A radioimmunoassay of androstenedione

Urinary Androgens Provide Additional Evidence Related to Metabolism and Are Correlated With Serum Androgens in Girls

Context

Androgen levels are generally measured in serum samples, but urine may be a more feasible option, especially in children, as it is a noninvasive alternative.

Objective

To assess the correlations of 10 urinary androgen metabolites with 4 serum androgens [dehydroepiandrosterone-sulfate (DHEA-S), androstenedione, and total and free testosterone] and assess if their correlations differ by participant characteristics.

Methods

Our study consisted of 44 girls, ages 6-13, who participated in the New York site of the LEGACY Girls Study and had both serum and urine samples collected at the same visit. We performed Pearson's correlation coefficient tests between 4 serum and 10 individual urinary metabolite measures and their sum. We examined the influence of participant characteristics on the magnitude and direction of the correlations.

Results

The summed urinary metabolite measures had the highest correlation with free testosterone in serum (global sum, r = 0.83) and correlated least with DHEA-S in serum (global sum, r = 0.64). The correlation between individual urinary metabolites and serum androgens ranged from 0.08 to 0.84.Two 11-oxygenated urinary metabolites (5α-androstane-3α-ol-11,17-dione5β-androstane-3α,11β-diol-17-one) were weakly correlated with all serum androgens. Participant age, weight, height, waist:hip ratio, and pubic hair growth stage changed the correlations between urinary and serum androgens measures between 10% and 213%.

Conclusion

The sum of urinary androgen metabolites was a good marker of circulating androstenedione, testosterone, and free testosterone. Individual urinary metabolites provide additional information about the metabolic processes of disease development compared to the antecedent serum androgens.

Quantitation of 5α-Androstanedione in Normal Women and Women with PCOS

In vitro studies show that 5α-androstane-3,17-dione (5α-A) is an important intermediate in the formation of dihydrotestosterone (DHT) from androstenedione (A) in women and men. Many studies involving hyperandrogenism, hirsutism, and polycystic ovary syndrome (PCOS) have measured A, testosterone (T), and DHT, but not 5α-A due to lack of a readily available assay to quantify this androgen. We have developed a specific and sensitive radioimmunoassay to measure 5α-A levels, together with A, T, and DHT, in both serum and genital skin. The present study involves 2 cohorts. Cohort 1 included 23 mostly postmenopausal women who provided both serum and genital skin to measure those androgens. In cohort 2, serum androgen levels were compared between women with PCOS and non-PCOS controls. Tissue-to-serum ratios were significantly higher for 5α-A and DHT as compared to A and T. None of the androgens showed a significant correlation between serum and genital tissue. In serum, 5α-A was significantly correlated with A, T, and DHT. In cohort 2, A, T, and DHT were significantly higher in the PCOS group compared to the control group. In contrast, 5α-A levels were similar between the 2 groups. Our findings support the view that 5α-A is an important intermediate in DHT formation in genital skin. Also, the relatively low levels of 5α-A in PCOS women suggest that it may play a more important intermediate role in the conversion of A to androsterone glucuronide.

Multicenter Evaluation of a New, Fully Automated Androstenedione Electrochemiluminescence Immunoassay: Precision Analysis, Method Comparison, and Determination of Reference Ranges

BACKGROUND

Androstenedione (ASD) levels can aid diagnosis of hyperandrogenism together with other clinical/laboratory findings. We evaluated performance of the new, automated Elecsys® ASD assay vs an ASD isotope dilution-liquid chromatography-tandem mass spectrometry (ID-LC-MS/MS) reference measurement procedure and determined reference ranges.

METHODS

Repeatability/intermediate precision were assessed using 3 control levels and 5 human serum pools (n = 75 each; Clinical and Laboratory Standards Institute EP05-A3). Method comparisons vs commercially available immunoassays [IMMULITE ASD (Siemens) and LIAISON ASD (DiaSorin)] and an ID-LC-MS/MS measurement procedure method were conducted using 421 serum samples; Passing-Bablok regression and Pearson's correlation coefficients were calculated. Reference ranges and distribution of values associated with polycystic ovary syndrome (PCOS) were determined in five clinical cohorts using samples from several sites/vendors.

RESULTS

Repeatability/intermediate precision coefficients of variation across all sites were 2.01% to 3.91% and 2.43% to 4.30%, respectively (mean ASD: 7.80-34.7 nmol/L). The Elecsys ASD assay showed poor agreement with IMMULITE ASD (slope = 0.459; r = 0.856; n = 320), fair agreement with LIAISON ASD (slope = 0.625; r = 0.984; n = 327), and very good agreement with ID-LC-MS/MS (slope = 1.040; r = 0.996; n = 332). Reference ranges (2.5th-97.5th percentiles) were: children (≤8 years; n = 140), <0.525 to 1.81 nmol/L; males (≥18 years; n = 138), 0.979 to 5.32 nmol/L; and postmenopausal females (n = 140), 0.654 to 3.74 nmol/L. Reference range (5th-95th percentiles) for females with fertile cycle (≥18 years; n = 84) was 1.71 to 4.58 nmol/L. The distribution of values (2.5th-97.5th percentiles) in females with PCOS (n = 125) was 2.26 to 12.1 nmol/L.

CONCLUSIONS

Elecsys ASD assay demonstrated excellent precision and very good agreement with ID-LC-MS/MS. Reference ranges were established to support results interpretation in routine practice.

Development and validation of a simple, sensitive enzyme immunoassay for quantification of androstenedione in bull plasma

As an alternative to radioimmunoassay a simple and highly sensitive enzyme immunoassay (EIA) was developed and validated for androstenedione quantification in plasma of Karan Fries bulls using second antibody coating technique. The wells of the microtitreplate were coated with affinity-purified goat immunoglobulin (antirabbit IgG) that binds the hormone specific antibody. The EIA was performed to analyze androstenedione directly in 40 μl of bull plasma. The androstenedione standards ranged from 0.20 to 200 pg/40 μl /well and the sensitivity of the assay was 5 pg/ml plasma. Serially diluted bull plasma containing high endogenous androstenedione showed good parallelism with bovine androstenedione standard curve. Intra- and inter-assay coefficients of variation (CV) were found to be 8 and 9%, respectively. Peripheral plasma androstenedione concentrations determined in young and adult bull samples ranged between 104–990 pg/ml and 184–2040 pg/ml, respectively.

Dexamethasone suppressibility and adrenal and ovarian venous effluents of 5α-reduced C19 conjugates in hyperandrogenic women

Several C19 conjugates, derived via 5α-reductase activity, are putative markers of peripheral androgen action and have been shown to correlate well with various clinical manifestations of androgen excess. While no ovarian vein gradient has been found for androsterone sulfate (ADT-S), androsterone glucuronide (ADT-G), 5α-androstane-3α,17β-diol sulfate (3α-diol-S), and 5α-androstane-3α,17β-diol glucuronide (3α-diol-G), the contribution of the adrenal gland to these conjugates has been unclear. Ten hirsute women were treated with 2mg/day dexamethasone (dex) for 7 days to determine the effect of adrenal androgen suppression on 5α-reduced androgen conjugate production. In addition, 11 women with mixed ovarian and adrenal androgen excess of non-neoplastic origin underwent ovarian and adrenal vein catheterization studies in order to assess gradients for the various C19 steroids. These women had significantly higher levels of both unconjugated and conjugated androgens, except for ADT-S, compared to 8 matched normal ovulatory women. After dex treatment, total testosterone (TT), unbound T (UT), androstenedione (A) and DHEAS, all decreased by 31-75%. ADT-S, ADT-G, 3α-diol-S and 3α-diol-G decreased by 48%, 71%, 46% and 68%, respectively. The suppression of the unconjugated androgens correlated highly and significantly with ADT-G. In the 11 patients undergoing adrenal venous catheterization, all patients exhibited a substantial adrenal gradient for TT and A. Of significance, in paired samples of peripheral venous and glandular effluents, no adrenal or ovarian gradient was found for any of the conjugated androgens. The data suggest that because dex suppression significantly decreases levels of the conjugated androgens, they are highly substrate dependent. However, since no adrenal or ovarian vein gradient exists, these markers of the manifestations of androgen excess largely reflect peripheral androgen metabolism.

Novel nucleotide insertions in two unrelated Indian patients with 5α reductase 2 deficiency leading to premature termination of SRD5A2 enzyme

T is converted to a more potent androgen, DHT by the action of microsomal membrane enzyme 5α reductase 2. Defects in 5α reductase 2 isozyme results in incomplete virilisation of external male genitalia. Mutations in SRD5A2 gene leads to diminished enzyme activity, thus hampering DHT synthesis from T. We describe two unrelated patients from India with 5αRD2 due to novel insertion of nucleotides in the exon 1 of SRD5A2 gene that lead to premature termination of protein. Master S (case 1; III.8) was 3 years old at initial evaluation, had perineoscrotal hypospadias, microphallus and both testes were palpable in the inguinal region. Master P (case 2; III.9) was born as normal full term baby. He had primary complaint of microphallus, penoscrotal hypospadias and gonads in the inguinal region. Diagnosis of 5αRD2 was made, as T/DHT ratio in the two cases was 41 and 131.2 respectively. Sequence analysis of SRD5A2 gene showed an insertion of nucleotides TA in exon 1 (c.188_189). This resulted in premature termination of the protein due to stop codon at amino acid position 7. The protein formed is drastically truncated and inadequate protein synthesized explains the phenotypic characteristics of our patients.

Variation in the end products of androgen biosynthesis and metabolism during postnatal differentiation of rat Leydig cells

The amount of testosterone (T) secreted by Leydig cells is determined by a balance between T biosynthetic and metabolizing enzyme activities. It has been established that 5alpha-androstan-3alpha,17beta-diol (3alpha-DIOL) is the predominant androgen secreted by the testes of immature rats during days 20-40 postpartum, whereas T is the major androgen by day 56. However, the underlying changes in T biosynthetic and metabolizing enzymes during Leydig cell development and their magnitudes have remained unclear. The aim of the present study was to define the developmental trends for T biosynthetic and metabolizing enzymes in Leydig cells at three distinct stages of pubertal differentiation: mesenchymal-like progenitors on day 21, immature Leydig cells on day 35, and adult Leydig cells on day 90. Production rates for precursor androgen (androstenedione), T, and 5alpha-reduced androgens [androsterone (AO) and 3alpha-DIOL] were measured in progenitor, immature, and adult Leydig cells in spent medium after 3 h in vitro. Steady state messenger RNA (mRNA) levels and enzyme activities of biosynthetic and metabolizing enzymes were measured in fractions of freshly isolated cells at each of the three stages. Unexpectedly, progenitor cells produced significant amounts of androgen, with basal levels of total androgens (androstenedione, AO, T, and 3alpha-DIOL) 14 times higher than those of T alone. However, compared with immature and adult Leydig cells, the capacity for steroidogenesis was lower in progenitor cells, with a LH-stimulated production rate for total androgens of 84.33 +/- 8.74 ng/10(6) cells x 3 h (mean +/- SE) vs. 330.13 +/- 44.19 in immature Leydig cells and 523.23 +/- 67.29 in adult Leydig cells. The predominant androgen produced by progenitor, immature, and adult Leydig cells differed, with AO being released by progenitor cells (72.08 +/- 9.02% of total androgens), 3alpha-DIOL by immature Leydig cells (73.33 +/- 14.52%), and T by adult Leydig cells (74.38 +/- 14.73%). Further examination indicated that changes in the predominant androgen resulted from differential gene expression of T biosynthetic and metabolizing enzymes. Low levels of type III 17beta-hydroxysteroid dehydrogenase (17betaHSD) mRNA and enzyme activity were present in progenitor cells compared with immature and adult Leydig cells. In contrast, levels of type I 5alpha-reductase (5alphaR) and 3alpha-hydroxysteroid dehydrogenase (3alphaHSD) mRNA and enzyme activities were dramatically lower in adult Leydig cells compared with those in progenitor and immature Leydig cells. Several T biosynthetic enzymes attained equivalent levels in immature and adult Leydig cells, but T was rapidly metabolized in the former to 3alpha-DIOL by high 5alphaR and 3alphaHSD activities, which were greatly reduced in the latter. Therefore, declines in 5alphaR and 3alphaHSD activities are hypothesized to be a major cause of the ascendancy of T as the predominant androgen end product produced by adult Leydig cells. These results indicate that steroidogenic enzyme gene expression is not induced simultaneously, but through sequential changes in T biosynthetic and metabolizing enzyme activities, resulting in different androgen end products being secreted by Leydig cells during pubertal development.

Finasteride in the treatment of hirsutism: new therapeutic perspectives

OBJECTIVE

To determine of the clinical and hormonal effects of finasteride (Proscar; Merck, Sharp, and Dohme, Rahway, NJ) in the treatment of idiopathic hirsutism and hirsutism in patients with polycystic ovary syndrome (PCOS).

DESIGN

Controlled clinical study.

SETTING

Istitute of Obstetrics and Gynecology, University of Naples "Federico II."

PATIENTS

Ten women affected by idiopathic hirsutism and 15 women with PCOS.

INTERVENTIONS

Finasteride was administered orally at a daily dose of 5 mg for a period of 6 months.

MAIN OUTCOME MEASURES

Rating of hirsutism with the Ferriman-Gallwey method; serum androgen assays.

RESULTS

Finasteride produced a reduction in the average hirsutism scores ( > 50% in all patients), whereas no change was observed in serum T, androstenedione, and DHEAS levels. A significant reduction was measured in serum dihydrotestosterone and 3 alpha, 17 beta-androstenediol glucuronide levels.

CONCLUSIONS

This study demonstrates that symptomatic hirsutism has to be considered as a skin disease associated with the increased activity of the 5 alpha-reductase. It also indicates that the selective 5 alpha-reductase inhibitor, finasteride, is very effective and well tolerated in the treatment of both idiopathic hirsutism and of hirsutism in patients with PCOS.

Behavioral stress responses in premenopausal and postmenopausal women and the effects of estrogen

OBJECTIVE

Our purpose was to determine the pattern of reactivity to stress in premenopausal and postmenopausal women and to assess the effects of estrogen.

STUDY DESIGN

A behavioral stress test was given to premenopausal (n = 13) and postmenopausal women (n = 36). Biophysical and neuroendocrine responses were measured during and on completion of the stress test. The postmenopausal women were then randomized to placebo or transdermal estradiol treatment for 6 weeks, at which time another behavioral stress test was given.

RESULTS

Stress reactivity to math and speech tasks elicited significantly greater systolic blood pressure responses in postmenopausal women compared with premenopausal women (p < 0.05). On retesting, significant biophysical responses that were present during the initial stress testing were still present (p < 0.05) in the placebo group but were blunted with estrogen treatment. Plasma corticotropin, cortisol, androstenedione, and norepinephrine increased during testing to a similar degree in premenopausal and postmenopausal women; this response was maintained after placebo treatment. Postmenopausal women treated with estrogen had blunted responses.

CONCLUSION

Significant differences in responses to psychologic stress exist in premenopausal and postmenopausal women. The lack of adaptation may account in part for the increased risk of cardiovascular disease in postmenopausal women. Estrogen appears to blunt the stress-induced response.

Increased circulating levels of immunoreactive beta-endorphin in polycystic ovary syndrome is not caused by increased pituitary secretion

OBJECTIVE

Our purpose was to investigate the source and role of elevated levels of immunoreactive beta-endorphin in polycystic ovary syndrome. We wished to determine whether immunoreactive beta-endorphin secretion in patients with polycystic ovary syndrome is influenced by body weight and whether the pituitary release of immunoreactive beta-endorphin with corticotropin-releasing hormone is related to luteinizing hormone levels or adrenal androgen secretion.

STUDY DESIGN

Eighteen patients with polycystic ovary syndrome and 10 ovulatory controls were studied. Each subject received 1 microgram/kg intravenous corticotropin-releasing hormone and an oral glucose tolerance test on alternate days. Levels of plasma immunoreactive beta-endorphin, corticotropin, luteinizing hormone, cortisol, adrenal androgens, and insulin were measured.

RESULTS

Although immunoreactive beta-endorphin levels were elevated in patients with polycystic ovary syndrome (p < 0.01), incremental responses after corticotropin-releasing hormone were similar to controls and were not influenced by body weight. Serum luteinizing hormone levels were not affected by corticotropin-releasing hormone and did not correlate with immunoreactive beta-endorphin levels. Adrenal androgen responses after corticotropin-releasing hormone were increased in patients with polycystic ovary syndrome (p < 0.01) but were not correlated with immunoreactive beta-endorphin secretion. After oral glucose was given, elevated fasting insulin levels increased significantly in patients with polycystic ovary syndrome (p < 0.01), as did immunoreactive beta-endorphin levels (p < 0.05). The increases in insulin and immunoreactive beta-endorphin levels were correlated (p < 0.05).

CONCLUSIONS

Pituitary secretion of immunoreactive beta-endorphin is normal in patients with polycystic ovary syndrome, and pancreatic secretion appears to be increased. Corticotropin-releasing hormone does not influence luteinizing hormone levels, and adrenal androgen sensitivity is not influenced by immunoreactive beta-endorphin secretion.

Is 11 beta-hydroxyandrostenedione a better marker of adrenal androgen excess than dehydroepiandrosterone sulfate?

To determine whether the adrenal androgen 11 beta-hydroxyandrostenedione is a more sensitive and specific marker than dehydroepiandrosterone sulfate, we compared these serum androgens in 81 women with anovulatory hyperandrogenism before treatment, after corticotropin and corticotropin-releasing-factor stimulation, and after short- and long-term dexamethasone suppression. Of all subjects, 65% and 57% had elevated levels of 11 beta-hydroxyandrostenedione (greater than 2.0 ng/ml) and dehydroepiandrosterone sulfate (greater than 2.8 micrograms/ml), respectively. However, 11 beta-hydroxyandrostenedione and dehydroepiandrosterone sulfate levels did not correlate in either the women with hyperandrogenism (r = 0.12) or the 26 normal women (r = 0.29). After 0.25 mg corticotropin was administered intravenously (n = 16), 11 beta-hydroxyandrostenedione increased by 157% +/- 53% (mean +/- SEM), whereas dehydroepiandrosterone sulfate, androstenedione, dehydroepiandrosterone, and cortisol increased by 6% +/- 2%, 46% +/- 10%, 416% +/- 80%, and 2326% +/- 371%, respectively. After intravenous administration of 100 micrograms corticotropin-releasing factor to eight patients, the percent change from baseline level to peak was 148% +/- 26%, 24% +/- 5%, 61% +/- 15%, 117% +/- 15%, and 116% +/- 18% for 11 beta-hydroxyandrostenedione, dehydroepiandrosterone sulfate, androstenedione, dehydroepiandrosterone, and cortisol, respectively. After 2 mg dexamethasone for 3 days (n = 10), 11 beta-hydroxyandrostenedione, dehydroepiandrosterone sulfate, androstenedione, and testosterone were suppressed by 95% +/- 2%, 74% +/- 3%, 51% +/- 9%, and 32% +/- 9%, respectively. Suppression with 0.5 mg dexamethasone for 3 months lowered 11 beta-hydroxyandrostenedione and dehydroepiandrosterone sulfate levels equally by 50% +/- 14% and 62% +/- 12%, respectively. 11 beta-Hydroxyandrostenedione is a useful marker of adrenal androgen secretion with a calculated sensitivity and specificity greater than that of dehydroepiandrosterone sulfate. The greater sensitivity of 11 beta-hydroxyandrostenedione over dehydroepiandrosterone sulfate to adrenal stimulation and suppression suggests its unique diagnostic use.

Is the inappropriate gonadotropin secretion of patients with polycystic ovary syndrome similar to that of patients with adult-onset congenital adrenal hyperplasia?

OBJECTIVE

To assess gonadotropin alterations in adult-onset congenital adrenal hyperplasia (CAH) and to compare these findings with those of patients with polycystic ovary syndrome (PCOS) in an effort to better understand the pathophysiology of these abnormalities.

DESIGN

Prospective study of 9 newly diagnosed patients with CAH, 10 with PCOS, and 10 ovulatory controls.

INTERVENTIONS

Baseline measurements of serum androgens, progestins, estradiol (E2), estrone (E1), unbound E2, luteinizing hormone (LH), and follicle-stimulating hormone (FSH). Serum LH and FSH were measured after intravenous gonadotropin-releasing hormone (GnRH) and in 15-minute blood samples for 6 hours to determine LH pulsatility.

RESULTS

Serum androgens were elevated but comparable in the two patient groups. Serum LH was also elevated (P less than 0.05) but was higher in PCOS than CAH. Serum LH:FSH ratios were similar as were the responses to GnRH. Serum E1 was elevated only in PCOS, but unbound E2 was elevated to the same degree in both PCOS and CAH (P less than 0.05). Patients with PCOS had a decreased LH interpulse interval compared with controls and CAH (P less than 0.05), but LH pulse amplitude was increased in both PCOS and CAH (P less than 0.05). Serum E2 and unbound E2 correlated significantly with LH (P less than 0.05), LH responses to GnRH as well as to LH pulse amplitude in CAH (P less than 0.05). The LH interpulse interval did not correlate with estrogen in any group. None of the LH parameters correlated with serum progestin levels in CAH.

CONCLUSIONS

The gonadotropin abnormalities of CAH appear to be intermediate between those of controls and PCOS. Although elevated estrogen may explain these abnormalities in CAH, additional factors may be operative in PCOS.

Age-dependent responsiveness of rabbit and human cartilage cells to sex steroids in vitro

Rabbit epiphyseal cartilage tissue has been shown to convert testosterone (T) to dihydrotestosterone (DHT). In this report, the metabolic conversion of T into DHT is shown to be age-dependent, being most active in cartilage from animal at the age of gonadal maturation. Human cartilage from newborn and prepubertal children is also shown to convert T into DHT and--to a lesser extent--to estradiol. Low concentrations of DHT and 17 beta-estradiol (E2) (10(-11)-10(-9) M) were also shown to stimulate in vitro cartilage cells from boys and girls respectively. As previously shown for cultured rabbit chondrocytes, the stimulating effects of both hormones on human chondrocytes was age-dependent. Cartilage cells derived from children up to one year old did not respond, while cells from boys and girls in the early phase of puberty responded best. These data indicate that human cartilage tissue in vivo, contains both 5 alpha-reductase and aromatase activities during post-natal skeletal growth. Androgens may act on cartilage after their metabolic conversion to estrogens. The mechanism of age-dependency of both cartilage androgen enzymatic activities and chondrocyte responsiveness to sex steroids in vitro remains to be explained.

Source of raised serum estrogens in male rats with portal bypass

We sought to establish the mechanism for the raised serum estrogen levels that occur in male rats with portal hypertension and resultant portal bypass. Using the portal vein ligated (PVL) rat model, we evaluated plasma steroid hormone concentrations, metabolic clearance rate (MCR) of estradiol, and hepatic metabolism of androstenedione to estrogens and other products. In contrast to serum testosterone levels that were reduced, serum androstenedione levels were normal in the PVL rat. Estradiol MCR was measured by a constant intravenous infusion technique and was found to be similar in PVL and control animals. Androstenedione MCR was determined during constant intravenous infusion of [3H]androstenedione, and the resultant radiolabeled steroids present in plasma were separated by thin layer chromatography. The MCR of androstenedione was not diminished in PVL rats compared with controls. However, there was a sevenfold increase in the plasma estradiol derived from [3H]androstenedione in rats with portal bypass. Examination of radiolabel excreted in bile during infusion of [3H]androstenedione showed that 25-46% of this steroid was converted to estradiol in PVL rats compared with less than 3% in control male rats (P less than 0.001). Moreover, there was a selective reduction in the excretion of 16 alpha-hydroxyandrostenedione, a finding which suggested that the metabolism of androstenedione via this pathway was decreased. Androstenedione 16 alpha-hydroxylation is known to be catalyzed by a male-specific cytochrome P-450 isoform, P-450UT-A. We conclude that raised plasma estradiol levels after portal bypass in male rats are due to increased production rates, resulting in turn from enhanced aromatization of androstenedione to estradiol. On the basis of the observed specific changes in androstenedione hydroxylation pathways, it is proposed that alterations in levels of sex-specific forms of cytochrome P-450 occur in male rats with portal bypass and could account for the enhanced formation of estradiol.

Increasing circulating androgens with oral testosterone undecanoate in eugonadal men

The effects of oral testosterone undecanoate (TU 80 mg; Organon) on plasma testosterone was assessed in 9 men (average age 55 yrs) complaining of loss of sexual interest. Absorption tests were carried out following the first dose of TU and again after 3 or 4 weeks of chronic administration. Absorption was variable in timing, peaks occurring from 30 min to 5 1/2 h after the oral dose. Increases in plasma testosterone of at least 50% of baseline levels occurred in 14 of the 18 tests. Apart from a slightly faster metabolic clearance on the second test, associated with a significant reduction in SHBG, there were no other significant differences between the first and second absorption tests. Variability of absorption may be related to dietary factors. If this can be reduced by dietary control, TU offers distinct advantages over injectable esters and implants in the short-term administration of testosterone to eugonadal men.

Oocyte maturation inhibitor activity in human follicular fluid: quantitative determination in unstimulated and clomiphene citrate- and human menopausal gonadotropin-stimulated ovarian cycles

Since removal of the oocyte from the intrafollicular milieu allows meiotic resumption and germinal vesical breakdown to proceed, the concept of an intrafollicular oocyte maturation inhibitor (OMI) has evolved. Accordingly, we asked the following questions: Is there OMI activity in human follicular fluid? Does OMI activity change with ovarian hyperstimulation? and Does OMI activity correlate with oocyte fertilization or the concentration of steroids in the corresponding follicular fluid? Fresh cumulus enclosed porcine oocytes from small follicles were incubated with human follicular fluid aspirates from normally menstruating patients with or without treatment: unstimulated follicles (N = 10), clomiphene citrate (150 mg/day) (N = 10)-treated cycles, and human menopausal gonadotropin (hMG) (N = 12)-treated cycles. A lyophylized porcine follicular fluid standard and serum-free culture media were used as positive and negative controls, respectively. After a 40-hr incubation with test materials, the oocytes were fixed, stained, and evaluated for oocyte maturation as determined by germinal vesical breakdown. Human follicular fluid, estradiol, progesterone, androstenedione, and testosterone levels were determined by radioimmunoassay. The 50% inhibitory dose (ID50) for OMI activity in follicular fluid from untreated, spontaneously menstruating women was less than that for follicular fluid from clomiphene-stimulated patients, which was less than that for follicular fluid from hMG-stimulated patients. The difference between OMI values from untreated and hMG-stimulated follicular fluids was statistically significant. Human oocytes removed from follicular fluid with higher OMI activity tended not to fertilize in vitro compared to the relatively lower OMI activity present in follicular fluid yielding oocytes which did fertilize.(ABSTRACT TRUNCATED AT 250 WORDS)

Weekly variations in body weight and plasma testosterone concentrations in the captive male possum, Trichosurus vulpecula

The possum is a seasonally breeding marsupial which gives birth in Queensland from March through to September. To ascertain whether this seasonality in breeding is manifest in the male reproductive system, body weight and plasma testosterone concentrations were examined in five possums. Plasma testosterone concentrations fluctuated throughout the year and a seasonal cycle was observed, with a peak in testosterone concentration in March and a nadir in September. Body weights fluctuated in a similar manner. Statistical analysis suggested that the annual plasma testosterone profile correlated well with the rate of change of daylength.

The effects of spironolactone on adrenal steroidogenesis in hirsute women

The effect of spironolactone on adrenal androgen and cortisol production was studied in six hirsute women. Hirsute women were evaluated before and 1 month after receiving 200 mg of spironolactone daily. Basal levels of serum androgens, 17-hydroxyprogesterone (17-OHP), cortisol (F), corticosteroid-binding globulin, and plasma adrenocorticotropic hormone (ACTH) were normal and did not change with therapy. The delta maximum (delta max) responses after dexamethasone suppression and ACTH administration of dehydroepiandrosterone (DHEA), androstenedione (delta 4A), 17-hydroxypregnenolone, and 17-OHP were similar in hirsute women and ovulatory control subjects. After spironolactone administration, the delta max DHEA response was unchanged, whereas the delta max delta 4A response was decreased (P less than 0.05). The delta max ratios of DHEA/delta 4A and 17-OHP/delta 4A were significantly increased after spironolactone in hirsute women, which suggested inhibitions of 3 beta-ol-dehydrogenase-isomerase and delta 4 17,20 desmolase activities. A significant reduction in delta max F occurred after spironolactone administration (P less than 0.05). Although baseline 11-desoxycortisol (S) and the plasma S/ACTH ratio were unaltered, the delta max S/F ratio increased after treatment (P less than 0.01), suggesting an inhibition of 11 beta-hydroxylase activity. Inhibition of adrenal androgen production occurs with spironolactone, but only serum levels of delta 4A are decreased, whereas DHEA and its sulfate (DHEA-S) levels remain unchanged.

Seasonal variations in plasma testosterone concentrations in the male marsupial bandicoot Isoodon macrourus in captivity

Although bandicoots in Queensland mate throughout the year, the majority of births occur in late winter and spring. To ascertain whether this seasonality in mating is manifest in the male reproductive system; body weight, testes size, and plasma testosterone concentration were examined in eight bandicoots throughout the year. The size of the testes increased with age in all bandicoots and there was no evidence of seasonal variation. Plasma testosterone concentrations fluctuated from 0.1 to 70.0 ng/ml and a seasonal cycle was observed, with a nadir in concentrations in March and a peak in September. The peak in testosterone concentration coincided with the period of the year when the majority of births occurred. Subsequent statistical analysis suggested that the annual plasma testosterone profile correlated well with the rate of change of day length.

Chemohormonal therapy and endocrine function in breast cancer patients

The administration of CMFVP (cyclophosphamide, methotrexate, 5-fluorouracil, vincristine, and prednisone) results in profound alterations in hormonal profiles of premenopausal women due to a reduction in ovarian and adrenal secretion of estrogens and androgens. Cytotoxic chemotherapy results in ovarian suppression as documented by decreases in estradiol with concomitant elevations in pituitary gonadotrophins, whereas the addition of prednisone to the cytotoxic regimen results in significant decreases in androgen levels due to adrenal suppression. In postmenopausal women, CMFVP also results in significant decreases in estrogens and estrogen precursors due to suppression of adrenal steroid metabolism. Continuous low-dose prednisone administration during cytotoxic chemotherapy appears to be more effective than an intermittent high-dose schedule in achieving and sustaining adrenal suppression. However, complete elimination of adrenal steroidogenesis does not occur in all cases since measurable amounts of adrenal steroids remain in the serum throughout chemohormonal therapy. The administration of tamoxifen plus CMFVP is associated with hyperestrogenemia in younger premenopausal patients which persists until the onset of ovarian suppression.

Seasonal variations of androgens, estrogens, and progesterone in the different lobules of the testis and in the plasma of Salamandra salamandra

Progesterone, 4-androstenedione, testosterone, dihydrotestosterone, 5 alpha-androstane-3 alpha,17 beta-diol (3 alpha-diol), 5 alpha-androstane-3 beta, 17 beta-diol (3 beta-diol), estrone, and estradiol levels were determined by radioimmunoassay in the different lobules of the testis of Salamandra salamandra throughout the year according to the seasonal cycle. 3 beta-diol levels were not detectable. High levels of steroids were found in the grandular tissue (enlarged pericystic cells after spermiation) and large variations were showed for progesterone, 4-androstenedione, testosterone, 3 alpha-diol, and estrone. In the mature lobule (formed by cysts with mature spermatozoa), only testosterone showed seasonal variations and in the immature lobule (with early stages of meiosis), 3 alpha-diol showed fluctuations. The major estrogen found in the testis of Salamandra was estrone; estradiol stayed at a low level throughout the cycle. The steroids fluctuation seems to be related to the histological evolution of the testis throughout the cycle. The present data were the first on steroid seasonal variations in the testis of an urodele.

The effects of two doses of spironolactone on serum androgens and anagen hair in hirsute women

Spironolactone (S) has been used successfully for the treatment of hirsutism. We evaluated whether the effects of S on serum androgens and hair growth are dose-related and whether S affects secreted androgens to the same degree as peripherally derived androgens. Two groups of 15 hirsute patients, similarly matched, received either 100 or 200 mg S daily for 3 months. Serum total testosterone (T) decreased significantly (P less than 0.05) and to a similar degree with both dosages, whereas unbound T was unaltered. Dehydroepiandrosterone sulfate was unaltered, whereas androstenedione decreased with 200 mg S (P less than 0.05). Peripherally derived serum dihydrotestosterone decreased to a similar degree with 100 and 200 mg S (P less than 0.05), whereas 5 alpha-androstane-3 alpha-17 beta-diol (3 alpha-diol) increased (P less than 0.05) similarly with both dosages. Serum 3 alpha-diol glucuronide (3 alpha-diol-G) increased with both dosages, but not significantly. Anagen hair shaft diameters decreased significantly in both groups by 19% +/- 8% and 30% +/- 4% (P less than 0.05). No correlation was found between hair growth and serum androgens. Because serum unbound T was largely unaltered by S, it is suggested that the antiandrogenic effects of S are primarily related to its peripheral effect. However, there is no good clinical marker for this effect as levels of 3 alpha-diol and 3 alpha-diol-G increase.

The prevalence and significance of elevated dehydroepiandrosterone sulfate levels in anovulatory women

One hundred nineteen euprolactinemic anovulatory infertility patients who were being evaluated for induction of ovulation with clomiphene citrate were studied to determine the prevalence of increased adrenal androgen (AA) secretion in this group. Fifty percent of these patients exhibited increased AA secretion, as evidenced by an elevated serum dehydroepiandrosterone sulfate (DHEA-S) level. Seventy-seven percent of these women with elevated levels of DHEA-S were nonhirsute . Twenty-six patients with elevated serum DHEA-S levels underwent adrenocorticotropic hormone (ACTH) stimulation tests in order to determine a possible mechanism(s) for the increase in DHEA-S. Plasma ACTH, as well as total, low-density lipoprotein, and high-density lipoprotein cholesterol were also measured. These levels were normal and did not correlate with the elevated levels of DHEA-S. Seven of 16 patients (34%) had exaggerated responses of serum DHEA-S and of 17-OH pregnenolone to ACTH stimulation. In six of these seven patients, our data suggested the occurrence of a mild deficiency of 3 beta-ol dehydrogenase-isomerase. All of these six patients were considered to have polycystic ovary syndrome. While these data do not explain the increased AA secretion in the majority of patients with elevated levels of DHEA-S, we suggest that serum DHEA-S is frequently elevated in anovulatory infertile patients.

Correlation of inhibin and follicle regulatory protein activities with follicular fluid steroid levels in anovulatory patients

Follicular fluid was obtained from anovulatory patients (n = 12), stimulated with human menopausal gonadotropin, clomiphene, and human chorionic gonadotropin to evaluate the relative responses of inhibin, follicle regulatory protein, and steroid levels in follicles from ovaries requiring exogenous stimulation for follicular development. Follicular fluid concentrations of estradiol, progesterone, androstenedione, testosterone, dihydrotestosterone, and 3 alpha-androstenediol were determined by radioimmunoassay. Follicular fluid inhibin activity was determined by suppression of rat pituicyte follicle-stimulating hormone, and follicle regulatory protein activity was determined by suppression of porcine granulosa cell aromatase. The mean level of steroids were progesterone (7529 +/- 1601 ng/ml), estradiol (1082 +/- 158 ng/ml), androstenedione (15.2 +/- 3.17 ng/ml), 3 alpha-androstenediol (0.90 +/- 0.13 ng/ml), testosterone (2.23 +/- 33 ng/ml), and dihydrotestosterone (0.77 +/- 0.11 ng/ml). Follicle regulatory protein activity was 16.6% +/- 4.3% and mean inhibin level was 62.9 +/- 7.52 U. These results are in contrast to reports of follicular fluid steroid levels from normal ovulatory patients treated with exogenous gonadotropin. Although altered levels of hormones were present within these follicles, they clearly were not atretic, as evidenced by elevated estradiol levels and estradiol/androstenedione ratios. Alterations in the normal follicular response to pharmacologic gonadotropin stimulation in the follicles of anovulatory women suggest the presence of granulosa cell dysynchrony .

Testosterone metabolism in prepubertal rabbit cartilage

Using thin-layer chromatography, celite column chromatography and recrystallization methods, articular (AR) and growth plate (GP) cartilage tissues and cells from prepubertal rabbits were shown to convert testosterone (T) into at least three main metabolites: dihydrotestosterone (DHT), delta 4-androstenedione and androstanediols. In tissue incubation experiments the amount of each newly formed metabolite per mg of tissue was always greater in AR than in GP cartilage. After a 24 h incubation with AR or GP cartilage tissues, T was mainly converted to DHT and delta 4-androstenedione in approximately equal amounts. The amount of androstanediol metabolites formed was much lower. In a time-course experiment, the conversion of T to DHT and delta 4-androstenedione was shown to increase in a linear fashion, while the conversion to androstanediols was more variable. Using cultured AR cartilage cell incubations, similar results were obtained. In addition, DHT was shown to be the sole metabolite which accumulated in the cellular pool during the first 3 h incubation, as well as during the 24 h incubation when maximum cellular uptake of radioactivity was observed. At this time, the intracellular amount of unmetabolized [3H]T (88 pmoles/100 micrograms DNA) was similar to the amount of [3H]DHT (70 pmoles/100 micrograms DNA) accumulated in the chondrocytes. For both delta 4-androstenedione and androstanediols, 99% of radioactivity was extracted from the incubation medium.

Effects of bromocriptine on pituitary-testicular function in the rat: possible inhibition of in vitro production of androgen by Leydig cells

The effect of bromocriptine (BR) on pituitary-testicular function has been investigated in vivo and in vitro in adult male rats. Testosterone production in vitro by collagenase- dispersed Leydig cells from 84-day-old rats was evaluated in the presence and absence of hCG and/or different doses of BR. In the presence of 1.5 X 10(-5) M BR, both basal and hCG-stimulated testosterone production were decreased whereas at lower doses BR was ineffective. In vivo 60-day-old rats were injected sc with BR (150 micrograms/rat or 750 micrograms/rat twice daily) or vehicle for 24 days. This treatment reduced the plasma level and pituitary content of prolactin, slightly increased the plasma levels of LH and FSH but did not affect pituitary gonadotrophin content. Irrespective of the dose of BR injected, plasma levels of androgen did not change, but with the large dose of BR a decrease in testicular content of testosterone (P = 0.05) was observed. In the same animals the number of LH/hCG receptors was significantly reduced, and the sensitivity of the isolated Leydig cells to hCG stimulation in vitro was reduced; however, both the basal secretion and the maximum testosterone response to hCG were unaffected. These results show impairment of pituitary-testicular function in BR-treated rats, either as a result of BR-induced hypoprolactinaemia or as a consequence of direct effects of BR on the Leydig cells.

Insulin resistance in polycystic ovary syndrome

Patients with polycystic ovary syndrome (PCO) who are obese and exhibit acanthosis nigricans have been reported to have insulin resistance. We studied 21 euglycemic, euprolactinemic patients with PCO without acanthosis nigricans. Eleven of these patients were hirsute and the remaining 10 were not. Eight women with chronic anovulation, who were weight matched with the PCO patients, were studied along with the 11 ovulatory control subjects. Compared to control subjects, women with chronic anovulation had similar levels of immunoreactive luteinizing hormone (LH), bioactive LH, 17 beta-estradiol, testosterone (T), and dehydroepiandrosterone sulfate but significantly higher fasting immunoreactive insulin levels (p less than 0.05). The nonhirsute patients with PCO had higher immunoreactive insulin levels compared to patients with chronic anovulation and control subjects (p less than 0.05) while hirsute patients with PCO had higher immunoreactive insulin levels than nonhirsute ones (p less than 0.05). There was a significant positive correlation between fasting immunoreactive insulin levels and serum T. Fasting immunoreactive insulin also showed a significant correlation with serum LH and bioactive LH. After receiving 100 gm of oral glucose, hirsute patients with PCO had significantly higher insulin responses compared to those of control subjects despite similar glucose responses. Red blood cell insulin-binding sites and receptor affinities were similar in hirsute patients and control subjects. These data suggest that the hyperinsulinemia of patients with PCO may be related, in part, to the elevated LH and androgen levels and may be a postreceptor defect.

Endocrine consequences of CMF adjuvant therapy in premenopausal and postmenopausal breast cancer patients

The effect of CMF adjuvant therapy (cyclophosphamide, methotrexate, and 5-fluorouracil) on endocrine function was investigated in breast cancer patients. CMF therapy resulted in suppression of ovarian function in some premenopausal patients but pituitary function and adrenal function were unaffected. There was an inverse relation between age and duration of treatment required to induce ovarian suppression. Although amenorrhea was achieved within 2-4 months in patients aged 40 years or older, younger women required larger cumulative doses of cytotoxic drugs to induce ovarian dysfunction. Patients younger than 30 years of age continued to menstruate with no major alteration in hormonal levels resulting from the cytotoxic drugs. CMF therapy had no significant effect on hormonal levels in postmenopausal patients indicating that in this group therapeutic response is not mediated via the endocrine system.

The activity of 3 beta-hydroxysteroid dehydrogenase and delta 4-5 isomerase in human follicular tissue

The steroidogenic enzymes 3 beta-hydroxysteroid dehydrogenase and delta 4-5 isomerase (3 beta-HSD) that convert delta 5-hydroxysteroids to delta 4-ketosteroids were measured in human follicular tissue collected during the follicular phase of the menstrual cycle. This study was done in order to determine whether 3 beta-HSD enzyme activity fluctuated during the follicular phase of the menstrual cycle and, if so, whether these changes were reflected by the concentration of steroids in the follicular fluid. A microsomal fraction was prepared from each of 14 follicular-phase follicles, and 3 beta-HSD enzyme activity was estimated by the amount of androstenedione synthesized in the presence of excess substrate (dehydroepiandrosterone) and cofactor (nicotinamide adenine dinucleotide). Androstenedione, dehydroepiandrosterone, and progesterone were measured in the aspirated follicular fluid of each follicle. 3 beta-HSD enzyme activity was undetectable in the smallest (3 to 5 mm) follicles, increased in 5 to 6 mm follicles to 363.2 +/- 60 pmol of androstenedione per milligram per hour, and increased still further in 9 to 11 mm follicles to 5,000 +/- 200 pmol of androstenedione per milligram per hour. The increase in 3 beta-HSD enzyme activity was accompanied by an increase in the concentration of androstenedione in the follicular fluid as well as of progesterone in larger follicles. These data indicate that 3 beta-HSD activity increases during the follicular phase of the menstrual cycle. It is suggested that the primary product of the increased enzyme activity is androstenedione. Since androstenedione is the principal C19 steroid produced by the ovulatory follicle and serves as a substrate for estradiol production, this increase in 3 beta-HSD activity may be important for the associated changes in the late follicular phase that lead to ovulation.

Psychological stress and increases in urinary norepinephrine metabolites, platelet serotonin, and adrenal androgens in women with polycystic ovary syndrome

Twenty-three women with polycystic ovary syndrome, 10 women with hypothalamic-pituitary dysfunction, and 50 control subjects were studied in an attempt to investigate the prevalence of psychological stress and its possible relationship to various hormonal parameters. Norepinephrine (NE) excretion, as reflected by urinary 3-methoxy-4-hydroxyphenylglycol (MHPG), and urinary 3-methoxy-4-hydroxymandelic acid (VMA), platelet serotonin, plasma adrenocorticotrophic hormone (ACTH), urinary free cortisol, serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), androstenedione (Adione), dehydroepiandrosterone (DHEA), its sulfate (DHEA-S), delta 5-androstenediol (delta 5-Adiol), testosterone (T), and unbound estradiol (E2) were measured. In addition, psychological stress was assessed by means of questionnaires modified from the Schedule of Recent Experiences, in which a Life Events Inventory was scored between 1 and 100. Women with polycystic ovary syndrome had significantly elevated levels of serum LH, LH:FSH ratios, unbound E2, Adione, DHEA, delta 5-Adiol, T, and DHEA-S (p less than 0.01). The number of Major Life Events (events scored on the questionnaire above 60) was significantly higher in women with polycystic ovary syndrome than in control women and women with hypothalamic-pituitary dysfunction (p less than 0.05). Urinary MHPG and platelet serotonin levels were also significantly higher in women with polycystic ovary syndrome (p less than 0.05), whereas VMA was normal. Levels of plasma ACTH and urinary free cortisol were similar in all groups. There was a significant positive correlation between MHPG and DHEA-S, MHPG and LH, and LH and T levels in women with polycystic ovary syndrome and those with hypothalamic-pituitary dysfunction (p less than 0.01). VMA also correlated with DHEA-S (p less than 0.05). In conclusion, psychological stress may be more prevalent in women with polycystic ovary syndrome and may be associated with elevated levels of MHPG and platelet serotonin. Because we have found that MHPG, but not VMA, correlated with LH, and because both MHPG and VMA correlated with DHEA-S, we hypothesize here that psychological stress and neurotransmitter levels may be linked to some of the hormonal derangements, including inappropriate gonadotropin secretion and elevated adrenal androgen levels in women with polycystic ovary syndrome.

A comparative study of steroid concentrations in human adipose tissue and the peripheral circulation

Using radioimmunological methods, levels of cortisol, dehydroepiandrosterone, androstenedione, testosterone, oestrogens (oestradiol + oestrone), progesterone and 17 alpha-hydroxyprogesterone were determined in adipose tissue and peripheral blood obtained during surgical treatment of patients with non-endocrine diseases. The steroid content of human adipose tissue was observed to be extremely high relative to that in the general circulation, giving a tissue/serum ratio of 0.4 to 13.2. The concentration of steroids decreased in the following order: dehydroepiandrosterone greater than cortisol greater than androstenedione greater than progesterone greater than testosterone greater than 17 alpha-hydroxyprogesterone greater than oestradiol + oestrone. This sequence is different from that found in blood. When anthropometric variables were taken into consideration, the adipose tissue mass of severely obese subjects contained a steroid pool far greater than that in the total blood volume.

A selective radioimmunoassay of androstenedione in plasma and saliva

A specific radioimmunoassay for 4-androstene-3,17-dione (androstenedione) based on rabbit antisera to 6 beta-hydroxy-4-androstene-3,17-dione-6-hemisuccinate-bovine serum albumin conjugate was developed. Cross reaction by testosterone was eliminated by addition of experimentally established amounts of testosterone antiserum, which cross reacted by only 0.004 with androstenedione. The method has been used for simultaneous determination of androstenedione in both plasma and saliva of normal women under basal conditions and following dynamic tests. The plasma levels in normal women averaged 3.6 +/- 0.9 nmol/l and correlated (r = 0.93) with those found in saliva (0.353 +/- 0.089 nmol/l).

The behavioural effects of testosterone undecanoate in adult men with Klinefelter's syndrome: a controlled study

The behavioural effects of exogenous testosterone in men with marginally low circulating androgen levels were investigated. Four adult men with Klinefelter's syndrome, low normal testosterone levels and normal sexual activity and interest were given testosterone undecanoate (TU 160 mg daily by mouth; Organon International) and placebo using a double blind cross-over design. A modest increase in sexual interest was observed during TU administration compared to placebo, though there were no effects on self-reported mood or energy, or on erectile responsiveness in the laboratory. Increase in circulating hormone levels during TU administration was more marked for DHT than for testosterone. The possible implications of this are discussed.

Sites of steroid production in the polycystic ovary

Tissue culture of slices of polycystic ovaries shows that androstenedione and oestradiol are mostly produced by the cortical, cyst-containing portions, with little steroid production in vitro by medullary stromal tissues.

Androgen replacement with oral testosterone undecanoate in hypogonadal men: a double blind controlled study

The effects of androgen withdrawal and replacement were investigated in six hypergonadotrophic and six hypogonadotrophic men with hypogonadism. A double blind cross-over design was used comparing testosterone undecanoate (T.U., Organon International), 160 mg daily by mouth, with placebo. There was a significant effect of T.U. on all measures of sexual interest and behaviour. Sexual interest increased within the first week of T.U. administration, ejaculation usually returning within the second week. Behavioural responses were similar in the hyper- and hypogonadotrophic groups. The rise in plasma testosterone during T.U. administration was modest, not reaching the normal range in several cases. 5 alpha dihydrotestosterone rose more substantially. There was a significant fall in sex hormone binding globulin, a rise in oestradiol and no significant change in gonadotrophin concentrations during T.U. administration.

Adult manifestation of congenital adrenal hyperplasia due to incomplete 21-hydroxylase deficiency mimicking polycystic ovarian disease

This study was carried out to document the postpubertal presentation of congenital adrenal hyperplasia (CAH), to elaborate the diagnostic criteria for it, and to investigate family members of CAH patients. Serum 17-hydroxyprogesterone (17OHP) was measured in normal women and 25 hirsute oligomenorrheic patients, five of whom were shown to have CAH. These five CAH patients, as a group, had significantly elevated levels of 17OHP when compared to normal and hirsute women, although the other 20 hirsute oligomenorrheic women also had higher levels of 17OHP than the follicular phase control subjects. A single intravenous bolus of 0.25 mg of adrenocorticotropic hormone (ACTH) caused much larger increased in 17OHP in all five CAH patients than in the control and hirsute women. The five CAH patients had decreased cortisol but normal 11-deoxycortisol responses to ACTH, thus indicating 21-hydroxylase deficiency (21HD). Clinically, they were indistinguishable from women with polycystic ovarian disease (PCO) and had basal serum levels of androgens and urinary 17-ketosteroids which were similar to those found in 47 other women presenting with the complaint of hirsutism. However, the androstenedione levels and androstenedione/cortisol ratios in response to ACTH were significantly higher in the five CAH patients than in both the normal and hirsute women. Of seven family members tested, two fathers and one mother had an intermediate 17OHP response to ACTH, thus suggesting heterozygosity. Human lymphocyte antigen (HLA) typing on family members indicated that the inheritance of the disorder may be linked to B antigens. Two siblings of one of the CAH patients had normal 17OHP responses to ACTH and also had a different HLA-B complement. These data document the existence of adult manifestation of CAH, due to 21 HD. This disorder presents with androgen excess and oligomenorrhea or amenorrhea and mimicks PCO. The diagnosis of it hinges upon the post-ACTH rise in 17OHP, whereas the levels of serum androgens and urinary 17-ketosteroids may be inconclusive.

A radioimmunoassay for plasma androstenedione using 125I tracer

A radioimmunoassay for plasma androst-4-en-3,17-dione is described using ether extracts of plasma and 125I radioligand. The reagent is easily prepared by an established radiochemical method from androst-4-en-3,17-dione-6 beta-(carboxymethyl) thioether and 125I-histamine.

A direct radio-immunoassay for plasma delta 4-androstenedione. Application to children

A RIA for the estimation of delta 4-androstenedione in human plasma without chromatographic purification is analyzed. Sensitivity, accuracy, precision and specificity are shown to be, at least, equivalent to those of methods involving chromatography.

Raised plasma oestradiol and oestrone levels in young survivors of myocardial infarction

Of 35 male survivors of myocardial infarction, aged 24-48 years, 34 had higher plasma-oestradiol levels than age-matched controls. 29 of the 35 had higher oestrone levels than controls.

The significance of adrenal and ovarian catheterization in patients with polycystic ovary syndrome

A previously unreported series of 15 anovulatory hirsute women with polycystic ovaries made up this study. Each underwent left adrenal and left ovarian vein catherization. Blood samples were obtained from the ovarian, adrenal and peripheral veins to test the levels of testosterone, delta 4 androstenedione (delta 4A), dehydroepiandrosterone (DHEA), estradiol and/or total estrogens, before and after administration of human chorionic gonadotropin (ten cases) and adrenocorticotropic hormone (ACTH) (five cases). Following intravenous human chorionic gonadotropin administration, the only response seen was a slight rise in ovarian levels of delta 4A and DHEA; after intravenous adrenocorticotropic hormone stimulation, the adrenal levels of delta 4A, testosterone and DHEA rose significantly. Peripheral concentrations of testosterone and delta 4A were in the high normal range and DHEA levels were high normal or slightly above normal range.

An improved radioimmunoassay for 4-androstene-3,17-dione

A radioimmunoassay using an antiserum produced against 6beta-hydroxy-4-androstene-3,17-dione-6-succinyl-BSA conjugate is described which permits the rapid determination of 4-androstene-3,17-dione in multiple serum samples that are purified by column chromatography on neutral alumina. Steroids which reacted significantly with the antiserum were found to be 5alpha-androstane-3,17-dione, 5beta-androstane-3,17-dione, and 6beta-hydroxy-4-androstene-3,17-dione. After column chromatography on alumina, however, the only significantly cross-reacting steroids were the 5alpha and 5beta-androstane-3,17-diones, while cross-reactivity from other steroids was reduced to less than 1%.