Cyproterone acetate in the treatment of hirsutism

Cyproterone acetate (100 mg daily on the 5th-14th days of the normal cycle) together with ethinyl estradiol (0.05 mg daily on the 5th-25th days) was used for the treatment of hirsutism in 23 women for six months. This treatment caused a significant decrease in the severity of the hirsutism after only three months, the effect being maximal after six months. Sixty per cent of our patients reported being subjectively satisfied with the results. A relapse occurred, however, within three months of the end of the treatment in half the patients. The serum testosterone was significantly decreased after three months of treatment, but the changes in serum testosterone did not follow the changes in the clinical picture of hirsutism, suggesting that one facet in the favorable action of cyproterone acetate is an inhibition of the action of androgen on target cells. Various side effects, such as nausea, headache, loss of libido and depression, were reported very frequently, which undoubtedly limits the large scale use of this treatment, at least with the doses used in this study.

The lack of significant change in plasma progesterone and estradiol-17 beta levels before the onset of human labor

Maternal plasma levels of progesterone and estradiol-17 beta were measured weekly by radioimmunoassay in 15 healthy women during the last trimester of normal pregnancy. There was a large individual variation for both hormones. The mean concentrations rose slightly with advancing gestational age but the ratio of progesterone to estradiol did not change. It is apparent that the onset of spontaneous labor cannot be predicted by measuring the levels of progesterone and estradiol-17 beta in maternal peripheral plasma.

Thromboxane A2 in pregnancy and puerperium

Images

Bromocriptine suppresses the thyrotrophin response to thyrotrophin releasing hormone during human pregnancy

Thyrotrophin (TSH) responses to 200 microgram of intravenous thyrotrophin releasing hormone (TRH) were measured in fifteen healthy women in normal early pregnancy before and at the end of a bromocriptine treatment of 5.0-7.5 mg daily for 1-2 weeks. Bromocriptine did not change the basal levels of TSH, triiodothyronine (T3) and thyroxine (T4) during pregnancy. Before the start of bromocriptine, TRH caused a significant TSH elevation from 12.8 +/- 0.5 muu/ml (mean +/- SE) to 21.2 +/- 1.9 muu/ml after 20 min. During bromocriptine intake, TRH caused a TSH elevation from 11.9 +/- 0.4 muu/ml to only 15.5 +/- 1.1 muu/ml which is significantly less (P less than 0.001) than before bromocriptine. Similarly, the mean maximal TSH increment of 8.4 +/- 1.5 muu/ml before bromocriptine was greater (P less than 0.001) than that of 3.8 +/- 60 muu/ml during bromocriptine intake. When women were retested with TRH before and during bromocriptine after legal abortion, bromocriptine did not change the basal levels of TSH, T3 and T4 or the TSH response to TRH. Therefore, the TSH inhibition caused by bromocriptine is specifically related to the pregnancy itself, but the mechanism for this inhibition remains unknown.

Sulpiride treatment during early human pregnancy: effect on the levels of prolactin, six steroids, and placental lactogen

To study the role of PRL in the regulation of the production of 17 beta-estradiol, progesterone, testosterone, and human placental lactogen (hPL), 11 healthy women were given 150 mg sulpiride daily for 14 days, beginning between weeks 6--9 of normal gestation. Plasma PRL, estradiol, progesterone, testosterone, and hPL were measured before and 1 and 2 weeks after the start of sulpiride treatment, and the results were compared with those from 16 control women who were followed similarly but without sulpiride treatment. Sulpiride treatment induced significant (P less than 0.001) elevations of plasma PRL at 1 week [84.1 +/- 4.9 vs. 23.7 +/- 2.8 ng/ml (mean +/- SE)] and 2 weeks (83.0 +/- 4.1 vs. 31.9 +/- 4.1 ng/ml). No differences were observed in the concentrations of estradiol, progesterone, testosterone, or hPL. Two women treated with sulpiride reported mild uterine contractions, but no spontaneous abortion occurred in either group. It is evident that hyperprolactinemia or sulpiride treatment do not change the circulating concentrations of sex steroids and hPL between 6--11 of normal gestation.

Does bromocriptine block thyrotropin-releasing hormone-induced prolactin release during pregnancy?

PRL responses to 200 microgram of iv TRH were measured in 16 healthy women with normal early pregnancy before and at the endo of bromocriptine treatment of 5.0--7.5 mg daily for 1--2 weeks. Before the start of bromocriptine, TRH caused a PRL elevation from 19.1 +/- 2.2 to 95.2 +/- 12.6 ng/ml (mean +/- SE) after 20 min, with a mean maximal PRL increment of 71.7 +/- 11.6 ng/ml. Bromocriptine suppressed basal plasma PRL level to 3.6 +/- 0.8 ng/ml (P less than 0.001). TRH then caused a PRL rise to 18.8 +/- 1.8 ng/ml at 20 min, with a mean maximal PRL increment of 15.7 +/- 1.8 ng/ml. The absolute PRL response was significantly smaller (P less than 0.001) during bromocriptine intake than before, whereas the mean percent increments in PRL levels after TRH administration were similar in the presence and absence of bromocriptine. Fifteen of these women were restudied with TRH stimulation 4--6 weeks after legal abortion, and the PRL responses to TRH were normal. When 7 of these women were once again treated with bromocriptine and retested with TRH, no absolute or relative PRL response to TRH emerged. These results release differs between the pregnant and nonpregnant states.

Metabolism of a new synthetic progestagen, Org 2969, in female volunteers. The distribution and excretion of radioactivity after an oral dose of the labelled drug

The metabolism of a new synthetic progestagen, Org 2969 was studied in 4 healthy female volunteers. During the first part of the study (Phase I), the volunteers ingested 50 microgram (about 0.1 mCi) of [16-3H5Org 2969 together with 50 microgram of ethinyloestradiol as a single dose. During the second part of the study (Phase II), a 10-day pre-treatment with the same dosage of non-radioactive compound preceded the administration of the radioactive steroid. A peak level of total radioactivity, representing 3.16-5.02% of the dose given/l of serum, was achieved within 2-3 h in Phase I. During Phase II, the corresponding figures were 4.54-5.13% after 1.5-3 h. The difference was mainly due to an increase of freely-extractable steroids during Phase II. The difference can at least partly be explained by assuming a change in the kinetics of the metabolism of Org 2969 by pre-treatment with Org 2969 and ethinyloestradiol. The mean recovery of radio activity in urine and faeces was 83.0%/48.1%/34.9% (total/urine/faeces) of the total dose in Phase I and 76.1%/45.2%/30.9% during Phase II. The differences in the total excretion and in the radioactivity excreted in the faeces were significant.

Intraamniotic or intravenous injection of dehydroepiandrosterone sulfate in midgestation: effect on prolactin level in maternal serum and amniotic fluid

The influence of dehydroepiandrosterone sulfate (DHEA-S) on PRL levels in maternal serum and amniotic fluid at midgestation was evaluated in a series of 32 women admitted for midtrimester abortion. Serum was collected hourly for 6 h in 13 women after intraamniotic (ia) instillation (100--200 mg) or in 10 women after iv injection (100 mg) of DHEA-S, and in 9 control women. Serum PRL levels rose significantly (P less than 0.05) 3--6 h after ia and 2--6 h after iv administration of DHEA-S but was unchanged in the control group. The elevation of serum PRL levels is most likely secondary to increased levels of serum estrogens which accompany ia or iv administration of DHEA-S. This suggests that maternal pituitary PRL secretion is responsive to additional stimulation by endogenous estrogens at midgestation. The amniotic fluid PRL level ranged from 1109-2473 ng/ml, with no consistent change after administration of ia DHEA-S, intimating that estrogens may not be implicated in the control of PRL in amniotic fluid.

Pituitary and ovarian function in women with congenitally absent uterus

Pituitary-ovarian function was studied in 2 women with congenital absence of the uterus and the vagina. Daily serum levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin, estradiol-17beta, and progesterone were measured by radioimmunoassay for 1 month. Gonadotropins and ovarian steroids showed normal cyclic variations in both patients. Prolactin was persistently elevated in one of them, who also demonstrated 2 abnormally high testosterone values among 6 determinations. The pituitary gland was stimulated by intravenous leasing hormone (LRH-TRY). Gonadotropin and prolactin responses to LRH-TRH were normal. The lifelong absence of the uterus does not alter the function of the pituitary-ovarian axis. The relation of hyperprolactinemia to this syndrome must be ascertained in a greater number of patients.

Hormonal pattern of adolescent menstrual cycles

Serum FSH, LH, PRL, estradiol, pregnenolone, progesterone, 17-hydroxyprogesterone, androstenedione, testosterone, 5 alpha-dihydrotestosterone, and androsterone were measured radioimmunologically in 20 normal girls aged 13-17 yr. Samples were taken every day or every second day during one menstrual cycle. The cycles recorded could be divided into three groups. The first and oldest group consisted of 10 girls with a mean gynecological age (years since menarche) of 2.9 yr. The luteal phase was at least 11 days and the progesterone concentration was at least 5 ng/ml. The testosterone rise (mean, 55%) on the day of LH surge correlated well with the simultaneous progesterone rise (mean, 270%) and the following luteal progesterone secretion. A negative correlation was seen between the FSH concentration on days 3-4 of the cycle and the length of the follicular phase. The second group consisted of 4 girls who had a mean gynecological age of 1.5 yr. The luteal phase was of 4- to 8-day duration and the progesterone secretion was lower than in group I. The follicular phase testosterone concentration was lower in group II as compared to group I. No "periovulatory" testosterone increases were seen, although every cycle displayed an LH and FSH peak. The third group consisted of 6 girls with a mean gynecological age of 1.1 yr. These cycles were anovulatory, as the serum progesterone concentration never exceeded 1.0 ng/ml. In two cycles, signs of follicular maturation were seen. In the four others, the androgen levels tended to be elevated. In two cases, the testosterone and androstenedione concentrations were 2-4 times elevated from the beginning of these two cycles. Thus, the hormonal pattern of adolescent menstrual cycles is far from uniform. It is very likely that in addition to gonadotropins, estradiol and progesterone, androgens may also have a role in the development and maintenance of normal menstrual function in the female.

Effects of ritodrine and isoxsuprine with and without dexamethasone during late pregnancy

beta-Adrenergic agents are used to inhibit preterm labor and glucocorticoids to accelerate fetal pulmonary maturation. A study was designed to investigate the metabolic effects of intravenous infusion of ritodrine (150 to 100 microgram/min) or isoxsuprine (200 to 150 microgram/min) in a series of 28 patients with gestations of 28 to 40 weeks, with and without concomitant dexamethasone therapy. Ritodrine was more potent than isoxsuprine in increasing the circulating levels of cyclic AMP, glucose, insulin, and triglycerides. The diabetogenic effect of both ritodrine and isoxsuprine was so slight that it did not have any clinical significance in women with normal glucose tolerance. The results were similar when these beta-adrenergic tocolytics were given to women concomitantly with intramuscular dexamethasone therapy, although dexamethasone appeared to minimally impair carbohydrate metabolism. Both ritodrine and isoxsuprine caused a significant fall in serum iron and potassium, and this effect was unaltered by dexamethasone. Serial serum potassium levels should be obtained during long-term infusion of beta-mimetics.

Effects of intravenous isoxsuprine and ritodrine, with and without concomitant dexamethasone, on fetoplacental and pituitary hormones and cyclic adenosine monophosphate during late pregnancy

Beta sympathomimetic drugs are used to inhibit preterm labor and glucocorticoids to accelerate fetal pulmonary maturation. A study was designed to investigate the hormonal effects of intravenous infusion of isoxsuprine 150 to 200 mcg. per minute or ritodrine 100 to 150 mcg. per minute in a series of 28 women at 28 to 40 weeks' gestation, with and without concomitant dexamethasone therapy. Serial serum samples taken before and during the six hours of infusion were assayed for cyclic adenosine-3,5-monophosphate (AMP), estradiol, estriol, progesterone, human placental lactogen (hPL), thyrotropin (TSH), follicle-stimulating hormone (FSH), and human growth hormone (gGH). Ritodrine was more potent than isoxsuprine in increasing the circulating levels of cyclic AMP. The levels of placental steroid hormones decreased slightly, as did the ratio of progesterone to estradiol. Human placental lactogen and pituitary hormones showed no consistent changes. Simultaneous administration of dexamethasone did not modify these results.

Automation of radioimmunoassays for some sex steroids with use of both iodinated and tritiated ligands

We describe an automated technique for estradiol, progesterone, and testosterone, in which System Olli 3000 pipetting and incubation units are used. After extraction or chromatography, steroids are redissolved in ethanol or buffer, and duplicate aliquots are arranged for radioimmunoassay in 24-tube blocks. Addition of antibodies, tracers (125I or 3H), dextran-coated charcoal for separating free and bound ligands, and removal of a portion of the supernate for counting are all performed by the pipetting instrument. Incubations are at 37 degrees C in the incubation unit, or at 4 degrees C. After counting, steroid concentrations are computed from punch tape records by a Nova 840 computer. The management of assays in 24-tube units, and accurate simultaneous pipetting has reduced experimental error, and because there is no carryover, many different assays can be performed concurrently or in rapid sequence. Various scintillation media are compared.

Automation of radioimmunoassays for some sex steroids with use of both iodinated and tritiated ligands

We describe an automated technique for estradiol, progesterone, and testosterone, in which System Olli 3000 pipetting and incubation units are used. After extraction or chromatography, steroids are redissolved in ethanol or buffer, and duplicate aliquots are arranged for radioimmunoassay in 24-tube blocks. Addition of antibodies, tracers (125I or 3H), dextran-coated charcoal for separating free and bound ligands, and removal of a portion of the supernate for counting are all performed by the pipetting instrument. Incubations are at 37 degrees C in the incubation unit, or at 4 degrees C. After counting, steroid concentrations are computed from punch tape records by a Nova 840 computer. The management of assays in 24-tube units, and accurate simultaneous pipetting has reduced experimental error, and because there is no carryover, many different assays can be performed concurrently or in rapid sequence. Various scintillation media are compared.

Abortifacient efficiency of 15 (S) 15-methyl-prostaglandin F2alpha-methyl ester administered vaginally during early pregnancy

Forty early pregnancies (menses delay 13 - 27 days) were terminated by administering four vaginal suppositoreis each containing 1.0 or 1.5 mg of 15 (S) 15-methyl-prostaglandin F2alpha-methyl ester, one every third hour. In 14 cases serial measurementsof serum estradiol and progesterone were performed during and after therapy. Uterine contractions and bleeding started 1 - 17 hours after administration of the first suppository. Abortion was complete after one week in five women (13%), and after two weeks in 30 (75%). A curettage was performed on eight women, residual placental fragments were found in seven and pregnancy continued in one woman. Mild diarrhoea (65%) and vomiting (40%) were the major side-effects, despite premedication. Estradiol and progesterone levels fell progressively during the therapy. Self-administration of 4 or 6 mg of the methyl ester caused too low a rate of complete abortion for use in practice, but it may be a valuable and practical agent for preoperative dilation of the cervix.

Biological effects of a new and potent progestagen. A clinical study

The biological effects of a new synthetic progestagen, Org 2969 (13-ethyl-11-methylene-18,19-dinor-17 alpha-pregn-4-en-20-yn-17-ol) were studied in healthy normally menstruating women. Two of them were given 0.125 mg, five 0.060 mg and two 0.030 mg of Org 2969 daily on days 1-20 during one menstrual cycle. Serum levels of follicle stimulating hormone, luteinizing hormone, progesterone and oestradiol were analyzed on days 8-23 in order to evaluate the function of the hypophyseal-ovarian axis. The serum concentrations of aspartate amino transferase, alanine amino transferase, alkaline phosphatase, gamma glutamyl transpeptidase and bilirubin were determined to evaluate possible side effects on live function on days 8, 15 and 23. Serum cortisol was measured on days 8 and 23. The basal body temperature was recorded daily during the whole cycle, and endometrium biopsies were taken on days 21 or 22 of the cycle. All samples were taken similaryl during the treatment cycle and the preceding control cycle. According to the hormone determinations, all the treatment cycles were anovulatory except in one woman receiving the lowest dose. The treatment led to decreased spinnbarkeit, arborization and sperum penetration in the cervical mucus. Liver function tests and serum cortisol remained unchanged during the treatment.