Lipid disturbances in women with polycystic ovary syndrome

Small but detectable disturbances concerning blood lipid levels manifested by somewhat higher concentrations of LDL-cholesterol and triglycerides as well as higher values of atherogenic indices expressing the ratio of cholesterol present in atherogenic lipoprotein fractions to that present in atheroprotective HDL fraction have been shown to exist in 36 women with polycystic ovary syndrome. HDL-cholesterol concentration was lower in women with polycystic ovary syndrome than in healthy women. The disturbances described above were more pronounced in obese patients. No correlation was found between the disturbances in lipid levels and hormonal disturbances particularly hyperandrogenemia.

Estrogens in tissues: uptake from the peripheral circulation or local production

Because intratissue levels of estrogens may be more important for the understanding of the endocrine status of an organ than are peripheral plasma levels, the concentrations of estrone and estradiol have been measured in normal and pathological breast and uterine specimens. Some breast tumors were collected in countries with differences in incidence and natural history of the disease. In other samples the subcellular distribution of the steroids was studied. Estrone levels did show much less variation than estradiol levels. Not related to estrogen receptors, estradiol levels were higher in uterine than in breast tissues. Also, the subcellular distribution observed could not be explained by changes in receptors. Malignant breast tumors of premenopausal and postmenopausal women contained similar amounts of estradiol. Unexplained large differences were found in the intratissue estradiol levels obtained in different countries.

21-Deoxycortisol (21-DF) and 17-hydroxyprogesterone (17-OHP) responses to adrenalcorticotropic hormone in males with idiopathic oligozoospermia

Combined results of 21-DF (via the specific RIA method) and 17-OHP levels in plasma were used to support the evidence that some of the cases with idiopathic oligozoospermia (I.O.) are the result of 21-hydroxylase deficiency (C-21-HD). In our current tests, in four out of 19 males with I.O., elevated levels of 21-DF prior to ACTH stimulation (24.3 +/- 2.3 ng/dl) and after ACTH stimulation (81.2 +/- 5.2 ng/dl) in comparison to the controls (10.6 +/- 4.3 ng/dl and 36.9 +/- 10.1 ng/dl after ACTH) and other I.O. cases were observed. Only one out of these cases presented elevated 17-OHP levels prior and after ACTH stimulation in comparison to the controls and other I.O. cases. Measuring the 21-DF levels along with the 17-OHP in males suspected of C-21-HD, seems to aid the establishing of a correct diagnosis.

Combined 21- and 11 beta-hydroxylase deficiency in familial congenital adrenal hyperplasia

Studies in three families (A, B, and C) revealed five patients with congenital adrenal hyperplasia (CAH) due to partial and combined 21- and 11 beta-hydroxylase deficiency. One patient (A-11 1), a 23-yr-old severely virilized chromosomal female, was reared as a male, and two females (B-11 2 and C-1) complained only of hirsutism, acne, and menstrual abnormalities. Patients A-11 2 and B-11 8 (17 1/2 and 10 yr old) were asymptomatic and detected by finding an HLA genotype identical to that of their respectively affected brother and sister. Three patients (A-11 1, A-11 2, and C-1) had moderate hypertension. In spite of the wide range of clinical manifestations, all individuals had elevated androgen levels, while cortisol secretion was severely impaired only in A-11 2. 21-Hydroxylase deficiency was diagnosed on the basis of markedly increased plasma and urinary levels of 17-hydroxyprogesterone (17-OHP) and 21-deoxycortisol and their respective urinary metabolites pregnanetriol and pregnanetriolone. PRA was elevated in three patients, while urinary aldosterone was normal or increased. 11 beta-Hydroxylase deficiency was diagnosed on the basis of increased 11-deoxycortisol and deoxycorticosterone in plasma and tetrahydro-11-deoxycortisol and deoxycorticosterone in urine, particularly after ACTH administration. In contrast to classical 11 beta-hydroxylase deficiency CAH, urinary 18-hydroxycorticosterone and 18-hydroxy-11-deoxycorticosterone were normal or elevated. The nature and mechanism of a combined enzymatic defect are unknown. The coincidental presence in a single individual of the mutant genes for both 21- and 11 beta-hydroxylase deficiency CAH is very unlikely to occur. Two alternative hypotheses may explain our findings. One is the existence of a genetically inherited abnormal (or aberrant) 11 beta-hydroxylase, whose affinity for its normal substrate is changed for an abnormal one (17-OHP). As a result, 11 beta-hydroxylation of 11-deoxycortisol is deficient while 17-OHP 11 beta-hydroxylation is markedly enhanced. Thus, both 11-deoxycortisol and 21-deoxycortisol as well as their urinary metabolites accumulate. The ability for 18-hydroxylation, however, remains normal. In this case, 21-hydroxylase is not deficient, yet 21-deoxycortisol cannot be further hydroxylated to cortisol, since this steroid is not a suitable substrate for the enzyme. Such a disorder may represent a new allelic variant of 11 beta-hydroxylase deficiency CAH, which, similar to 21-hydroxylase deficiency, is completely linked to the HLA complex.(ABSTRACT TRUNCATED AT 400 WORDS)

Development of plasma 21-deoxycortisol radioimmunoassay and application to the diagnosis of patients with 21-hydroxylase deficiency

Specific 21-deoxycortisol (21-DF) antiserum was raised in New Zealand white rabbits using a 21-DF-3,20-oxime-bovine serum albumin complex. Plasma radioimmunoassay of 21-DF was developed and used together with a radioimmunoassay of 17-hydroxyprogesterone (17-OH-P) for diagnosis of patients with 21-hydroxylase deficiency of congenital and postpubertal forms. The assays were performed in plasma extracts after isolation by paper chromatography. The response of plasma 21-DF and 17-OH-P to i.v. ACTH (25 IU) was studied in 15 adult controls and compared to 8 women with the late onset form of 21-hydroxylase deficiency and 23 women with idiopathic hirsutism. Normal 21-DF values for women were 6.9 +/- 3.6 ng/dl and for men 9.71 +/- 2.73 ng/dl. Newborn children (age: 3-10 days) had a value of 8.3 +/- 4.8 ng/dl. These values are definitely lower than the lowest value ever published. This is possibly due to the specificity of the antibody. During the menstrual cycle the 21-DF values did not change. The baseline and post-stimulated concentrations of hormone were similar in controls and women with hirsutism but were significantly higher in women with the late onset form of 21-hydroxylase deficiency. In the congenital form of 21-hydroxylase deficiency the 21-DF values (baseline) were high. In general, the 21-DF and 17-OH-P values have shown parallel changes. However, one case of 21-hydroxylase deficiency with elevated 21-DF but normal 17-OH-P was observed. The use of 21-DF for the diagnosis of 21-hydroxylase deficiency is suggested.

Prolactin levels in the polycystic ovary syndrome

Plasma prolactin (PRL) was measured in 34 patients with polycystic ovary syndrome (PCO) before and after the intravenous administration of 200 micrograms of thyrotropin-releasing hormone (TRH). The results were compared with those from 30 normal female volunteers. The distinctive features of PCO were elevated plasma concentrations of luteinizing hormone (LH), testosterone and androstenedione and increased 24-hour urinary estrogen excretion. Abnormal secretion of PRL was observed in ten patients with PCO. Hyperprolactinemia was detected in five patients, and the prolactin response to TRH was exaggerated or prolonged in five normoprolactinemic patients with PCO. A statistically significant correlation was found between mean prolactin concentrations and the mean plasma dehydroepiandrosterone sulphate (DHEAS) concentration (r = 0.67, p less than 0.01). These data suggest that a significant portion of women with PCO syndrome have abnormalities of PRL secretion.

The origin of androgen synthesis in polycystic ovary syndrome

The site of androgen synthesis was determined in 21 women with polycystic ovary syndrome on the basis of radiographic studies, catheterization of ovarian and adrenal veins, and/or inferior vena cava samplings. Gradients of testosterone, androstenedione, and dehydroepiandrosterone sulfate were determined by comparing the levels in adrenal and ovarian veins with those found in antecubital veins. In six patients, the adrenals were the predominant site of androgen synthesis. In five patients, both the ovaries and adrenals participated equally in androgen production. A good correlation was observed between the results obtained from gonadal and adrenal vein catheterizations and dynamic studies using stimulation with pregnyl and inhibition with dexamethasone. The results point to the important role of adrenals and ovaries in androgen overproduction. Stimulation and inhibition tests were in agreement with catheterization data. No correlation was found between morphology and hormonal disturbances.

Therapeutic effects of spironolactone in polycystic ovary syndrome

The authors examined the effect of three months' treatment with spironolactone in 34 women with polycystic ovary syndrome. In all patients a significant decrease in hirsutism was noted as well as restoration of a regular although anovulatory menstrual pattern. Plasma luteinizing hormone and follicle-stimulating hormone levels remained unchanged after spironolactone treatment; however, prolactin levels were lowered in both women with normal and those with elevated basal levels. Plasma testosterone, androstenedione, and dehydroepiandrosterone sulfate levels were decreased after three months of therapy. No side effects were observed. Plasma electrolytes and liver function tests were normal during the entire time of treatment. This therapy is recommended as initial nontoxic but effective treatment for women with polycystic ovary syndrome who are hirsute and have menstrual disturbances.

The aldolase and pyruvate kinase isoenzyme patterns in a malignant testicular tumor from a 27 year old male

On the basis of performed tests, we observed the change of pattern of pyruvate kinase isoenzyme in a malignant testicular tumor (only isoenzyme K) and the same isoenzyme in the tissue of other testis not being tumorously changed. In control group pyruvate kinase isoenzyme K and M was observed. Similarly, another pattern of aldolase isoenzymes in tumorous tissue was stated (AC) comparing with control group (arrangement AC, BC). The changes referred also to the activity of both examined enzymes in tumorous tissue and in the tissue of testis not being tumorously changed. The authors suggest the existence of a factor with depressor characteristics, which is produced by neoplasm and changes the function of genes that are responsible for synthesis examined isoenzymes in the tissue not being tumorously changed.