Radioimmunoassay of human follicle stimulating and luteinizing hormones in plasma

Nature of alpha subunit secretion in men: circadian rhythms, pulsatile release and secretory profiles

Alpha subunit complements LH as a marker of the activity of the hypothalamic GnRH pulse generator. To characterize episodes of alpha subunit release and to determine if a circadian pattern of alpha subunit secretion is present in man, spontaneous alpha subunit pulsatility was analyzed in six healthy young men by blood sampling every 5 min for 24 h. The resulting alpha subunit concentration time series were analyzed by two statistically based independent peak detection methods, and subjected to Fourier transformation to assess underlying circadian rhythms. Cross-correlation analyses and multiple parameter deconvolution were used to estimate the concordance of spontaneous and exogenous GnRH-stimulated LH and alpha subunit secretion. These analyses revealed that two independent discrete peak detection algorithms yielded similar estimates of spontaneous alpha subunit pulse frequency, namely, 21 +/- 1.1 (Cluster) and 21 +/- 1.5 (Detect) alpha subunit peaks/24 h. Sampling intensity markedly influenced the estimate of endogenous alpha subunit pulse frequency, inasmuch as estimates from 5-min sampling were significantly greater than those of 10-min or 20-min sampling. Fourier transformation unmasked a significant circadian alpha subunit rhythm in all six men, with maximal concentrations at 0836 h and an average amplitude of 28% of the 24-hr mean hormone concentration. Cross-correlation analysis of spontaneous glycoprotein release revealed that serum LH and alpha subunit concentrations were highly cross-correlated when considered simultaneously, but not at various lags. Finally, deconvolution analysis of exogenous GnRH-stimulated glycoprotein release disclosed distinct half-times of alpha subunit and LH clearance with virtually simultaneous underlying secretory bursts. These data indicate that human alpha subunit is secreted in both a circadian and a discrete pulsatile fashion at a pulse frequency that is significantly underestimated at conventional sampling rates. The approximately hourly alpha subunit interpulse interval (68 +/- 4.6 min) is similar to that reported earlier for LH in peripheral blood and for testosterone in gonadal vein blood in healthy men. Moreover, cross-correlation analysis of endogenous GnRH-driven alpha subunit and deconvolution analysis of exogenous GnRH-stimulated alpha subunit and LH secretion suggest that these glycoproteins are secreted virtually simultaneously, but have significantly different endogenous clearance properties. The remarkably similar in vivo pulse frequencies for alpha subunit, LH, and testosterone in man suggest that the release of these three hormones is coordinately regulated.

LDH isoenzymes in semen of infertile men

LDH isoenzymes (LDH1, LDH2, LDH3, LDH4, LDH5, and LDHx) were evaluated in 68 infertile men and in a control of 10 fertile men. No statistically significant difference was found in the value of the 5 isoenzymes (LDH 1-5) in the different subgroups of infertile men and in the comparison of the infertile men with the control group. LDHx was detected in the infertile men, regardless of the cause of infertility, as long as the sperm concentration was greater than or equal to 16 million/ml, LDHx was not detected not only in all azoospermic men but, also, in those infertile men whose sperm count was less than or equal to 15 million/ml. There is a positive relationship (p less than 0.001) between LDHx and sperm concentration, but there is no such relationship between LDHx and % motility.

Neuroendocrine-gonadal axis in men: frequent sampling of LH, FSH, and testosterone

Previous studies of episodic hormone secretion of the hypothalamic-pituitary-gonadal axis in normal men have produced conflicting results due to examinations of small cohorts of subjects or to limited sampling techniques. We evaluated gonadotropin and testosterone (T) secretory patterns in 20 normal men by sampling blood at 10-min intervals for luteinizing hormone (LH) and follicle-stimulating hormone (FSH). T concentrations were also analyzed at 20-min intervals in 10 subjects. A previously unappreciated spectrum of gonadotropin and T secretory patterns was observed in normal men. Both mean LH concentrations and mean LH pulse amplitudes varied fourfold between individuals. LH interpulse intervals varied from 30 to 480 min (mean 119 +/- 32). Results also suggested a relative refractory period at the level of the hypothalamus or pituitary. In three subjects, a striking nighttime accentuation of LH pulsations was noted. Through use of Fourier analysis, a diurnal variation in LH was observed in the population (P less than 0.02). Mean FSH levels showed marked variation between individual subjects, with discrete pulses rarely observed. No diurnal variation in FSH secretion was noted. Serum T concentrations determined at 6-h intervals ranged from 105 to 1,316 ng/dl between subjects. When T was measured at 20-min intervals, marked intermittent declines in the T concentrations to levels well below the normal range were observed in 3 of 10 subjects. T secretion was found to lag behind LH secretion by approximately 40 min (P less than 0.02).

Opioid regulation of pituitary gonadotropins and prolactin in women using oral contraceptives

To determine the effect of oral contraceptives on endogenous opioid modulation of the hypothalamic-pituitary axis, we gave a bolus dose of 10 mg of naloxone intravenously in women using Lo/Ovral-28 oral contraceptives and in normal (control) women during the follicular (days 8 to 9) and luteal (days 21 to 23) phases. Plasma follicle-stimulating hormone, luteinizing hormone, and prolactin were measured by radioimmunoassay before and after naloxone at regular intervals. In oral contraceptive users (n = 5) basal plasma follicle-stimulating hormone (3.7 +/- 0.4 mIU/ml) and luteinizing hormone (3.2 +/- 0.5 mIU/ml) levels were significantly lower than in control subjects during both follicular (10.7 +/- 0.9 and 16.7 +/- 2.0) and luteal (7.7 +/- 1.4 and 10.0 +/- 0.9, respectively) phases (p less than 0.05 to 0.001). In contrast the basal plasma prolactin level was significantly higher in oral contraceptive users (25.0 +/- 4.1 ng/ml) than in control subjects during the follicular (11.8 +/- 1.2) and luteal (11.0 +/- 0.8) phases (p less than 0.01). In control subjects, follicle-stimulating hormone, luteinizing hormone, and prolactin levels did not change significantly after naloxone in the follicular phase, but naloxone elicited a significant synchronous release of luteinizing hormone and prolactin during the luteal phase. In contrast, oral contraceptive users showed increases in luteinizing hormone and prolactin after naloxone that were not significantly different from the basal plasma levels.

Clinical validation of enzymeimmunoassay of human luteinizing hormone (hLH) in the detection of the preovulatory luteinizing hormone (LH) surge in urine

The preovulatory luteinizing hormone (LH) surge (mean, 60.7 standard error +/- 4.7 mIU/ml) as determined by a solid-phase enzymeimmunoassay in urine has been correlated with clinical parameters in 24 women. In group A, of seven women, the preovulatory LH surge correlated with basal body temperature and cervical mucus. In one of the women in group A, serum levels of pituitary and gonadal hormones confirmed ovulation. In group B, of 17 women, the urinary estrone-3-glucuronide (E1-3-G) peak was either coincident with or preceded the LH surge. The LH surge in all cases occurred 12 to 24 hours prior to follicular rupture, as visualized by real-time sonography. The enzymeimmunoassay for the detection of the preovulatory LH surge is useful in patients for artificial insemination and for aspiration of mature oocytes for in vitro fertilization.

Hormone profile in infertile men

Plasma basal levels of FSH, LH, prolactin, and testosterone were evaluated in 263 men with fertility problems. Significant increases in FSH were detected in all groups of infertile men except those with infection, varicocele, infection and varicocele, and obstructive azoospermia. No differences in LH were detected in all groups, except those with chromosomal testicular abnormality and idiopathic seminiferous tubular failure where significant increases were revealed. No differences in prolactin were detected, while a decrease was found in testosterone in the group with chromosomal testicular abnormality. FSH seems to be a most valuable hormone index in the routine workup of male infertility, while prolactin does not offer substantial information. The combined LH and testosterone evaluation might be of diagnostic importance in selected cases.

24 hour melatonin secretory pattern in Cushing's syndrome

The concentrations of plasma melatonin and cortisol were determined every 20 min during a 24 h period in 6 women aged 24 to 45 years with Cushing's syndrome of differing aetiologies (4 adrenal adenomas, 2 adrenal hyperplasia). Melatonin was assayed after chloroform extraction according to the method of Rollag and Niswender (1976). Abnormal melatonin secretory patterns were found in all the patients; 24 h melatonin concentration means varied from 130 to 413 pg/ml and were not significantly higher than the 24 h mean in 4 controls (215 +/- 126 pg/ml). All six subjects however showed a significant increase of melatonin during the day period (302 +/- 109 as compared with controls 129 +/- 65 mg/ml, mean +/- SD; P less than 0.005). No relationship could be found between abnormal melatonin levels and the sexual status of the patients (4 with amenorrhoea, 2 normally menstruating women). An alteration of melatonin secretory pattern is present in Cushing's syndrome, whatever the aetiology. It is suggested that hypercortisolism, by itself, may modify the pattern of melatonin secretion.

Vaginal organic acids and hormonal changes in the menstrual cycle

Twenty-seven women not using oral contraceptives (OCs) and 22 women using OCs were studied during one complete menstrual cycle. Twenty-four-hour vaginal secretions, collected on alternate days by a tampon method, were analyzed for acetic and other short-chain aliphatic acids and for lactic acid. Daily blood samples were analyzed for estrogens, progesterone (P), and luteinizing hormone (LH). No difference was found between OC users and nonusers in either amount or variability of vaginal aliphatic acids throughout the menstrual cycle. Aliphatic acids did not correlate with estrogen of P levels. A significant positive correlation was found between vaginal lactic acid and blood estrogens in those subjects not using OCs.

Cytogenetic and histological studies in a series of subfertile males

Cytogenetic and histological studies were carried out on a series of 68 men during investigations for subfertility. Somatic chromosome analysis identified 4 cases with abnormal karyotypes. Meiotic chromosome analysis identified 4 cases with abnormal meiosis. Analysis of cell stages of the spermatogenic cycle in cytogenetic preparations identified 12 cases with missing cell cycle stages. Histological analysis of tissue samples identified defects of the spermatogenic cycle in 23 cases. A kinetic model of spermatogenesis is used in order to relate the different types of abnormality to the spermatogenic cycle.

Basal body temperature: unreliable method of ovulation detection

Basal body temperature (BBT) charts for menstrual cycles of 98 women were evaluated by six experienced physicians. The time of ovulation as estimated from the charts by a consensus of at least five of the evaluators coincided with the luteinizing hormone (LH) peak +/- 1 day in only 17 (22.1%) of the 77 cycles that were determined by endocrine profiles to be ovulatory and to have adequate luteal phases. An additional 22.1% of these cycles were thought to have monophasic patterns by a consensus of the physicians. Extreme caution in interpretation is urged when BBT is used for clinical or research evaluations of ovulation or menstrual cycle dynamics.

Gonadotrophin levels in women with Cushing's syndrome before and after treatment

Basal serum concentrations of LH and FSH and their response to LHRH were studied in twelve pre- and ten post-menopausal women with Cushing's syndrome before and after treatment. Subnormal basal concentrations of LH were found in twelve out of twenty-two, and of FSH in ten of the twenty untreated patients. There was a correlation between the urinary free cortisol (UFC) and basal LH values, r = -0.59 (P less than 0.05), and UFC and basal FSH values, r = -0.76 (P less than 0.02) in the premenopausal women. All seven patients with a UFC value greater than 1080 nmol/24 h (normal range less than 270) had both a subnormal basal gonadotrophin level and a subnormal response of at least one gonadotrophin to the releasing hormone. In those patients in whom successful remission was obtained and who did not require replacement therapy, subnormal basal gonadotrophins were usually restored towards or into the normal range. It is concluded that while gonadotrophin levels may be normal in women with Cushing's syndrome, they are subnormal in those with the highest cortisol values. This may be due to a direct suppressive effect of cortisol on the release of stored pituitary hormone, and/or on LHRH release from the hypothalamus.

Delayed puberty in males with chronic renal failure

The effects of chronic renal failure on the pituitary-testicular axis of 31 males, aged 11.7 to 20.0 yr (mean, 16.0 yr) were studied. Nine patients not on hemodialysis (group I) had serum creatinines between 2.5 and 8.0 mg/dl, 10 patients were on hemodialysis (group II) and 12 patients had received a renal transplant (group III). The Tanner stage of pubertal development was delayed relative to chronologic age. Testosterone (T), delta 4-androstenedione (delta 4), and urinary 17-keto steroids were normal when related to pubertal stage in groups I and II; and dehydroepiandrosterone (DHEA) and DHEA sulfate (DS) were in the low normal range. In group III, adrenal androgens (delta 4, DHEA, DS) were decreased as a consequence of prednisone therapy whereas T was normal. Luteinizing hormone levels were normal in all. Follicle-stimulating hormone levels were normal in all. Follicle-stimulating hormone (FSH) was significantly increased in groups I and II. In group III, FSH was normal in 6 of 9 patients with serum creatinine concentrations < 2 mg/dl. FSH levels were uniformly elevated in Tanner I-V patients with creatinines > 2 mg/dl. The data shows that FSH is elevated in patients with chronic renal failure even in prepuberty and early adolescence. This may reflect damage to germinal epithelium prior to the advent of spermatogenesis, whereas Leydig cell function appears to remain intact.

Conjugation of a fetuin glycopeptide to human follicle-stimulating hormone and its subunits by photoactivation

Human follicle-stimulating hormone (human FSH), dansylated human FSH, human FSH-alpha and human FSH-beta subunits were individually conjugated by photoactivation to an azidobenzoyl derivative of a glycopeptide isolated from fetuin. The conjugates were purified on a column of Sephadex G-100. The carbohydrate content of the conjugated human FSH increased 2.7-fold with a concomitant 1.5- and 2-fold increase in the immunological and biological activity of the human FSH. The glucosamine content of the human FSH-alpha and human FSH-beta increased 6- and 1.4-fold, respectively, after conjugation. Human FSH-alpha conjugate, when recombined with untreated human FSH-beta showed up to 50% increase in the biological activity over the control. When the conjugated human FSH-beta was combined with untreated human FSH-alpha, there was little change in the biological activity. These experiments demonstrate that the photoactivation procedure, although random and site-nonspecific in nature, provides a potential means of attachment of glycopeptides to the protein moiety and enhancement of the hormonal activity of human FSH.

A rapid solid-phase radioimmunoassay for human plasma follicle-stimulating hormone

The measurement of plasma levels of human follicle-stimulating hormone (FSH) has proved to be of value for the study of the hypothalamic-hypophyseal-gonadal axis, greatly facilitating the diagnosis and mangement of problems relating to the menopause and infertility. In the present work a solid-phase radioimmunoassay for human FSH has been developed. This system is characterised by high precision, is economical, and is considerably faster to operate than conventional double antibody systems used in the hospital assay service. Reference values for plasma FSH in various endocrine states are recorded and discussed.

Endocrine changes after diethylstilbestrol therapy. Effects on prostatic neoplasm and pituitary-gonadal axis

This study was undertaken to determine the effects of DES (diethylstilbestrol) on prostatic neoplasms and of different dosage levels on the pituitary-gonadal axis. It is recommended that when DES is chosen for treatment plasma testosterone be monitored carefully and for long periods of time to evaluate the ability of the dose to achieve levels comparable to castration in each patient.

The presence of gonadotropin and prostaglandin E receptors in the cell membranes of bovine corpora lutea throughout pregnancy

These studies revealed that the cell membranes prepared from bovine corpora lutea contain receptors for both human chorionic gonadotropin and prostaglandin E throughout pregnancy. The presence of these receptors correlated well with the earlier findings that the corpus luteum remains functional and responds to gonadotropic stimulation throughout the bovine pregnancy. This contrasts with our earlier findings that human corpora lutea of pregnancy of more than 6 weeks contain very few or no available receptors for human chorionic gonadotropin or prostaglandin E.

Hormonal studies in Klinefelter's syndrome

Some aspects of the hormonal abnormalities of Klinefelter's syndrome have been studied in nineteen patients. As a group the plasma production rate, the total and free levels of testosterone, and the metabolic clearance rates of testosterone and oestradiol were low. Plasma oestradiol, LH and FSH levels were elevated and there was increased peripheral conversion of testosterone to oestradiol. The production rates of oestradiol and the binding capacities of the sex steroid binding globulin were normal. There were fluctuations in the blood levels of LH, FSH, testosterone and oestradiol, but these appeared to be less marked than in healthy men. Both LH and FSH levels were suppressed by acute or prolonged testosterone administration and there was no evidence for a differential effect on LH. It is suggested that the threshold for suppression of LH and FSH is increased in hypergonadotrophic states. Although no statistically significant relationships were found between the hormonal and clinical abnormalities of the syndrome it is probable that the hyperoestrogenism and androgen deficiency are linked to the development of the signs of feminization and hypogonadism.

Prostatic cancer and SCH-13521: II. Histological alterations and the pituitary gonadal axis

We herein report on the results of treatment of 13 men with stage D prostatic carcinoma with a non-steroidal compound, SCH-13521 (flutamide). The dosage of the drug was 750 mg. in 3 divided doses daily and treatment extended for 2 to 20 months. Two patients failed to respond in any fashion, 7 had objective evidence of response and the others had varying degrees of subjective response. Plasma testosterone was never suppressed and sexual potency was not altered by the drug. Gynecomastia occurred in several patients, 1 patient had intractable vomiting and 2 had thromboembolic disease. In tissue biopsies after therapy, cytotoxic changes in some acinar cells were noted but healthy-appearing neoplastic cells were always abundant. These observations suggest the pre-treatment existence of autonomous cells that no conventional hormonal manipulation will succeed in destorying. However, the palliation that flutamide seems to afford makes it important to conduct an appropriately designed study that will compare it in a suitable fashion to the effectiveness of diethylstilbestrol.

Feminizing interstitial cell tumor of the testis: personal observations and a review of the literature

A 28-year-old man with evidence of feminization was demonstrated after 4 years of investigation to have a estrogen-secreting interstitial cell tumor. Such feminizing neoplasms are uncommon, only 37 having been described. They are usually benign and are characterized by gynecomastia, a testicular mass and, with lesser frequency, by decreased libido and potency and poor semen quality. The urinary excretion and plasma levels of estrogen are increased and, by selective testicular catheterization, the site of increased estrogen production can be localized. Secondary histologic changes occur in the nontumorous portions of the testis as well as in the contralateral testis; they are most marked in the area immediately adjacent to the tumor. Postoperatively, the gynecomastia regresses, the excessive levels of estrogen return to normal, libido improves, and the sperm count increases to normal.

Plasma gonadotropins and androgens in surgically treated cryptorchid patients

Plasma LH, FSH, and total 17betaOH androgen levels were measured in a group of 40 adult patients who underwent orchiopexy for either unilateral or bilateral cryptorchism during childhood. Gonadotropin abnormalities were found in 15 of 40 patients and thereby appeared to be a much more sensitive indicator of testicular malfunction than the androgens which were abnormal in only four patients. In the postpubertal phase, the estimation of gonadotropins and androgens appeared valuable, first, as an additional help in the prognosis of fertility, where combined raised levels of LH and FSH were found to indicate a poor prognosis; second, to detect in infertile patients gonadotropin deficiency which, if previously missed, can still be expected to respond to gonadotropin therapy; third, for the detection of the subclinically hypogonad group who may require follow-up, and finally for the detection of the low-androgen group who may require some form of hormonal therapy. As several patients in this study were found to have low gonadotropins, it is postulated that low levels of gonadotropin may play a role in the production of cryptorchism. The finding of high gonadotropin levels in another group may indicate a feedback mechanism sensitive to a damaged testis, but alternatively it is possible that there might be a primary resistance to the action of gonadotropins and it is postulated that such a resistance may be an additional factor of the causation of cryptorchism in some cases.

Pituitary-testicular responsiveness in male hypogonadotropic hypogonadism

An isolated deficiency of pituitary gonadotropins was demonstrated in six 46 XY males, 22 to 36 years of age, with and without anosmia. Undetectable or low levels of serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) clearly separated hypogonadotropic from normal adult males. Chronic (8-12 wk) administration of clomiphene citrate caused no increase in serum FSH or LH in gonadotropin-deficient subjects. However, the administration of synthetic luteinizing hormone releasing factor (LRF) resulted in the appearance of serum LH and, to a lesser degree, serum FSH in three subjects tested. While levels of plasma testosterone were significantly lower in gonadotropin-deficient subjects, plasma androstenedione and dehydroepiandrosterone were in a range similar to that of age-matched normal men. Treatment with human chorionic gonadotropin (HCG) increased levels of plasma testosterone to normal adult male values in all gonadotropin-deficient subjects. Cessation of treatment with HCG resulted in the return of plasma testosterone to low, pretreatment levels. That HCG therapy with resultant normal levels of plasma testosterone may somehow stimulate endogenous gonadotropin secretion in gonadotropin-deficient subjects was not evident. The adult male levels of serum FSH and LH after LRF, and plasma testosterone after HCG, confirm pituitary and Leydig cell responsiveness in these subjects.

Syndrome of pigmentary retinal degeneration, cataract, microcephaly, and severe mental retardation

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Gonadotropin secretion during sleep in normal adult men

Release of luteinizing hormone and follicle stimulating hormone during sleep in young adult men occurred in unrelated, random, arrhythmic peaks, with no consistency from night to night in the same subject. Release of luteinizing hormone was modestly but significantly larger (14 perecnt) during rapid-eye-movement sleep than it was in non-REM sleep, but release of follicle stimulating hormone was not clearly related to stages of sleep.

Serum follicular-stimulating hormone and luteinizing hormone as measured by radioimmunoassay correlated with sexual development in hypopituitary subjects

Serum follicular-stimulating hormone (FSH) and luteinizing hormone (LH) as determined by radioimmunoassay, were correlated with sexual development in 29 patients with hypopituitarism (ages 14.2-29.9 yr).16 of 25 idiopathic hypopituitary patients (20 males and 5 females) exhibited some degree of sexual development. Stage III of sexual development or beyond was achieved by 12 of the 16. Of 13 patients with growth hormone (GH), adrenocortical-stimulating hormone (ACTH), and thyroid-stimulating hormone (TSH) deficiency, 8 did not develop beyond stage I. In contrast, five of six patients with GH deficiency without ACTH or TSH deficiency developed to stage III of sexual development or beyond. The mean (+/-sd) serum LH concentration while in stage I (4.3 +/-0.9 mIU/ml) of eight patients (seven males and one female) who developed beyond stage I was significantly (P < 0.005) greater than the mean serum LH concentration (2.3 +/-0.9 mIU/ml) in nine patients (seven males and two females) who had not developed beyond stage I. Mean serum FSH concentrations were not different. Three of four males with organic hypopituitarism did not develop beyond stage I of sexual development. Serum FSH and LH concentrations in the idiopathic and organic hypopituitary patients were more compatible with stage of sexual development than with age. A serum LH concentration below the range of normal for stage I of sexual development in a prepubertal patient suggests that the patient will remain sexually infantile as an adult.