Prospective observations over a ten-year period of 108 juvenile diabetics treated with unmeasured diet are reported. Description is given of the patient material, circumstances at diagnosis, and course of management. Hyperglycemia and glycosuria were common, and ketoacidosis occurred often. Total plasma lipidswere elevated. Chemical control was unsatisfactory according to current popular standards. Growth was less in those with onset before puberty, and the men were underweight. Infections may have been excessive. Adolescent emotional difficulties were exaggerated. Educational, athletic, and vocational achievements probably equaled the normal expectation. Pregnancies were only 55 per cent successful when fetuses were viable. The prevalence of degenerative complication was similar to that reported from restricted diet studies. No factors were found to account for vascular disease. It is surmised that the general course of the patients compared favorably to those reported to be following diets. It is also suggested that if diet control does have favorable effects, then those reported to follow diets are not following them, or factors other than control are more influential on the progression of juvenile diabetic vascular disease.

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Studies were made of glucose tolerance and other characteristics related to diabetes in fifty-one patients with hyperthyroidism. Glucose tolerance compatible with diabetes was present in 57 per cent of patients when toxic and 30 per cent on return to euthyroidism. Histories of family diabetes in both sexes and of heavy babies delivered by the women were obtained more frequently than expected in the general population. Reasons are given to suggest a genetic relation between hyperthyroidism and diabetes. DIABETES 14:740-44, November 1965.The prevalence of diabetes mellitus in clinical hyperthyroidism is not known with certainty. Estimates of 2.0 to 3.3 per cent have been given, figures little different from that expected for genetic diabetes in the general population. 1 Since this frequency seemed lower than that encountered on the Medical Service at the Cincinnati General Hospital, studies were made of glucose tolerance in hyperthyroid patients over a three-year period. In addition, observations were made of other traits related to genetic diabetes mellitus. METHODS(1) Patients. The sample for study included all patients in whom the diagnosis of hyperthyroidism was made by the Medical Service of the Cincinnati General Hospital from 12/1/60 to 11/30/63. There were fortyfour women and seven men. The mean age was fortythree years. The distributions of thyroid disease and ages are given in table 1.(2) Assessment of thyroid function. Hyperthyroidism was diagnosed by symptoms, signs, and appropriate tests. The mean weight loss claimed was twenty-five pounds or 16.5 per cent of pretoxic weight. The mean

Plasma kinetics and metabolism of labeled dexamethasone were evaluated in nine subjects before and after administration of diphenylhydantoin. Labeled dexamethasone was injected intravenously followed by frequent sampling of blood and urine. The labeled dexamethasone in plasma was isolated chromatographically. Total urine and fractional radioactivity after solvent extraction (chloroform and ethyl acetate), with and without glucuronide hydrolysis, were determined. Baseline plasma equilibrated tj4's and metabolic clearance rates (2 compartment model) ranged from 167 to 368 minutes and 222 to 456 liters/day, respectively. After diphenylhydantoin there were consistent decreases in t j^ and increases in metabolic clearance rate; mean changes -5 1 % and -f-140% respectively.Mean recovery of urinary radioactivity at 4 and 24 hours was 16 and 64 percent of dose respectively. The largest fraction was a more polar unconjugated one, 7 and 31 percent of dose at 4 and 24 hours. Following diphenylhydantoin there was a significant increase in rate of appearance of radioactivity in urine, the greatest increase being in the more polar unconjugated fraction.It is concluded that 1) the metabolic kinetics of plasma dexamethasone vary considerably among individuals and 2) diphenylhydantoin administration markedly hastens removal rate of dexamethasone from plasma mainly by increasing conversion to more polar metabolites. ( / Clin Endocr 34: 44, 1972) A LTHOUGH synthetic glucocorticoids have been employed clinically for several years little attention has been given to their metabolism. Our interest in this problem developed a few years ago when it was noted that diphenylhydantoin (DPH) inhibited the effectiveness of dexamathasone during standard plasma dexamethasone suppression tests (1). The current report describes studies of plasma disappearance and metabolic clearance rates of circulating labeled dexamethasone, of rate of appearance of radioactivity in urine fractions and of the manner in which DPH affects these measurements.Jubiz et al. have reported on certain aspects of this problem (2). It was demon-

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