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Bone loss in young hypoestrogenic women due to primary ovarian failure: Spinal quantitative computed tomography
304
Cìtations front the Literature
in hypogonadotropic hypogonadic males, leading to a greater testicular growth than T preparations. Therefore, hCG treatment may have an advantageous effect on the eventual induction of fertility with human menopausal gonadotropin. Hyperprolactinemis Report of two cases
in clinically asymptomatic,
fertile men:
Colon JM; Ginsburg F; Schmidt CL; Weiss G Divtsion of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Medicine and Dentistry, Newark, NJ; USA Obstetrics and Gynecology/74/3 11SUPPL. (510-513)/1989/ Although the role of prolactin (PRL) in men is undefined, hyperprolactinemia has been associated with decreased reproductive potential. Two healthy, fertile, asymptomatic men with hyperprolactinemia are reported. Both men had normal puberty. Both were euthyroid and had normal gonadotropin levels and androgen profiles. Semen analyses were normal and both had fathered children. The serum RL leve1 (mean 2 standard error of the mean) (N = 5) of subject 1 was 48 f 12 ng/mL, and of subject 2 was 214 f 5 ng/mL. Sella turcica computed tomography stans with contrast were normal. The two subjects underwent a thyrotropin-releasing hormone stimulation test. Serum PRL and TSH were measured by radioimmunoassay. At time 0 and at 15 minutes, PRL bioactivity was measured in the Nb2 node rat lymphoma assay. Both subjects showed a normal TSH response to thyrotropin-releasing hormone. Subject 1 had baseline PRL immunoactivity and bioactivity measuring 41 and 50 ng/mL, respectively, peaking at 76 and 70 ng/ mL 15 minutes after infusion of thyrotropin releasing hormone. Subject 2 had baseline PRL immunoactivity of 200 ng/ mL and bioactivity of 67 ng/mL, neither of which were altered by infusion of thyrotropin-releasing hormone. Administration of L-dopa decreased the serum PRL of subject 1 from 33 to 7 ng/mL, but had no clinically significant effect in subject 2. Prolactin and gonadotropin secretion may be dissociated in men so that hyperprolactinemia may not always manifest as reproductive dysfunction. Use of a gonadotropin-releasing hormone agonist during ovarian stimulation leads to significant concentrations of peptide in follicular fluids
Loumaye E; Coen G; Pampfer S; Vankrieken L; Thomas K Physiologv of Human Reproduction Research Unit, Department of Obstetrics and Gynecology, University of Louvain, B1200 Brussels; Belgium Fertility and Sterility/52/2 (256-263)/1989/ The penetration of a gonadotropin-releasing hormone agonist (GnRH-a), Buserelin (Hoechst AG, Frankfurt, West Germany), into human follicular fluids (FF) was studied by means of a radioimmunoassay (RIA) and a bioassay. Acute nasal administration of a therapeutic dose of Buserelin (300 and 600 mu g) before the ovum pickup for in vitro fertilization leads to significant concentrations of Buserelin in one-third of the FF. These concentrations ranged between 28 and 124 pg/ ml, which represents 10% to 50% of the serum concentrations achieved in these patients. Follicular penetration of this agonist Znt J Gynecol Obstet 31
is time-dependent. Chronic administration during the follicular phase leads to low but significant concentrations of peptide 36 hours after the last inhalation. A very good correlation was observed between the RIA and the bioassay. This demonstrates the accuracy and the specificity of the RIA. In addition, it indicates that the Buserelin that reaches follicles is intact and is not the inactive product of degradation. Intranasal administration of Buserelin stopped 35 hours before ovum pickup appears to be an adequate way of minimizing the exposure of maturing oocytes to the GnRH-a. A pharmacodynamic comparison of human urinary folliclestimulating hormone and human menopausal gonadotropin in normal women and polycystic ovary syndrome
Anderson RE; Cragun JM; Chang RJ; Stanczyk FZ; Lobo RA Department of Obstetrics and Gynecology, University of Southern Cahfornia, Los Angeles, CA; USA Fertility and Sterility/52/2 (216-220)/1989/ We performed a pharmacodynamic comparison of human urinary follicle-stimulating hormone (hFSH) and human menopausal gonadotropin (hMG) to characterize differences in the bioavailability of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) as wel1 as to compare estrogen responses in normal women and those with polycystic ovary syndrome (PCOS). Ten women with PCOS and ten normal ovulatory controls were randomized to receive a single dose (2 ampules) of either hFSH or hMG. Serum LH decreased significantly following hFSH with responses occurring earlier in controls (24.5 f 10.9% after 30 minutes) than in PCOS patients (27.3 f 7.5% after 18 hours). After hMG, LH increased only in controls (33.8 f 16.3%). An FSH increment following hFSH was observed in both PCOS patients (54.7 rr 24.8%) and controls (74.6 f 36.8%), with peak responses at 6 and 4 hours, respectively. However, after hMG, FSH increased only in controls. The LH/FSH ratio after hFSH decreased, with the nadir at 18 hours (1.438 f 0.183) being similar to baseline LH/FSH ratios of controls (1.433 f 0.341). Serum estradiol (E,) increased following hMG, with peak responses after 18 hours, in both PCOS patients (75.4 f 28.6%) and controls (88.5 f 32.5%). The peak E, response to hGSH was observed to be earlier in PCOs patients (147 f 34%), occurring after 12 hours, compared with controls (58 f 29% after 18 hours). Two patients with hypergonadotropic pituitary hyperplasia
ovarian failure due to
Okuda K; Yoshikawa M; Ushiroyama T; Sugimoto 0; Maeda T; Mori H Department of Obstetrics and Gynecology, Osaka Medical College, Takatsuki, Osaka 569; Japan Obstetrics and Gynecology/74/3 11SUPPL. (498-501)/1989/ Two patients with hypergonadotropic ovarian failure were examined. Plasma levels of LH and FSH were markedly elevated to over 113 mIU/mL (Second International Reference Preparation - human menopausal gonadotropin standard), but the FSH/LH ratio was 1 or less in both women. The plasma estradiol (E2) leve1 was 65 pg/mL in one woman before medication, and in the other increased from below 25 to 130 pg/mL after large dose of clomiphene citrate treatment. The
Citationi from the Literature pituitary tissues removed by transsphenoidal surgery showed hyperplasia with numerous cells immunohistochemically positive for LH and FSH. After surgery, the elevated plasma gonadotropins decreased and plasma E2 levels increased. Human menopausal gonadotropin after clomiphene citrate treatment induced ovulation in one patient, and cyclic administration of estrogen and progesterone induced ovulation in the other. These results suggest that elevated gonadotropins may suppress ovarian function in some cases. Bone loss in young bypoestrogenic women due to primary ovarian faihre: Spinal quantitative computed tomograpby
Louis 0;Devroey P; Kalender W; Osteaux M Department of Radiology, Akademisch Ziekenhu& Vrije Universiteit Brussel, B 1090 Brussel; Belgium Fertility and Sterility/.52/2 (227-23 1)/1989/ Vertebral bone mineral density was investigated in 22 young (29.3 f 1 years) women with primary ovarian failure, attending for infertility. The lumbar spine was studied, using a preprocessing dual-energy quantitative computed tomography technique and assessing vertebral bone mineral density from the reconstructed 125kV image. Previously untreated women had significantly (P < 0.001) lower values than a group of agematched healthy controls, while the differente between those women having received estrogen therapy and the same controls was not significant. Sixteen patients were restudied after 6 to 21 months of estrogen therapy, part of a regimen intended to prepare the endometrium for oocyte donation, and vertebral bone mineral density increased in 12 of them. The authors conclude that primary ovarian failure is a cause for bone loss in these young women and that estrogen therapy is effective. Is it safe to prescribe bormonal contraception and replacement tberapy to patieats witb premslignant and malignant uterine cervices?
Sadan 0; Frohlich RP; Driscoll JA; Apostoleris A; Savage N; Zakut H Department of Obstetrics and Gynecology, Sackler Faculty of Medicine, Tel-Aviv University, Edith Wolfson Medical Center, Holon; Israel Gynecologic Oncology/34/2 (í59-163)/1989/ The levels of estrogen and progesterone receptors in normal and abnormal uterine cervices were determined. The study group consisted of 14 patients with cervical intraepithelial neoplasia (CIN 111)and 7 patients with invasive carcinoma of the cervix (stage IB-DA). The control group included 23 patients who underwent total abdominal hysterectomy for menorrhagia, leiomyoma, etc. The concentration of total estrogen receptors in premalignant and malignant cervices did not differ from the patients with benign conditions of the cervix. The concentration of progesterone receptors was significantly higher in the nonaffected cervices than in the patients with preinvasive and invasive carcinoma of the cervix (P < 0.05). We have shown that estrogen receptor concentrations do not differ between women with normal and abnormal uterine cervices. Therefore, we fee1 that the contraceptive pil1 is not contraindicated in women who have been treated for CIN 111.
305
We also maintain that hormone replacement therapy should be given, when indicated, to women who have been sterilized following surgery and/or radiotherapy for invasive carcinoma of the cervix.
CLINICAL OBSTETRICS Eariy pregnancy glycosylated bemoglobin, severity of diabetes, and fetal malformations
Lucas MJ; Leveno KJ; Williams ML; Raskin P; Whalley PJ Division of Maternal-Fetal Medicine, Department of Obstetrits and Gynecology, University of Texas Southwfltern Medical School, Dallas, TX 752359032; USA American Journal of Obstetrics and Gynecology/lól/L (426431)/1989/ Total percent glycosylated hemoglobin (A(la + b + c)) was measured before 16 weeks’ gestation in 105 insulin-treated diabetic women enrolled for prenatal care at Parkland Memorial Hospital. Seventy-three of the infants were normal, 14 had malformations, and there were 18 spontaneous abortions. The mean glycosylated hemoglobin leve1 for the entire study group was 9.2%, compared with 9.4% for those pregnancies ending in abortion, 8.9% for those resulting in normal infants, and 10.3% when malformations occurred. The mean glycosylated hemoglobin value for women delivered of normal infants was significantly lower than the mean of those with malformed infants. Ten of the 14 malformations occurred in mothers whose early pregnancy values exceeded the mean of the entire study group. There was also an association between malformations and White classification of matemal diabetes since 10 of the 14 fetal anomalies occurred in women assigned to White Classes C, D, F, H, and R. When the distribution of malformations was analyzed according to both glycosylated hemoglobin leve1 and White Class, there was evidente of an interaction to suggest that hyperglycemia increases the relative risk of fetal malformations when associated with maternal diabetes of longer duration and/or with vascular complications. Predictive vaiues, relative risks, and overall benefits of high and low maternal serum alpba-fetoprotein screening in singleton pregnancies: New epidemiologic data
Milunsky A; Jick SS; Bruell CL; MacLaughlin DS; Tsung Y-K; Jick H; Rothman KJ; Willett W Center for Human Genetics, Boston University Schoool of Medicine, Boston, MA 02118-2394; USA American Journal of Obstetrics and Gynecology/lól/L (291297)/1989/ In a prospective study of maternal serum alpha-fetoprotein screening for both high and low values, we assessed the overall predictive value, sensitivity, specificity, and relative risks for congenital defects and complications of pregnancy. Among 13,486 women with singleton pregnancies interviewed at the time of screening (15 to 20 weeks of gestation), 3.9% had high and 3.4% had low values. A high maternal serum alpha-fetoprotein value was associated with the following adverse outInt J Gynecol Obstet 31
Cìtations front the Literature
in hypogonadotropic hypogonadic males, leading to a greater testicular growth than T preparations. Therefore, hCG treatment may have an advantageous effect on the eventual induction of fertility with human menopausal gonadotropin. Hyperprolactinemis Report of two cases
in clinically asymptomatic,
fertile men:
Colon JM; Ginsburg F; Schmidt CL; Weiss G Divtsion of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Medicine and Dentistry, Newark, NJ; USA Obstetrics and Gynecology/74/3 11SUPPL. (510-513)/1989/ Although the role of prolactin (PRL) in men is undefined, hyperprolactinemia has been associated with decreased reproductive potential. Two healthy, fertile, asymptomatic men with hyperprolactinemia are reported. Both men had normal puberty. Both were euthyroid and had normal gonadotropin levels and androgen profiles. Semen analyses were normal and both had fathered children. The serum RL leve1 (mean 2 standard error of the mean) (N = 5) of subject 1 was 48 f 12 ng/mL, and of subject 2 was 214 f 5 ng/mL. Sella turcica computed tomography stans with contrast were normal. The two subjects underwent a thyrotropin-releasing hormone stimulation test. Serum PRL and TSH were measured by radioimmunoassay. At time 0 and at 15 minutes, PRL bioactivity was measured in the Nb2 node rat lymphoma assay. Both subjects showed a normal TSH response to thyrotropin-releasing hormone. Subject 1 had baseline PRL immunoactivity and bioactivity measuring 41 and 50 ng/mL, respectively, peaking at 76 and 70 ng/ mL 15 minutes after infusion of thyrotropin releasing hormone. Subject 2 had baseline PRL immunoactivity of 200 ng/ mL and bioactivity of 67 ng/mL, neither of which were altered by infusion of thyrotropin-releasing hormone. Administration of L-dopa decreased the serum PRL of subject 1 from 33 to 7 ng/mL, but had no clinically significant effect in subject 2. Prolactin and gonadotropin secretion may be dissociated in men so that hyperprolactinemia may not always manifest as reproductive dysfunction. Use of a gonadotropin-releasing hormone agonist during ovarian stimulation leads to significant concentrations of peptide in follicular fluids
Loumaye E; Coen G; Pampfer S; Vankrieken L; Thomas K Physiologv of Human Reproduction Research Unit, Department of Obstetrics and Gynecology, University of Louvain, B1200 Brussels; Belgium Fertility and Sterility/52/2 (256-263)/1989/ The penetration of a gonadotropin-releasing hormone agonist (GnRH-a), Buserelin (Hoechst AG, Frankfurt, West Germany), into human follicular fluids (FF) was studied by means of a radioimmunoassay (RIA) and a bioassay. Acute nasal administration of a therapeutic dose of Buserelin (300 and 600 mu g) before the ovum pickup for in vitro fertilization leads to significant concentrations of Buserelin in one-third of the FF. These concentrations ranged between 28 and 124 pg/ ml, which represents 10% to 50% of the serum concentrations achieved in these patients. Follicular penetration of this agonist Znt J Gynecol Obstet 31
is time-dependent. Chronic administration during the follicular phase leads to low but significant concentrations of peptide 36 hours after the last inhalation. A very good correlation was observed between the RIA and the bioassay. This demonstrates the accuracy and the specificity of the RIA. In addition, it indicates that the Buserelin that reaches follicles is intact and is not the inactive product of degradation. Intranasal administration of Buserelin stopped 35 hours before ovum pickup appears to be an adequate way of minimizing the exposure of maturing oocytes to the GnRH-a. A pharmacodynamic comparison of human urinary folliclestimulating hormone and human menopausal gonadotropin in normal women and polycystic ovary syndrome
Anderson RE; Cragun JM; Chang RJ; Stanczyk FZ; Lobo RA Department of Obstetrics and Gynecology, University of Southern Cahfornia, Los Angeles, CA; USA Fertility and Sterility/52/2 (216-220)/1989/ We performed a pharmacodynamic comparison of human urinary follicle-stimulating hormone (hFSH) and human menopausal gonadotropin (hMG) to characterize differences in the bioavailability of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) as wel1 as to compare estrogen responses in normal women and those with polycystic ovary syndrome (PCOS). Ten women with PCOS and ten normal ovulatory controls were randomized to receive a single dose (2 ampules) of either hFSH or hMG. Serum LH decreased significantly following hFSH with responses occurring earlier in controls (24.5 f 10.9% after 30 minutes) than in PCOS patients (27.3 f 7.5% after 18 hours). After hMG, LH increased only in controls (33.8 f 16.3%). An FSH increment following hFSH was observed in both PCOS patients (54.7 rr 24.8%) and controls (74.6 f 36.8%), with peak responses at 6 and 4 hours, respectively. However, after hMG, FSH increased only in controls. The LH/FSH ratio after hFSH decreased, with the nadir at 18 hours (1.438 f 0.183) being similar to baseline LH/FSH ratios of controls (1.433 f 0.341). Serum estradiol (E,) increased following hMG, with peak responses after 18 hours, in both PCOS patients (75.4 f 28.6%) and controls (88.5 f 32.5%). The peak E, response to hGSH was observed to be earlier in PCOs patients (147 f 34%), occurring after 12 hours, compared with controls (58 f 29% after 18 hours). Two patients with hypergonadotropic pituitary hyperplasia
ovarian failure due to
Okuda K; Yoshikawa M; Ushiroyama T; Sugimoto 0; Maeda T; Mori H Department of Obstetrics and Gynecology, Osaka Medical College, Takatsuki, Osaka 569; Japan Obstetrics and Gynecology/74/3 11SUPPL. (498-501)/1989/ Two patients with hypergonadotropic ovarian failure were examined. Plasma levels of LH and FSH were markedly elevated to over 113 mIU/mL (Second International Reference Preparation - human menopausal gonadotropin standard), but the FSH/LH ratio was 1 or less in both women. The plasma estradiol (E2) leve1 was 65 pg/mL in one woman before medication, and in the other increased from below 25 to 130 pg/mL after large dose of clomiphene citrate treatment. The
Citationi from the Literature pituitary tissues removed by transsphenoidal surgery showed hyperplasia with numerous cells immunohistochemically positive for LH and FSH. After surgery, the elevated plasma gonadotropins decreased and plasma E2 levels increased. Human menopausal gonadotropin after clomiphene citrate treatment induced ovulation in one patient, and cyclic administration of estrogen and progesterone induced ovulation in the other. These results suggest that elevated gonadotropins may suppress ovarian function in some cases. Bone loss in young bypoestrogenic women due to primary ovarian faihre: Spinal quantitative computed tomograpby
Louis 0;Devroey P; Kalender W; Osteaux M Department of Radiology, Akademisch Ziekenhu& Vrije Universiteit Brussel, B 1090 Brussel; Belgium Fertility and Sterility/.52/2 (227-23 1)/1989/ Vertebral bone mineral density was investigated in 22 young (29.3 f 1 years) women with primary ovarian failure, attending for infertility. The lumbar spine was studied, using a preprocessing dual-energy quantitative computed tomography technique and assessing vertebral bone mineral density from the reconstructed 125kV image. Previously untreated women had significantly (P < 0.001) lower values than a group of agematched healthy controls, while the differente between those women having received estrogen therapy and the same controls was not significant. Sixteen patients were restudied after 6 to 21 months of estrogen therapy, part of a regimen intended to prepare the endometrium for oocyte donation, and vertebral bone mineral density increased in 12 of them. The authors conclude that primary ovarian failure is a cause for bone loss in these young women and that estrogen therapy is effective. Is it safe to prescribe bormonal contraception and replacement tberapy to patieats witb premslignant and malignant uterine cervices?
Sadan 0; Frohlich RP; Driscoll JA; Apostoleris A; Savage N; Zakut H Department of Obstetrics and Gynecology, Sackler Faculty of Medicine, Tel-Aviv University, Edith Wolfson Medical Center, Holon; Israel Gynecologic Oncology/34/2 (í59-163)/1989/ The levels of estrogen and progesterone receptors in normal and abnormal uterine cervices were determined. The study group consisted of 14 patients with cervical intraepithelial neoplasia (CIN 111)and 7 patients with invasive carcinoma of the cervix (stage IB-DA). The control group included 23 patients who underwent total abdominal hysterectomy for menorrhagia, leiomyoma, etc. The concentration of total estrogen receptors in premalignant and malignant cervices did not differ from the patients with benign conditions of the cervix. The concentration of progesterone receptors was significantly higher in the nonaffected cervices than in the patients with preinvasive and invasive carcinoma of the cervix (P < 0.05). We have shown that estrogen receptor concentrations do not differ between women with normal and abnormal uterine cervices. Therefore, we fee1 that the contraceptive pil1 is not contraindicated in women who have been treated for CIN 111.
305
We also maintain that hormone replacement therapy should be given, when indicated, to women who have been sterilized following surgery and/or radiotherapy for invasive carcinoma of the cervix.
CLINICAL OBSTETRICS Eariy pregnancy glycosylated bemoglobin, severity of diabetes, and fetal malformations
Lucas MJ; Leveno KJ; Williams ML; Raskin P; Whalley PJ Division of Maternal-Fetal Medicine, Department of Obstetrits and Gynecology, University of Texas Southwfltern Medical School, Dallas, TX 752359032; USA American Journal of Obstetrics and Gynecology/lól/L (426431)/1989/ Total percent glycosylated hemoglobin (A(la + b + c)) was measured before 16 weeks’ gestation in 105 insulin-treated diabetic women enrolled for prenatal care at Parkland Memorial Hospital. Seventy-three of the infants were normal, 14 had malformations, and there were 18 spontaneous abortions. The mean glycosylated hemoglobin leve1 for the entire study group was 9.2%, compared with 9.4% for those pregnancies ending in abortion, 8.9% for those resulting in normal infants, and 10.3% when malformations occurred. The mean glycosylated hemoglobin value for women delivered of normal infants was significantly lower than the mean of those with malformed infants. Ten of the 14 malformations occurred in mothers whose early pregnancy values exceeded the mean of the entire study group. There was also an association between malformations and White classification of matemal diabetes since 10 of the 14 fetal anomalies occurred in women assigned to White Classes C, D, F, H, and R. When the distribution of malformations was analyzed according to both glycosylated hemoglobin leve1 and White Class, there was evidente of an interaction to suggest that hyperglycemia increases the relative risk of fetal malformations when associated with maternal diabetes of longer duration and/or with vascular complications. Predictive vaiues, relative risks, and overall benefits of high and low maternal serum alpba-fetoprotein screening in singleton pregnancies: New epidemiologic data
Milunsky A; Jick SS; Bruell CL; MacLaughlin DS; Tsung Y-K; Jick H; Rothman KJ; Willett W Center for Human Genetics, Boston University Schoool of Medicine, Boston, MA 02118-2394; USA American Journal of Obstetrics and Gynecology/lól/L (291297)/1989/ In a prospective study of maternal serum alpha-fetoprotein screening for both high and low values, we assessed the overall predictive value, sensitivity, specificity, and relative risks for congenital defects and complications of pregnancy. Among 13,486 women with singleton pregnancies interviewed at the time of screening (15 to 20 weeks of gestation), 3.9% had high and 3.4% had low values. A high maternal serum alpha-fetoprotein value was associated with the following adverse outInt J Gynecol Obstet 31