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The aim of this study was to clarify the extent of bone mineral deficiency in patients with Klinefelter's syndrome on the premise that testosterone substitution could prevent this deficiency. Bone mineral density was measured by single-photon absorptiometry in 42 patients with Klinefelter's syndrome, (21 patients without therapy, 10 with testosterone substitution before the age of 20 and 11 patients with testosterone substitution beginning after the age of 20). We found significantly lower bone mineral density in patients without therapy and in patients when the therapy began later compared to normal individuals. Patients with early therapy showed a high proportion of normal values of bone mineral density. We found a positive correlation between bone mineral density and plasma testosterone and a negative correlation between plasma testosterone and age for patients without therapy. These findings suggest that low testosterone levels before or during puberty cause inadequate bone development and low bone mineral density in Klinefelter's syndrome. Only early testosterone substitution may prevent bone mineral deficiency. Later substitution no longer affects bone mineral density.

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Fifteen patients with a total of 16 islet-cell tumors 7-20 mm in diameter (average, 12 mm) were examined preoperatively by computed tomography (CT) and ultrasound. Seven out of 16 tumors were detected by CT and 9 out of 15 by ultrasound. Marked contrast enhancement was seen on dynamic CT scans following a bolus injection, while a circumscribed, hypoechoic mass was seen on ultrasound. Tumors of the tail of the pancreas and those outside the pancreas were difficult to detect. Ultrasound is recommended as the initial step for locating islet-cell tumors, followed by CT; angiography and transhepatic venous sampling should be restricted to tumors which are not detectable by other methods. Intraoperative ultrasound was successful in 3 patients and may facilitate the operative search.

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