Endometrial pathology and estrogens

Endometrial biopsies were obtained from 46 hypogonadal patients (44 with gonadal dysgenesis; 2 panhypopituitary) who were receiving estrogen-progestogen therapy. Endometrial abnormalities occurred only in patients receiving a total lifetime conjugated estrogen dose of greater than or equal to 2500 mg and who had received estrogen treatment for a period longer than 4.2 years. The biopsy outcome was significantly related (P less than 0.01) to the estrogen dose at time of biopsy and to the total lifetime dose (P less than 0.05). The progestational drugs administered did not protect against development of endometrial abnormalities. None of the abnormal endometrial patterns were associated with abnormal vaginal bleeding.

Endocrine features of an adrenal-like tumor of the ovary

Detailed in vivo endocrine studies of a virilizing adrenal-like tumor of the ovary are reported. A nonspecific steroidogenic baseline profile was observed in the face of clearcut histological adrenal-like features. Dynamic testing disclosed incomplete dexamethasone-related steroidogenic suppression suggestive of partial tumoral autonomy. At the same time, the observation of sizable dexamethasone-related steroidogenic decrements, unaccounted for by normal adrenal contribution, may be interpreted to suggest a direct, pharmacological, inhibitory effect of dexamethasone on tumoral and/or ovarian stromal steroidogenesis. These observations confirm the limited role of baseline steroid profiling and dynamic testing in the preoperative localization of androgen-secreting tumors. Reversible dysfunction of hypothalamic gonadotropic feedback mechanisms was suggested by combined single dose LRH-clomiphene testing. Complete resolution followed tumor removal.

Adult height and fertility in men with congenital virilizing adrenal hyperplasia

The effects of congenital adrenal hyperplasia on adult height and fertility were studied in 30 afflicted men. The patients' heights ranged from 150.0 to 178.6 cm (mean +/- 1 S.D. of 164.0 +/- 7.6), which is significantly lower than both the mean adult height for American men and that of the patients' parents (P less than 0.005). There was no correlation between adult height and the age at which therapy was begun, possibly because the patients treated before one year of age had the salt-losing form of the syndrome. Therapeutic compliance may also have been involved. Apparently normal fertility, indicated by paternity and normal sperm counts, was found in 18 out of 20 patients evaluated. This group included five untreated patients who were found to be fertile and to have normal plasma testosterone and gonadotropin but elevated androstenedione levels.

Positive feedback of gonadotropins in males

The influence of estradiol and progesterone upon serum LH and FSH has been evaluated in three groups of five normal adult males. These steroids were administered to ascertain whether the hypothalamus and pituitary in the male possesses the capability for acute release and positive feedback of gonadotropins, a well established characteristic of the hypothalamus and pituitary in the female. Suppression of circulating levels of gonadotropins occurred after the oral administration of 0.1 mg of ethinyl estradiol daily for three days to experimental group 1, and after 0.1 mg ethinyl estradiol given daily for nine days plus 1.0 mg given on day 10 to experimental group 2. Positive feedback of serum LH levels occurred in two of five men of experimental group 3 after they received 0.5 mg ethinyl estradiol orally daily for three days. Three men had a rise of FSH concentration between day 5 and 8 of the administration of this drug. Ten mg of progesterone (IM) given to these men after suppression with estradiol also produced a positive feedback of FSH in three and of LH in four of the five men.

Evaluation of the growth hormone exercise test in normal and growth hormone-deficient children

A group of 168 short but otherwise normal children (group A) and 25 children deficient in growth hormone (GH) (group B) wwere studied with an exercise stimulation test to determine the expected error of this method. In group A, 125 (74.4%) had maximum GH responses greater than 15 ng/ml, 23 (13.7%) had responses between 10 and 15 ng/ml, and 20 (11.9%) had responses less than 10 ng/ml. The mean +/- SD values were 8.4 +/- 0.4 ng/ml at 0 time, 26.3 +/- 15.0 at 20 minutes, and 10.7 +/- 8.3 at 40 minutes. The mean maximum response was 27.7 +/- 14.3 ng/ml. In group B, 22 (88%) had maximum responses less than 10 ng/ml and 3 (12%) had responses between 10 and 15 ng/ml. Patients with maximum responses less than 10 ng/ml have a high probability of being GH-deficinet, whereas patients with responses between 10 and 15 ng/ml are less likely to be GH-deficient. No patients with responses greater than 15 ng/ml were GH-deficient.

Independence of gonadotropin and adrenal androgen secretion

Five groups of 5 normal adult males have been studied. Group 1 received clomiphene, group 2 received exogenous FSH and group 3 testosterone. These three groups received drugs to stimulate LH and FSH, increase levels of FSH or suppress LH and FSH respectively. Circulating levels of testosterone (T), estrone (E1) and 17-hydroxyprogesterone (17-OHP) were altered while serum concentrations of androstenedione (A), dehydroepiandrosterone (DHA), dehydroepiandrosterone sulfate (DS) and urinary 17-ketosteroids (17-KS) were not. The other two groups of 5 adult males had adrenal androgen levels suppressed or stimulated while receiving dexamethasone or ACTH. Serum 17 OHP, A, DHA and DS levels and urinary 17 KS were affected while gonadotropins were unaltered. Hence, no relationship has been demonstrated between circulating levels of adrenal androgens and gonadotropins.

The diagnosis of Leydig cell tumors in childhood

We report the clinical and hormonal findings in two boys with isosexual precocity secondary to Levdig cell tumor of the testis. The hormonal profile at the initial evaluation was quite different in the two cases suggesting differences in steroid biosynthesis by the tumors. These differences indicate that a dexamethasone suppression test may be required to differentiate between Leydig cell tumors and congenital virilizing adrenal hyperplasia with adrenal rest tissue located within the testes.

Integrated concentrations of follicle stimulating hormone and puberty

Integrated serum concentrations of follicle stimulating hormone are compared from 25 males (aged 6-27 years) and 8 females (aged 5-16 years). Mean levels of FSH among prepubertal and early-to-mid pubertal individuals were significantly greater during sleep than while awake. Levels for late pubertal and postpubertal individuals do not differ between waking and sleeping periods.

Endocrine and metabolic alterations with food and water deprivation

Two healthy men were evaluated before and after a 56-day raft voyage to determine endocrine and metabolic status immediately after and during the recovery phase after long-term caloric, protein, and water deprivation. Daily intake during the trip consisted of no protein, 300 ml water, and for the first 40 days, 300 kcal glucose. The subjects lost weight from 84.1 to 58.1 and 78.3 to 57.7 kg, respectively. Significant variations included: 1) decreased excretion and loss of diurnal pattern of 17-hydroxycorticoids with normal serum corticoid levels and variation; 2) decreased serum testosterone levels and concomitant low follicle stimulating hormone and low normal luteinizing hormone levels; 3) decreased urinary 17-ketosteroid levels; 4) low plasma insulin levels with normal serum glucose concentrations; 5) increased triglyceride content in the 1.006 less than d less than 1.063 lipoproteins during fasting with a marked increase in high density lipoprotein cholesterol upon refeeding. The percent content of the R-serine (C-I) apoprotein among the soluble apoproteins of very low density lipoproteins diminished markedly during the fast; 6) abnormal liver function immediately after fasting with increased abnormality after the 2 weeks of refeeding and return to normal by 6 weeks; 7) normal fat and xylose absorption, normal estradiol, estrone and prolactin levels, and renal function studies.

Effect of intramuscular triamcinolone acetonide on the human ovulatory cycle

The effect of intramuscular triamcinolone acetonide (TCA-A) on pituitary gonadotropins and ovarian hormones was studied in a normally menstruating woman. Serum levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), as well estradiol 17-beta (E2) and progesterone (P), were determined daily in a normal "ovulatory" pretreatment cycle. A total of 160 mg of TCA-A was then administered in four injections over two and a half months. Daily serum levels of LH, FHS, E2, and P were again measured during a period beginning thirty days after the last injection of TCA-A. Cyclicity of all these hormones was absent after treatment. Both LH and FSH were suppressed in the first half of the post-treatment period when compared with the pretreatment ovulatory cycle. A potent corticosteroid such as TCA-A is apparently capable of producing anovulatory cycles in humans by disruption of cyclic pituitary gonadotropin secretion.

Puberty in girls: correlation of serum levels of gonadotropins, prolactin, androgens, estrogens, and progestins with physical changes

Twenty-seven girls aged 8 to 18 were studied in a longitudinal prospective fashion. Serum samples were collected at 6 month intervals up to 4 years and radioassayed for hormones of pituitary, ovarian, and adrenal origin. A progressive elevation of luteinizing hormone (LH), follicle-stimulating hormone/FSH), estradiol (E2), dehydroepiandrosterone (DHA), and androstenedione (delta4) occurred during puberty and continued until menarche. The onset of puberty occurred concomitantly with an elevation of estrone (E1) dehydroepiandrosterone (DHA), dehydroepiandrosterone sulfate (DHAS), and 17-hydroxyprogesterone (17-OH-P). Prolactin (Prol) and progesterone (Prog) concentrations did not change during puberty until after menarche. After menarche, levels of LH and FSH were comparable with menstruating adult females. Concentrations of E2 and Prog were lower during the second half of the cycle among most regularly menstruating subjects than expected during the luteal phase. LH and Prog levels indirectly suggest that ovulation occurs in a few girls within months after menarche.

Integrated concentrations of luteinizing hormone and puberty

Integrated serum concentrations of luteinizing hormone have been compared among 30-minute collections from 10 boys (6-18 years old) and 5 girls (5-11 years old). This study suggests that perpubertal as well as pubertal boys have greater mean integrated concentrations of LH during sleep than during waking. One of two pubertal girls had greater concentrations of LH during sleep, while three prepubertal girls did not.

Gonadotropin and sex steroid response to luteinizing hormone-releasing hormone in patients with premature adrenarche

Luteinizing hormone-releasing hormone (100 mug iv) produced a response of LH, FSH, testosterone, and estradiol in children with premature pubarche that was not different from that among normal prepubertal children. Hence, this study provides no evidence that hypothalamic-pituitary-gonadal maturation occurs with the onset of premature sexual hair.

Effect of prolactin on diluting and concentrating ability in the rat

The effect of prolactin on free water clearance (C(H2O)) and reabsorption (T(cH2O)) was assessed in hereditary hypothalamic diabetes insipidus (HHDI) and hydropenic Sprague-Dawley rats. Infusion of ovine prolactin (200 nmol/kg per h) ablated C(H2O) in HHDI rats but had no effect on T(cH2O) in hydropenic rats. Additional experiments in HHDI rats employing submaximal infusions of both ovine and rat prolactin indicated that with increasing infusion rates of these hormones, urine osmolality progressively increased with a maximum effect being reached at 30-40 nmol/kg per h with ovine and 15-20 nmol/kg per h with rat prolactin. In similar experiments, using synthetic lysine-arginine vasopressin, maximum effect on urine osmolality was achieved with an infusion rate of 25-75 pmol/kg per h. During infusion of all three hormones, urinary cyclic AMP excretion increased significantly in a similar fashion. These data suggested that prolactin had a direct effect on collecting tubule permeability and acted through stimulation of cyclic AMP production.

Increased prolactin levels during reserpine treatment of hypertensive patients

Serum prolactin levels are significantly greater among hypertensive patients receiving reserpine as compared to levels six weeks after discontinuing the treatment (P less than .005). This association between regular, long-term reserpine use and greater prolactin levels may be clinically significant, since an increased incidence of breast cancer has been reported among hypertensive patients receiving reserpine.

The effect of danazol in sexual precocity

The effect of Danazol, a synthetic 2,3 isoxazol derivative of 17 alpha-ethinyl testosterone, was assessed in three girls and two boys with sexual precocity. Progression of sexual development ceased during administration of Danazol; the effect upon growth rate and skeletal maturation was equivocal. Serum estrogen and progesterone concentrations in the girls were lower during treatment; serum testosterone and dehydroepiandrosterone levels in the boys were also lower. Serum and urinary luteinizing hormone concentrations were inconsistently suppressed. No effect upon follicle-stimulating hormone levels could be demonstrated. Although Danazol appears to inhibit sexual development, this study indicates that the pituitary-gonadal axis is not completely suppressed. Growth rate is not reverted to normal, and virilization may occur among girls. Because undesirable side effects may outweight desirable results, careful consideration is recommended before Danazol is prescribed in the management of sexual precocity.

Puberty in boys: correlation of plasma levels of gonadotropins (LH, FSH), androgens (testosterone, androstenedione, dehydroepiandrosterone and its sulfate), estrogens (estrone and estradiol) and progestins (progesterone and 17-hydroxyprogesterone)

Mean serum concentration dehydroepiandrosterone (DHA), DHA sulfate (DHAS), progesterone (P), 17-hydroxyprogesterone (17-OH-P), estrone (E1), estradiol (E2), and androstenedione (A) were compared from 43 boys followed longitudinally for as long as 4 yr during puberty. These data were also compared with serum levels of LH, FSH, and testosterone. Elevation is recognized early in puberty for DHAS, late in puberty for P and A, and gradually throughout puberty for E1, 17-OH-P, and DHA. When compared by age, the same general pattern is apparent with adult levels of E1 reached at age 12, DHAS and E2 by 13, and DHA, P, 17-OH-P, and A not until after age 15. Significant elevations of DHA occurred with the onset of pubic hair and voice change; elevations of DHAS occurred with the onset of genital and axillary hair growth; and testosterone increased with the onset of genital and pubic hair growth and voice change.

Evidence for partial 21-hydroxylase deficiency among heterozygote carriers of congenital adrenal hyperplasia

Concentrations of 17-hydroxyprogesterone are significantly greater in heterozygous carriers of CVAH than in controls 30 and 60 minutes after an infusion of 25 units of synthetic ACTH 1-24 and 2 hours after beginning a 4-hour infusion of 50 units ACTH. The majority of carriers were clearly above the control range at these collection times. Hence, heterozygous carriers have a partial enzyme deficiency although all cannot be diagnosed based on 17-hydroxyprogesterone levels after ACTH stimulation.

Lack of correlation between gonadotropin and adrenal androgen levels in agonadal children

To evaluate the relationship between the secretion of gonadotropins and adrenal androgens, patients with gonadal agenesis were evaluated by (a) administering human luteinizing hormone (hLH) for 5 days with or without estrogen pretreatment to agonadal patients who had prepubertal LH levels; (b) correlating circulating gonadotropin levels with adrenal androgens in 45 patients; and (c) comparing adrenal androgens with gonadotropins after long-term administration of estrogen or androgens. Results are as follows: (a) No alteration in serum concentrations of dehydroepiandrosterone (DHA), dehydroepiandrosterone sulfate (DHAS), estrone (E1), testosterone (T), or in excretion of urinary 17-ketosteroid (17 KS) occurred after the administration of hLH. (b) No clearcut relationship between endogenous level of LH or FSH and DHA OR DHAS was demonstrated although a coincident increase of all hormones with age occurred. (c) Administration of estrogen to patients with gonadal agenesis did not affect their levels of DHA and DHAS although those patients given androgen developed higher DHAS, but not DHA, levels. Hence, increasing gonadotropin concentrations would not appear to be a primary etiologic factor in the maturation of the adrenal.

The relationship of concentrations of serum hormones to pubertal gynecomastia

Pubertal gynecomastia occurred in 20 to 29 boys who were followed for 24 or more months during puberty. Mean concentrations of LH, FSH, prolactin, testosterone, and estrone and estradiol were compared. Although levels did not differ between boys who developed gynecomastia and those who did not, when compared with the stage of puberty, changes were noted between mean concentrations from samples before and when gynecomastia was first noted. A significant increase of estradiol occurred with the onset of gynecomastia, while testosterone levels did not change; thus the testosterone-estradiol ratio decreased. Prolactin concentrations fell significantly with the onset of gynecomastia. These data indicate a difference of hormonal dynamics between boys with and without gynecomastia.