Effect of acute and chronic androgen suppression by glucocorticoids on gonadotropin levels in hirsute women

Hirsute women may have increased serum LH levels and increased ratios of LH to FSH in serum as well as increased serum androgen levels. Glucocorticoid therapy lowers serum testosterone (T) levels in some hirsute women, but no significant effects on gonadotropin levels have been reported. Sixty hirsute women had serum T, LH, and FSH levels measured before and after acute and chronic glucocorticoid administration. Both acute and chronic treatment resulted in significant suppression of T levels. Serum LH levels significantly decreased after chronic therapy. Significant direct correlations were found between T and LH or T and the LH to FSH ratio, both before and after therapy. In 11 women with normal T levels, acute or chronic glucocorticoid treatment did not produce a significant change in LH levels or LH to FSH ratios. Women (n = 26) with elevated T levels that were suppressed more than 50% during treatment had significant decreases in their mean LH levels and LH to FSH ratios. No significant change in mean LH or LH to FSH ratio occurred in women (n = 23) with elevated T levels that were not suppressed by 50%. These results demonstrate that chronic, but not acute, glucocorticoid-induced suppression of T levels in hyperandrogenic hirsute women results in lowering of LH and LH to FSH ratios.

Testosterone, dehydroepiandrosterone, and dehydroepiandrosterone sulfate in hyperandrogenic women

Serum levels of testosterone (T), dehydroepiandrosterone (DHEA), and DHEA sulfate (DHEA-S) were measured in a group of 285 women with clinical signs of hyperandrogenism (hirsutism and/or acne). Levels of T were elevated in 75.8% of the patients, DHEA in 57.5%, and DHEA-S in 20%. Normal levels of all 3 androgens were found in 13.3%. Significant correlations were demonstrated among levels of all androgens. Only 7.7% of the patients had elevated levels of DHEA in the presence of normal T, and 3.2% had elevated DHEA-S and normal T levels. Subdivision of the study population on the basis of presence of acne, hirsutism, or both demonstrated no significant differences in androgen levels. Amenorrheic women had higher serum T levels than those with menstrual cycles. Women with laparoscopically demonstrated polycystic ovaries had significantly higher serum androgen levels than hyperandrogenic women with no laparoscopic evidence for polycystic ovarian disease. All 285 patients were treated with chronic low dose prednisone therapy. Overall suppression of all 3 androgens occurred in a large proportion of the patients. The pretreatment levels of DHEA or DHEA-S did not predict the responsiveness of T to chronic glucocorticoid therapy. On the other hand, a 2-day dexamethasone (DEX) suppression test quantitatively predicted the degree of T suppression achieved by chronic therapy. An overnight DEX suppression test was considerably less precise for this purpose. In conclusion, chronic low dose prednisone therapy resulted in suppression of serum T levels in a large proportion of women with hyperandrogenism of undetermined cause. The response to therapy could not be predicted on the basis of pretreatment serum DHEA or DHEA-S levels, but was predicted with a 2-day DEX suppression test.

Acne and hyperandrogenism: impact of lowering androgen levels with glucocorticoid treatment

The impact of lowering androgen levels with glucocorticoid treatment in a group of consecutive female patients presenting to the Department of Reproductive Medicine and Biology, University of Texas, with a chief complaint of acne has been studied. One hundred fifty-eight patients, ages 16 to 40, who received prednisone at a maximum daily dose ranging from 7.5 to 15 mg for a period of at least 6 months were selected for the study. These patients were not taking other systemic medication affecting androgens or acne. Only thirty patients (19%) had pretreatment testosterone levels below the upper limits (40 ng/dl) of our normal range; while on treatment 146 patients (92.4%) had testosterone levels below 40 ng/dl. In sixty-three patients (39.9%) the acne completely cleared, in eighty patients (50.6%) it significantly improved, and in only fifteen patients (9.5%) was the acne not affected by the medication. There was a highly significant difference between the mean testosterone levels during treatment of those who cleared or improved, versus those who did not (p less than 0.05), the percentage drop in testosterone being greatest in those who cleared. Pretreatment testosterone levels were not significantly different in those who cleared, improved or did neither. It is concluded that glucocorticoid treatment frequently results in a lowering of androgen levels in hyperandrogenic women with acne and that this is associated with clearing or improvement of the acne.

Fecal Isolation of Corynebacterium equi from a Foal with Chronic Diarrhea

Corynebacterium equi was isolated from the feces of a foal with chronic diarrhea. The foal had multiple walnut-sized masses associated with the intestine on rectal examination. These were thought to be enlarged lymph nodes and/or abscesses. The foal also had an elevated plasma fibrinogen. The diarrhea was controlled with antibiotics but recurred when the treatment was stopped.

Diaphanography as a means of detecting breast cancer

Diaphanography (lightscanning) is a noninvasive method of examining the breast by transillumination using visible or infrared light. It was compared to xeromammography in 1,000 patients, 91 of whom had biopsy. There were 34 malignant tumors, of which 29 were detected by xeromammography and 26 by lightscanning; 27 patients with positive lightscans were not biopsied. All patients with true-positive lightscans also had positive mammograms. Major criteria of malignancy on diaphanography included an area of light absorption and abnormal or hypervascularity. These criteria could be demonstrated on retrospect on 6 scans previously considered negative; one xeromammogram previously interpreted as negative was diagnosed as positive on retrospect. Diaphanography may be sensitive enough to warrant further investigation.

Acne and hyperandrogenism

Elevated serum androgen levels have been reported in patients with acne resistant to conventional dermatologic therapy. This study was designed to investigate the relationship between serum androgen levels and the presence of acne in an unselected population of women seen consecutively by a dermatologist for various dermatologic complaints. Elevated serum testosterone levels were associated with acne regardless of whether this was the presenting complaint or an incidental finding. Women with both acne and hirsutism had higher serum testosterone levels than those with acne alone. Higher incidence of irregular menstrual cycles was noted in women complaining of acne. Normal serum testosterone levels were found only in those patients with regular menstrual cycles and the absence of acne or hirsutism. In conclusion, this study suggests that elevated serum testosterone levels are related to the presence of acne. Attention is called to the possibility that acne may be a clinical manifestation of a disorder with systemic and reproductive consequences.

Transcripts homologous to a long repeated DNA element in the human genome

Using three cloned DNA fragments from a 6.4-kb (kilobase pair) DNA element repeated several thousand times in the human genome (Adams, J. W., Kaufman, R. E., Kretschmer, P. J., Harrison, M. and Nienhuis, A. W. (1980) Nucleic Acids Res. 8, 6113-6128) and DNA/RNA hybridization, we show that transcripts homologous to this DNA family exist in total cellular RNA from human blood cells and from a mouse-human hybrid cell line with one human chromosome, the X. No such transcripts were detected in RNA from rabbit blood or a mouse cell line. For each DNA fragment studied, we found that blood transcripts and X-chromosome transcripts were indistinguishable in electrophoretic mobility and very heterogeneous in length; in addition, prominent hybridization bands were seen at 4.7 and 1.9 kb. Transcription from this DNA family likely occurs from heterogeneous templates. The existence of RNAs smaller than 6.4 kb suggests that part of the repeat unit can be transcribed and/or there exists a cellular mechanism to make these short RNAs from longer precursors. The vast majority of the RNAs homologous to the long repeat are not polyadenylated. In blood RNA there are a few hundred copies of beta-globin mRNA for every transcript homologous to this 6.4 kb repeat.

Use of repetitive DNA for diagnosis of chromosomal rearrangements

We have used two repeated DNA fragments (3.4 and 2.1 kb) released from Y chromosome DNA by digestion with the restriction endonuclease Hae III to analyze potential Y chromosome/autosome translocations. Two female patients were studied who each had an abnormal chromosome 22 with extra quinacrine fluorescent material on the short arm. The origin of the 22p+ chromosomes was uncertain after standard cytologic examinations. Analysis of one patient's DNA with the Y-specific repeated DNA probes revealed the presence of both the 3.4 and 2.1kb Y-specific fragments. Thus, in this patient, the additional material was from the Y chromosome. Analysis of the second patient's DNA for Y-specific repeated DNA was negative, indicating that the extra chromosomal segment was not from the long arm of the Y chromosome. These two cases demonstrate that repeated DNA can distinguish between similar appearing aberrant chromosomes and may be useful in karyotypic and prenatal diagnosis.

Isolation and characterization of a major tandem repeat family from the human X chromosome

We report the identification and characterization of a family of repeated restriction fragments whose molecular organization is apparently specific to the human X chromosome. This fragment, identified as an ethidium bromide-staining 2.0 kilobase (kb) band in BamHI-digested DNA from a Chinese hamster-human somatic cell hybrid containing a human X chromosome, has been cloned into pBR325 and characterized. The 2.0 kb repeated family has been assigned to the Xp11 leads to Xq12 region on the X by Southern blot analysis of somatic cell hybrids and is predominantly arranged in tandem clusters of up to seven 2.0 kb monomers. Homologous DNA sequences, not organized as 2.0 kb BamHI fragments, are found elsewhere on the X chromosome and on at least some autosomes, but are not found on the Y chromosome. From a dosing experiment using various amounts of the cloned repeat, we estimate that there are 5,000-7,500 copies of the 2.0 kb BamHI repeat per haploid genome. Since the vast majority, if not all, of these are confined to the X chromosome, this repeated DNA family must account for 5-10% of all X chromosome DNA and must constitute the major sequence component of the pericentromeric region of the X.

Adjuvants to immunological methods for mRNA purification. Application to the isolation of mRNA for carbonic anhydrase I from rabbit reticulocytes

In order to generate the molecular probes needed to investigate the seemingly coordinate expression of carbonic anhydrase (CA I) and beta-globin within erythrocytes during human development, CA I-containing polyribosomes have been isolated from rabbit reticulocytes by reaction with purified antibodies to CA I followed by immunoadsorption of immune complexes with formalin-fixed protein A-bearing bacteria. In the course of such isolation, a series of maneuvers were seen to have a markedly favorable influence on the level of purity attained. These maneuvers include the use of 5 mg/ml of heparin concentrations to attenuate nonspecific binding and entrapment of unwanted polyribosomes, the addition of 200 units/ml of placental ribonuclease inhibitor to augment recovery in reactions which by test already appeared RNase-free, and the preadsorption of polyribosomes with formalin-fixed bacteria prior to immunological reaction so as to remove a subset of polyribosomes seemingly predisposed to nonspecific binding. In the absence of all of the maneuvers, attained purity was no greater than a few per cent. When all were employed, CA I-mRNA derived from immunopurified polyribosomes was recovered with more than 80% purity and 20% yield, as evident from both immunoassays and electrophoresis of its cell-free products.

Evolution of human Y-chromosome DNA

We have used human male-specific 3.4 kb Hae III restriction endonuclease fragments to explore the evolutionary history of man's Y-chromosome. We have identified four sets of reiterated sequences on the basis of their relative sequence homology with autosomal DNA. The sequences account for approximately 40% of the human Y-chromosome, are interspersed within the same 3.4 kb Hae III fragments, are heterogeneous and contain all reiterated DNA previously demonstrated to be specific for the Y-chromosome (it-Y DNA). Y-specific 3.4 kb Hae III sequences do not reassociate with either human female or ape DNA at standard reassociation criteria. However, approximately half of it-Y DNA (cross reacting it-Y) reassociates with both human female and ape DNA at reduced reassociation criteria. The remaining half (Y-specific it-Y) retains its specificity for the human Y-chromosome. These two sets of it-Y DNA have distinct reiteration frequencies and thermal stabilities with their Y-chromosome homologs. Non-Y-specific 3.4 kb Hae III sequences reassociate with both human female and ape DNA at standard reassociation criteria. The abundance of these non-Y-specific sequences decreases as a function of their evolutionary distance for man. One subset of non-Y-specific 3.4 kb Hae III sequences forms stable duplexes with human Y-chromosome DNA and with human and ape autosomal DNA. No detectable base-mismatch occurs among these homologs suggesting complete conservation of these sequences during primate evolution. The second subset of Non-Y-specific Hae III sequences form stable duplexes with human Y-chromosome DNA but highly mismatched duplexes with human and ape autosomal DNA. The finding that homologs of 3.4 kb Hae III sequences are not found within the Y-chromosome of apes but are only present in autosomes suggests that 3.4 kb Hae III sequences are largely autosomal in origin. Since autosomal homologs of most 3.4 kb Hae III-sequences exhibit a greater degree of divergence that those localized to the Y-chromosome, their evolutionary history seems to be chromosome-dependent. Our findings are not easily correlated with the comparative morphology of primate Y-chromosomes and suggest that sequence rearrangement has been a major event in the evolution of the human Y-chromosome. The significance of the specific interspersion of four sets of reiterated sequences, with distinct evolutionary histories, within a repeating unit specific to the human Y-chromosome is not clear. The apparent conservation of at least some of these reiterated sequences suggests they may be of functional importance.

Circannual rhythm in human sperm count revealed by serially independent sampling

Sperm concentration and total sperm counts from single semen and samples from each of 4435 patients requesting vasectomy between September 1972 and December 1977 were analyzed for circannual (about 1 year) rhythmicity. Although large temporal variations were found both between years and within years, a trend was noted for higher sperm concentration during the winter than during the summer. When the entire series of data were analyzed by months, a strong circannual pattern was apparent, with the highest sperm counts between February and March and the lowest counts during September. To the authors' knowledge, this is the first report of a circannual rhythm in human sperm concentration and total sperm count. The data must be considered preliminary, but if confirmed by other investigators studying comparable populations, the influence on clinical investigations will be profound.

Endocrine problems and treatment

All drugs employed for the purpose of improving sperm production, motility, viability, and morphology may be expected to have positive effects in some patients. However, the wide variation in these measures in all men make the confirmation of beneficial effects difficult. It is likely that definitive therapy of the infertile male will not be very successful until the causes of idiopathic oligospermia can be clearly elucidated. At that time, it is possible that definitive therapy may be devised. Until then, the clinician can expect to continue to read controversial reports about the effects of various therapeutic agents on male infertility. Even varicocele ligation, long considered one of the few definitive therapies of oligospermia or azoospermia does not appear to be equally effective in all series. In our own series, varicocele ligation has been of little benefit to those men who need it most, those with sperm counts below 10 million/ml (11).

Response of the adrenal to adrenocorticotropic hormone (ACTH) in hyperandrogenic women treated chronically with low doses of prednisone

A group of 43 women of reproductive age with clinical signs of hyperandrogenism was treated with a low dose (7.5 mg daily) of prednisone. An acute dexamethasone (DEX) suppression-adrenocorticotropic hormone (ACTH) stimulation test was performed before and after a minimum of 2 months of prednisone administration. The therapy produced a significant decrease of plasma testosterone (T) levels in a majority of patients. During the treatment period DEX failed to induce further suppression, while ACTH caused a significant rise in plasma T levels. The cortisol (F) levels were suppressed during treatment, but their response to ACTH stimulation was similar to that observed prior to initiation of therapy.

The prognostic value of acute adrenal suppression and stimulation tests in hyperandrogenic women

A group of 106 consecutively seen hyperandrogenic women were subjected to an acute adrenal suppression and stimulation test. The results of these tests were analyzed with respect to androgen suppression achieved after chronic glucocorticoid therapy in the same patients. The data suggested that an acute dexamethasone test may identify the group of hyperandrogenic women who respond poorly to chronic glucocorticoid therapy. This group of patients were found to have elevated luteinizing hormone (LH) levels and LH/follicle-stimulating hormone (FSH) ratios, suggesting the possibility of an LH-related hyperandrogenism. In patients whose elevated testosterone levels were suppressed by dexamethasone, adrenocorticotropic hormone (ACTH) induced a prompt return of the testosterone levels to baseline, suggesting an ACTH-dependent hyperandrogenism. In these patients, the degree of testosterone suppression after dexamethasone was not quantitatively related to the degree of testosterone suppression after chronic glucocorticoid therapy. In all cases chronic therapy resulted in a greater suppression of androgen levels than the acute dexamethasone test. In conclusion, an acute dexamethasone suppression test appears to be of clinical value in the management of the hyperandrogenic female, particularly in identification of women who will not respond to chronic glucocorticoid suppression therapy.

The influence of ovulatory dysfunction and timing of insemination on the success of artificial insemination donor (AID) with fresh or cryopreserved semen

The influence of ovulatory dysfunction and timing of insemination on the success of AID with either fresh or cryopreserved semen was investigated. A total of 238 patients were inseminated, resulting in 170 pregnancies during 1201 insemination cycles, an average of 5.0 cycles per pregnancy. Pregnancy rates were similar in those patients receiving either fresh or cryopreserved semen, but the number of cycles required for pregnancy to occur was doubled in the latter group. Ovulatory dysfunction further delayed the number of cycles before conception. The poorest results occurred in those patients with ovulatory dysfunction receiving cryopreserved semen. The timing of insemination was more important in patients receiving cryopreserved semen than those receiving fresh semen. With cryopreserved semen, pregnancy was not likely to occur unless the insemination was performed on the day of ovulation. These data suggest that frozen semen is less efficacious than fresh semen, a difference that is compounded by the presence of ovulatory dysfunction in the recipient. It is possible that an increase in the frequency of insemination from every other day to daily may improve the results of AID with cryopreserved semen.

Isolation and characterization of cloned human DNA fragments carrying reiterated sequences common to both autosomes and the X chromosome

Several recombinants were identified and purified from a cloned library of human DNA by virtue of their homology to DNA from a mouse-human hybrid cell line containing a single human chromosome, the X, and their lack of homology to mouse DNA. Three recombinants were characterized in detail, and all were homologous to reiterated DNA from the human X chromosome. These recombinants also were homologous to reiterated sequences on one or more human autosomes and, therefore, were not X chromosome specific. The recombinant DNA fragments homologous to human reiterated X DNA were the same fragments homologous to human reiterated autosomal DNA. Digestion of genomic DNAs with several restriction enzymes revealed that the pattern of fragments homologous to one recombinant, lambda Hb2, was the same on autosomes as on the X chromosome, suggesting that the molecular organization of these elements on the X is not distinct from their organization on autosomes.

Population heterogeneity of the Hpa I restriction site associated with the beta globin gene: implications for prenatal diagnosis

The Hpa I restriction endonuclease site polymorphism that results in some human beta globin genes being contained in a 13-kilobase (kb) DNA restriction fragment rather than in the usual 7.6-kb fragment has been reported to be in linkage disequilibrium with the beta S mutation. The frequency of the 13-kb fragment among Baltimore black sickle cell (SS) disease patients (58%) is lower than that reported for San Francisco black SS disease patients (87%) and similar to that reported for such New York patients (59%). There is, then, considerable heterogeneity among American black populations. Therefore, for the purposes of prenatal diagnosis, the frequency in the particular population at risk should be established. When the frequency of association of the 13-kb fragment and the beta S mutation is low, the linkage phase must also be established. When the linkage phase is known, the Hpa I pattern alone can exclude SS disease 54% of the time for Baltimore AS X AS couples.