Influence of major surgical stress on plasma levels of testosterone, luteinizing hormone and follicle-stimulating hormone in male patients

Male hypogonadism in systemic disease

Hypogonadism is often observed in the presence of common acute and chronic illnesses in men. Low testosterone levels in these patients can be associated with loss of lean body mass and bone mass density, decline in mood, loss of energy, and sexual dysfunction. The mechanisms explaining hypogonadism and various systemic diseases are not completely understood, but these conditions are likely caused by a combination of stress, nonspecific weight loss, inflammation, and medication. Testosterone replacement can be considered in this population to improve lean body mass, bone mass density, and quality of life. More information is needed regarding the risk benefits of testosterone treatment on health outcomes in men who have systemic illness.

Quantification of testosterone and epitestosterone in human urine samples by stir bar sorptive extraction – thermal desorption – gas chromatography/mass spectrometry: Application to HIV-positive urine samples

A simple method is described for the measurement of testosterone (T) and epitestosterone (ET) in human urine samples. The deconjugated steroids were extracted directly from the samples by stir bar sorptive extraction (SBSE) and derivatized in situ on the stir bar by headspace acylation prior to thermal desorption and GC/MS. Extraction and derivatization parameters, namely salt addition, temperature, and time, were optimized to improve the recovery of T and ET by SBSE. The limits of quantification (S/N 10) were 0.9 ng/mL for T and 2.8 ng/mL for ET. Quantification of the steroids in urine samples was performed using standard addition to avoid the influence of matrix effects. The method was applied for the measurement of urinary T and ET in a group of healthy volunteers and HIV+ patients. Decreased levels of T were detected in the HIV+ group, whereas the excretion of ET was comparable for the two groups. Further clinical research is required to elucidate the biomarker significance of the T/ET ratio in HIV infection.

Increases in serum estrogen levels during major illness are caused by increased peripheral aromatization

Although serum testosterone levels decrease acutely in critically ill patients, estrogen levels rise. We hypothesized that increased rates of aromatization of androgens to estrogens underlie the increase in serum estrogen levels. Eleven men and three women (age 42-69 yr) were prospectively studied before and again after elective coronary artery bypass graft surgery (CABG). Each patient received priming doses of [(14)C]androgen and [(3)H]estrogen that were immediately followed by peripheral infusions for 210 min. Eight men and three women received androstenedione (A(4))/estrone (E(1)) and three men received testosterone (T)/estradiol (E(2)). Adipose tissue biopsies were obtained in another six men before and after CABG to evaluate levels of P450 aromatase mRNA. Serum T levels decreased postoperatively in all 17 men (P < 0.001), whereas E(1) levels rose (P = 0.004), with a trend toward a rise in E(2) (P = 0.23). Peripheral aromatization rates of androgens to estrogens rose markedly in all 14 patients (P < 0.0001). Estrogen clearance rates rose (P < 0.002). Mean serum A(4) levels increased slightly postoperatively (P = 0.04), although no increase in A(4) production rates (PRs) was observed. T PRs decreased in two of three men, whereas clearance rates increased in all three. Adipose tissue P450 aromatase mRNA content increased postoperatively (P < 0.001). We conclude that the primary cause of increased estrogen levels in acute illness is increased aromatase P450 gene expression, resulting in enhanced aromatization of androgens to estrogens, a previously undescribed endocrine response to acute illness. Both increased T clearance and decreased T production contribute to decreased serum T levels. Animal studies suggest that these opposing changes in circulating estrogen and androgen levels may be important to reduce morbidity and mortality in critical illness.

Acute changes in circulating hormones in older patients with impaired ventricular function undergoing on-pump coronary artery bypass grafting

OBJECTIVES

Coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) causes an acute stress response characterized by changes in the levels of several hormones, which might play a role in the high complication rate experienced by older patients after CABG. Thus, the aim of the study was to investigate changes in the circulating levels of anabolic and catabolic hormones in old people undergoing CABG with CPB.

DESIGN

Intervention case study.

METHODS

19 patients (12 males, 7 females) aged 70.1 +/- 6.1 yr (age range 62-80) with coronary artery disease and an ejection fraction <40% who underwent cardiac surgery. Cortisol (Cort), DHEA, DHEAS, LH, estradiol (E2), total testosterone (Te), SHBG, IGF-I were measured the day before, on the day of the procedure and 1, 2, 3, 4, and 30 days after CABG.

RESULTS

After surgery, serum IGF-I levels decreased (p<0.001), while levels of Cort, DHEAS and E2 significantly increased in both men and women. Alterations in Te levels differed between the two sexes with a significant decline in men and a significant increment in women.

CONCLUSION

CABG with CPB resulted in a dramatic drop in Te levels in old men and a significant decline in IGF-I in both sexes. Serum Cort levels also significantly increased in both sexes. These hormonal changes may, at least partially, explain why the elderly need prolonged rehabilitation after CABG.

Heritability of plasma sex hormones and hormone binding globulin in adult male twins

Plasma sex hormone concentrations have been used as biomarkers in epidemiological studies of many conditions including cancer, obesity, bone density, and coronary heart disease. The objective of this analysis was to estimate genetic and nongenetic influences on endogenous sex hormones (testosterone, estradiol, estrone, and SHBG) in a large sample of 532 adult white male twins (134 monozygotic and 132 dizygotic twin pairs) from the National Heart, Lung, and Blood Institute Twin Study. Participants were aged 59-70 yr at the time of plasma collection, and hormone concentrations were determined with RIA. Genetic models were fitted by the method of maximum likelihood. Testosterone and SHBG concentrations have substantial genetic variation, with additive genetic factors accounting for 57 and 68% of the total phenotypic variation, respectively. In contrast, variation in estrone (37% shared environmental and 63% individual specific environmental effects) and estradiol concentrations (25% genetic effect, 44% shared environmental effects, and 31% individual specific environmental effects) were largely influenced by nongenetic factors. Assessment of the relative contribution of genetic and nongenetic influences on hormone concentrations may help in the search for genes underlying variation and covariation in complex traits affected by plasma sex hormone concentrations.

Altered gonadal steroidogenesis in critical illness: is treatment with anabolic steroids indicated?

The physiology of the reproductive system changes dramatically with the onset of major illness. The serum testosterone concentrations fall to pre-pubertal levels secondary to a decreased secretion of gonadotropins and a decreased Leydig cell response to luteinizing hormone. At the same time, the serum oestrogen concentration rises as the result of an increased rate of peripheral aromatization. The clinical consequences of these marked changes are not yet well understood. One line of evidence argues for the administration of anabolic steroids (derivatives of testosterone) to critically ill patients to improve their catabolic state. Another line of evidence in animal models suggests that testosterone may suppress the immune system and myocardial function in critical illness. No clinical trials of oestrogen administration to critically ill patients have been reported, although two animal studies suggest that oestrogen may have a positive effect on survival. This chapter reviews changes in the physiology of the reproductive system in major illness as well as current evidence regarding the clinical effects of androgens and oestrogens in critical illness and their potential therapeutic roles.

Occupational hazards for the male reproductive system

The etiology of male infertilities is largely undetermined, and our knowledge of exogenous factors affecting the male reproductive system is still limited. In particular, the role of specific environmental and occupational factors is incompletely elucidated. Various occupational (physical and chemical) agents have been shown to affect male reproductive functions in animals, but large differences in reproductive function and/or xenobiotic handling between species limit extrapolation to humans. When available, human data are often conflicting and, except in a few instances, usually refer to broad and heterogenous occupational categories or to groups of agents (e.g., solvents). It is often difficult to elucidate the role of a single agent because occupational exposure conditions are often complex and various confounding factors related to lifestyle (smoking, alcohol, and diet) or socioeconomic state may also affect sperm quality, fertility, or pregnancy outcomes. The objective of this work is to summarize the main epidemiological and, where relevant, experimental findings pertaining to agents (physical and chemical) encountered in the occupational environment that might affect the male reproductive system (sperm count, motility and morphology, libido, and fertility) and/or related pregnancy outcomes (spontaneous abortion, stillbirth, low birth weight, and birth defects and childhood malignancy in offspring). Some methodological issues related to research on the reproductive effects of toxicants are also discussed briefly.

Reversal of sexual impotence in male patients with chronic obstructive pulmonary disease and hypoxemia with long-term oxygen therapy

Erectile impotence is commonly encountered in male patients with respiratory failure and hypoxia. In this study, 42% of the patients experienced reversal of sexual impotence during long-term oxygen therapy (LTOT). We examine the association between sexual impotence, gonadal axis hormones, hypoxia, and oxygen therapy. Nineteen sexually impotent male patients eligible for LTOT (pO2 < 7.3 kPa during stable disease) and with sexual impotence received oxygen therapy for 1 month (n = 12) or 24 h (n = 7). pO2, LH, FSH, testosterone, and SHBG (sex hormone binding globulin) were monitored. Five of 12 patients receiving oxygen for 1 month regained sexual potency. The responders showed a significant increase in arterial pO2 and serum testosterone, and a decline in SHBG compared to non-responders. None of the patients receiving oxygen for 24 h experienced reversal of sexual impotence, despite a significant increase in pO2. In these patients, serum testosterone did not increase significantly. Reversal of sexual impotence may be achieved in some patients with respiratory failure. The oxygen therapy must, however be administered for an adequate length of time.

Seasonal changes in thyroid-gonadal interactions in the edible dormouse, Glis glis

This study was conducted to determine changes in thyroid-gonadal interaction in the edible dormouse during the phase of the annual cycle that corresponds to the end of the breeding season (from June to September). We evaluated intra-hypothalamic luteinizing hormone-releasing hormone (LHRH) content, and plasma concentrations of luteinizing hormone (LH), testosterone, thyroid-stimulating hormone (TSH) and thyroxine (T4) in three groups of dormice: (1) controls; (2) dormice receiving sufficient T4 supplementation to maintain June levels in control animals until September, thus counteracting the seasonal reduction of T4 that normally begins in July; and (3) thyroidectomized dormice. The effect of thyroidectomy was only detectable in June, when plasma T4 concentration in the control group was maximal, and consisted of a significant decrease in plasma testosterone levels. This provides strong support for the hypothesis that thyroid function positively influences gondal function during the breeding season. The T4 supplementation resulted in a decrease in hypothalamic LHRH concentration, suggesting that an increased LHRH release led to the observed stimulated hypophyseal secretion of LH in June and September and the increased circulating testosterone levels in September. There was no detectable effect in July and August. These results show that thyroid axis activation of the hypothalamic-pituitary-gondal system is only possible during certain phases of the annual cycle, particularly evidenced here during the breeding season. They also reinforce our conclusions drawn from the thyroidectomy results. Conversely, the summer testicular regression which normally occurs after the breeding season is no longer controlled by plasma T4 levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Subnormal serum testosterone levels in male internal medicine residents

The consequences of sleep deprivation and stress in residency training have not been quantified. In the course of assembling a control group for other studies, we unexpectedly observed a significant (P less than 0.005) and marked depression of serum testosterone levels in healthy male internal medicine residents (means = 11.8 +/- 1.1 nmol/L, n = 7) compared with other hospital personnel (means = 20.6 +/- 5.3 nmol/L, n = 18). Testosterone concentrations in the two groups were entirely nonoverlapping, while luteinizing hormone levels were not significantly different. We conclude that the stress of residency training leads to a quantifiable depression of gonadal function, and that gonadal steroid concentrations may be useful in evaluating measures intended to reduce that stress.

Stress induced changes in testis function

The mechanism through which chronic stress inhibits the hypothalamic-pituitary-testicular axis has been investigated. Chronic restraint stress decreases testosterone secretion, an effect that is associated with a decrease in plasma gonadotropin levels. In chronically stressed rats there was a decrease in hypothalamic luteinizing hormone-releasing hormone (LHRH) content and the response on plasma gonadotropins to LHRH administration was enhanced. Thus the inhibitory effect of chronic stress on plasma LH and FSH levels seems not to be due to a reduction in pituitary responsiveness to LHRH, but rather to a modification in LHRH secretion. It has been suggested that beta-endorphin might interfere with hypothalamic LHRH secretion during stress. Chronic immobilization did not modify hypothalamic beta-endorphin, while an increase in pituitary beta-endorphin secretion was observed. Since we cannot exclude that changes in beta-endorphin secreted by the pituitary or other opioids may play some role in the stress-induced decrease in LHRH secretion, the effect of naltrexone administration on plasma gonadotropin was studied in chronically stressed rats. Naltrexone treatment did not modify the decrease in plasma concentrations of LH or FSH. These findings suggest that the inhibitory effect of restraint on the testicular axis is exerted at hypothalamic level by some mechanism other than opioids.

Effects of a fat-containing meal on sex hormones in men

The effect of a fat-containing meal on plasma sex steroid concentrations was investigated in normal men. After an overnight fast on two separate occasions, subjects ingested a liquid meal containing either a nonnutritive sweetener (control), or isocaloric meals of mixed calorie sources with either high-fat content or mixed carbohydrate and protein with minimal fat. The order of the meals was alternated. Blood samples were collected at 15-minute intervals and pooled each hour. Sampling began at 7:00 AM and the test meal was ingested at 8:00 AM. Sex steroids, including estrone, estradiol, testosterone, and dihydrotestosterone (DHT), sex hormone-binding globulin (SHBG) capacity, free testosterone concentration, and luteinizing hormone (LH) were determined by either specific radioimmunoassay or dialysis. The fat-containing meal, but not the nonnutritive or mixed carbohydrate and protein meal, resulted in a significant (P less than .01) reduction in total and free testosterone. Estrogens and luteinizing hormone were unaffected by either meal. This is the first documentation, to our knowledge, of the acute effect of a fat-containing meal on sex steroid concentrations in blood. Our observations suggest that a fat-containing meal reduces testosterone concentrations without affecting luteinizing hormone. This might indicate that fatty acids modulate testosterone production by the testes.

Effect of restraint stress on gonadal proopiomelanocortin peptides and the pituitary-testicular axis in rats

We examined the effect of restraint on testicular interstitial fluid (TIF) concentrations of ACTH, beta-endorphin-lipotropin (beta-E-LI) and testosterone and correlated those changes with plasma concentrations of ACTH, beta-E-LI, corticosterone, LH and testosterone in adult rats. Animals were subjected to 1, 2, or 3 h of restraint and were killed immediately following the stress period. Plasma values of ACTH and beta-E-LI were elevated above control values after 1 and 2 h, but not after 3 h of restraint. Plasma corticosterone showed a similar response to restraint except that concentrations were also elevated after 3 h. Plasma testosterone concentrations were elevated after 1 h of restraint, but after 3 h of restraint had fallen below control values. Restraint reduced plasma testosterone concentrations without altering plasma LH concentrations. The decline in plasma testosterone during restraint was associated with a parallel decrease in testosterone in the TIF. Concentrations of ACTH and beta-E-LI were 6- and 3-fold greater in TIF than in the plasma. While 1 or 2 h of restraint did not affect ACTH and beta-E-LI in TIF, values of these hormones were elevated in rats exposed to 3 h of restraint. These data, coupled with recent reports that testicular proopiomelanocortin (POMC)-derived peptides may modulate testicular steroidogenesis, suggest that these factors may play an autocrine or paracrine role in mediating stressor-induced changes in testicular function.

Relationship between body mass index, cigarette smoking, and plasma sex steroids in normal male twins

Smoking has been observed to affect plasma sex hormones and body mass index. The relationship between smoking, body mass index, and plasma concentration of sex hormones was studied in normal adult male twins. The analyses were performed for between 150 and 159 twin pairs for whom hormonal data were available on both twins. With bivariate analysis, neither body mass index nor smoking affected estrone, luteinizing hormone, follicle-stimulating hormone, ratio of testosterone to estradiol, or ratio of testosterone to dihydrotestosterone. Body mass index significantly (P less than 0.05) affected sex hormone binding globulin, whereas smoking had no effect. The plasma contents of testosterone and dihydrotestosterone and the luteinizing hormone/testosterone ratio were affected by both body mass index and smoking, although, after allowing for body mass, smoking was less significant (0.05 less than P less than 0.10). A path model was formulated to examine the relationship of body mass and sex steroid levels. Our results suggest that body mass index affects sex steroids, since common environmental factors do not account for the strength of the relationship. The bivariate analysis suggests that the smoking effect on sex hormones (except perhaps for dihydrotestosterone) is secondary to an effect on body mass index.

Effect of clomiphene citrate administration during the early luteal phase on the luteal function and pregnancy rate of women

To study the effect of clomiphene citrate (clomiphene) administration during the early luteal phase of the menstrual cycle on the luteal function and the pregnancy rate in women, 75 infertile women who ovulated but did not conceive after clomiphene treatment during the early follicular phase and 6 normal cycling women were chosen. Clomiphene was administered orally to 35 of the 75 infertile women at a dose of 50 mg per day for 5 days from the second day of the rise in the basal body temperature (BBT) as well as during the follicular phase, while 40 control patients received clomiphene only during the follicular phase. In the test patients, the rate of pregnancy (25.7%) was significantly (p less than 0.05) higher than that of control patients (10.0%). On the 7th of the rise of BBT, the mean serum progesterone levels of the test patients and normal cycling women treated with clomiphene were significantly (p less than 0.05) higher than those of the control patients. However, the levels of serum estradiol, LH and FSH, the gonadotropin pulsatilities, and the pituitary responses to LH-RH in the test women were not significantly different from those of the control. These data suggest that, when administered during the early luteal phase, clomiphene may act directly on the ovary, enhancing the secretion of progesterone from the corpus luteum, and thereby increasing the rate of pregnancy in infertile women with clomiphene-induced ovulation.

Thyroid function and endocrine abnormalities in elderly patients with severe chronic obstructive lung disease

Serum pituitary and thyroid hormones, testosterone, and the response of pituitary hormones to thyrotrophin releasing hormone were measured in 20 inpatients (mean age 68, range 42-81 years) with severe chronic obstructive lung disease and in 15 control convalescent inpatients (mean age 73, range 57-83 years) who had normal respiratory function. No significant differences were found in total and free thyroid hormone concentrations and basal concentrations of thyrotrophin, growth hormone, and prolactin; and their increments after injection of thyrotrophin releasing hormone were similar in patients with chronic obstructive lung disease, and control patients. Three patients with chronic obstructive lung disease, however, had no thyrotrophin responses to thyrotrophin releasing hormone. In men, low testosterone concentrations were found both in patients with chronic obstructive lung disease and in controls. Luteinising hormone concentrations were higher in men with chronic obstructive lung disease (p less than 0.02), whereas concentrations of follicle stimulating hormone in the two groups were not significantly different. There was no significant correlation between arterial blood gas tensions and these hormone measurements. General effects of age and illness may be more important than direct effects of hypoxia in determining hypothalamic-pituitary function in elderly patients with chronic obstructive lung disease.

Familial factors affecting prostatic cancer risk and plasma sex-steroid levels

Whether familial factors affect the frequency of prostatic cancer and the plasma content of sex-steroids was investigated. Brothers (n = 257) of probands (n = 150) diagnosed with prostatic cancer before age 62 years had a fourfold higher risk for developing the disease than men in the general population in the State of Utah and their brothers-in-law (n = 202). Familial factors markedly affected the plasma content of sex steroids (testosterone, dihydrotestosterone, the ratio of testosterone to DHT, sex-hormone binding globulin, and the free fraction of testosterone) in nonendocrinologically treated probands and their brothers and sons and in normal men in the general populations. Index cases and their brothers and sons had a significantly lower mean plasma testosterone content than controls of comparable age. Preliminary data suggest that the metabolic clearance rate of testosterone and the conversion ratio of testosterone to estradiol are relatively high in probands. The observations indicate that familial factors are potent risk factors for the development of prostatic cancer. They also suggest that plasma androgen values in families with prostatic cancer cluster in the lower range of normal and that plasma sex-steroid content is more similar in each brothers with or without prostatic cancer than among nonbrothers.

Effects of electroejaculation and ketamine-HCI on serum cortisol, progesterone, and testosterone in the male cat

The influence of manual restraint, ketamine-hydrochloride anesthesia and electroejaculation under anesthesia on circulating levels of cortisol, progesterone and testosterone was examined in male domestic cats. In the first experiment, cats were anesthetized with ketamine-HCI (17.5 mg/kg of body weight) and serially bled (controls) or serially bled and electroejaculated. These animals showed signs of recovering from anesthesia within 45 to 60 minutes of ketamine-HCI injection. Average serum cortisol concentrations increased (P less than 0.01) over the 84-minute sampling interval in both the electroejaculated and control groups. Cortisol levels reached their maximum concentration in the electrically stimulated males immediately postelectroejaculation (95.1 ng/ml) and were significantly greater (P less than 0.01) than in the controls (36.1 ng/ml) at a comparable time. Maximal mean cortisol concentrations in the control group (62.8 ng/ml) occurred 54 minutes after the first blood sample and occurred together with the onset of anesthesia recovery. Mean testosterone levels did not differ between electroejaculated and control cats, but did decrease (P less than 0.05) between the first and last blood sampling in both groups. In the second experiment, cats were bled on the same time schedule as in Experiment 1, but were bled while awake and manually restrained, or else during a deeper plane of anesthesia induced and maintained with higher doses of ketamine-HCI (initial dose, 23 mg/kg). Mean serum cortisol levels were greater (P less than 0.05) during manual restraint (range, 36.3-41.1 ng/ml) compared to deep anesthesia (range, 16.7-25.8 ng/ml), but did not change over the 84 minute sampling interval in either group.(ABSTRACT TRUNCATED AT 250 WORDS)

Review: prostate cancer epidemiology

Prostate cancer is common among men in the United States. Factors of possible importance in the etiology of prostate cancer include diet, primarily implicated by ecologic studies of national, regional, and ethnic variation in rates; endocrine function, implicated by the importance of endocrine function in normal prostatic growth and in the treatment of prostate cancer; genetic susceptibility, supported by familial aggregation; some aspect of sexual behavior, suggested by case-control differences in sexual behavior; and occupational exposure, particularly cadmium exposure. Despite the public health importance of prostate cancer, it has received only moderate epidemiologic study; thus the etiologic importance of these and other possible determinants of prostate cancer risk is uncertain [55].

Effects of surgery and epidural or general anaesthesia on testosterone, 17-hydroxyprogesterone and cortisol plasma levels in prepubertal boys

Testosterone (T), 17-hydroxyprogesterone (17P) and cortisol (F) plasma levels have been measured in two groups of prepubertal boys before and during surgery under general anaesthesia (Group 1) and epidural anaesthesia (Group 2) respectively. The mean plasma levels of T, 17P and F increased significantly (P less than 0.05; P less than 0.001; P less than 0.005, respectively) during surgery in Group 1; in Group 2 the plasma levels of T and F did not show any significant variation, whereas 17P significantly increased (P less than 0.05). However the mean level reached by 17P in Group 2 was significantly lower (P less than 0.005) than that observed in Group 1. No significant variation of LH and FSH plasma levels was observed in either group. Our report suggests that the modifications of T and 17P plasma levels observed during surgery under general anaesthesia (GA) are probably due to the stress induced adrenal response. This response can be inhibited or reduced by epidural anaesthesia (EA).

Suppressive effects of surgical stress on circulating androgens during and after prostatectomy

Changes in circulating testosterone (T) and dihydrotestosterone (DHT) levels were investigated 2 days before and 2, 7, 30 and 60 days after retropubic prostatectomy in 28 patients with benign prostatic hypertrophy. Following operation the concentrations of both steroids declined and reached minimal levels 2 days after surgery. One month post-operatively testosterone had recovered to its pre-operative value, whilst the recovery of dihydrotestosterone to its pre-operative level required a minimum period of 2 months. These data indicate the need for careful interpretation of any androgen measurement following surgery.

Induction of ovulation in patients with normoprolactinemic amenorrhea by combined therapy with bromocriptine and clomiphene

Bromocriptine is known to be effective in the treatment of women with hyperprolactinemic anovulation or amenorrhea-galactorrhea. A new schedule of combined treatment with bromocriptine and clomiphene citrate was applied to 23 patients with normoprolactinemic amenorrhea who failed to respond to clomiphene alone. Ovulation was restored by treatment in 14 of these patients (60.9%), resulting in pregnancy in 3 women. Treatment resulted in immediate suppression of serum prolactin levels and a gradual increase in serum luteinizing hormone levels and estradiol levels followed by a luteinizing hormone surge. The present results indicate that bromocriptine/clomiphene combination therapy is effective in the treatment of amenorrheic patients with normoprolactinemia who do not respond to clomiphene alone, and suggest that bromocriptine restores the responsiveness of the hypothalamic-pituitary-ovarian system to clomiphene.

Androblastoma: pre-, per- and post-operative steroid hormone and binding protein concentrations in peripheral plasma, cyst fluid and tumor vein

A case-report of arrhenoblastoma is presented where the endocrine profile has been determined before, during and after removal of the tumor. Sex steroids, cortisol, corticosteroid binding globulin (CBG) and sex steroid binding protein (SBP) were measured in fluid from 2 cysts, tumor vein and peripheral plasma. Hormones were measures by specific RIAs after stepwise chromatography on celite support according to a new elution pattern allowing the resolution of 8 sex steroid in a single chromatographic system. Excessive amounts of androgen, the most prominent being testosterone, and 17-OH-progesterone, but low levels of estrogens and progesterone were found in preoperative plasma. Due to an androgen-directed rise of CBG, large amounts of plasma cortisol were detected. However, preoperative SBP capacity was found to be reduced. The steroid profile of cyst fluids was found to be similar to that of peripheral plasma. Neoplastic cells were found capable of producing an androgen binding protein. These results correlated well with Sertoli-Leydig cell tumors histology, i.e. a testis-like endocrine structure. From the endocrine profile, the steroid biosynthetic pathways are discussed with respect to the possibility that biosynthesis, once the 17-OH-pregnenolone structure was reached, was active along both the delta 5 and delta 4-steroid pathways. The steroid levels in tumor vein and their corresponding gradients to the periphery are discussed with respect to: i) the possibility of metabolic and biosynthetic capacities of cancer cells bearing an undifferentiated steroidogenic appearance, ii) the possibility for tumor steroid secretion by others means than by venous blood and iii) the possibility that both point i) and ii) could be the cause of inconsistent diagnosis significant of endocrine profile as observed in some patients.

Impact of acute surgical stress on anterior pituitary function in female subjects

The effects of acute surgical stress and the accompanying anesthesia on anterior pituitary function in female subjects was studied by means of frequent perioperative determinations of the circulating concentrations of luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin (PRL), growth hormone (GH), and thyroid-stimulating hormone (TSH). No appreciable alteration in the circulating concentrations of either LH or FSH could be detected. In contrast, the levels of PRL and GH were found to be markedly increased during the perioperative period, with the increase in pRL invariably preceding any noticeable alteration in GH levels. In addition, perioperative PRL but not GH levels were significantly higher (p < 0.01) in patients undergoing a major surgical procedure, in contrast to a minor one. Finally, this study furnishes detailed evidence of a small but significant (p < 0.05) increase in TSH levels in patients undergoing a major surgical procedure. These data indicate that augmentation of pituitary secretion of three stress-related hormones, but not gonadotropins, occurs during surgical procedures.

Plasma luteinizing hormone-releasing hormone levels in normal women and patients with amenorrhea

Plasma levels of immunoreactive luteinizing hormone-releasing hormone (LH-RH) in 89 women with normal menstrual cycles and 109 patients with amenorrhea of various etiologies were determined by specific radioimmunoassay after methanol extraction. The LH-RH levels in patients with hypergonadotropism and Sheehan's syndrome were more than 10 pg/ml, and were significantly higher than basal levels during normal cycles (4.2 +/- 0.3 pg/ml). The mean levels of LH-RH were low in all hypogonadotropic patients with amenorrhea, with the exception of a few patients who showed high LH-RH levels suggestive of a pituitary lesion. The LH-RH levels in patients with polycystic ovary syndrome were comparable with basal levels during normal cycles. It is concluded that, although there is considerable overlap of the plasma LH-RH levels in each group of amenorrheic patients divided according to gonadotropin level, determination of LH-RH levels may be useful for the differentiation of hypothalamic amenorrhea from pituitary amenorrhea.

Plasma levels of testosterone, LH and FSH after prostatic adenomectomy

Changes in blood testosterone, LH and FSH induced by the surgical management of BPH were studied. It is felt that the observation of depressed testosterone and enhanced LH mean levels one year after surgery, substantiates a previously advanced personal view that hyperplastic nodules are heavy consumers of testosterone.

Endocrine changes at operation under general anesthesia: reproductive hormone fluctuations in young women

This study investigated changes in peripheral serum estrogen (E), Progesterone (P), luteinizing hormone (LH), follicle-stimulating hormone, and prolactin (PRL) in 11 women of reproductive age undergoing a variety of operations under general anesthesia without compromise of ovarian vasculature. All hormone determinations were plotted in relation to the midcycle LH peak; eight women with cyclic ovulatory menses served as controls. The absolute value of E declined after surgery but did not reach statistical significance. P levels postoperatively were significantly lower following ovulation (P less than 0.01) on cycle days +1 through +5. Intraoperative and postoperative PRL values were significantly greater than those of control subjects (P less than 0.05). Aside from a transient intraoperative decline in LH, the pattern of gonadotropin secretion was similar to that of control subjects. The decline in peripheral ovarian steroid levels appeared to be independent of abdominal entry or pelvic manipulation. The evidence favors direct inhibition of ovarian steroidogenesis by (1) toxic effects of anesthetic agents or (2) stress-induced changes in other hormone levels, e.g., hyperprolactinemia.

Effects of enflurane anaesthesia and surgery on endocrine function in man

Forty-five patients underwent enflurane anaesthesia and surgery. Anaesthesia alone evoked little change in the plasma concentrations of ACTH, cortisol or antidiuretic hormone (ADH), but there were significant increases during surgery. The plasma levels of aldosterone rose during anaesthesia alone, and a further increase was noted during surgery. Neither enflurane anaesthesia nor surgery significantly influenced plasma concentrations of renin activity and thyroxine. A significant decrease in the plasma triiodothyronine levels was detected during anaesthesia alone, and a further decrease was found during and following surgery. Enflurane anaesthesia did not affect the plasma level of luteinizing hormone (LH) in male subjects throughout surgery, but a significant decrease was detected in female patients on the first postoperative day. The plasma concentrations of testosterone decreased during anaesthesia alone and surgery, and a further decrease was noted on the first postoperative day.

Plasma testosterone, luteinizing hormone and follicle-stimulating hormone one day after vasectomy

Plasma testosterone, LH and FSH were measured in 20 healthy subjects prior to and one day after bilateral vasectomy. No significant change in these hormones was noted after surgery. These data suggest that the decrease in free testosterone index and FSH reported by others at one week post-vasectomy is probably not related to the effects of psychological stress, local anesthesia or surgical stress, either singularly or in concert. Further studies are indicated to evaluate the transient hormonal changes reported within the first few weeks following vasectomy.

Production and origin of estrogen in two true hermaphrodites

Two 46,XX true hermaphrodites with genital ambiguity since birth and gynecomastia were studied. The production rates of estradiol in these subjects, 77 and 71 microgram per 24 hours, and of estrone, 82 and 136 microgram per 24 hours, were approximately twice those of normal adult men. In one of these subjects the plasma production rates of androstenedione and testosterone were measured and found to be 389 and 1,271 microgram per 24 hours, respectively. In this subject all estrone production, 82 microgram per 24 hours, could be accounted for by extraglandular formation from plasma prehormones, whereas 71 microgram of estradiol per 24 hours could not be accounted for by extraglandular formation and presumably arose from glandular secretion. The concentration of testosterone in the testicular portion of the ovotestis of this subject was 465 ng. per gram of tissue, a value comparable to that found in testicular tissue obtained from adult men. In the other subject of this study, who had a malignant gonadal tumor, the plasma concentration of human chorionic gonadotropin was 3,000 ml.U. per milliliter. From the results of this study we conclude that both ovarian and testicular components of the gonads of these two individuals were endocrinologically active, and that their gynecomastia likely developed as a consequence of gonadal estradiol secretion.

Effect of acute myocardial infarction on pituitary-testicular function

The effect of acute myocardial infarction on the secretions of LH, FSH and testosterone was studied in thirteen male patients. Plasma testosterone fell transiently on the fourth day after acute myocardial infarction. This was accompanied by a rise in LH on the same day which persisted for a week after infarction. Serum FSH showed no significant change. The data suggest that following the medical stress of myocardial infarction, testosterone concentration was suppressed resulting in a compensatory rise in LH.

Effect of surgical stress on pituitary-testicular function

The effect of surgical stress on the secretions of LH, FSH, testosterone (T) and oestradiol (E2) were studied in twelve male patients. During surgery LH rose significantly; post-operatively, LH fell but remained persistently elevated a week after operation. However, T and E2 fell progressively to a nadir on the second and fifth post-operative day respectively and remained suppressed. Serum FSH showed no significant change. Despite a post-operative decrease in sex hormone binding globulin (SHBG) binding capacity, non-SHBG bound T showed a decrease parallel to T. Multiple sampling studies showed that the secretions of LH were increased and that of T were decreased post-operatively. Following surgery, LH responses to LHRH were magnified, FSH and T responses showed no significant change when compared with the pre-operative responses. These data suggest that secretions of LH were increased during surgery. Following surgical stress, T and E2 concentrations were suppressed resulting in a compensatory elevation of LH concentrations.

Hormone studies in a gynandroblastoma

Plasma gonadotropin, testosterone, androstenedione, and estradiol levels were determined before and after removal of a 37-pound gynandroblastoma from an 18-year-old virilized, mentally retarded female. Testosterone and androstenedione levels preoperatively were in the normal female range and fell dramatically after castration. Histologic examination showed active atypical granulosa and Sertoli elements. The hormonal data obtained do not account for the marked virilization observed.

Pregnancy following 2-bromo-alpha-ergocryptine (CB-154)-induced ovulation in an acromegalic patient with galactorrhea and amenorrhea

An acromegalic patient with galactorrhea-amenorrhea who conceived following long-term 2-bromo-alpha-ergocryptine (CB-154) therapy is described. During CB-154 therapy, determinations of serum prolactin (PRL), luteinizing hormone (LH)-human chorionic gonadotropin, follicle-stimulating hormone a reduction in PRL level followed by an LH peak, a rise in basal body temperature and menstruation. The patient became pregnant during the next cycle, but therapeutic abortion was performed because of the active acromegaly. These results demonstrate that CB-154 can restore ovulatory function not only to the patient with a hypothalamic disorder but also to the acromegalic patient with an enlarged sella turcica.

The acute effect of hysterectomy on ovarian function

The acute effect of abdominal and vaginal hysterectomy on the ovarian production of estradiol-17-beta (E2) and progesterone (P) was studied in a group of patients undergoing hysterectomy for various gynecologic indications. Plasma levels of steroids as well as gonadotropins (FSH and LH) were measured by RIA. There was a significant but transient drop of plasma E2 during the follicular phase and of plasma E2 and P during the luteal phase, following hysterectomy. No significant variations in the steroid plasma levels were found in a control group of patients undergoing laparoscopy for diagnostic purposes. No changes were noted in either group in the plasma levels of gonadotropins. The changes seen appear to be related to the surgical manipulation in the ovarian region rather than to the type of hysterectomy performed or the stress of surgery.