Prolactin and adrenal androgen secretion

ACTH and prolactin synergistically and selectively regulate CYP17 expression and adrenal androgen production in human foetal adrenal organ cultures

OBJECTIVE

The essential role of ACTH on the growth and function of the human foetal adrenal (HFA) has long been recognized. In addition, many studies have suggested a role of the pituitary hormone prolactin (PRL) in the regulation of the HFA, but the effects of this hormone on steroidogenesis and gene expression are still unknown. Our objective was to investigate the effect of ACTH and PRL on the steroidogenic capacities of the HFA.

DESIGN

In vitro/ex vivo experimental study.

METHODS

We used a hanging drop in vitro organ culture system. First trimester HFA samples were cultured for 14 days in basal conditions or treated with ACTH, PRL, or a combination of the 2 (3 to 11 replicates depending on the experiment). Steroids were measured by liquid chromatography/tandem mass spectrometry or immunoassay, gene expression by RT-qPCR, and protein expression by immunoblot.

RESULTS

ACTH significantly increased corticosterone, cortisol, and cortisone production, both by itself and when used together with PRL. PRL stimulation by itself had no effect. Combined stimulation with ACTH + PRL synergistically and selectively increased adrenal androgen (DHEAS and Δ4-androstenedione) production and CYP17A1 expression in the HFA, while treatment with each single hormone had no significant effect on those steroids.

CONCLUSIONS

These results have important implications for our understanding of the hormonal cues regulating adrenal steroidogenesis in the HFA during the first trimester in physiological and pathological conditions and warrant further studies to characterize the molecular mechanisms of converging ACTH and PRL signalling to regulate CYP17A1 expression.

Increased androgen secretion in patients with prolactinomas: the impact of altered HPA function

BACKGROUND AND OBJECTIVES

Earlier studies suggested that hyperprolactinemia was associated with elevated serum DHEA-S levels. The importance of DHEA-S measurements in the diagnosis of adrenal insufficiency prompted us to assess adrenal androgen levels in hyperprolactinemic subjects with normal or impaired function.

METHODS

Prospective study including 122 medically treated and 26 surgically patients with prolactinomas. Serum PRL, DHEA and DHEA-S levels were measured before and repeatedly after cabergoline therapy and also in the perioperative period of surgically treated patients.

RESULTS

Serum PRL levels decreased (P < 0.001) in all 101 medically treated patients with normal HPA function from 728.3 ± 1507 reaching 29.1 ± 39 and 14.9 ± 24.4 µg/L at 3 and 12 months, respectively. Concurrently serum DHEA-S levels decreased (P < 0.001) from 245.9 ± 196 to 216.2 ± 203.3 and to 169.7 ± 121.1 µg/dl at 3 and 12 months, respectively. These effects were reversed in 19 patients who discontinued treatment and were re-demonstrated after therapy resumption. Among the 22 surgically treated patients with normal HPA, peri-operative PRL levels decreased rapidly (P < 0.001) with a parallel decline in serum DHEA-S levels (P = 0.03). Strong correlations were noted between PRL and DHEA-S decrements observed with medical or surgical therapy. Medically (n = 21) and surgically (n = 4) patients with impaired HPA function had very low DHEA-S values that were unchanged despite marked reductions in PRL secretion.

CONCLUSION

Hyperprolactinemia is associated with a reproducible and reversible increase in serum DHEA-S that was observed in medically- and surgically-treated patients with normal HPA function. Thus, a normal age- and gender-adjusted serum DHEA-S level continues to imply normal HPA function even among hyperprolactinemic subjects.

Correlation between Levels of Dehydroepiandrosterone-Sulphate and Prolactin in Human Breast Cyst Fluid

Concentration of dehydroepiandrosterone sulphate (DHAS), cortisol (F), aldosterone (A) and prolactin (PRL) were measured in 70 samples of breast cyst fluid (BCF) obtained by needle aspiration from patients having gross cystic disease of the breast. DHAS concentrations in our series of BCF were scattered over a broad range, up to values 200-fold higher than in plasma, with ample interindividual variability; Cortisol was present in BCF in very small amounts. Aldosterone and PRL values were in the same order of plasma levels; moreover, a significant correlation was found between DHAS and PRL concentrations in BCF.

Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline

OBJECTIVE

The aim was to formulate practice guidelines for the diagnosis and treatment of polycystic ovary syndrome (PCOS).

PARTICIPANTS

An Endocrine Society-appointed Task Force of experts, a methodologist, and a medical writer developed the guideline.

EVIDENCE

This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence.

CONSENSUS PROCESS

One group meeting, several conference calls, and e-mail communications enabled consensus. Committees and members of The Endocrine Society and the European Society of Endocrinology reviewed and commented on preliminary drafts of these guidelines. Two systematic reviews were conducted to summarize supporting evidence.

CONCLUSIONS

We suggest using the Rotterdam criteria for diagnosing PCOS (presence of two of the following criteria: androgen excess, ovulatory dysfunction, or polycystic ovaries). Establishing a diagnosis of PCOS is problematic in adolescents and menopausal women. Hyperandrogenism is central to the presentation in adolescents, whereas there is no consistent phenotype in postmenopausal women. Evaluation of women with PCOS should exclude alternate androgen-excess disorders and risk factors for endometrial cancer, mood disorders, obstructive sleep apnea, diabetes, and cardiovascular disease. Hormonal contraceptives are the first-line management for menstrual abnormalities and hirsutism/acne in PCOS. Clomiphene is currently the first-line therapy for infertility; metformin is beneficial for metabolic/glycemic abnormalities and for improving menstrual irregularities, but it has limited or no benefit in treating hirsutism, acne, or infertility. Hormonal contraceptives and metformin are the treatment options in adolescents with PCOS. The role of weight loss in improving PCOS status per se is uncertain, but lifestyle intervention is beneficial in overweight/obese patients for other health benefits. Thiazolidinediones have an unfavorable risk-benefit ratio overall, and statins require further study.

Plasma dehydroepiandrosterone sulphate and insulin-like growth factor I levels in obstructive sleep apnoea syndrome

CONTEXT

We aimed to assess whether obstructive sleep apnoea syndrome (OSAS) affects plasma IGF-1 and dehydroepiandrosterone sulphate (DHEA-S) levels in men, factors implicated in the development of age-related metabolic disorders.

DESIGN

We conducted a cross-sectional and longitudinal clinical study.

PATIENTS AND SETTING

We measured plasma IGF-1 and DHEA-S levels in 191 non-drug-treated Japanese men (34 primary snorers (PS), 88 patients with mild-to-moderate OSAS and 69 patients severe OSAS ).

RESULTS

Plasma IGF-1 and DHEA-S were negatively correlated with age. Plasma IGF-1 was also negatively correlated with plasma glucose, HOMA-IR and systolic blood pressure and apnoea parameters such as the apnoea-hypopnea index, minimum oxygen saturation and slow-wave sleep (SWS) time. Plasma DHEA-S was associated with plasma glucose, HbA1c and free fatty acid and was negatively correlated with SWS time. To eliminate the influence of age, PS, patients with mild-to-moderate OSAS and severe OSAS were divided into three groups by age: young (<40 years), middle-aged (40-59 years) and elderly (≥ 60 years). Patients with severe OSAS aged <40 or <60 years had lower plasma IGF-1 or DHEA-S levels, respectively, than did the corresponding snorers and mild-to-moderate OSAS groups. Continuous positive airway pressure therapy for generally 16-18 months increased plasma IGF-1 levels in patients with severe OSAS aged <40 years (n = 18). Plasma DHEA-S levels were increased in patients with severe OSAS aged <60 years, whose DHEA-S level was below the mean value for that age (n = 23/41).

CONCLUSION

Severe OSAS could reduce plasma IGF-1 and DHEA-S levels in younger, but not elderly Japanese men, which is potentially associated with the development of metabolic abnormalities.

DHEA therapy for women: effect on sexual function and wellbeing

DHEA is increasingly available commercially as a supplement aimed at improving libido and wellbeing in postmenopausal women. However there is scant evidence to support the use of DHEA for this purpose, and safety data for DHEA therapy are lacking. Dehydroepiandrosterone (DHEA) and its sulphate DHEAS are the most abundant circulating sex steroid hormones in women, providing a large precursor reservoir for the intracellular production of androgens and oestrogens in non-reproductive tissues. Levels of DHEA and DHEAS decline with age. It has been proposed that restoring the circulating levels of these steroids to those found in young people may have anti-ageing effects and improve wellbeing and sexual function. However this is not supported by the published literature. We have reviewed the physiology of DHEA and DHEAS in women and the published literature pertaining to the use of DHEA therapy for libido and wellbeing in postmenopausal women. The literature was searched using Medline (Ovid) and Pub-Med for original studies. Overall, the interpretation of data from randomised controlled trials conducted in well women is limited by inadequate sample size and short treatment durations with inconsistent results for the outcomes of libido and wellbeing. Studies of DHEA in women with adrenal insufficiency, although indicating potential improvements in mood and libido, are also limited by their short treatment phase durations. In addition safety data for DHEA therapy are lacking. The potential value of DHEA therapy for women still requires exploration in adequately powered well-designed randomised placebo-controlled trials. The studies of DHEA therapy in women with adrenal insufficiency suggest that this group is the most likely to derive health benefits from DHEA supplementation.

The stress system in the human brain in depression and neurodegeneration

Corticotropin-releasing hormone (CRH) plays a central role in the regulation of the hypothalamic-pituitary-adrenal (HPA)-axis, i.e., the final common pathway in the stress response. The action of CRH on ACTH release is strongly potentiated by vasopressin, that is co-produced in increasing amounts when the hypothalamic paraventricular neurons are chronically activated. Whereas vasopressin stimulates ACTH release in humans, oxytocin inhibits it. ACTH release results in the release of corticosteroids from the adrenal that, subsequently, through mineralocorticoid and glucocorticoid receptors, exert negative feedback on, among other things, the hippocampus, the pituitary and the hypothalamus. The most important glucocorticoid in humans is cortisol, present in higher levels in women than in men. During aging, the activation of the CRH neurons is modest compared to the extra activation observed in Alzheimer's disease (AD) and the even stronger increase in major depression. The HPA-axis is hyperactive in depression, due to genetic factors or due to aversive stimuli that may occur during early development or adult life. At least five interacting hypothalamic peptidergic systems are involved in the symptoms of major depression. Increased production of vasopressin in depression does not only occur in neurons that colocalize CRH, but also in neurons of the supraoptic nucleus (SON), which may lead to increased plasma levels of vasopressin, that have been related to an enhanced suicide risk. The increased activity of oxytocin neurons in the paraventricular nucleus (PVN) may be related to the eating disorders in depression. The suprachiasmatic nucleus (SCN), i.e., the biological clock of the brain, shows lower vasopressin production and a smaller circadian amplitude in depression, which may explain the sleeping problems in this disorder and may contribute to the strong CRH activation. The hypothalamo-pituitary thyroid (HPT)-axis is inhibited in depression. These hypothalamic peptidergic systems, i.e., the HPA-axis, the SCN, the SON and the HPT-axis, have many interactions with aminergic systems that are also implicated in depression. CRH neurons are strongly activated in depressed patients, and so is their HPA-axis, at all levels, but the individual variability is large. It is hypothesized that particularly a subgroup of CRH neurons that projects into the brain is activated in depression and induces the symptoms of this disorder. On the other hand, there is also a lot of evidence for a direct involvement of glucocorticoids in the etiology and symptoms of depression. Although there is a close association between cerebrospinal fluid (CSF) levels of CRH and alterations in the HPA-axis in depression, much of the CRH in CSF is likely to be derived from sources other than the PVN. Furthermore, a close interaction between the HPA-axis and the hypothalamic-pituitary-gonadal (HPG)-axis exists. Organizing effects during fetal life as well as activating effects of sex hormones on the HPA-axis have been reported. Such mechanisms may be a basis for the higher prevalence of mood disorders in women as compared to men. In addition, the stress system is affected by changing levels of sex hormones, as found, e.g., in the premenstrual period, ante- and postpartum, during the transition phase to the menopause and during the use of oral contraceptives. In depressed women, plasma levels of estrogen are usually lower and plasma levels of androgens are increased, while testosterone levels are decreased in depressed men. This is explained by the fact that both in depressed males and females the HPA-axis is increased in activity, parallel to a diminished HPG-axis, while the major source of androgens in women is the adrenal, whereas in men it is the testes. It is speculated, however, that in the etiology of depression the relative levels of sex hormones play a more important role than their absolute levels. Sex hormone replacement therapy indeed seems to improve mood in elderly people and AD patients. Studies of rats have shown that high levels of cumulative corticosteroid exposure and rather extreme chronic stress induce neuronal damage that selectively affects hippocampal structure. Studies performed under less extreme circumstances have so far provided conflicting data. The corticosteroid neurotoxicity hypothesis that evolved as a result of these initial observations is, however, not supported by clinical and experimental observations. In a few recent postmortem studies in patients treated with corticosteroids and patients who had been seriously and chronically depressed no indications for AD neuropathology, massive cell loss, or loss of plasticity could be found, while the incidence of apoptosis was extremely rare and only seen outside regions expected to be at risk for steroid overexposure. In addition, various recent experimental studies using good stereological methods failed to find massive cell loss in the hippocampus following exposure to stress or steroids, but rather showed adaptive and reversible changes in structural parameters after stress. Thus, the HPA-axis in AD is only moderately activated, possibly due to the initial (primary) hippocampal degeneration in this condition. There are no convincing arguments to presume a causal, primary role for cortisol in the pathogenesis of AD. Although cortisol and CRH may well be causally involved in the signs and symptoms of depression, there is so far no evidence for any major irreversible damage in the human hippocampus in this disorder.

Testosterone effects on the breast: implications for testosterone therapy for women

Androgens have important physiological effects in women. Postmenopausal androgen replacement, most commonly as testosterone therapy, is becoming increasingly widespread. This is despite the lack of clear guidelines regarding the diagnosis of androgen insufficiency, optimal therapeutic doses, and long-term safety data. With respect to the breast specifically, there is the potential for exogenous testosterone to exert either androgenic or indirect estrogenic actions, with the latter potentially increasing breast cancer risk. In experimental studies, androgens exhibit growth-inhibitory and apoptotic effects in some, but not all, breast cancer cell lines. Differing effects between cell lines appear to be due primarily to variations in concentrations of specific coregulatory proteins at the receptor level. In rodent breast cancer models, androgen action is antiproliferative and proapoptotic, and is mediated via the androgen receptor, despite the potential for testosterone and dehydroepiandrosterone to be aromatized to estrogen. The results from studies in rhesus monkeys suggest that testosterone may serve as a natural endogenous protector of the breast and limit mitogenic and cancer-promoting effects of estrogen on mammary epithelium. Epidemiological studies have significant methodological limitations and provide inconclusive results. The strongest data for exogenous testosterone therapy comes from primate studies. Based on such simulations, inclusion of testosterone in postmenopausal estrogen-progestin regimens has the potential to ameliorate the stimulating effects of combined estrogen-progestin on the breast. Research addressing this is warranted; however, the number of women that would be required for an adequately powered randomized controlled trial renders such a study unlikely.

Androgen supplementation in older women: too much hype, not enough data

Androgen supplementation in women has received enormous attention in the scientific and lay communities. That it enhances some aspects of cognitive function, sexual function, muscle mass, strength, and sense of well-being is not in question. What is not known is whether physiological testosterone replacement can improve health-related outcome in older women without its virilizing side effects. Although it is assumed that the testosterone dose-response relationship is different in women than in men and that clinically relevant outcomes on the above-mentioned effects can be achieved at lower testosterone doses, these assumptions have not been tested rigorously. Androgen deficiency has no clear-cut definition. Clinical features may include impaired sexual function, low energy, depression, and a total testosterone level of less than 15 ng/dL, the lower end of the normal range. Measurement of free testosterone is ideal, because it provides a better estimate of the biologically relevant fraction. It is not widely used in clinical practice, because some methods of measuring free testosterone assay are hampered by methodological difficulties. In marked contrast to the abrupt decline in estrogen and progesterone production at menopause, serum testosterone is lower in older women than in menstruating women, with the decline becoming apparent a decade before menopause. This article reviews testosterone's effects on sexual function, cognitive function, muscle mass, body composition, and immune function in postmenopausal women.

Altered profile of endogenous steroids in the urine of patients with prolactinoma

OBJECTIVE

The aim of this study was to investigate the possible effect of prolactin on the metabolism of androgens and estrogens in patients with prolactinoma. To accomplish this, prolactin, urinary androgen, and estrogen metabolite levels were determined. In order to indirectly evaluate the possible involvement of enzymes, the concentration ratios of precursor metabolite to product metabolite were also compared with controls.

METHODS

Urine samples were obtained from 27 female patients with prolactinoma (macro, micro, and idiopathic) and from 31 age-matched normal female subjects. Urinary metabolites of 21 androgens and corticoids and 20 estrogens were analyzed by a gas chromatography-mass spectrometry system.

RESULTS

In patients with prolactinoma, urinary 17-ketosteroids, and all estrogen metabolite concentrations were elevated. The ratios of delta 5/delta 4-steroids and 5 beta/5 alpha-hydrogensteroids were higher in the patients with prolactinoma than in normal female controls. In addition, no significant differences between patients and controls were observed in the precursor metabolite to product metabolite ratios relating to estrogen metabolism.

CONCLUSION

Our data suggests that enhanced PRL levels have a direct effect on urinary steroid secretion and metabolism, probably due to lowered activities of 5 alpha-reductase and 3 beta-hydroxysteroid dehydrogenase in the patients with prolactinoma.

The rationale for physiological testosterone replacement in women

Androgens have an important physiological role in women. Not only are they the precursor hormones for oestrogen production in the ovaries and extragonadal tissues, but they also appear to act directly, via androgen receptors, throughout the body. Androgen levels decline with increasing age in women, who may experience a variety of physical symptoms secondary to androgen depletion, as well as physiological changes that affect their quality of life. In this chapter, the changes in androgens as women age are reviewed, and the rationale for physiological androgen, specifically testosterone replacement, in women is addressed.

The clinical use of androgens in female sexual disorders

Sexual health is an important component of overall health and well being. Multiple factors clearly influence an individual's sexuality; however, there is a general trend in Western societies to blame psychosocial factors for diminished sexuality in women. Sex steroid hormones are important determinants of sexual function in women and men, and there is increasing agreement that androgens play a key role in female sexuality. Androgen levels in women decline substantially during the reproductive years, with little change subsequent to spontaneous menopause. The most common complaint of women experiencing androgen deficiency is loss of sexual desire, and several studies have now shown improvements in a number of parameters of sexuality in postmenopausal women treated with exogenous testosterone.

The chronic administration of cabergoline normalizes androgen secretion and improves menstrual cyclicity in women with polycystic ovary syndrome

OBJECTIVE

To investigate whether the administration of the long-lasting dopaminergic drug, cabergoline, improves endocrine and clinical features of women with polycystic ovary syndrome (PCOS).

PATIENTS

Twenty-nine women participated in the study: 14 women with clinical and endocrinologic features of PCOS and 15 age- and weight-matched normal cycling women. Each subject was assigned randomly to receive either a tablet of cabergoline at the dose of 0.5 mg/wk or placebo for 4 months. Sixteen subjects (PCOS: n = 8; controls: n = 8) received cabergoline, whereas 13 (PCOS: n = 6; controls: n = 7) received placebo.

INTERVENTIONS

Both before and during the 4th month of treatment, blood samples were collected every 10 minutes from 9:00 A.M. to 3:00 P.M., 3 to 7 days after spontaneous or medroxy-progesterone acetate (MPA; 5 mg daily for 5 days)-induced menses. Follicle-stimulating hormone and androgen levels were measured in the basal samples, whereas LH levels were measured in all samples.

MAIN OUTCOME MEASURES

Menstrual cyclicity, LH pulsatility, and circulating levels of FSH, PRL, E2, total T, free T, androstenedione, 17 alpha-hydroxyprogesterone, DHEAS, and sex hormone-binding globulin.

RESULTS

Both in controls and in PCOS-affected women, cabergoline administration blunted plasma PRL levels without affecting LH pulsatility. Androgen levels were reduced in controls and normalized in PCOS. Cabergoline, but not placebo, induced menses reappearance in amenorrheic and a normalization of menstrual cyclicity in oligoamenorrheic women with PCOS.

CONCLUSIONS

The administration of cabergoline is capable to normalize androgen levels and to improve menstrual cyclicity in PCOS-affected women. Cabergoline may represent an useful treatment for menstrual irregularities of PCOS patients.

Androgen biology as a basis for the diagnosis and treatment of androgenic disorders in women. II

In the May 1993 issue of the Journal we reviewed the basic science of androgen biology in women. We now discuss the evaluation of suspected hyperandrogenism and the therapeutic modalities available.

The role of the adrenal glands in regulating onset of winter fur growth in mink (Mustela vison)

The role of the adrenal glands in regulating onset of winter fur growth in mink was investigated in long-term adrenalectomized animals. Bilateral adrenalectomy of adult female standard dark mink between June 23 and July 11, 1990, initiated onset of winter fur growth approximately 6 weeks earlier than controls. One month following completion of the winter fur growth in adrenalectomized mink, molting and growth of a new coat was observed. The type of pelage that grew as a result of the second growth wave was less dense than the normal summer or winter fur. However, this renewed hair growth suggests that adrenal hormones not only inhibit the onset of winter fur growth but also influence the duration of inactivity following each period of hair growth. Administration of deoxycorticosterone as a mineralocorticoid supplement had no effect on initiation of fur growth. It would appear that adrenal hormones are part of the mechanism through which photoperiod regulates fur growth in the mink. The identity of the adrenal hormones and their site of action is unknown.

Dehydroepiandrosterone sulphate plasma levels in normal women and patients with benign breast disease

Dehydroepiandrosterone sulphate plasma levels were measured in patients with benign breast disease and in healthy women. In addition the adrenal secretion of dehydroepiandrosterone sulphate was assessed by means of an ACTH stimulation test in some patients and control subjects. The results obtained demonstrate that dehydroepiandrosterone sulphate plasma levels of patients with benign breast disease overlap those found in controls and that the adrenal response to ACTH of patients with breast pathology does not differ from that of healthy women.

Cost effectiveness of routine gonadotropin and androgen measurements in hirsute women

Many physicians routinely measure the gonadotropins PRL, LH, and FSH and the androgens dehydroepiandrosterone (DHEA), androstenedione (ADIONE), and testosterone, as well as testosterone's biologically active fractions in the evaluation of hirsute women. Is this cost effective? To answer this question, 38 consecutive premenopausal hirsute women were evaluated. Two women each had minor elevations in PRL and FSH, and 11 had minor elevations in LH. Three women had minor elevations in the LH/FSH ratio, and only one was above a ratio of 3, believed to be indicative of polycystic ovarian syndrome. Because these gonadotropin elevations did not correlate with the androgens measured and were of no value in the diagnosis or management of these women, they were not believed to be cost effective. Their routine measurements should be abandoned.

The effect of placenta on lactogen receptor in pseudopregnant rabbits

This study examines the effect of placenta on the evolution of lactogen receptor in virgin pseudopregnant rabbit ovary, adrenal gland and mammary gland. Pseudopregnancy was induced with human chorionic gonadotropin. Does were injected with vehicle or placenta daily beginning on day six of the pseudopregnancy. Vehicle-treated rabbits during pseudopregnancy demonstrated a peak of ovarian lactogen receptor on day eight of pseudopregnancy. After treatment with placental homogenate a shift of this peak to twenty days of pseudopregnancy occurred. Lactogen receptor in adrenal and mammary gland membranes had peak receptor concentrations on day 14 of pseudopregnancy. Injection of placenta induced a shift to day 17 and days 17-20 in mammary and adrenal membranes, respectively. Serum concentrations of progesterone, estradiol, 20 alpha dihydroprogesterone and prolactin in placenta-treated groups were not significantly different from those of vehicle-treated groups. Treatment of pseudopregnant does with a composite of hormones at the concentrations found in placental homogenate produced no modulation of tissue lactogen receptor. Fractionation of 20-day pregnant rabbit placenta revealed that 80% of this activity could be found in the acetone extract while 20% was in the bicarbonate extract. These observations suggest that increases of lactogen receptor in ovary, adrenal and mammary glands occur during pseudopregnancy in rabbits and it is further concluded that placenta can alter these receptor induction patterns to ones similar to those seen in these tissues during pregnancy.

Prolactin secretion and dehydroepiandrosterone sulphate plasma levels in women with benign breast disease

The purpose of the present investigation was to verify possible positive correlations between prolactin secretion and dehydroepiandrosterone sulphate levels in plasma of women with benign breast disease. Prolactin secretion was evaluated in terms of basal levels, maximum peak, percent increase above baseline levels, total integrated area, response area after TRH stimulation. No correlation was found between the parameters of prolactin secretion and dehydroepiandrosterone sulphate levels.

Effects of androgens, prolactin and bromocriptine on seminal vesicular enzymes of the pyruvate malate cycle involved in lipogenesis in castrated mature monkeys, Macaca radiata

The interaction of androgens and prolactin, the major factors regulating the male accessory sex organs, on the specific activity of seminal vesicular enzymes of the pyruvate/malate cycle were studied in castrated mature monkeys. Castration decreased the activity of these enzymes, including NADP+ isocitrate dehydrogenase, ATP citrate lyase, malate dehydrogenase, malic enzyme and fatty acid synthase. Testosterone propionate (TP)/dihydrotestosterone given as replacement to castrates increased the activity of all these enzymes, except for malate dehydrogenase. Prolactin restored normal activity of ATP citrate lyase, malic enzyme and fatty acid synthase but not of isocitrate dehydrogenase and malate dehydrogenase (MDH). Prolactin had a specific control over MDH. Moreover, when prolactin was combined with androgens a further stimulatory influence was observed on fatty acid synthase activity. In order to prove the direct influence of prolactin on enzymes of the pyruvate/malate cycle, bromocriptine was administered and this inhibited all of the enzymes. Thus prolactin was found to have a direct, as well as a synergistic, action with androgens on enzymes of the pyruvate/malate cycle in the seminal vesicles of monkeys.

Interactions of androgens and prolactin in the seminal vesicles of mature bonnet monkeys, Macaca radiata. I. Nucleic acids and phosphatases

The effects of prolactin (PRL), bromocriptine, testosterone propionate (TP), dihydrotestosterone (DHT), and the combinations of these androgens with PRL or bromocriptine on nucleic acids (RNA and DNA) and phosphomonoesterases (acid and alkaline phosphatase) of the seminal vesicles of castrated mature bonnet monkeys were studied. Castration decreased body weight, and seminal vesicle organ weight, nucleic acids and acid and alkaline phosphatases. TP/DHT replacement to castrates restored body weights and seminal vesicle DNA to normal and markedly increased the weight, RNA content and acid and alkaline phosphatase activities of the seminal vesicles. PRL did not alter body weight and increased the weight of the seminal vesicles, and their RNA content and phosphomonoesterase activities. PRL + TP/DHT enhanced all parameters. Bromocriptine given alone decreased body weight and acid phosphatase. Bromocriptine given along with TP/DHT suppressed the stimulatory influence of these androgens on most of the parameters studied. The results of the present study suggest that PRL has a specific stimulatory effect on seminal vesicle growth and function, that the presence of PRL is essential for androgen action, and that PRL acts synergistically with androgens.

Full oestrogenic activity of C19-delta 5 adrenal steroids in rat pituitary lactotrophs and somatotrophs

Oestrogens are known to exert specific stimulatory effects on basal and dopamine (DA)-inhibited prolactin (PRL) release as well as on PRL cell content in rat adenohypophysial cells in primary culture. Recently, we have demonstrated that classical oestrogens increase growth hormone (GH) release and cellular GH content in rat pituitary somatotrophs. Since there is evidence that 5-androstene-3 beta, 17 beta-diol (delta 5-diol), a metabolite of dehydroepiandrosterone (DHEA) and DHEA-sulfate (DHEA-S) can induce typical oestrogenic responses in target tissues, we have investigated the effect of C19 adrenal steroids and compared them to that of 17 beta-oestradiol (E2) on the above-indicated parameters. Following a 72-h incubation, maximal concentrations of E2, delta 5-diol and DHEA caused a similar increase in PRL cell content at respective EC50 values of 0.020, 14 and 115 nM. The sensitivity of lactotrophs to DA action was decreased by approximately 4-fold after a 48-h exposure to maximal concentrations of delta 5-diol or DHEA. The time course of the antidopaminergic effect of delta 5-diol and DHEA was almost superimposable to that of E2. A 72-h incubation with 5 microM DHEA-S, a concentration within the range of blood levels found in women, doubled (P less than or equal to 0.001) cellular PRL accumulation. On the other hand, androstenedione (delta 4-dione) was without effect on any of the parameters measured. All stimulatory effects induced by maximal effective concentrations of delta 5-diol, DHEA or DHEA-S were competitively inhibited by simultaneous incubation with the antioestrogen LY156758. The amplitude of the stimulatory effects of delta 5-diol and DHEA on GH cell content as well as on spontaneous GH-releasing factor (GRF)-induced GH release was superimposable to that observed with E2. The effect of the steroids on GH cell content was exerted at 0.016 nM (E2), 12 nM (delta 5-diol) and 250 nM (DHEA). Simultaneous incubation with LY156758 completely blocked the effect of maximally effective concentrations of E2, delta 5-diol and DHEA in somatotrophs. Furthermore, a physiological concentration of DHEA-S (5 microM) enhanced spontaneous as well as GRF-induced GH release. On the other hand, delta 4-dione as well as testosterone and dihydrotestosterone did not alter GH release. The present data demonstrate that delta 5-diol, DHEA and DHEA-S can exert full oestrogenic effects in lactotrophs and somatotrophs, thus supporting their potential oestrogenic role under both physiological and pathological conditions.

Plasma and cyst fluid levels of delta 5 and delta 4 steroid hormones in women with gross cystic breast disease

delta 5 and delta 4 steroid levels were studied in the plasma and cyst fluid of women with gross cystic breast disease (GCBD). In luteal phase a significant increase in plasma levels (mean +/- SEM) of DHA (11.2 +/- 2.4 ng/ml), DHAS (1.45 +/- 0.6 micrograms/ml) and cortisol 277 +/- 15.7 ng/ml) was found; in follicular phase the mean levels were 4.09 +/- 0.47 ng/ml for DHA, 0.65 +/- 0.08 microgram/ml for DHAS and 190 +/- 46.3 micrograms/ml for cortisol. The DHA/DHAS and cortisol/androstenedione ratios were significantly higher in the plasma and lower in the cyst fluid of GCBD patients, than in the plasma of controls; the androstenedione/DHA ratio was higher in the cyst fluid than in the plasma of controls. The hormonal situation of the GCBD patients thus differed from that of the controls both in the plasma and cyst fluid, particularly as regards the delta 5 steroids.

Morphological and functional stimulation of adrenal reticularis zone by dopaminergic blockade in dogs

In order to investigate factors affecting adrenal maturation leading to adrenarche, the effect of dopaminergic blockade on the morphology and function of the adrenal reticularis zone was studied in fourteen preadrenarchal dogs. Seven animals of 7 weeks of age (adrenarche at 11 weeks) were treated with domperidone (DOM) 3 times/day p.o. (3 mg/kg) at 09.00 h, 14.00 h, and 21.00 h, plus an additional injection of DOM s.c. (0.6 mg/kg) at 21.00 h for 15 days. Seven control animals received diluent. Twelve hours after the last injection, dogs received 0.25 mg ACTH i.m. and were sacrificed 60 min later. Blood was collected and adrenals removed. After histological evaluation, the percent of the reticularis, fasciculata, and glomerulosa zones with respect to the total cortex was calculated. Plasma androstenedione (A), dehydroepiandrosterone (DHA), 17-OH-progesterone (17P), and cortisol (F) levels in response to ACTH were also assessed. DOM-treated dogs show a significant development of the zona reticularis compared to control animals (19.2 +/- 0.6% vs 8.8 +/- 2.09% respectively, X +/- SE, P less than 0.01). In the same animals, the DHA response to ACTH (9.0 +/- 1.6 ng/dl) was significantly higher than in placebo-treated dogs (3.8 +/- 1.1 ng/dl, P less than 0.05) while no significant differences were found in F, A, and 17P levels between the two groups. Finally the post-ACTH A/DHA ratio of DOM-treated dogs (1.33 +/- 0.28) was significantly decreased in respect to the placebo-treated animals (5.49 +/- 2.54, P less than 0.01). These data demonstrate that the morphological and functional development of zona reticularis may be subject to dopaminergic control and this could represent an important step in the initiation of adrenarche. However, the cellular mechanism responsible remains to be clarified.

New evidence for a direct effect of prolactin on rat adrenal steroidogenesis

The direct effect of prolactin on rat adrenal steroidogenic enzyme activity was evaluated by measuring plasma and adrenal cytosol steroid levels and adrenal microsomal 3B-hydroxysteroid dehydrogenase/isomerase (3B-HSD), 21 hydroxylase (21-OHase) and mitochondrial 11-hydroxylase (11-OHase) after in vivo administration of purified rat prolactin (rPRL) to adult, female Sprague-Dawley rats. Animals were ovariectomized, hypophysectomized and replaced with ACTH. Two days after surgery rPRL was administered i.p. at doses of 1.0, 10.0 and 100.0 micrograms (micrograms) every 4 hours for 5 days to experimental animals. Control rats received vehicle injections. All rats were sacrificed by decapitation and blood and adrenal glands collected. The adrenals were pooled into each rPRL dose group and mitochondria, microsomes and cytosol prepared from each pool. The activities of 3B-HSD, 21-OHase and 11-OHase were measured using as substrates 14C-dehydroepiandrosterone, 14C-progesterone and 14C-deoxycorticosterone, respectively. Plasma prolactin levels rose from 9.9 +/- 2.5 ng/ml in the control animals to 166.0 +/- 37.7 ng/ml (p less than 0.001) in the 100 micrograms rPRL dose group. Plasma corticosterone levels were not statistically different in the experimental groups when compared to controls. However, adrenal weight was increased in the high dose rPRL group (34.9 +/- 0.9 mg vs 41.9 +/- 1.2 mg, p less than 0.025). Hyperprolactinemia did not influence microsomal 3B-HSD or mitochondrial 11-OHase activities but was associated with a dose dependent decrease in microsomal 21-OHase activity when compared to controls (p less than 0.001). Adrenal cytosol progesterone levels increased with increasing rPRL dose consistent with a 21-OHase block during hyperprolactinemia. These data suggest that prolactin has a direct effect on rat adrenal 21-OHase in vivo.

Effect of prolactin and androgens on the prostate of bonnet monkeys, Macaca radiata: I. Nucleic acids, phosphatases, and citric acid

The effects of prolactin (PRL), bromocriptine (Br), testosterone propionate (TP), dihydrotestosterone (DHT), and the combinations of these androgens with PRL/Br on the growth and secretory activities of cranial and caudal prostates were studied in castrated mature monkeys, Macaca radiata. Castration decreased the body weight, organ weights, nucleic acids (DNA and RNA), phosphatases, and citric acid of cranial and caudal prostates. PRL did not alter the body weight but increased the organ weights, nucleic acids, phosphatase activities, and citric acid. Br given alone decreased the body weight and the secretory activities of prostates but caused no significant alteration in the nucleic acids. TP/DHT replacement brought back the body weight and prostatic nucleic acids to normal. It enhanced the weights, phosphatase activities, and citric acid contents of cranial and caudal prostates. PRL + TP/DHT enhanced the body weight, organ weight, and secretory activities. Br + TP/DHT decreased the body weight and secretory products of prostate but it did not produce any alteration in the organ weight and RNA content. These results suggest that PRL plays a specific stimulatory influence on monkey prostate.

Effect of chronic hyperprolactinemia induced by sulpiride on plasma dehydroepiandrosterone (DHA) in normal men

In order to elucidate the relationship between plasma dehydroepiandrosterone (DHA) and sulpiride-induced hyperprolactinemia (of 60 day duration) in normal men, five normal men (aged 27-46) were administered daily 300 mg of sulpiride orally for 60 days to induce hyperprolactinemia. Plasma levels of prolactin, DHA and cortisol were measured by radioimmunoassay before sulpiride treatment, at day 14 and day 60 after initiation of the treatment. Plasma levels of prolactin after the administration rose significantly (P less than 0.001) to 71.6-95.3 ng/ml in four out of the five subjects compared with those of the controls. In the same four subjects the mean DHA values in plasma were elevated significantly (P less than 0.05) to 877 +/- 160 ng/dl from the mean baseline values (669 +/- 91 ng/dl). The elevated values remained during sulpiride treatment. Plasma levels of cortisol did not change significantly during sulpiride administration in all subjects. Our results suggest that sulpiride-induced hyperprolactinemia sustained at least 14-60 days in normal men stimulates the adrenal cortex to secrete DHA.

Adrenal and gonadal androgen secretion in normal females

Both the adrenal and the ovary contain the biosynthetic pathways necessary for androgen synthesis and secretion. The fetal ovary is not very active but the fetal adrenal is an important source of DHAS. However the secretion of DHAS declines markedly after birth and until puberty there is little androgen secretion by either the adrenal or the ovary. Post-pubertally, the adrenal secretes DHAS, DHA, delta 4-A and T from the reticularis and probably the fasciculata. This secretion is under ACTH control, at least in part, but apparently also under control of another pituitary polypeptide tentatively called 'adrenal androgen secretory hormone'. THe adrenal secretion rates are in the range of 7-14 mg/day for DHAS, 3-4 mg/day for DHA, 1-1.5 mg/day for delta 4-A and 50 micrograms/day for T. Androgen secretion from the ovary arises in part from the theca cells of the follicle, the corpus luteum and the stromal cells, under LH control, and will vary somewhat during the normal menstrual cycle. The ovarian secretion rate in the follicular phase is 1-2 mg/day for DHA, 1-1.5 mg/day for delta 4-A and about 50 micrograms/day for T. In the peri-ovulatory period the secretion rate of delta 4-A can rise to 3-3.5 mg/day but there appears to be little change in the secretion of DHA and T. The normal ovary does not secrete significant amounts of DHAS. In about 50% of post-menopausal women the ovaries continue to secrete some T but little delta 4-A or DHA.

Effect of ACTH and prolactin on dehydroepiandrosterone, its sulfate ester and cortisol production by normal and tumorous human adrenocortical cells

The effect of ACTH and prolactin on the synthesis of dehydroepiandrosterone (DHEA) and its sulfate ester (DHEAS) was studied in cell suspensions of "normal" and tumorous (adenoma) human adrenal cortex. A stimulation of DHEA and no response of DHEAS production by ACTH in "normal" adrenocortical cell suspension was observed. However ACTH stimulated both DHEA and DHEAS synthesis in tumorous adrenocortical cells. Prolactin did not influence either the basal or the ACTH stimulated DHEA and DHEAS production of adrenocortical cells irrespective of their origin. Our results are compatible with the concept that the biosynthesis of DHEA is under ACTH control, while other factor(s) regulate(s) the sulfate pathway of DHEA secretion under normal conditions. In tumorous adrenocortical cells DHEA may be regulated--at least partly--by ACTH. Prolactin seems to have no direct effect on DHEA and DHEAS synthesis. It is postulated that the relationship between serum prolactin and DHEAS (or DHEA) levels observed by several authors might be an extraadrenal effect of prolactin on adrenal androgens.

Discordance of plasma DHEA-S, DHEA, and cortisol responses with various ACTH regimens

The origin and time course of ACTH-stimulated adrenal androgens are controversial. Since previous protocols have used differing ACTH preparations and routes of administration, we sought to compare plasma DHEA and DHEA-S responses to four ACTH regimens. Fourteen young men underwent the following five three-day study periods: (1) placebo, (2) alpha 1-24 ACTH, 400 micrograms intravenously (IV); (3) alpha 1-39 ACTH, 400 micrograms intramuscularly (IM); (4) alpha 1-18 (D-Ser1, Lys17, Lys18) ACTH, 400 micrograms IM; and (5) alpha 1-18 ACTH, 400 micrograms IV. alpha 1-18 ACTH IV had the most potent and prolonged corticotropic effect, listing more than 24 hours, as measured by plasma cortisol, 17-OHCS, and cortisol secretion rates. alpha 1-39 ACTH and alpha 1-18 ACTH IM were corticotropic up to 12 hours, and alpha 1-24 ACTH IV was corticotropic only up to one hour. Plasma DHEA rose acutely at one hour with all of the ACTH regimens (P less than 0.05). This response was correlated with cortisol (r = 0.62, P less than 0.01) and reflected the relative corticotropic potency of each of the ACTH regimens. Plasma DHEA-S, on the other hand, did not rise acutely at one hour with any of the regimens. DHEA-S did rise at 12 hours with three of the ACTH regimens (alpha-1-24, alpha 1-39, alpha 1-18 IM), but this response was not synchronous with cortisol (r = 0.14, P = NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Androgen levels during cyproterone acetate and ethinyl oestradiol treatment of hirsutism

Androgen levels were measured before and during 12 months of treatment with cyproterone acetate (50 mg 5th to 16th day of cycle) and ethinyl oestradiol (50 micrograms 5th to 26th day of cycle) in 26 patients suffering from dysfunctional hirsutism. Patients were included in whom androgen levels after a dexamethasone suppression test fell above the range found in normal non-hirsute women on dexamethasone. Eighty percent of patients showed a substantial improvement of their Ferriman and Gallwey score after 12 months of treatment. During the treatment the mean level of testosterone was 64%, androstenedione 55%, testosterone oestradiol binding globulin 365%, apparent free testosterone 30%, dihydrotestosterone 74%, 5-androstanediol 43%, dehydroepiandrosterone 44%, 5-androstenediol 67% and dehydroepiandrosterone sulphate 74% of basal levels. From the results it is concluded that this treatment is effective both clinically and biochemically in reducing hyperandrogenism.

Androgen plasma levels in male diabetics

Plasma level of androgens were studied in 47 normal male controls (20-50 yr-old; mean age 38 yr) and in a group of forty-one male diabetics (23-55 yr-old; mean age: 37.5 yr). Of these 36 showed type II and 5 type I diabetes. The results showed that while the mean basal plasma LH was unchanged, there was a decrease in testosterone levels in the diabetics. Moreover, testosterone binding globulin (TeBG) capacity appeared to be augmented and, as a consequence, the apparent free testosterone concentration (AFTC) was markedly decreased. It is interesting to note that the anomalies in androgen secretion observed are rather similar to those found in elderly man and could play some role (with other factors) in the onset of the frequent sexual disturbances in male diabetics.

Control of adrenal androgen production

The major adrenal androgens are dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulphate (DHEAS) and androstenedione (delta 4). Studies by Cutler et al in 1978 demonstrated that these androgens are detectable in blood of all domestic and laboratory animals studied, but that only 4 species show increase in one or more with sexual maturation: rabbit, dog, chimpanzee and man. Studies by Grover and Odell in 1975 show these androgens do not bind to the androgen receptor obtained from rat prostate and thus probably are androgens only by conversion to an active androgen in vivo. Thomas and Oake in 1974 showed human skin converted DHEA to testosterone. The control of adrenal androgen secretion is in part modulated by ACTH. However, other factors or hormones must exist also, for a variety of clinical observations show dissociation in adrenal androgen versus cortisol secretion. Other substances that have been said to be controllers of adrenal androgen secretion include estrogens, prolactin, growth hormone, gonadotropins and lipotropin. None of these appear to be the usual physiological modulator, although under some circumstances each may increase androgen production. Studies from our laboratory using in vivo experiments in the castrate dog and published in 1979 indicated that crude extracts of bovine pituitary contained a substance that either modified ACTH stimulation of adrenal androgen secretion, or stimulated secretion itself - Cortisol Androgen Stimulating Hormone. Parker et al in 1983 showed a 60,000 MW glycoprotein was extractable from human pituitaries, which stimulated DHA secretion by dispersed canine adrenal cells in vitro, but did not stimulate cortisol secretion. This material contained no ACTH by radioimmunoassay. In 1982 Brubaker et al reported a substance was also present in human fetal pituitaries, which stimulated DHA secretion, but did not effect cortisol.

Effects of drugs associated with hyperprolactinemia on plasma steroids and on steroid receptors and metabolism in human breast cancer

Certain commonly taken pharmaceutical preparations induce increased levels of plasma prolactin. The effects of these drugs on (a) tumor steroid receptors and metabolism, and (b) plasma hormones and hormone binding proteins have been studied in postmenopausal women with breast cancer. Two groups have been compared, 18 patients on drug treatment for at least 2 months and 15 subjects with no history of drug ingestion. Patients taking medication had significantly higher levels of plasma prolactin compared with control women. No significant difference was observed between the groups with regard to the plasma concentrations of dehydroepiandrosterone (DHA) and its sulphate (DHS), testosterone, estrone, estradiol-17 beta, sex hormone binding globulin (SHBG), and albumin. Similarly, no difference was observed between these two groups with regard to estrogen receptor (ER), progestogen receptor (PR), or androgen receptor (AR) levels in the tumors nor their ability to metabolize (7(-3)H) testosterone. It is considered that the ingestion of these drugs does not affect tumor mechanisms involving steroids.

Endometrial tissue and plasma concentrations of 5-androstene-3 beta, 17 beta-diol during the menstrual cycle in normal premenopausal and perimenopausal women

A radioimmunoassay for 5-androstene-3 beta, 17 beta-diol (ADIOL) in human endometrium and plasma is described. The recognised criteria of reliability have been fulfilled. Plasma and endometrial tissue concentrations of ADIOL were determined in samples obtained from normal premenopausal and perimenopausal women (average ages 37 and 48 years respectively) at different phases of the menstrual cycle. In perimenopausal women plasma concentrations of ADIOL did not vary throughout the cycle (proliferative phase: 411 +/- 95 (SEM) pg/ml; secretory phase: 462 +/- 28.5 (SEM) pg/ml). For the premenopausal group the pattern was similar (proliferative phase: 568.4 +/- 56.9 (SEM) pg/ml; secretory phase: 663.1 +/- 64.7 (SEM) pg/ml) although a significant difference (P less than 0.05) was noted between late proliferative and late secretory phase levels in these women. A different pattern was observed for endometrial tissue concentrations of ADIOL. In both groups of women a significant (3-4-fold) increase occurred during the secretory phase. There was no apparent relationship between plasma and tissue concentrations of ADIOL either during the proliferative or the secretory phase. There was, however, an age associated decrease for both tissue and plasma ADIOL. Theories are proposed to account for the increase in ADIOL concentration during the luteal phase.

The effect of sleep deprivation on the plasma levels of hormones during prolonged physical strain and calorie deficiency

The effect of sleep on the serum levels of hormones during prolonged heavy physical strain and calorie deficiency were investigated in 19 young men participating in a 5 day ranger training course with a calorie consumption of 35,000-50,000 kJ X 24 h-1, and a calorie intake of about 6,000 kJ X 24 h-1. The subjects were divided into two groups: the stress group (8 cadets) were allowed no organized sleep during the course, whereas the sleep group (9 cadets) had 3 h sleep each night. Small but significantly (p less than 0.01) higher serum levels were found in the sleep group compared to the stress group for cortisol, growth hormone and testosterone. No such differences were found for catecholamines, androstendione, dihydrotestosterone, LH, triiodothyronine and thyroxine. Androstendione and dihydrotestosterone decreased in parallel with testosterone (r = 0.5) during the course, changes which directly or indirectly seem to be due to decreased testicular secretion. The changes found during this investigation for the other hormones are similar to changes found during previous courses. LH showed only small variation during the course and cannot explain the decreased secretion from the testis or the difference between the two groups for testosterone. All hormones were normal within 23 days after the end of the course.

Seasonal variation of plasma dehydroepiandrosterone sulphate and urinary androgen excretion in post-menopausal women

Urinary levels of the glucuronides of androsterone, aetiocholanolone, 5 alpha-androstane-3 alpha, 17 beta-diol and 5 beta-androstane-3 alpha, 17 beta-diol, were determined in twenty-two-post menopausal women both in spring and in autumn--winter. In sixteen women dehydroepiandrosterone sulphate plasma levels were also measured. Plasma DHAS levels as well as urinary metabolite excretion values were significantly higher in autumn--winter than in spring. This seasonal variability should be taken into account in long-term studies involving adrenal hormone levels, excretion or metabolism. Moreover this seasonal variability might be of relevance for the cyclical growth rate of hormone dependent tumours such as breast cancer.

Adrenocortical steroids, bone mineral content and endometrial condition in post-menopausal women

In 23 post-menopausal women, serum levels of cortisol, unconjugated dehydroepiandrosterone (DHA), dehydroepiandrosterone sulphate (DHAS), testosterone, unconjugated and total oestrone and prolactin were measured before and during an ACTH test. Significant positive correlations were found between basal levels of DHA and DHAS; DHA and unconjugated oestrone; DHA and total oestrone; testosterone and total oestrone and between unconjugated and total oestrone. ACTH significantly raised the levels of the steroids but not of prolactin. Significant positive correlations were found between basal levels and ACTH induced increments in DHA; between basal DHAS and increments in DHA and between increments in DHA and DHAS. A significant negative correlation was found between basal levels and increments in cortisol. No significant correlations were found between other combinations of hormone basal levels and/or increments. Significant positive correlations were found between basal levels of DHAS and the DHA response to ACTH respectively, and trabecular bone mineral content of the distal forearm. A significant correlation was also found between bone mineral content and pre-cancerous/cancerous state of the uterine epithelium. The results are a further support to the concept of a link between adrenal androgens and bone mineral density, and do also indicate a relation to endometrial pathology. The lack of correlation between cortisol and other steroids indicate different regulatory mechanisms. Prolactin does not seem to be involved in the regulation of the adrenal androgen synthesis.

Serum levels of cortisol, dehydroepiandrosterone, dehydroepiandrosterone sulphate, estrone and prolactin after surgical trauma in postmenopausal women

Changes in serum hormone concentrations induced by surgical trauma were studied by determination of cortisol, dehydroepiandrosterone (DHA), dehydroepiandrosterone sulphate (DHAS), estrone (E1) and prolactin in 25 postmenopausal women. Blood samples were collected before, during and after mastectomy (14 women) and cholecystectomy (11 women). A slight peroperative increase in DHA preceded a marked postoperative decrease whereas no significant changes were seen concerning DHAS. The posttraumatic increase in cortisol values was delayed in relation to that of DHA, reaching its maximum on the first postoperative day. There was a pronounced postoperative increase in estrone which was only slightly (r = 0.3) correlated to the concomitant changes in the serum levels of DHA and cortisol indicating that other factors than increased availability of precursor steroids might influence this change. Prolactin levels showed an about fourfold peroperative increase and were normalized on the first day after surgery. No significant differences in preoperative values were seen between the groups although generally more pronounced and retarded changes were seen after cholecystectomy than after mastectomy.

Hirsutism: implications, etiology, and management

Hirsutism usually results from a subtle excess of androgens. As such, it is a clue to possible endocrine disturbance in addition to presenting cosmetic problems. We use the term hirsutism to mean male-pattern hirsutism--excessive growth of hair in areas where female subjects normally have considerably less than male subjects. An elevation of the plasma free (unbound) testosterone level is the single most consistent endocrinologic finding in hirsutism. The plasma free testosterone level is sometimes elevated when the total level of plasma testosterone is normal because testosterone-estradiol--binding globulin (TEBG) levels are often depressed in hirsute women. Frequent blood sampling is sometimes necessary to demonstrate subtle hyperandrogenic states since androgen levels in the blood are pulsatile and seemingly reflect episodic ovarian and adrenal secretion. The source of hyperandrogenemia can usually be determined from dexamethasone suppression testing. Those patients whose plasma free androgen levels do not suppress normally usually have functional ovarian hyperandrogenism (polycystic ovary syndrome variants). Very high plasma androgen levels or evidence of hypercortisolism, which is not normally suppressible by dexamethasone, should lead to the search for a tumor or Cushing's syndrome. Those patients in whom hyperandrogenemia is suppressed normally by dexamethasone have a form of the adrenogenital syndrome, a prolactinoma, obesity, or idiopathic hyperandrogenemia. In such patients, glucocorticoid therapy may reduce hirsutism and acne and normalize menses. The treatment of hirsutism resulting from functional ovarian hyperandrogenism is not as satisfactory; estrogen-progestin treatment is the most useful adjunct to cosmetic approaches to hirsutism in this country. However, other manifestations of polycystic ovary syndrome, such as infertility, may take precedence over hirsutism when an optimal therapeutic program is designed for many patients.

Effect of clomiphene citrate on testicular steroid metabolism in man

Administration of clomiphene citrate to males with normal peripheral testosterone levels increased the serum levels of FSH, LH, testosterone and low polar oestrogens and also the urinary excretion of LH, low polar oestrogens, dehydroepiandrosterone, androsterone and aetiocholanolone. No significant change was noted for the urinary excretion of 17-oxogenic steroids. Addition of clomiphene citrate (10(-4) to 2 X 10(-3) M) to incubations of [7-3H, 21-14C] progesterone with human testicular biopsy specimens in vitro caused a slight inhibition in the formation of 17 alpha-hydroxyprogesterone and a slightly increased formation of 20 alpha-hydroxy-4-pregnen-3-one but no measurable changes in the C19 steroid formation. The results support the hypothesis that there is selective action of clomiphene citrate upon the adrenal C19 steroid biosynthesis in the human male, combined with an indirect effect upon the testes via the hypothalamic-pituitary system. A direct effect on the gonadal steroidogenesis can, however, not be ruled out.

The physiology of the perimenopausal years: a minireview

Selected studies on the physiology of the perimenopausal years and the subtle transitional changes that occur up to the postmenopause are reviewed. Extraovarian sources of estrogen, which must be considered when recommending dosage of replacement therapy, are described. The effects of hormonal therapy on endogenous hormones and the important roles of progesterone and prolactin are highlighted. The collected evidence suggests that (a) the vasomotor disturbance and depression experienced by estrogen-deficient women are not psychosomatic disorders, (b) osteoporosis is preventable if estrogen therapy is initiated soon after cessation of ovarian function, and (c) administraton of a weak estrogen combined with a progestogen can effectively prevent or treat the difficulties experienced during the female climacteric.

Relationship between plasma prolactin concentration and pituitary function in patients with a pituitary adenoma

The influence of hyperprolactinaemia on endocrine functions in forty-two consecutive patients with untreated pituitary tumours was studied. Patients with acromegaly, Cushing's disease and Nelson's syndrome were excluded. Sixteen patients (eleven men and five women) had a pituitary adenoma with suprasellar extension and twenty-six (eleven men and fifteen women) had a small intrasellar tumour. Basal plasma prolactin concentration was measured in all. Thyroid function was assessed by plasma thyroxine (T4) and TSH concentrations, adrenocortical function and growth hormone (GH) secretion by the maximum plasma cortisol, adrenocorticotrophin (ACTH) and GH concentrations, respectively, during insulin-induced hypoglycaemia (tITT). Gonadal function was studied by measuring plasma concentrations of luteinizing hormone (LH), follicle stimulating hormone (FSH), oestradiol-17 beta and in men, testosterone. On the basis of computer assisted tomography of the sella turcica, the tumour volume was calculated. The basal plasma prolactin concentration was elevated in 69% of the patients. Decreased GH secretion was the most frequent pituitary dysfunction (78%) followed in men by gonadal insufficiency (77%), adrenocortical insufficiency (31%) and thyroid insufficiency (21%). There was no difference between patients with elevated and normal plasma prolactin concentration as to the tumour volume and any of the endocrine variables.