Complete androgen insensitivity with a normal amount of 5 alpha-dihydrotestosterone-binding activity in labium majus skin fibroblasts

We have studied labium majus skin fibroblast strains from six unrelated, previously unreported, patients with complete androgen insensitivity (CAI). Four have markedly reduced specific 5 alpha-dihydrotestosterone-binding (DHT-binding) activity (receptor-negative). The other two (receptor-positive) have normal activities in whole-cell homogenates, the 100,000g supernatant of cell sonicates prepared in 0.4 MKCl, purified whole nuclei, and the nuclear fraction that resists extraction with 0.4 MKCl. In one of the two, the DHT-binding macromolecules in the cytosol and 0.4 M KCl-extractable nuclear fraction have normal molecular sieving profiles and binding activities. One of the receptor-positive patients has maternally related affected relatives in three successive genetations. Appreciable unexplained interexperimental variation of the DHT-binding activities in genital skin fibroblast strains demands that multiple assays be performed on a strain before its receptor status is classified quantitatively. In our experience to date with genital skin fibroblasts, four of 13 propositi with CAI have been receptor-positive.

Some properties of the specific androgen-binding activities in cultured human genital skin fibroblasts

Specific 5 alpha-dihydrotestosterone (DHT)-binding activity in the cytosol (C) and 0.4 M KCl-extractable nuclear fraction (N) of cultured human fibroblast cell strains developed from preputial (n = 12) and labium majus (n = 12) skin were analyzed by gel exclusion chromatography, sucrose gradient sedimentation, and thermostability. Both fractions had activities that were excluded from Sephacryl S-200 columns; another component (mol wt, 20,000) was present in the N fraction. The C was more thermostable than a homologous N activity, and addition to the former of KCl to 0.4 M had no effect. There was large, overlapping variation in thermostability of the C and N activities among strains from either site, sister strains developed from a single skin biopsy, and even among serial subcultures within a strain; likewise, the variable sedimentability of the C (4-7S) and N (3.2-5.9S) activities prevented their consistent discrimination. Each type of variation occurred despite excellent intraexperimental replication. The thermostability of a given N activity varied directly with its sedimentation coefficient. By cluster analysis, the data relating thermostability of a given N activity with the percentage of 0.4 M KCl-resistant nuclear activity segregated into two populations; within each population these two measurements were related inversely. We suggest that these coordinate behaviors of the N activity reflect intrinsic properties of the androgen-receptor system in normal genital skin fibroblasts which may be useful for defining qualitative aberrations of the system in receptor-positive forms of congenital androgen insensitivity.

5alpha-reductase activity of genital and nongenital skin fibroblasts from patients with 5alpha-reductase deficiency, androgen insensitivity, or unknown forms of male pseudohermaphroditism

Serially subcultured fibroblast strains from genital (foreskin, labium majus) skin, as a group, have considerably more steroid (testosterone) 5alpha-reductase activity than those form nongenital skin. Foreskin strains varied 40-fold and labial strains even more. Labial strains overlapped nongenital strains of either sex more frequently than did prepuce strains. The activity of foreskin strains from two siblings with proven 5alpha-reductase deficiency was clearly lower than that of any of 18 control stains. The comparative behavior of the various strain types indicates that labial and nongenital strains should not be used to support a clinical suspicion of male pseudohermaphroditism due to 5alpha-reductase deficiency. The activities of labial strains from patients with complete androgen insensitivity (testicular feminization) - five with the receptor-negative variety and two with the receptor-positive type - were as variable as those of control labial strains. The decreased 5alpha-reductase activity observed in fresh skin slices of some patients is probably and expression of their functional estrogen/androgen imbalance in vivo.

Male pseudohermaphroditism: diagnosis in cell culture

Testicular feminization is a classic form of complete male pseudohermaphroditism. The individuals have a normal XY karyotype but unambiguously female external genitalia. They have congenital complete insensitivity to androgen due to an X-linked mutation. In four patients (from tow families with several affected members) with the typical phenotype of testicular feminization, a severe deficit of specific androgen-binding activity was detected in cultured fibroblasts from labium majus skin. Measurement of this activity in genital skin fibroblasts improves the differential diagnosis in patients with complete or imcomplete male pseudohermaphroditism before puberty.

Stilbestrol administration in the puerperium and its effect on the prolactin excretion of non-lactacting patients

The relationship between stilbestrol treatment and placebo treatment was studied in 2 groups of non-nursing patients. Plasma prolactin levels were evaluated in these 2 groups on day 1, 3 and 7 of the treatment, by a radioimmunoassay technique with the double antibody method using Serono hPRL kit. Our results show that prolactin values increased significantly in the stilbestrol-group and decreased in the placebo group. It seems that the main reason for "the drying up of milk" is the lack of stimulation of the nipples, which after a releatively constant time of 5--10 days will lead to decreased prolactin levels. Stilbestrol treatment is not effective in "drying up" the milk more rapidly in patients who do not want to nurse. When patients have symptoms a combination of analgesia and breast support usually brings relief within 24 to 48 hours.

Expression of androgen-responsive properties in human skin fibroblast strains of genital and nongenital origin

Specific 5alpha-dihydrotestosterone (DHT) binding capacity (Bmax) has been determined for human skin fibroblast strains from non-genital areas of males and females (N = 8), as well as prepuce and labium majus (N = 9). Genital strains had a mean three times that of non-genital ones (32 vs. 11 fmol/mg cell protein). There were no sex differences. Variation among strains was not simply correlated with donor age; that within strains was unrelated to in vitro age. The lowest values for genital strains overlapped the nongenital ones; those of the nongenital strains approached the limit of detectability. These results parallel those for delta4-3-ketosteroid 5alpha-reductase activity. Thus, serially cultured genital and nongenital skin fibroblasts express their relative differentiative ancestry as androgen target cells. This expression may affect the diagnosis of androgen insensitivity and certain inborn errors of metabolism; its variability is discussed in terms of clonal heterogeneity.

Male pseudohermaphroditism presumably due to target organ unresponsiveness to androgens. Deficient 5alpha-dihydrotestosterone binding in cultured skin fibroblasts

Maximum specific 5alpha-dihydrotestosterone (DHT) binding activity (Bmax) had been measured in intact confluent monolayers representing fibroblast strains derived form nongenital and genital (labium majus) skin of normal individuals and of 11 patients fulfilling the clinicogenetic criteria of complete testicular feminization (TF). Nine labium majus strains from adult females had a mean Bmax value three times greater than that of seven nongenital strains from adult females (33 vs. 11 fmol/mg cell protein). The Bmax results for 13 adult nongenital strains varied from 5.6 to 23.3 fmol/mg protein; the values for males and females had very similar means and ranges. The variation could not be correlated with the chronologic age of adult skin explant donors or with the in vitro age (mean population doubling level) of the cultures assayed. The Bmax activities of three nongenital strains from normal infants (two male, one female) did not exceed 5 fmol/mg protein. Seven of eight nongenital TF strains had Bmax values below 2 fmol/mg protein; the value for the eighth coincided with the lower limit of normal adults. The lower limit of DHT binding in normal labium majus strains was 15 fmol/mg protein. Three of five labial strains from patients with TF had Bmax values close to zero; the other two fell between 10 and 15 fmol/mg protein. It is apparant that labial skin fibroblast strains from clinically homogeneous patients with TF had highly variable degrees of DHT binding deficiency, and that they permit a more reliable diagnosis of severe and intermediate degrees of DHT binding deficiency than do strains of nongenital skin fibroblasts.

Specific 5alpha-dihydrotestosterone binding in labial skin fibroblasts cultured from patients.with male pseudohermaphroditism

The cytoplasm of skin fibroblasts serially subcultured from the labium majus of normal human females binds 5alpha-dihydrotestosterone (5alpha-DHT) with high affinity and low capacity. Such binding was absent from the strains of two male pseudohermaphrodites with unambiguous female external genitalia: one of these was from a patient with the clinical features and a family history typical of complete testicular feminization; the other merited the same diagnosis on anatomic and endocrine grounds, but had an XYY karyotype in multiple tissues, including the testes. Normal cytoplasmic binding was found in strains from two prepubertal male pseudohermaphrodites with bilateral inguinal testes: one had unambiguous female external genitalia, the other had clitoromegaly; the former had normal specific nuclear binding of 5alpha-DHT, and thereby the target cell capacity for pubertal masculinization. Measurement of specific 5alpha-DHT binding by cultured labial skin fibroblasts should be an early step in the investigation of male pseudohermaphroditism with female external genitalia.

Primary carcinoid tumor of the urethra

The first reported case of a carcinoid tumor of the urinary tract is presented. Because of rapid local recurrence and distant spread early radical surgery is recommended. Several methods of palliation of the carcinoid syndrome-surgical, pharmacologic and chemotherapeutic-are discussed.

Peritonitis fibroplastica incapsulata with superadded post-operative starch powder peritonitis

Peritonitis fibroplastica incapsulata is not generally accepted as a distinct syndrome. However, characteristic pathological alterations can be identified at laparotomy and by histological examinations. The aetiology of the disease is unknown. In the case reported a second disease arose, i.e. the peritoneal reaction to corn starch powder in the course of the surgical treatment of the peritonitis fibroplastica.