Oestrogen and androgen states in oligo-amenorrhoeic women with polycystic ovaries

234

Cifotions ,from lhe Literature

treatment suppressed menstrual activity in all patients. Serum T and estrone were significantly elevated after treatment with oral T undecanoate. The parameters of the pulsatile secretion of LH were not affected by androgen administration. Levels of FSH, estradiol, and progesterone also did not change significantly.

sulin acts on the ovary to stimulate androgen production, they may be because of the short time course of insulin elevation that occurs during an IVGTT. Probing genomic deoxyribonucleic acid for gene rearrangement in 14 patients with aodrogen insensitivity syndrome

DiLauro SL; Behzadian A; Tho SPT; McDonough PG Detection of premature lutehdzation with scram progesterone levels at the time of the postcoital test

Departmeni of Obstetrics and Gynecology. Medical College of

Taney FH; Grazi RV; Weiss G; Schmidt CL

FERTIL STERIL 1991, 55/3 (481-485) Androgen insensitivity appears to, involve mutations in the X-linked androgen receptor (AR) gene in genetic males. In this study; 14 patients with androgen insensitivity syndrome (unrelated patients (n = 6); related patients (n = 8)) were studied. Ten patients had complete and 4 had partial insensitivity to androgens. Deoxyribonucleic acid samples from controls and study subjects were examined with probes specific for the AR gene domains (hAR1, hAR2, hAR3). In one subject with complete androgen insensitivity syndrome, a reduction in size of the 2.4 kilobase band hybridizing to hARl was noted. Southern blot analysis of these subjects, however, did not detect deletions or gene rearrangement. These results suggest that deletions detectable by Southern method are infrequent mutants of the AR gene in patients with androgen insensitivity syndrome.

Deparrment of Obstetrics and Gynecology, UMDNJ-New Jersey Medical School, 150 Bergen Sireet, Newark, NJ 07103-2757. USA

FERTIL STERIL 1991, 55/3 (513-515) Poor cervical mucus (CM) may be caused by a number of factors, including premature luteinization, local cervical effects, and inadequate folliculogenesis. In an attempt to distinguish between these causes of poor CM, we obtained progesterone (P) levels at the time of postcoital tests (PCTs) in infertile women during spontaneous or clomiphene citrate (CC)stimulated cycles. The amount.of CM, viscosity, ferning, spinnbarkeit, and cellularity were each scored from 0 to 3 points on the day after detection of the urinary luteinizing hormone surge (luteal day 1). The charts of 46 such patients were retrospectively reviewed. Eleven control patients with good CM scores (> 10) had low P levels (<2.5 ng/mL). Of the remaining 35 cycles, 19 were marked by low P levels, and 16 were accompanied by P levels of >2.5 ng/mL. Overall, 94.4% of CCstimulated cycles versus 64.3% of spontaneous cycles had abnormal CM scores (< 9). On the basis of these inappropriately elevated P levels, premature luteinization can be cited as the cause of poor mucus quality. In fact, premature luteinization may be responsible for some of the purported antiestrogenic effects of CC. Therefore, it is appropriate to draw a P level at the time of a poor PCT, particularly in cycles stimulated by CC. Aodrogen

responses

to acutely

levels in hyperandrogenic

increased

endogenous

insulin

and normal cycling women

Elkind-Hirsch KE; Valdes CT; McConnell TG; Malinak LR Methodisi Hospital, 6565 Fannin, Houston, TX 77030, USA

FERTIL STERIL 1991, 55/3 (486-491) We examined androgen responses in hyperandrogenic (polycystic ovarian disease (PCOD)) and normal women after an acute endogenous insulin elevation. Standard intravenous glucose tolerance tests (IVGTTs), modified to include a tolbutamide injection 20 min after IVGTTs, were performed. Polycystic ovarian disease patients were studied in the untreated state, after 6 weeks of ovarian androgen suppression with leuprolide acetate, after a 6-week rest period, and after 6 weeks of antiandrogen therapy with spironolactone. Normal menstruating women were studied during the early follicular, midcycle, and luteal phases of a single cycle. An acute rise in insulin did not alter serum testosterone or androstenedione levels in PCOD or normal women. A significant rise in dehydroepiandrosterone sulfate after modified IVGTTs was found in both hyperandrogenic and normal cycling women. Although these results are not supportive of the theory that inInt J Gynerol Ohstet 37

Georgia, Augusta, GA 30912, USA

GYNECOLOGICAL

ENDOCRINOLOGY

Polycystic ovaries: Do these represent a specific eodocriwpathy? Abdel Gadir A; Khatim MS; Mowafi RS; Alnaser HMI; Alzaid HGN; Shaw RW Department ofObstetrics and Gynaecology, Faculty of Medicine, Kuwait University Health Sciences Centre. Kuwait, KWT

BR J OBSTET GYNAECOL 1991 9813 (300-305) Serum pituitary gonadotrophins, oestradiol, testosterone and insulin pulse patterns were examined at 15-min intervals for 6 h in 40 women with a previous diagnosis of polycystic ovarian disease (PCO) based on clinical, endocrinological and ultrasound data. Age, duration of symptoms, body mass index (BMI) and ovarian volume showed no correlation with the 6-h mean value of any hormone and testosterone blood levels did not correlate with those of insulin. Some patients had high and others low LH pulse pattern components, and few had an inverted LH:FSH ratio. Morphological polycystic ovarian changes may be a reflection of various rather than a single pattern of gonadotrophin Oestrogen

secretion.

and androgen states in oligo-amenorrhoeic

women

with polycystic ovaries

Fox R; Corrigan E; Thomas PG; Hull MGR University Department of Obstetrics and Gynaecology, Bristol Maternity Hospital, Southwell Sireet, Bristol BS2 8EG. GBR

BR J OBSTET GYNAECOL 1991 98/3 (294-299) Oestrogen and androgen states have been studied in relation to ovarian morphology defined by ultrasonography in 65 women with oligo-amenorrhoea. Of the 48 women with

Citations ,/iom the Literature

polycystic ovaries (PCO), 44 (920/u) had a withdrawal bleed following progestogen challenge (indicating oestrogenization) compared with just three (18%) of the I7 with non-PC0 (P < 0.001). Median serum concentrations of oestradiol and oestrone were statistically significantly higher in the PC0 group but the ranges overlapped widely. Of the four women with PC0 but oestrogen deficiency, two were hirsute and had evidence of a severe form of the disorder. The other two were not hirsute and appeared to have hypothalamic dysfunction associated with weight loss overriding the disorder due to preexisting PCO. Compared with the non-PC0 group, the PC0 subgroup without hirsutism (n = 31) had statistically significantly higher median values of LH, testosterone, androstenedione, and dehydroepiandrosterone sulphate concentrations, and free androgen index. Concentrations of androgen, but not LH, were significantly higher still in the PC0 subgroup with hirsutism (n = 17). Variations of luteinizing hormone serum concentrations after exogenous human chorionic gonadotropin administration during ovarian hyperstimulation

Demoulin A; Dubois M; Gerday C; Gillain D; Lambotte R; Franchimont P Department

of

Obstetrics

and

Gynecology,

Hopiral

de la

Ciradelle. I, Boulevard du I2e de Ligne, 4000 Liege. BEL

FERTIL STERIL 1991 55/4 (797-804) Changes in luteinizing hormone (LH), estradiol, and progesterone serum levels before and after preovulatory administration of human chorionic gonadotropin (hCG) were assayed in 30 patients stimulated with clomiphene citrate (CC) and human menopausal gonadotropin (hMG) and compared with LH variations in 43 patients submitted to pharmacological hypophysectomy with a gonadotropin-releasing hormone agonist (GnRH-a) and stimulation with hMG. In CC + hMGtreated patients, an endogenous LH surge occurred systematically 4.25 f 2.75 h after hCG injection. Multiparametric analysis indicated an inverse correlation between the delay in the initial rise of the LH surge and the increase in P levels during the 6 h after hCG administration. Gonadotropin-releasing hormone agonist + hMG treatment did not lead to an LH surge after hCG but to a significant fall in LH levels. Thus, exogenous hCG, administered before ovulation, induces an endogenous LH surge if pituitary function is not blocked by a GnRH-a, probably through an increase in P secretion. Abnormal pattern of luteinizing hormone pulsatility in women with epilepsy

Bilo L; Meo R; Valentino R; Buscaino GA; Striano S; Nappi C Clinica Napoli,

Neurologica. 2a Facolta di Medicina. Universita Via Sergio Pansini 5. 80131 Napoli, ITA

di

FERTIL STERIL 1991 55/4 (705-71 I) Dysfunction of the hypothalamic-pituitary-ovarian axis in epileptic females has been suggested in the latest years. To further elucidate this issue, we assessed reproductive endocrine function in IO normally cycling, drug-free epileptic women and in 5 normal controls, evaluating the basal hormonal profile and

235

luteinizing hormone (LH) pulsatility in the midfollicular phase. Luteinizing hormone pulse frequency was significantly higher in epileptic women with a consequent reduction of the LH interpulse interval. We suggest that epilepsy may interfere with the functional activity of the gonadotropin-releasing hormone pulse generator. The pathogenetic mechanisms for this phenomenon may be the spreading of paroxysmal activity within the hypothalamic areas or, alternatively, a neurotransmitter dysfunction giving rise both to the seizure disorder and to the abnormal LH pulsatile pattern. Luteinizing hormone responses to gonadotropin-releasing hormone and naloxone in menstruating women with type I diabetes of different duration

Coiro V; Volpi R; Capretti Chiodera P

L; Speroni

G; Castelli A;

Chair of Medical Clinic, University of Parma. 43100 Parma, ITA

Via Gramsci 14,

FERTIL STERIL 1991 55/4 (712-716) Luteinizing hormone (LH) responses to gonadotropinreleasing hormone (GnRH) (100 gg injected intravenously (IV) or naloxone (4 mg injected plus 8 mg infused in 2 h IV) were evaluated in 29 women with insulin-dependent diabetes mellitus (IDDM) (duration, group I (n = 15): < IO years, range 3 to 9 years; group II (n = 14): > IO years, range I I to 20 years) and in 15 normal controls, on the 22nd days of normal menstrual cycles. Both GnRH- and naloxone-induced LH responses were similar in group I diabetics and normal controls, whereas they were significantly lower in group II than in group I diabetics or normal controls. Positive correlations were found between LH responses to GnRH and naloxone, whereas negative correlations were observed between maximal LH peaks in response to GnRH or naloxone and duration of diabetes. These data indicate that a hypothalamic pituitary disorder affects LH secretion with time after the onset of IDDM. Treatment of hirsutism by an association of oral cyproterone acetate and transdermal 17&estradiol

Jasonni VM; Bulletti C; Naldi S; Di Cosmo E; Cappuccini F; Flamigni C Reproductive Medicine Unit, University Massarenii, 13, 40138 Bologna, ITA

of

Bologna,

Via

FERTIL STERIL 1991 5514 (742-745) Twenty-four hirsute women were treated with an inversal sequential scheme of cyproterone acetate, 50 mg/d by oral route from the 1st to the 15th day of the menstrual cycle, along with 100 pg/24 h of 17&estradiol transdermally administered from days I to 21, for nine cycles at weekly intervals. The acne and seborrhea as well as hirsutism showed a significant improvement in all subjects studied. The plasma testosterone and dehydroepiandrosterone sulfate decrease from I.5 f I .3 ng/mL and 6.9 & 1.3 &mL to 0.5 f 0.03 ng/mL and 2.7 & I.7 &mL, respectively. Similar values were observed in subjects with idiopathic hirsutism during the treatment. The metabolic parameters, as well as the plasma levels of sex hormone-binding globulin, appeared unaffected by the therapy. Furthermore, the luteinizing hormone and follicle-stimulating hormone secretion Inr J Gynecol 0hste1 37