An evaluation of the anterior pituitary-like substance intradermal test for pregnancy

AN EVALUATIOX OF THE SlJBRTANCE INTRADERMAL WITH JOSEPH (From

ANTERIOR PITUITARY-LIKE TEST FOR PREGNANCY

A STUDY 0~ THE POSSIBLE RELATIOX TO PROLAX CONTENT

OF THIS

JOEL FRHDMAN, M.D., ASD li-r~Ror,n BROOKLI'X, s. kT. fhe

Kkpartmc~xt

of

Pntkolo!t,y

of

the

t’on~

FINK,

!t Islrc~d

TEST X.11..

Hospiirrli

ERY sOon after Gilfillen autl Greg@ described t.heir “t~ew, rapid, economical test for pregnancy and gynecdogical conclitiolls, ” t,his study was undertaken. That this test is not entirely new has alread been pointed out, by the do~ts~r2 of fhc A~c~‘~ccIE~. Mdicd Associhm” The test. was first proposed in 1929 by Porpes and Pollatschek” of Vienna who subsequently reported the test as not wholly reliable. Alfred Dentsch4 in 1929 and IIynan Strauss” in 1930 also reported the test as unreliable after their iuvestigatious. W&man ancl Yerbury’; recently came to the same ~nclnsion. Huberman. Israeloff and IIynowjtz7 reported in their paper r~tl nt the American Medical Bssoritilion (hJiver)tion iti i\tlantic (‘ity iI, ,Jutle. 1937, that the test was They used “folluteill” awurate iu 95 per mmt of thf: ~TY~IMII~ wome~i. as all ;tJltipll in perfotmillg the ilitratlermal test. They do Hot offer this t,est. a.s a substitlite for other tests but as a simple aid itI tilt diagnosis of the gravid state. Schneider ad A. E. Cohen,8 however, c~~lcludetl that the results obtained with atltuitrin-M injected iutraclermally itI no way exhibit the reliability of this test as a me&ns of diagnosing pregnaucy or py~~ecologi~ disorders. The present authors ’ coutrollecl studies upon a la,rge group of patients completely justify the statement in the Jowuc~l of the Lhevicrc~~~ Medical Associatkm, ‘
V

‘I’he test aa performed hy Gilfill(>n an11 Gregg was duplicated exactly. This c>on. sisted of the intradermal injection of two minims of fresh anterior pituitary-like substance from pregnancy urine which lxtd heen kept on ictl. Readings were taken af. the end of one-half Ilonr am1 at the ~ntl of one hour. A failure of the skin t(i react was read as poGtivr for pregnnnq. .\n increase in the size of the wheat above 7 mm. in diametcar with a surrounding erythemn was read as nrgat,ive fog date that was a minimum pregnancy. The test material used had :rn ‘ ‘cqiration” of four to five month8 after its use. Eighty-eight pregnant women were used in the fir& part of the study. TheBe women all attended the Prenatal Out,-Patient Clinic of the Coney Island Hospital and were pregnant two or more months. T~lrle I summarizes the readinga and w dta in this group. rrudi11g; x0 gave it prrg7mnc.y rchallOf tllPW 88 wo*nNI, s yavt’ :I non[‘rrgrlaI,cy ,ng. m t11r second part of the study 41 VioIIIRn wc>re usecl. ‘I’hrse on the wards of the hospital and female technicians in the laboratory. 116

ineluded One

patients

of them

FRIFDMAN-FINK TABLE

NUMBER CASES

OF

I.

:

RESC-LTS OF

SKIN

LENGTH

OF PREGNANCY IN MONTHS

6 6

TEsST

FOR

TESTS

IX PREGNANTWO~IEN

NUMBER NANCY

15 17 11 3

NUMBER OF NONPREGNANCY REACTIONS

OF PREGREACTIONS

4 6 16 12 13 16

2 3 4 5 6

18 12

117

PREGXANCY

7 s 9

2 0 2 0

2 1

10

3

women was admitted to the hospital for a threatened abortion. She was approximately fifteen weeks pregnant and was expected to give a positive pregnancy reading but did not. After several days in bed, she was discharged as still pregnant. Of the remaining 40 women, 37 gave a positive pregnancy reading; 12 gave a negative pregnancy reading.

During pregnancy the prolan content of the body increases. The findings of an increased prolan in the female may mean pregnancy. In view of the unexpected high number of positive pregnancy readings obtained in the nonpregnant group of women, it was decided to study the possible relationship of these findings to prolan content. Ten nonpregnant women who gave a definitely positive pregnancy reading were selected for prolan determinations. These detrrminations were done using a modification of Zondek’s method for the extra&on and assay of follicle stimulating hormone (Prolan “A”) from the urine.9 Microscopic examinations of the ovaries from the autopsied mice was done in all cases as a check on the gross diagnosis of positive or negative prolan. Of the 10 women selected for these prolan studies, all indicating no imrease in their prolan excretions showed negative prolan readings, in the urine. TABLE

II.

PKOLGN

STVIIIES IN NOKPREGNANT Woxmx POSITIVE SKIN TESTS NO. STUDIED FOR PROLAN

Nonpregnant women with positive naney skin test Men with positive pregnancy skin

pregtest

10 6

-

AND

MEP: WITH

IN

PROLAN NEGATIVE

10 5

I'ROLAN POSITIVE

-

0 1

Increased prolan may be found in such conditions as early menopause, hyperthyroidism, incomplete abortion, chorioepithelioma, follicular cystosis of the ovary, persistent corpus luteum cyst of the ovary, testicular atrophy, removal of the testicles, over-secretion of the pituitary gland as in gigantism, acromegaly, etc., pregnancy, and following bilateral oophorectomy. If any of these conditions were present they were not marked by an increased prolan. The mechanism of this “intradermal test for pregnancy” is not entirely clear. It does not seem to be related to either pregnancy or to prolan content of the body.

318

AMERICAN

JOURNAL

Oli’ OBFTE’IW(:S

AKI)

C:PME(‘OI,OKY

I -- .~.-

Number Snmher Number ----- Total

.--~~~_-

___--__..

number __--___

RSWTIOh-S ~____-.__

~3 I

of pregnant women of nonpregnant women of men

30 n:: .~~. 161

of cases .___ studied

j

80 27 26

_P;ANCY

REACTIONS--.

/

1:: 8

s

I

SUMMART

I. The intradermal administration of anterior pituitary-like substance of pregnancy urine as a diagnostic test for pregnancy shows the following cleviat.ions from expected results oil proved eases : a. Of expected ative results.

positive

1). Of pregnancy

negative results in 40 nonpregnant 27 were positive for pregnancy.

expected reading,

c. Of expected negative Aowed positive pregnancy

results

results tests.

in 88 pregnant

in

X1 men,

women

there

women, 8 showed

were only the

8 who 1:; pave

expected

gave

neg-

a negative result,

25

2. Prolan studies done on 10 nonpregnant women who gave a definitely positive pregnancy reading were negative. 3. Prolan studies done on six men who gave a definitely positive pregnancy reading were negative in 5 and positive in 1. 4. Of 7 nonpregnaut women with a positive prolan, 5 gave a positive pregnancy test and 2 a negative test. 5. The results are in substantial agreement with other recent critical analyses of this diagnost.ie procedure. authors wish to thank Dr. D. A. McAteer, Director of the Surgical Service, and H. B. Matthews, Director of the Obstetrical Service, for their cooperation. The authors also wish to thank Dr. Charles H. Blrnberg for his kin?% suggestions during this study. The Anterior-Pituitary-like substance used was antuitrin-S (Parke-Davis & Co. ) .

Dr.

The

RHEUBY

:

UTERINE

BLEEDING

WITH

119

VIRILISY

REEERENCES (1) Gilfillen, G. C., and Gregg, W. IL: AK J. OBST. & GYNEC. 32: 498, 1936. (2) J. A. M. A. 108: 412, 1937. (3) Porges and PoEEatschelc: J. A. M. A. 559, (5) Strauss, 1929. (4) Deutsch, Alfred: Zentralbl. f. GynPk. 53: 2920, 1929. Hyman : Am. J. Surg. 8: 1271, 1930. (6) Weisman, a. I., and Yerbury, C. C.: Med. Record 203, 1937. (7) HzLberman, J., Israeloff, H. H., and Hymowitz, B.: Paper read at the American Medical Association Convention, 88th session at Atlantic City, Friday, June 11, 1937. (8) Schneider, B., and Cohen, A. E’.: .J. A. M. A. 109: 115, 1937. (9) Kurzrok, Raphael : The Endocrine8 in Obstetrics and Gynecology, Baltimore, 1937, The Williams and Wilkins Co., p. 454.

UTERINE VIRUINIA (From

the

BLEEDING G.

Gynecological

RHEUBY,

WITH M.D.,

VIRILISM” DEL.

WILMINGTON,

and Pathological Services Hospital of Philadelphia)

of the

Woman’s

T

HIS patient, a 21-year-old, colored, siugle female, illustrates an unusual type of uterine bleeding. She began to flow at thirteen and had a normal menstrual cycle thereafter. During her eighteenth year she noticed an incipient growth of hair on her chin, cheeks, and upper lip. Soon her menstrual periods became increasingly more abundant, and the interval between the bleeding grew shorter. She was chronically tired, had vertigo, anorexia, and her psychic condition was far from serene with the consciousness of her unfeminine appearance. She gave up her job and, aside from her visits to several physicians, remained secluded. By the autumn of 1936 the hypertrichosis required shaving every other day, and the bleeding was severe, occasionally lasting as long as a month, with irregular short intervals. Various physicians consulted seemed to have presumed that she had committed an abortion, and she was apparently treated on that hypothesis, or on the basis of a mild pelvic inflammation. In October, 1936, she had a transfusion. When she was admitted to the Gynecological Service of the Woman’s Hospital of Philadelphia, Jan. 4, 1937, the patient was not acutely ill, although she had bled most of the month previously. Her hemoglobin was 52 per cent Dare, R. B. C. 2,610,000, W. B. C. 15,000, polymorphonuclear leueocytes 78 per cent, lymphocytes 22 per cent, blood sedimentation time 155 minutes, temperature S8.4”, pulse 96, and respiration 20. A physical examination revealed no deviation from the normal, except a slightly low blood pressure, hypertrichosis, and pallor. Her voice was contralto. The pelvic examination disclosed no signs of inflammation. The clitoris protruded sufficiently 3.75 cm. long by 0.75 cm. diameter. to separate the labia majora and measured Aside from size it was not abnormal. The vaginal introitus was intact. The cervical OS easily admitted a cotton applicator, and the cervix was soft, pink, intact, The fundus was slightly enlarged, soft, smooth, mobile, anterior, and mobile. and tender. In the right and left fornices were two discrete, firm, ovoid masses about 5 by 3 by 2 cm. in size. The following day a diagnostic curettage of the uterus was performed. The uterine cavity measured 7.5 cm. and abundant, thick, soft, irregular scrapings were secured. Dr. Berta Meine, Pathologist, examined the scrapings and believing that the diagnosis lay between severe hyperplasia of the endometrium and adenocarcinoma, and feeling the situation too precarious to risk a final diagnosis, returned the pathologic report as adenocarcinoma. The patient was given a blood transfusion and on Jan. 13, 1937, Dr. Fetterman performed a panhysterectomy with a bilateral salpingo-oophorectomy. No radiation was given. The patient made a rapid uneventful convalescence, and has been well since. There has been no diminution of the hypertrichosis and size of clitoris. Basal metabolic rate tests have not fluctuated more than four points from plus 16. *Read

at a meeting

of the

Obstetrical

Society

of Philadelphia.

October

7, 1937.