Danazol and prolactin status in patients with endometriosis

A group of 55 women with endometriosis was studied before and during danazol therapy. An unexpectedly high proportion (36%) had a raised serum prolactin level before treatment which was reduced after 50 days of danazol (before treatment 783 +/- 333 mU/l; on danazol 243 +/- 113 mU/l, P less than 0.001). In contrast patients with normal serum prolactin levels showed no significant drop on danazol therapy. In all patients serum oestradiol was significantly reduced during treatment (before treatment 449 +/- 188 pmol/l; on danazol 207 +/- 117 pmol/l, P less than 0.001). In one patient with hyperprolactinaemia danazol reduced both basal and stimulated prolactin levels, whereas in 5 women with normal prolactin levels we could detect no gross alteration in metoclopramide or TRH stimulated prolactin levels associated with danazol therapy. The possibility that normalisation of raised prolactin levels may be secondary to reduced oestrogens and that patients with endometriosis have an increased sensitivity to oestrogen-induced prolactin secretion is discussed.

The predictive value of three pregnancy-associated proteins in the detection of the light-for-dates baby

Three pregnancy-associated proteins, human placental lactogen, pregnancy-specific beta 1-glycoprotein and pregnancy-associated plasma protein-A have been measured in two groups of pregnant women. One group subsequently gave birth to children of normal birthweight, the other group were all delivered of a child with a birthweight less than the 10th centile. From the results obtained the values of the tests in predicting intrauterine growth retardation have been calculated. Human placental lactogen proved to be the most useful of the tests compared in predicting intrauterine growth retardation in the individual patient.

Dissociation of adrenarche and gonadarche in diabetes mellitus

Serum concentrations of testosterone and dehydroepiandrosterone sulphate (DHAS) have been measured in 10 stable insulin-dependent diabetic (IDD) males (chronological age (CA) range 13.0-17.5 years). Their results have been compared with those of a control population of 69 non-diabetic males who presented with mild constitutional growth delay and whose skeletal maturity and pubertal development were similar to the diabetic subjects. Within bone ages (BA) 11.0-14.5 years no significant difference was observed between the serum testosterone concentrations of the diabetic patients and controls: diabetic males, 8.2 (0.3-25) nmol/l (median and range); controls, 7.0 (less than 0.3-23) nmol/l. In contrast, within BA 11.0-14.5 years, the diabetic males had significantly lower serum DHAS concentrations: diabetic males, 1.1 (0.7-4.2) mumol/l; controls, 3.7 (0.7-5.6) mumol/l (P less than 0.001). The serum DHAS concentrations of the diabetic males were also significantly lower than the controls when matched separately for pubic hair and genital development, testicular volume and serum testosterone, (in each comparison P less than 0.02). Serum DHAS concentrations of the diabetic males did not correlate significantly with CA, BA, BA delay (CA-BA), age of onset of diabetes, duration of diabetes, or glycosylated haemoglobin (GHb), but significant correlation was observed between BA delay and duration of diabetes, r = 0.65, P less than 0.05. We conclude that gonadarche appears to proceed despite delayed adrenarche in IDD males. This study presents further evidence in favour of adrenarche and gonadarche being independent physiological events. The causes and clinical significance of low serum DHAS concentrations in adolescent diabetic males remain to be established.

Serum immunoreactive melatonin in boys with delayed puberty

Serum immunoreactive melatonin was measured in thirty-three male subjects with delayed puberty, thirty of whom had simple (idiopathic) delayed puberty (SDP) and three of whom were GH deficient. The results were compared with a control population of twenty-six subjects. Significantly elevated values of serum melatonin were demonstrated in both groups of abnormal subjects as compared with the control population (P less than 0.0001). No significant fall of serum melatonin was noted in the subjects with simple pubertal delay prior to the onset of puberty. However, there was a significant fall of serum melatonin in these subjects between mid and late puberty (P less than 0.025). The results suggest that whilst melatonin may inhibit puberty, a fall in serum levels is not essential for the commencement of puberty in man.

Alterations in haem biosynthesis during the human menstrual cycle: studies in normal subjects and patients with latent and active acute intermittent porphyria

1. The timing of onset of attacks of acute intermittent porphyria (AIP) in relation to the menstrual cycle has been studied in three patients experiencing frequent attacks. Nineteen of their 27 admissions in attack for which no exogenous precipitating causes could be identified were during the 7 days before the onset of menstruation.

2. Haem biosynthesis has been monitored throughout a complete menstrual cycle in six normal females and compared with that in male control subjects. In the females, there was marked fluctuation in the activity of the rate-controlling enzyme of haem biosynthesis, δ-aminolaevulinate (ALA) synthase, which was monitored in peripheral leucocytes. The fluctuation did not show any clear association with menstruation and no association was found between the enzyme activity and ovarian or adrenal steroid production as monitored by measurement of plasma concentrations of androstenedione, dehydroepiandrosterone (DHA), dehydroepiandrosterone sulphate (DHAS), testosterone, oestradiol and progesterone. The activity of uroporphyrinogen I (URO) synthase, the enzyme which is deficient in AIP, was monitored in peripheral erythrocytes of four of the normal female subjects and was similar to that found in four male control subjects. The urinary excretion of ALA and porphobilinogen (PBG) was also similar in the male and female subjects and there was no association with the phase of the menstrual cycle or activity of the enzymes studied.

3. Studies of haem biosynthesis have been made throughout a complete menstrual cycle in a 26 year old female with latent AIP. The activity of leucocyte ALA synthase showed more marked fluctuation than in the normal female subjects and was highest at the time of menstruation. No association was apparent between the activity of ALA synthase and plasma concentrations of androstenedione, DHA and DHAS. The fluctuation in activity of erthrocyte URO synthase was similar to that of the normal subjects. The urinary excretion of ALA and PBG was normal throughout and showed no correlation with fluctuations in enzyme activity.

4. The human menstrual cycle modifies haem biosynthesis in normal subjects as well as in subjects with latent and manifested AIP.

5. The human female menstrual cycle modifies haem biosynthesis in peripheral blood cells as well as in the liver.

Antenatal diagnosis of placental sulphatase deficiency

A dynamic test for the antenatal diagnosis of placenta sulphatase deficiency was examined in ten patients, selected on the basis of low urinary oestrogen levels (i.e. below the 10th centile at between 30 and 40 weeks gestation). The test consisted of measurement of plasma oestradiol levels over a period of 120 min after an i.v. injection of dehydroepiandrosterone sulphate. The oestradiol response was vigorous in seven patients, absent in two and small, but significant, in one. The three patients with reduced oestradiol response were also found to have raised levels of urinary steroid monosulphates and thus were probably placental sulphatase deficient. The overall clinical importance of placental sulphatase deficiency and the value of the dehydroepiandrosterone sulphate loading test in antenatal diagnosis are discussed.

Clinical value of adrenal androgen measurement in the diagnosis of delayed puberty

Serum levels of the adrenal androgens dehydroepiandrosterone (DHA), dehydroepiandrosterone sulphate (DHAS), and androstenedione (A) were measured in 90 males (age range 14 1/2--26 years) presenting with delayed puberty to an adult endocrine clinic over a period of 3 years. The results show that adrenal androgen levels are significantly lower (p less than 0.0005) in subjects with growth-hormone (GH) deficiency than in patients with simple and constitutional delayed puberty and other, less common, conditions. By contrast, subjects with hypogonadotropic hypogonadism had significantly raised values (p less than 0.0005). On initial presentation DHA and DHAS measurements correctly identified all GH-deficient subjects and in addition DHAS measurements identified 89% of subjects with hypogonadotropic hypogonadism. It is suggested that measurement of serum levels of DHA and DHAS may assist greatly in the early diagnosis of conditions causing delayed puberty, and thus may prevent unnecessary delay in treatment.

Lymphocyte stimulation in hepatitis B infections

Cell-mediated responses in patients with acute and chronic forms of Type B hepatitis were tested by lymphocyte transformation to purified hepatitis surface antigen (HBS Ag) and to phytohemagglutinin, by dinitrochlorobenzene sensitization and by response to skin-test antigens. Although absent during acute Type B hepatitis, lymphocyte transformation by HBS Ag appeared during early convalescence and remained detectable for six years after recovery. Patients with Type B chronic active hepatitis with increased serum transaminase levels showed a partial lymphocyte transformation with HBS Ag, whereas those with normal transaminase values demonstrated no transformation. Patients with Type B chronic persistent hepatitis and carriers of HBS Ag did not have lymphocyte transformation. Normal responses to dinitrochlorobenzene, intradermal skin tests and phytohemmaglutinin were found in all patients with acute, chronic active or chronic persistent hepatitis and carriers. These results indicate that recovery from Type B hepatitis is associated with the ability to elicit a specific lymphocyte response to HBS Ag.