
10"
EBV
10’
(particles
10"
per mU
curve of lymphocytes from 30 N.P.C. patients and from 20 controls against E.B.V. virion antigen as assessed by thymidine-uptake assay.
Dose-response
cells.2 High antibody titres to E.B.v. viral capsid antigen and early antigen have been associated with poor prognosis whereas high antibody titres as measured in the antibodydependent lymphocyte cytolysis assay are associated with good prognosis.3-s It has been suggested that high E.B.v. antibody titres may be the result of depressed cell-mediated immunity
N.P.C. tumour
(C.M.I.).6 Since newly diagnosed N.P.C. patients have depressed general C.M.I. it is important to assess C.M.I. to E.B.v. antigens in these patients. C.M.I. to sucrose-gradient-banded E.B.V. virion anugen 1. Henle, W., and others J. natn. Cancer Inst. 1970, 44, 2. zur Hausen, H., and others Nature, 1970, 228, 1056.
225.
