Danazol: endocrine consequences in healthy women

We studied the effects of danazol on pituitary and gonadal function in seven normal women who volunteered to take danazol, 400 mg twice daily, for 2 months. We measured circulating levels of sex steroids, gonadotropins, and prolactin on alternate days throughout a control menstrual cycle and during treatment. Danazol inhibited ovulation in all subjects. The amenorrheic state induced by danazol was characterized by normal basal levels of gonadotropins, prolactin, and estrogen. Serum androgen levels were significantly increased as was the urinary excretion of 17-ketosteroids. The LH and FSH responses to gonadotropin-releasing hormone were enhanced during treatment, and there was a normal LH rise following administration of estradiol valerate, indicative of intact positive feedback. These observations fail to support the contention that danazol suppresses pituitary gonadotropin secretion or directly inhibits steroidogenesis. The results suggest that danazol may have a primary site of action at the ovary by suppressing the normal, orderly process of follicular maturation.

Stimulatory activity of serum on prolactin production by human decidua

Fetal calf serum (FCS) enhances the synthesis and secretion of prolactin (PRL) by explants of human decidua incubated in Gey's balanced salt solution. In order to further characterize the factors involved in the prolactin-stimulating activity (PSA) of serum, decidua was incubated in Gey's buffer alone and in buffer containing either FCS, bovine serum albumin (BSA), or human serum (HS). When buffer was supplemented with varying concentrations of FCS, ad dose-related PSA was apparent between 0.1% and 10%. The PSA of FCS was not altered by eithr heating (85degrees C for 30 minutes), boiling, or dialysis. The protein fraction of FCS, precipitated with trichloroacetic acid, redissolved in dilute NaOH, and dialyzed against Dulbecco's phosphate buffer, demonstrated PSA comparable to that of whole serum. A similar concentration of BSA added to Gey's buffer did not stimulate the production of PRL by decidua. The PSA of human serum obtained from euprolactinemic men and women was not different from that of FCS. These data indicate that FCS and HS contain a substance(s) (1) which stimulates the secretion of PRL by human decidua, (2) which is very stable, being resistant to dialysis, boiling, and denaturation by trichloroacetic acid, (3) and which is most likely a large polypeptide with a molecular weight greater than 12,000 or a smaller moiety tightly bound to a protein.

The luteal phase defect: the relative frequency of, and encouraging response to, treatment with vaginal progesterone

Three hundred and ninety-six patients were evaluated for primary and secondary infertility between December 1976 and May 1979 at a large referral center. Timed late luteal endometrial biopsies were routinely obtained as part of the work-up and were repeated for confirmation if subsequent menses did not occur within 2 days of the expected date. If both biopsies were abnormal, a diagnosis of luteal phase defect (LPD) was made and patients were treated with vaginal progesterone suppositories for a minimum of 6 months. LPD was discovered in 32 of 396 patients (8.1%); among those patients whose infertility was not complicated by other abnormalities, 9 of 13 conceived (70%) and 7 of 13 carried to term (54%). These data suggest an incidence higher than generally recognized and a very encouraging response to replacement therapy.

Gonorrhea screening. Comparison of three techniques

A total of 1,336 men were screened for gonococcal urethritis by one or more of three techniques: Gram-stain smears, urethral cultures, and cultures of first-voided urine (FVU). The sensitivity of these techniques in a group of 113 symptomatic patients was 99.1%, 98.2%, and 95.6%, respectively. In a group of 248 asymptomatic men, FVU cultures yielded a positivity rate of 2.4%, comparable to the 2.8% obtained with urethral cultures. In view of the reduction in time, cost, and patient discomfort associated with the use of FVU cultures, it appears to be a valuable diagnostic technique for asymptomatic gonococcal urethritis.

Thyroxine uptake and metabolism by fetal sheep after intra-amniotic thyroxine injection

Thyroxine (T4) uptake from amniotic fluid was investigated in fetal sheep. Samples of fetal and maternal blood and of amniotic fluid were obtained from indwelling catheters at specific intervals after intra-amniotic injection of T4. T4 and reverse T3 (rT3) were measured by radioimmunoassay. Basal levels of T4 were 7.3 +/- 0.92, less than 2, and 6.28 +/- 0.49 microgram/dl in the fetus, amniotic fluid, and ewe, respectively. Basal levels of rT3 were 3,858 +/- 214, 189 +/- 62, and 385 +/- 20 pg/ml in the fetus, amniotic fluid, and ewe, respectively. T4 and rT3 rose progressively in the fetus with maximum concentrations of 25 to 30 microgram/dl T4 by 10 hours and 11,000 to 14,000 pg/ml rT3 by 20 hours after intra-amniotic injection of 500 microgram of T4. These concentrations returned toward baseline by 50 and 70 hours for T4 and rT3, respectively. The increase of fetal T4 was proportional to the amount of T4 injected in a range of 250 and 2,500 microgram. Esophageal ligation abolished the changes in fetal T4 but not rT3. Amniotic fluid rT3 increased with time after intra-amniotic injection of T4 and returned to baseline long after amniotic fluid T4 had reached basal levels. This pattern persisted despite esophageal ligation. T4 was converted to rT3 during incubation in amniotic fluid in vitro. It is concluded that (1) substantial amounts of T4 are taken up by fetal fetal sheep from the amniotic fluid by deglutition, (2) increases in fetal concentrations of T4 and rT3 are related to the amount of T4 added to the amniotic fluid, (3) amniotic fluid and fetal rT3 concentrations increase following intra-amniotic injection of T4 in the absence of significant uptake of T4 by the fetus, and (4) significant amounts of T4 may be converted to rT3 in vitro during incubation of T4 in amniotic fluid.

Evidence for a nonpituitary source of amniotic fluid prolactin

Prolactin levels were determined during a gonadotropin-induced pregnancy following hypophysectomy for a chromophobe adenoma. Maternal plasma prolactin concentrations did not vary significantly from prepregnancy values throughout gestation, remaining between 25 and 35 ng/ml. Fetal prolactin levels were 55 ng/ml and maternal levels were 29 ng/ml at delivery. Amniotic fluid prolactin concentration was approximately 100 ng/ml. Decidual tissue isolated from the maternal surface of the chorion released significant amounts of prolactin into the medium during a 24-hour incubation. Final concentrations of prolactin in the incubation medium were as high as 196 ng/ml. It is concluded that after hypophysectomy (1) prolactin is present in the maternal circulation during pregnancy, and the concentration does not change significantly throughout gestation; (2) fetal and amniotic fluid prolactin concentrations near term do not differ significantly from those reported for normal pregnancy; and (3) the capacity of the decidua to release prolactin in vitro is not diminished compared with normal term decidua, suggesting a nonpituitary source of amniotic fluid prolactin.