Occurrence of osteopenia among adolescent girls with oligo/amenorrhea

The occurrence of reduced bone mineral density (BMD) among adolescent girls with oligomenorrhea or secondary amenorrhea, due to 'pure' dysfunction of the hypothalamo-pituitary-ovarian (HPO) axis (without anorexia nervosa, excessive sport or ballet, slimming diet, etc.) was examined. The study group consisted of 19 adolescent girls (age 16-18 years) with oligo/amenorrhea. Clinical (height, weight, age at menarche, duration of amenorrhea, body mass index (BMI)), hormonal (follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol, progesterone, testosterone, prolactin), and ion (calcium, sodium, potassium, phosphate, chloride) parameters and the BMD of the lumbar spine were investigated. Correlations between BMD and other parameters were also examined. Twenty healthy volunteers (same age and regular cycles) served as controls. Three girls had osteoporosis, with a BMD below -2 standard deviations (SD). Ten showed osteopenia, with a BMD value between -1 and -2 SD. Only six of the study group had a normal BMD within +/- 1 SD. A positive correlation was observed between the BMD and the BMI (r = 0.73; p < 0.05). All the controls had normal hormonal, ion and BMD parameters. 'Pure' dysfunction of the HPO axis in adolescents, causing oligomenorrhea or secondary amenorrhea, might result in reduced BMD and, consequently, lower peak bone mass. Treatment of menstrual cycle disorders is necessary for the prevention of osteoporosis.

Calcium dobesilate lowers the blood pressure in mild to moderate midtrimester hypertension: a pilot study

To test the effects of calcium dobesilate (Doxium) in pregnancies complicated with pregnancy-induced hypertension or mild/moderate pre-eclampsia a double-blind, placebo-controlled pilot study was carried out. Primigravida patients (gestational age </=34 weeks) daily took 2 g Doxium or placebo until delivery. Twelve patients received placebo for 53 days, and 11 patients took the drug for 57 days on average. At the start of the study 2 patients in the placebo group (PG) and 8 in the Doxium group (DG) had pre-eclampsia. The mean arterial pressure (mean +/- SD) significantly decreased from 118 +/- 7 to 99 +/- 9 mm Hg in the DG (p = 0.003), while in the PG it had slightly increased by the end of the study. Proteinuria was higher in the DG at the start but not at the end; however, significant changes of this parameter were detected in neither of the groups throughout the study. Fibronectin decreased significantly in both groups but it was more pronounced in the DG (23.8 vs. 9.4%). Changes of platelet count, plasma and blood viscosity, and erythrocyte deformability were favourable in the DG but in the PG these parameters had deteriorated although the alterations were not significant. No marked differences were found between the two groups regarding fetal well-being, courses of deliveries, and the neonatal period. Neither maternal nor fetal/neonatal side effects were noticed. It seems that Doxium favourably influences the blood pressure and consequently decreases the requirement for medication and hospitalisation in cases of mild to moderate midtrimester hypertension.

[Ovulation induction therapy and malignant ovarian cancer]

In the authors' institute 1097 patients received treatment for ovarian cancer between the 1st of January, 1960 and the 31st of December, 1997. 92 of them had malignant granulosa cell tumor. In this study the link between ovulation induction therapy and ovarian cancer was analyzed with retrospective questionnaire. 236 questionnaires were shared out among patients with malignant ovarian tumor, who were treated between 1990 and 1997. 7 of 113 patients, who gave correct answers to the questions (6.2%) received ovulation induction therapy. Epithelial ovarian cancer developed in 2 of the cases during, and in 5 cases just 6-16 years after the clomiphene-citrate treatment. None of the 45 patients with granulosa cell tumors received induction therapy. The number of patients admitted because of malignant ovarian tumor before and after the induction therapy was also compared. There was no significant increase in the occurrence of the malignancy. Since 1986 in the in vitro fertilization program of the clinic nearly 1,500 patients were treated with effected ovulation induction drugs causing superovulation. The authors don't know of any development of malignant ovarian tumor, and 732 woman have confirmed this fact. The number of patients deceased in consequence of ovarian cancer in different age groups, and the distribution of the women population in every age group in Hungary, from the year of 1979 was also analyzed. There was no significant increase found in the number of deceased among the studied age groups, moreover a significant decrease among them could be observed. The link between ovulation induction therapy and ovarian cancer can neither be strengthen, nor deny by the result of the study, however the close relationship which seemed to be logical can be queried. To give an exact answer for the question a vast, long-term, prospective of retrospective follow-up case-control study is needed.

[Lower bone density (osteopenia) in adolescent girls with oligomenorrhea and secondary amenorrhea]

Occurrence of reduced BMD among adolescent girls and young women due to certain specific oligomenorrhea or amenorrhea (anorexia nervosa, excessive sport or ballet, etc.) is well known. However the prevalence of osteopenia among 16-18 years old girls with the cycle disorders mentioned above--caused by "pure" hypothalamo-pituitary-ovarian insufficiency--is not yet sufficiently examined. The hormonal (FSH, LH, prolactin, LH/FSH, estradiol. testosterone, progesterone) and ion (Ca++,PO4(3-),Na+,K+,Cl-) parameters and the bone mineral density (BMD) of the lumbar spine of 19 girls age 16-18 with oligomenorrhea or secondary amenorrhea, due to hypothalamo-pituitary-ovarian axis insufficiency were investigated, and correlation were searched for among them. In 3 of the case significant BMD reduction was found with a value lower than the -2 SD. compared to the age, sex and race matched control values, showing definite osteoporosis. The BMD of 10 girls was between the -2.SD. and -1 SD.: they had osteopenia. Only 6 of them had normal BMD ranging from the -1 SD. to the +1 SD. Neither the ion or hormonal values, nor the clinical parameters (height, weight age, age at menarche, duration of amenorrheic period) showed correlation with the BMD values, except of the body mass index (BMI), which showed a loose positive linear correlation. The measured low BMD values have a significance, referring to a possible reduction in the peak BMD. Patients having low peak BMD have an inclination for earlier, and more sever osteoporosis and fractures in the climacteric decades. These results emphasize the need of effective and early treatment of adolescent bleeding disorders from the point of view of prevention of osteoporosis as well.

[17 beta-hydroxysteroid dehydrogenase defect: female phenotype with 46,XY karyotype]

Deficiency of the 17 beta-hydroxysteroid dehydrogenase (17b-HSD-d) causes female external genital phenotype in spite of 46,XY karyotype and presence of testes due to disorder in biosynthesis of testosterone. However, marked somatic and genital virilization occurs during puberty. Clinical and laboratory investigation of three cases are presented with typical elevation of the precursor steroid androstenedione, and decrease of product steroid testosterone. All the three patients were reared as girls. During puberty orchidectomy was performed in two cases and vaginoplasty in one case. Estrogen replacement therapy contributed to development of female secondary sex characteristics.

Nuclear type II estradiol binding sites and type I estrogen receptors in human endometrial cancer: a 5-year follow-up study

Type II nuclear-estrogen binding sites (type II EBS) have been postulated to play a crucial regulatory role in estrogen-stimulated uterine growth. The pathogenesis of endometrial cancer is known to be connected to estrogens. However, there are no data on type II EBS in human endometrial cancer. Therefore, we investigated the presence of nuclear type II EBS and nuclear type I estrogen receptors (ER) by radioligand-binding assays in endometrial tumorous tissues (n = 135). Determination of cytoplasmic ER and progesterone receptor (PR) concentrations were also included in the study. Estradiol (E2) and progesterone (P) hormone levels in sera of patients were determined by RIAs. In addition, all data were analyzed on 5-year survival rates. Saturation analyses of 3H-E2 binding in crude nuclear pellets (n = 5) showed two types of estradiol binding: type I ER having high affinity and low capacity and type II EBS binding estradiol with lower affinity and high capacity in a positive cooperative fashion. The nuclear type II EBS and type I ER concentrations were significantly higher in cancers of increasing grade. In contrast, a significant decrease of cytoplasmic 3H-E2 binding was detected. Cytoplasmic PR binding capacities were high in G1 and G2, but low in G3 tumors. The 5-year survival data showed nuclear type I ER to have the best correlation for prognostic value (cut-off, 0.5 pmol/mg DNA), while type II EBS had no significant impact on it. Serum E2 concentrations decreased with tumors of higher grade, but were generally still higher than the control values. The serum P levels did not alter. None of the parameters investigated here differed from control values in adenoacanthoma (n = 6), suggesting a separate pathomechanism. As type II EBS are known to be stimulated by E2 under conditions that cause uterine hyperplasia, we concluded that the higher "runaway" nuclear type II EBS levels, in contrast with the lower serum estradiol concentrations, might be connected with the strong proliferative and invasive character of higher grade endometrial adenocarcinomas. This is the first demonstration of the presence of nuclear type II EBS and their possible pathological role in human endometrial cancer, and of the high prognostic significance of nuclear type I ER to identify a subgroup having a fatal form of the disease in a 5-year survival study.

Changes in circulating hormone levels after ovarian wedge resection in patients with polycystic ovary syndrome

Serum gonadotropin, prolactin, estradiol, sex hormone binding globulin (SHBG) and androgen levels were measured before, 5 days and 6 weeks following ovarian wedge resection in 9 patients with polycystic ovary syndrome. Elevated levels of LH, androstenedione, testosterone and dehydroepiandrosterone-sulphate (DHEA-S) were found before surgery. There was a marked decrease in androstenedione and DHEA-S levels 5 days following wedge resection, but a rebound effect could be observed 6 weeks later. Serum gonadotropin, prolactin, testosterone and SHBG concentrations were practically unaffected by surgery. At 6-12 months follow up patients showed regular, mainly ovulatory cycles, but pregnancy occurred only in two cases.

Increased prolactin response to TRH in polycystic ovary syndrome with low basal prolactin values

An intravenous TRH loading test with 200 micrograms TRH was carried out in 9 hypoprolactinemic (serum prolactin less than 100 mIU/ml) and 6 normoprolactinemic PCO patients and 6 normal subjects. Basal and stimulated prolactin and TSH levels were measured. The latter were within normal values. Prolactin responses to TRH were exaggerated in PCO patients, irrespective of the basal prolactin values. According to literary data, these results indicate that increased prolactin response to TRH in PCO is independent of the basal prolactin values and suggest disturbed tuberoinfundibular dopaminergic function.

Two types of nuclear oestradiol binding sites in human myometrium and leiomyoma during the menstrual cycle

Two types of oestradiol binding sites were identified in human myometrium and myoma by saturation analysis. Nuclear type I receptors bind Oe with high affinity (KD = 1.4 nM) and low capacity (0.1-2.0 pmole/mg DNA) in a competitive fashion (Hill coeff. = 1.0), while nuclear type II sites bind the hormone with reduced affinity (KD: approximately 20 nM in myometrium and KD: approximately 40 nM in myoma), but high capacity (1-15 pmole/mg DNA) by positive cooperation (Hill coeff.: 4-5 in myometrium and 2-3 in myoma). Binding properties of type II sites in myoma are similar to those found in endometrium in previous studies of our laboratory, rather than those found in normal myometrium. The concentration of both nuclear Oe binding sites varied with the menstrual cycle. In myometrium, maximal concentration of nuclear type I and type II sites occurred between 10-14 days of cycle, when blood Oe level is the highest. In myoma the concentration of type I receptors was highest during the late follicular phase, but type II sites were uniformly high during the first 14 days of the cycle. In the luteal phase, receptor concentrations were low and apparently unaltered. It is possible that these changes in Oe binding capability of leiomyoma play a role in the pathomechanism.