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192. A role of aldosterone in ACTH-induced hypertension
Abstracts U. M.. Institute for Research in Reproduction, Bombay 400012. India
Parel.
Hyperprolactinaemia as a cause of anovulation is well established. Though there are ample reports on the evaluation of the hypothalamic-pituitary axis in these patients, the data on ovarian steroid levels are limited. in the present communication, serum estradiol and progesterone in 6 cases of hyperprolactinaemia (proiactin levels. 8&330 ng/ml) before and after bromoergocryptine treatment are reported. The Sella rurcica in these patients were normal on lateral skull X-ray. Serum estradiol in all the cases was less than 40 pg/ml. These patients had no cervical mucus and-no withdrawal bleeding on progesterone challenge. The threshold for a positive test in our hands is a serum estradiol >6Opg/ml. On bromoergocryptine, serum estradiol rose to levels of 2OOpg/ml at the height of the cervical-mucus score. This was followed by ovulatory menstruation (progesterone > 5 ng/ml) within 6 to 8 weeks of therapy, in all but one patient. The present report indicates the severe degree of estrogen deficiency in patients with hyperprolactinemic amenorrhea.
191. Effects of spironolactone administration on testosterone and 17-beta-oestradiol secretion in boys with delayed puberty Lutst. M., BARLETTA,D.. CASPERI, M.. FRANCHI,F..
ARGENIO.G. and BERNINI,G. P.. Endocrine Laboratory of C.N.R.. 1st Medical Clinic, Pisa University School of Medicine 56100 Pisa, Italy Spironolactone has been shown to act as an antiadrogen in boys with delayed adolescence, by blocking testosterone biosynthesis or competing with androgens for the specific receptors. This leads to an interruption of the testicularpituitary-hypothalamic negative feedback and to an increase of plasma LH and FSH. However, no reliable information concerning plasma testosterone (T) and oestradiol-17-beta (E,) is. at present, available. During long-term studies on normal and delayed male puberty, we have demonstrated some aspects of T and E, variations after spironolactone administration. Highly specific and sensitive radioimmunoassay methods (up to !2 pg/tube for both steroids) have been used. Following administration of spironolactone (5mg,ikg) daily for 7 days to 10 boys with delayed puberty. there was a significant (P < 0.01) mean decrease in plasma E, of SO?,, and T of 60’:;,, reflecting either adrenal or testicular 17-alpha-hydroxylase and lyase activity inhibition. In the same boys, mean plasma FSH levels thereby increased by 200?,, (P < 0.001). while mean LH values increased by 80?:, (P < 0.01). In addition progesterone and 17-alpha-hydroxyprogesterone increased significantly. The significant decrease of T and E,, together with the dramatic increase of FSH, indicates an inhibitory action of spironolactone on the enzymatic systems of steroidogenesis, and suggests that the intrinsic action of the drug, in delayed puberty. is the blockade of testicularpituitary-hypothalamic negative feedback. 192. A role of aldusterone in ACTH-induced hypertension OTOKIDA, K., KAMATA. S., KANAZAWA, S. and KKMURA, T., Department of Medicine, Iwate Medical University, Morioka, Japan The experiment was carried out in order to investigate whether the combined infusion of ACTH and steroids causes hy~rtension in man. ACTH (Cortrosyn) was infused into 20 patients with essential hypertension at a constant rate of 50miU or 4OOmIU/h for 5 h starting at 9.00a.m. There was little change in the blood pressure, the renin activity, the aldosterone level, or the deoxycorticosterone level (DOC) in the plasma for the initial 2 h.
After this time cortisol (Solu-Cartel) or aldosterone (Aldocorten) (infusion rate: 40pg or 3.6mg/h) was added to the ACTH infusion. The combined infusion of ACTH and cortisol for 3 hr slightly elevated the blood pressure, whereas the combined infusion of ACTH and aldosterone signilicantly raised it, especially in the subjects receiving 4~mIU/h of ACTH. it is suggested that aldosterone has a synergistic effect for elevating blood pressure in ACTHinduced hypertension as compared with renin. DOC. cortisol. corticosterone and deoxycortisol.
193. Good correlation between the night (10:~:~
h)
and the 24-h urinary excretion of &trio1
WIRIYA.P. and VISUTAKUL.P.. Department of Physiology, Faculty of Medicine. Siriraj ‘Hospital, Mahidol University. Bangkok, Thailand In an attempt to avoid the trouble of 24-h urine collection, several urinary fractions excreted during 24 h were analysed for estriol using a colourimetric method. The determination of estriol was carried out each week in 6 pregnant subjects starting at 20-26 weeks of gestation until the end of pregnancy. The results reveated a high correlation (r = 0.97) between the night-morning fraction collected from IO:00 h. till 06.00 h. and the 24-h fraction, when the results were expressed as the ratio of estriol/creatinine. The correlation obtained in this experiment seemed to be better than those previously reported between morning urine butfixed time) and 24-h urine specimens. Urine collection at this period of time also appeared to be more convenient for the patients. 194. Circadian variation in plasma steroid levels in patients with adrenocortical disease JAMES,V. H. T., TUNBRIDGE.R. D. G., WILSON.G. A.
and GOODALL, A., St. Mary’s School, London, W2 IPG, U.K.
Hospital
Medical
Peripheral plasma levels of cortisol, androstenedione and aldosterone show closely related changes when studied in normal subjects by sequential blood sampling. Cortisol and androstenedione levels reflect the pattern of pulsatile release of ACTH whereas the basal changes in afdosterone are clearly ACTH independent and seem to be responsive to the renin-angiotension system. These correlations are lost in patients with adrenocortical disease. In Cushing’s syndrome [adenoma or hyperplasia) cortisol levels are elevated, whereas aldosterone and testosterone levels tended to be low. Androstenedione levels were in the normal range but did not correlate well with cortisol levels. Eight patients with Conn’s syndrome (adrenal adenoma) showed plasma aldosterone levels, which were elevated throughout the period of study. After administration of dexamethasone (tmg) at 23:00, control subjects showed only minor changes in the nocturnal pattern of plasma aldosterone levels, whilst all the patients showed marked suppression. At 08:00, this was 6@;, or fess of the level found at 08:OO on the previous day. The study of circadian variations in steroid levels and the response to dexamethasone may be of value in identifying patients with adrenocortical dysfunction. 1%. Oral medroxyprogesterone acetate in the management of endometriosis
HENRIQUES,E. S., RAMAN,V. R., FRIEDLANDER, R. L. and SWARTZ,D. P., Albany Medical College, Albany, New York, U.S.A. Oral medroxyprogesterone acetate (MPA) was used in 1Omg dosages three times daily for three to four months in fifty-seven patients with endometriosis to assess its effect on symptoms and fertility. All patients showed satisfactory
Parel.
Hyperprolactinaemia as a cause of anovulation is well established. Though there are ample reports on the evaluation of the hypothalamic-pituitary axis in these patients, the data on ovarian steroid levels are limited. in the present communication, serum estradiol and progesterone in 6 cases of hyperprolactinaemia (proiactin levels. 8&330 ng/ml) before and after bromoergocryptine treatment are reported. The Sella rurcica in these patients were normal on lateral skull X-ray. Serum estradiol in all the cases was less than 40 pg/ml. These patients had no cervical mucus and-no withdrawal bleeding on progesterone challenge. The threshold for a positive test in our hands is a serum estradiol >6Opg/ml. On bromoergocryptine, serum estradiol rose to levels of 2OOpg/ml at the height of the cervical-mucus score. This was followed by ovulatory menstruation (progesterone > 5 ng/ml) within 6 to 8 weeks of therapy, in all but one patient. The present report indicates the severe degree of estrogen deficiency in patients with hyperprolactinemic amenorrhea.
191. Effects of spironolactone administration on testosterone and 17-beta-oestradiol secretion in boys with delayed puberty Lutst. M., BARLETTA,D.. CASPERI, M.. FRANCHI,F..
ARGENIO.G. and BERNINI,G. P.. Endocrine Laboratory of C.N.R.. 1st Medical Clinic, Pisa University School of Medicine 56100 Pisa, Italy Spironolactone has been shown to act as an antiadrogen in boys with delayed adolescence, by blocking testosterone biosynthesis or competing with androgens for the specific receptors. This leads to an interruption of the testicularpituitary-hypothalamic negative feedback and to an increase of plasma LH and FSH. However, no reliable information concerning plasma testosterone (T) and oestradiol-17-beta (E,) is. at present, available. During long-term studies on normal and delayed male puberty, we have demonstrated some aspects of T and E, variations after spironolactone administration. Highly specific and sensitive radioimmunoassay methods (up to !2 pg/tube for both steroids) have been used. Following administration of spironolactone (5mg,ikg) daily for 7 days to 10 boys with delayed puberty. there was a significant (P < 0.01) mean decrease in plasma E, of SO?,, and T of 60’:;,, reflecting either adrenal or testicular 17-alpha-hydroxylase and lyase activity inhibition. In the same boys, mean plasma FSH levels thereby increased by 200?,, (P < 0.001). while mean LH values increased by 80?:, (P < 0.01). In addition progesterone and 17-alpha-hydroxyprogesterone increased significantly. The significant decrease of T and E,, together with the dramatic increase of FSH, indicates an inhibitory action of spironolactone on the enzymatic systems of steroidogenesis, and suggests that the intrinsic action of the drug, in delayed puberty. is the blockade of testicularpituitary-hypothalamic negative feedback. 192. A role of aldusterone in ACTH-induced hypertension OTOKIDA, K., KAMATA. S., KANAZAWA, S. and KKMURA, T., Department of Medicine, Iwate Medical University, Morioka, Japan The experiment was carried out in order to investigate whether the combined infusion of ACTH and steroids causes hy~rtension in man. ACTH (Cortrosyn) was infused into 20 patients with essential hypertension at a constant rate of 50miU or 4OOmIU/h for 5 h starting at 9.00a.m. There was little change in the blood pressure, the renin activity, the aldosterone level, or the deoxycorticosterone level (DOC) in the plasma for the initial 2 h.
After this time cortisol (Solu-Cartel) or aldosterone (Aldocorten) (infusion rate: 40pg or 3.6mg/h) was added to the ACTH infusion. The combined infusion of ACTH and cortisol for 3 hr slightly elevated the blood pressure, whereas the combined infusion of ACTH and aldosterone signilicantly raised it, especially in the subjects receiving 4~mIU/h of ACTH. it is suggested that aldosterone has a synergistic effect for elevating blood pressure in ACTHinduced hypertension as compared with renin. DOC. cortisol. corticosterone and deoxycortisol.
193. Good correlation between the night (10:~:~
h)
and the 24-h urinary excretion of &trio1
WIRIYA.P. and VISUTAKUL.P.. Department of Physiology, Faculty of Medicine. Siriraj ‘Hospital, Mahidol University. Bangkok, Thailand In an attempt to avoid the trouble of 24-h urine collection, several urinary fractions excreted during 24 h were analysed for estriol using a colourimetric method. The determination of estriol was carried out each week in 6 pregnant subjects starting at 20-26 weeks of gestation until the end of pregnancy. The results reveated a high correlation (r = 0.97) between the night-morning fraction collected from IO:00 h. till 06.00 h. and the 24-h fraction, when the results were expressed as the ratio of estriol/creatinine. The correlation obtained in this experiment seemed to be better than those previously reported between morning urine butfixed time) and 24-h urine specimens. Urine collection at this period of time also appeared to be more convenient for the patients. 194. Circadian variation in plasma steroid levels in patients with adrenocortical disease JAMES,V. H. T., TUNBRIDGE.R. D. G., WILSON.G. A.
and GOODALL, A., St. Mary’s School, London, W2 IPG, U.K.
Hospital
Medical
Peripheral plasma levels of cortisol, androstenedione and aldosterone show closely related changes when studied in normal subjects by sequential blood sampling. Cortisol and androstenedione levels reflect the pattern of pulsatile release of ACTH whereas the basal changes in afdosterone are clearly ACTH independent and seem to be responsive to the renin-angiotension system. These correlations are lost in patients with adrenocortical disease. In Cushing’s syndrome [adenoma or hyperplasia) cortisol levels are elevated, whereas aldosterone and testosterone levels tended to be low. Androstenedione levels were in the normal range but did not correlate well with cortisol levels. Eight patients with Conn’s syndrome (adrenal adenoma) showed plasma aldosterone levels, which were elevated throughout the period of study. After administration of dexamethasone (tmg) at 23:00, control subjects showed only minor changes in the nocturnal pattern of plasma aldosterone levels, whilst all the patients showed marked suppression. At 08:00, this was 6@;, or fess of the level found at 08:OO on the previous day. The study of circadian variations in steroid levels and the response to dexamethasone may be of value in identifying patients with adrenocortical dysfunction. 1%. Oral medroxyprogesterone acetate in the management of endometriosis
HENRIQUES,E. S., RAMAN,V. R., FRIEDLANDER, R. L. and SWARTZ,D. P., Albany Medical College, Albany, New York, U.S.A. Oral medroxyprogesterone acetate (MPA) was used in 1Omg dosages three times daily for three to four months in fifty-seven patients with endometriosis to assess its effect on symptoms and fertility. All patients showed satisfactory