Ovarian and adrenal vein steroids in healthy women with ovulatory cycles--selective catheterization findings

Bilateral ovarian-adrenal vein catheterization and androgen measurements in the efferent samples were utilized to directly assess glandular steroid release in 8 healthy volunteers with proven ovulatory cycles during the early follicular phase. Side effects did not occur in any of the women. Hormone levels were as follows (mean +/- SD; ng/ml) T: peripheral vein (PV) 0.36 +/- 0.16, ovarian veins (OV) 0.39 +/- 0.13, adrenal veins (AV) 0.85 +/- 0.63; dihydro-T (DHT): PV 0.25 +/- 0.09, OV 0.29 +/- 0.10, AV 0.93 +/- 0.65; delta 4-androstendione (A): PV 0.88 +/- 0.34, OV 1.82 +/- 1.04, AV 9.22 +/- 8.04; DHEA; PV 5.13 +/- 1.96, OV 6.73 +/- 2.69, AV 146.79 +/- 217.24; DS PV 1860 +/- 850, OV 1937 +/- 1039, AV 2567 +/- 1201; 17 alpha-hydroxyprogesterone (17P): PV 0.60 +/- 0.19, OV 1.46 +/- 1.64, AV 6.94 +/- 6.20; F: PV 170 +/- 50, OV 130 +/- 21, AV 788 +/- 1320; the bilateral differences of effluent levels were not significant. Glandular-peripheral vein steroid gradients served as semiquantitative estimates of momentary secretory activity; they were as follows (mean +/- SD; ng/ml) T: ovarian-peripheral vein gradient (OPG) 0.03 +/- 0.09, adrenal-peripheral vein gradient (APG) 0.48 +/- 0.57; DHT: OPG 0.05 +/- 0.05, APG 0.69 +/- 0.60; A: OPG 0.97 +/- 1.13, APG 8.33 +/- 7.86; DHEA: OPG 1.70 +/- 1.80, APG 141.80 +/- 216.60; DS: OPG 191 +/- 72, APG 706 +/- 824; 17P: OPG 0.87 +/- 1.67, APG 6.30 +/- 6.10; F: OPG 38 +/- 11, APG 610 +/- 1329. Gradient, analysis revealed that the ovaries produced significant quantities of A, DHEA and 17P, but no T, DHT or F between day 3-7 of the cycle; direct gonadal DS output was detected in 2 individuals. A significant OPG for DS was detected in two individuals possibly indicating its partially gonadal origin. The adrenals released larger amounts of A, DHEA and 17P than the ovaries at this stage (P less than 0.05); also, they consistently secreted T, DHT, DS and F.

Bloodspot 17 alpha-hydroxyprogesterone radioimmunoassay for diagnosis of congenital adrenal hyperplasia and home monitoring of corticosteroid replacement therapy

A convenient and inexpensive radioimmunoassay for bloodspot 17 alpha-hydroxyprogesterone (17-OHP) has been evaluated in the screening of newborn infants for congenital adrenal hyperplasia (CAH) and for home monitoring of CAH patients on steroid replacement therapy. In the screening study, analysis of 491 bloodspots taken for routine screening programmes for phenylketonuria and hypothyroidism established the upper limit of normal for infants aged 5-10 days as 64 nmol 17-OHP/l blood (99.9 centile). Home monitoring of patients by examination of fingerprick bloodspot 17-OHP profiles taken by parents over Saturday and Sunday on consecutive weekends showed that changes in control occurred as a result of transition from inpatient to outpatient treatment or following adjustment of steroid replacement regimens. The method was found to be valuable in the diagnosis and management of children with CAH.

Rapid diagnosis of congenital adrenal hyperplasia by high performance liquid chromatography

This manuscript describes methods for the quantitation of serum concentrations of 17-hydroxyprogesterone and 11-deoxycortisol (Compound S) employing reverse-phase high-performance liquid chromatography (HPLC) and ultraviolet (UV) absorbance which are applicable to the diagnosis of congenital adrenal hyperplasia due to deficiencies of 21- and 11-hydroxylase activities, respectively. These methods are simple, specific, precise and rapid. Data obtained by the HPLC-UV methods are highly correlated (p less than 0.001) with radioimmunoassay measurements.

Differential effect of single high dose and divided small dose administration of human chorionic gonadotropin on Leydig cell steroidogenic desensitization

This study compared the effect of a single high dose of hCG (1500 IU) with that of the same dose administered in multiple small doses (300 IU, once daily for 5 days) on Leydig cell steroidogenesis. Administration of a single high dose of hCG to seven healthy men raised the mean plasma testosterone (T) level to peak levels 2.1 +/- 0.2 (SEM) X the baseline value at 48 h. Thereafter plasma T decreased to below normal (0.7 +/- 0.1 X baseline) 7 days after the injection. The mean 17-hydroxyprogesterone (17-OHP) level peaked at 24 h (2.5 +/- 0.2 X baseline) and then also fell to a nadir value of 0.6 +/- 0.2 X baseline on day 7. Reflecting the early accumulation of 17-OHP over T, the 17 OHP/T ratio reached its maximum (1.6 +/- 0.1 X baseline) at 24 h at the same time when plasma estradiol [(E2) 4.4 +/- 0.6 X baseline] and the ratio E2/T (2.7 +/- 0.3 X baseline) achieved their maximal values. Administration of 1500 IU hCG in five divided doses of 300 IU daily increased the mean plasma T levels to peak value of 2.1 +/- 0.2 X baseline at 5 days and the levels remained elevated thereafter. The response of T as reflected by the area under the curve was almost twice as great as in the single dose study (2844 +/- 360 vs. 1647 +/- 214). In contrast to the single high dose experiment, mean plasma 17-OHP levels in the divided dose protocol did not peak at 24 h but only gradually increased. As the increase of T exceeded the 17-OHP increase at almost all time intervals, no accumulation of 17-OHP over T occurred as in the single dose experiment. Instead the 17-OHP/T ratio fell to a nadir value of 0.6 +/- 0.1 X baseline on day 7. The initial E2 peak was absent in the divided dose protocol and the E2/T ratio only marginally increased. Considering both experiments together a close relation was found between the hCG-induced increases in E2 and 17-OHP (r = +0.88, P less than 0.001), as well as the ratio 17 OHP/T (r = +0.64, P less than 0.02).(ABSTRACT TRUNCATED AT 400 WORDS)

Gynecomastia in association with a complex tumor of the testis secreting chorionic gonadotropin: studies on the testicular venous effluent

The levels of progesterone, 17 alpha-hydroxyprogesterone, androstenedione, testosterone and estradiol were measured in the testicular venous effluent from a testis containing a complex malignant tumor associated with gynecomastia and increased serum levels of beta-human chorionic gonadotropin. An abnormally low testosterone/estradiol ratio was encountered (83 in the peripheral serum and 101 in the spermatic venous effluent). On the basis of the available data no delineation could be made as to the relative contributions to estradiol production of tumor tissue and Leydig cells.

Direct effect of the luteinizing hormone releasing hormone analog D-Trp6-Pro9-Net-LHRH on rat testicular steroidogenesis

The luteinizing hormone releasing hormone analog D-Trp6-Pro9-Net-LHRH (LHRHa) inhibits rat testicular testosterone secretion. To determine whether LHRHa decreases serum testosterone concentrations solely by inhibiting gonadotropin secretion or, in addition, by influencing directly testicular testosterone biosynthesis, we examined the effects of LHRHa on the activities of 5 key testicular steroidogenic enzymes. Thirty hypophysectomized, hOG treated rats were given either LHRHa (1 micrograms sc/day) or saline during 7 days. The LHRHa treated animals exhibited a significant decrease of serum testosterone when compared to the control group (498 +/- 37 ng/dl vs 2044 +/- 105 ng/dl, mean +/- SEM, P less than 0.001). 17-Hydroxyprogesterone serum levels were also decreased in the LHRHa treated rats (61 +/- 6 ng/dl vs 93 +/- 7 ng/dl, P less than 0.005), while serum progesterone levels were similar in both groups of animals. These changes in steroid concentrations were associated with decreases in the microsomal enzyme activities of 17-hydroxylase (37 +/- 9 vs 654 +/- 41 pmol/mg protein/min, P less than 0.001), 17,20-desmolase (103 +/- 9 vs 522 +/- 47 pmol/mg protein/min, P less than 0.001), 3 beta-hydroxysteroid dehydrogenase (1.7 +/- 0.02 vs 4.1 +/- 0.1 nmol/mg protein/min, P less than 0.001), aromatase (95 +/- 7 vs 228 +/- 6 pmol/mg protein/min, P less than 0.001) and 17-ketosteroid reductase (167 +/- 9 vs 290 +/- 18 pmol/mg protein/min, P less than 0.01) in the LHRHa treated animals. These findings indicate that LHRHa can inhibit directly rat testicular testosterone biosynthesis.

Time relationships between basal body temperature and ovulation or plasma progestins

The basal body temperature (BBT) curve and the estimated time of ovulation, defined by the onset of gonadotropin preovulatory discharge, were analyzed in 38 spontaneous cycles. The BBT nadir was usually located at the beginning of the luteinizing hormone surge, and the first high point was 8 hours after ovulation, which was itself usually at the time when the temperature passed 37 degrees C. This temperature rise was related to the increases in plasma progesterone and 17-hydroxyprogesterone with 24 to 36 hours' delay. The BBT was found to be an unreliable technique for precise ovulation timing but would be of use if the clinical precision required for the diagnosis of ovulation were less.

Effect of short-term bile duct ligation on peripheral blood steroids, urinary PGE2 and the rate of sodium excretion in male rabbits

Short-term bile duct ligation in male rabbits resulted in a significant reduction in the rate of sodium excretion after saline challenge (10 ml/kg/hr for 4 hr, P less than 0.03). The reduction in the sodium excretory rate (14.3 +/- 7.8 to 6.3 +/- 5 mu-equiv/min, P less than 0.03) was associated with an increased urinary PGE2 excretion (200.9 +/- 174 to 731.8 +/- 1039.8 pg/min, P less than 0.01) without significant change in serum aldosterone and cortisol concentrations. Serum progesterone concentration increased (37.2 +/- 15.6 to 119.2 +/- 34.6 ng/dl, P less than 0.01) whereas serum 17-hydroxyprogesterone concentration declined after bile duct ligation suggesting the development of a 17-hydroxylase enzymatic block.

Therapeutic significance and the mechanism of action of the LH-RH agonist ICI 118630 in breast and prostate cancer

The influence of the LH-RH agonist ICI 118630 on circulating levels of the pituitary gonadotrophins LH and FSH and the gonadal steroids oestradiol, progesterone, 17-hydroxyprogesterone and testosterone has been studied in phase I clinical trials of the drug in patients with advanced breast or prostate cancer. ICI 118630 initially stimulated plasma levels of LH and FSH. On continued treatment however, the drug reversed this response and produced a rapid decline in plasma testosterone and progesterone in male and female patients respectively. Plasma oestradiol concentrations equivalent to those seen in oophorectomised or postmenopausal women were eventually produced in all 5 female patients treated with ICI 118630. In one patient however persistent follicular activity occurred until her third menstrual cycle. No appreciable side effects of the drug were observed. These data indicate that ICI 118630 initiates a castration-like endocrine response and has potential in the treatment of hormone dependent tumours of the breast and prostate.

Prolactin secretion in polycystic ovary syndrome (PCO): correlation with the steroid pattern

To evaluate the prevalence of hyperprolactinaemia in PCO patients and its possible correlation with a steroid pattern, we studied prolactin secretion (basal and after TRH stimulation) in 40 women affected by typical PCO. LH, FSH, testosterone, oestradiol, oestrone, DHEA-s and 17-OHP serum levels were also evaluated. Twenty-one patients had prolactin (Prl) values in the normal range both in baseline conditions and after TRH stimulation; 10 patients had normal basal values of Prl but an exaggerated response to TRH stimulation; 9 patients had high Prl basal values and an exaggerated response to TRH. The presence of hyperprolactinaemia was associated with increased serum levels of oestrone (P less than 0.01), DHEA-s (P less than 0.01) and 17-OHP (P less than 0.05). In conclusion, hyperprolactinaemia is as relatively frequent condition which affects almost half the patients suffering from PCO and is probably related to an increase of serum oestrogens, mostly oestrone. Moreover, in patients with PCO and hyperprolactinaemia, the production of some other steroids is also affected.

Does adrenal cortex influence prolactin secretion? Evaluation in hirsute women

To define the role of adrenal hormones on PRL secretion, we investigated 28 women by administering i.v. 0.25 mg. ACTH (h 8.00) every 45' for 135' to better evaluate any relationship between enhanced adrenal steroidogenic activity (both glycoactive and androgenic) and PRL secretion. Blood samples were drawn at 0', 45', 90', 135', and PRL, F, DHEAS, and 170HP were measured by RIA methods. A significant lowering of PRL levels and a concomitant enhancement of steroid plasma levels were found. Our data are in line with those found by some Authors who observed the lack of PRL enhancement after hypoglycemia during glucocorticoid administration and the absence of nocturnal peak of PRL in patients with Cushing's disease. However statistical evaluation (linear analysis regression) of data obtained provides further evidence for the extremely influential role played by adrenal gland hormones on PRL secretion in women.

Importance of serum androgens chromatography on the acth stimulated adrenal steroidogenesis evaluation in hirsute women

20 hirsute women ageing between 13-38 and 10 age matched controls were investigated. Steroid pattern (F, 170HP, T, DHEAS, A, DHT) were evaluated after repetitive ACTH administration (0.25 mg every 45' for 135'). Testosterone was assayed either directly in ether serum extract (T) or after a previous silica-gel thin layer chromatography (Tc). Basal serum values of all steroids under investigation were significantly higher in hirsute women than in controls. T values resulted higher than Tc thus stressing the high degree of cross-reactivity among DHT, DHEAS, A and T in unchromatographed serum steroid RIA. On the other hand ACTH repeated administration elicited an earlier and more significant T value increase in normals than in hirsutes, whereas Tc did not show any significant change in either group. Similarly DHT serum values did not vary after repetitive ACTH administration either in controls or in hirsute women. During ACTH test A serum values enhanced at 45' in both controls and hirsute women without any further increase after ACTH injections, whereas a lower degree of DHEAS enhancement during ACTH test was observed. On the contrary both F and 17-OHP plasma values strongly enhanced at 45' but a further increase of their values after every ACTH stimulus was also observed. Our data seem to confirm the enhanced adrenal steroidogenesis in hirsutism. But the adrenal contribution to enhanced androgen serum pattern of hirsute women appears to be more evident in androstenedione than in the testosterone fraction.

[Neonatal mass-screening for congenital adrenal hyperplasia due to 21-hydroxylase deficiency. II. A pilot neonatal mass-screening study in the west of Shizuoka Prefecture, Japan]

Using a simplified radioimmunoassay method for "Disc-17 alpha-hydroxyprogesterone (Disc-17-OHP)", a pilot neonatal mass-screening study for 21-hydroxylase deficiency was performed in the West of Shizuoka Prefecture for a period of 19 months. During this period, 20,975 neonates were studied, and the mean value and S.D. of "Disc-17-OHP" values were 21.1 and 9.65 pg/disc, respectively. We tentatively decided the 99th-percentile value as a recalling point, and 219 neonates (1.04%) were the candidates for recall by this criteria. One hundred thirty-six neonates out of these 219 candidates who responded to recall were evaluated by physical examination, family history and measurements of plasma electrolytes, 17-OHP and 21-deoxycortisol values as well as concentrations of pregnanetriol and pregnanetriolone in spot urine specimens. As a result, 2 infants were proved to have the salt-losing type of 21-hydroxylase deficiency (21-OHD). Approximately one half of the candidates were premature or low birth-weight infants, and at least 80% had a history of some kind of problem at delivery or in the early neonatal period. Despite the problems remaining to be solved, the present study demonstrates the feasibility and importance of neonatal mass-screening programs for 21-OHD, and suggests that the incidence of 21-OHD is probably greater than previously expected.

[Neonatal mass-screening for congenital adrenal hyperplasia due to 21-hydroxylase deficiency. I. Microfilter paper methods for radioimmunoassay of 17 alpha-hydroxyprogesterone]

In order to perform neonatal mass-screening for 21-hydroxylase deficiency (21-OHD), two simplified radioimmunoassay (RIA) methods to estimate 17 alpha-hydroxyprogesterone (17-OHP) were devised, using discs 3 mm in diameter cut from filter paper impregnated with whole blood. One was a direct method to use assay buffer eluent as a sample, and the other was an extraction method to use diethyl ether extract. One disc in the direct method and one-fourth to four discs in the extraction method were used. We used [1, 2, 6, 7-3H(N)]-17-OHP as a tracer, anti-17-OHP-3-carboxymethyloxime-BSA serum as an antiserum and saturated ammonium sulfate to separate the bound from free 17-OHP. The specificity of the antiserum was nearly satisfactory, except for an unnegligible cross-reactivity with 17 alpha-hydroxypregnenolone (17-OH-delta 5P). Both methods were practically easy and rapid, and had satisfactory accuracy and precision. A significant correlation (p less than 0.005) was observed between "Disc-17-OHP" values by both methods and plasma 17-OHP concentrations measured by highly specific RIA, although the values obtained by the direct method were significantly higher (p less than 0.005) than plasma 17-OHP concentrations, which presumably resulted from the cross-reactivity of the antiserum with 17-OH-delta 5P-sulfate. "Disc-17-OHP" values of the untreated or poorly controlled patients with 21-OHD were extremely high compared with normal neonates and children. However, as most premature infants also showed high values, the possibility of giving false-positive results had to be considered.(ABSTRACT TRUNCATED AT 250 WORDS)

[Hormone levels, celioscopy and ovarian histology in the hirsutism-anovulation syndrome]

Among 50 women with hirsutism, spanio- or amenorrhoea and anovulation, coelioscopy and histological examination of ovarian biopsies showed that 26 had typically polycystic ovaries (PCO), 17 had "borderline ovaries" (BO)--i.e. apparently normal or subnormal but with histological abnormalities identical to those of PCO--and 7 had normal ovaries. The hormonal profiles of BO and PCO were very similar. An increase in LH or in LH response to LHRH, which is regarded as characteristic of polycystic ovarian disease, was only observed in 75% of women with PCO or BO. The PCO and BO detection value of simple basal LH determination was slightly enhanced by the LHRH test, and no further enhancement was observed after repeated LHRH injections. 38% of PCO's and 75% of BO's were associated with adrenal hyperandrogenism, as evidenced by a rise in dehydroepiandrosterone values. Thus, more than one half of hirsute and non-ovulating women have polycystic ovaries. Most of these can be diagnosed by hormonal investigations without having recourse to coelioscopy. However, some do not display, at least permanently, the hormonal profile characteristic of polycystic ovarian disease.

Endocrinologic events in early pregnancy failure

Fourteen women experiencing early pregnancy failure have been studied during the time of conception and at frequent intervals until spontaneous abortion occurred. Serial measurements of serum estradiol, progesterone, 17 alpha-hydroxyprogesterone, prolactin, human placental lactogen (hPL), and human chorionic gonadotropin (hCG) were determined; regular sonar scanning allowed the time of fetal death to be determined to within 7 days in six patients and a diagnosis of blighted ovum to be made in the remainder. In all patients serum progesterone and estradiol concentrations were within the normal range up to 7 weeks but appeared to decrease from about 8 weeks' gestation whether or not a living fetus was present. The placenta continued to produce hCG and hPL but, despite the continuing presence of hCG, the levels of 17 alpha-hydroxyprogesterone declined to concentrations below those associated with normal pregnancy. These data suggest that the placenta may require a particular stimulus to take over production of progesterone and estradiol.

Salivary and plasma androstenedione and 17-hydroxyprogesterone levels in congenital adrenal hyperplasia

Androstenedione (A-dione) and 17-hydroxyprogesterone (17-OHP) levels were measured in matched samples of saliva and of plasma collected from patients with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency (eight patients) and 11-hydroxylase deficiency (one patient). Positive correlations were found between salivary and plasma values of either steroid with correlation coefficients of 0.968 for A-dione and 0.935 for 17-OHP. All five inadequately treated patients with 21-hydroxylase deficiency had greatly elevated plasma and salivary 17-OHP concentrations compared to values in age matched controls. In two of three well controlled patients plasma 17-OHP levels were less than 40 nmol/liter and salivary levels were less than 1.5 nmol/liter, the upper limits which have been formulated as a guideline for monitoring control in treated CAH patients. Patients in good control had A-dione levels in plasma (0.6-2.2 nmol/liter) and saliva (0.04-0.15 nmol/liter) which were both within the normal range for prepubertal children (0.14-2.40 nmol/liter and 0.02-0.25 nmol/liter respectively). Patients in poor control had A-dione levels in plasma of 5.2-25.4 nmol and in saliva of 0.50-2.21 nmol/liter. These values exceeded without exception the normal ranges for their respective ages. Salivary A-dione and 17-OHP determinations are a useful adjunct in the diagnosis and the monitoring of CAH patients since they can be obtained easily and nonstressfully.

Participation of endogenous opiates in regulation of the hypothalamic-pituitary-testicular axis in normal men

To assess the influence of endogenous opioids on human gonadotropin secretion, integrated concentrations of gonadotropins during 24-h naloxone infusion (2.08 mg/h) were examined in a group of six normal men. Naloxone significantly stimulated LH secretion in all subjects, whereas serum FSH levels were similar during both saline and naloxone infusion. Serum testosterone, dihydrotestosterone, and 17 alpha-hydroxyprogesterone levels increased during the infusion of naloxone, but the delta 4-androstenedione concentration was not modified. The frequency and amplitude of LH secretory episodes were clearly increased when an equal amount of the drug was given and LH concentrations were measured every 15 min for 6 h. The results suggest the endogenous opioids inhibit the hypothalamic-pituitary-gonadal axis in normal men.

Effects of surgery and epidural or general anaesthesia on testosterone, 17-hydroxyprogesterone and cortisol plasma levels in prepubertal boys

Testosterone (T), 17-hydroxyprogesterone (17P) and cortisol (F) plasma levels have been measured in two groups of prepubertal boys before and during surgery under general anaesthesia (Group 1) and epidural anaesthesia (Group 2) respectively. The mean plasma levels of T, 17P and F increased significantly (P less than 0.05; P less than 0.001; P less than 0.005, respectively) during surgery in Group 1; in Group 2 the plasma levels of T and F did not show any significant variation, whereas 17P significantly increased (P less than 0.05). However the mean level reached by 17P in Group 2 was significantly lower (P less than 0.005) than that observed in Group 1. No significant variation of LH and FSH plasma levels was observed in either group. Our report suggests that the modifications of T and 17P plasma levels observed during surgery under general anaesthesia (GA) are probably due to the stress induced adrenal response. This response can be inhibited or reduced by epidural anaesthesia (EA).

Mode of action of dl-norgestrel and ethinylestradiol combination in postcoital contraception. III. Effect of preovulatory administration following the luteinizing hormone surge on ovarian steroidogenesis

A combination of 1.0 mg dl-norgestrel and 0.1 mg ethinylestradiol was administered orally at 18 hours after the detection of luteinizing hormone rise and again at 30 hours in five healthy volunteers with normal menstrual cycles. The effects on ovarian function were studied by comparing the daily serum levels of progesterone (P), 17 alpha-hydroxyprogesterone, and estradiol (E2) measured in a control (placebo) cycle with those in two consecutive treatment cycles. Treatment did not alter the steroid levels in one subject. P was suppressed in one or both treatment cycles of four subjects. E2 was suppressed in both treatment cycles of one subject and produced widely fluctuating patterns in another. The hormonal patterns in the two consecutive treatment cycles of the same individual were similar in all but one instance, where only the P level in the second treatment cycle was diminished. These results showed that this treatment can elicit steroidogenic responses of varying degrees and duration. The contraceptive action may lie in the altered P and/or E2 level at certain points in the menstrual cycle.

Relationship between ovarian and placental steroid production during early pregnancy in the marmoset monkey (Callithrix jacchus)

Concentrations of progesterone, 17 alpha-hydroxyprogesterone, oestrone and oestradiol-17 beta in peripheral and utero-ovarian vein blood were measured during the first 60 days of pregnancy. The same hormones were also measured in peripheral blood samples from non-fertile cycles. Peripheral levels of 17 alpha-hydroxyprogesterone, oestrone and oestradiol increased gradually during early pregnancy whereas concentrations of progesterone declined. The patterns of secretion of progesterone, 17 alpha-hydroxyprogesterone and oestrone, but not oestradiol, were significantly different in fertile and non-fertile cycles by 15 days after ovulation. Comparison of hormone values in peripheral and utero-ovarian vein samples from ovaries with and without corpora lutea (Days 7, 9, 13, 21, 40 and 60 of pregnancy) showed that: (a) progesterone was secreted by the corpus luteum until at least Day 40 by which time there was also placental secretion; (2) although 17 alpha-hydroxyprogesterone was secreted by the corpus luteum, the relative contribution of luteal and placental secretion after Day 21 was not clear; (3) oestrone secretion by the corpus luteum was no longer detectable by Day 40, but placental oestrone secretion appeared to be present by this time; (4) the corpus luteum did not secrete significant amounts of oestradiol at any stage of early pregnancy, although there was evidence for placental secretion by Day 40. These results suggest that progesterone secretion by the corpus luteum of early pregnancy continues beyond the time when oestrogen secretion has declined. The corpus luteum to placental shift in the marmoset appears to occur at a later stage of pregnancy than it does in the macaque monkey and probably also in man.

Detection of late-onset 21-hydroxylase deficiency congenital adrenal hyperplasia in adolescents

Because severe hirsutism is difficult to reverse, the evaluation of the adolescent girl with progressive hirsutism should aim at the pathophysiology of androgen excess in order to select appropriate therapies. A prospective study was undertaken to determine the occurrence of late-onset 21-hydroxylase deficiency among adolescents with androgen excess. Twenty-two young women (mean age 17.3 +/- 2.6 years) with androgen excess had serum 17-hydroxyprogesterone measured before and after bolus intravenous infusion of synthetic ACTH (Cortrosyn), 0.25 mg. Two patients, aged 13 and 19 years old, had elevated base line 17-hydroxyprogesterone and 30- and 60-minute responses to Cortrosyn consistent with 21-hydroxylase deficiency. Chromosome 6p haplotypes provided supportive evidence of 21-hydroxylase deficiency. The base line androgen levels, clinical presentation, and a four-day dexamethasone test did not distinguish patients with 21-hydroxylase deficiency from other hirsute adolescents. The Cortrosyn test identifies a population of adolescents who need long-term corticosteroid therapy. The use of major histocompatibility complex haplotypes could be of help in identifying affected siblings prior to the development of significant hirsutism.