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Urinary ketosteroids and pregnanetriol in hirsutism
1034
Selected
abstracts
tween T-12 and S-l but the most suitable is generally found to be between L-3 and L-4. As the dura is not punctured there is no risk of damaging the cord. When the ligamenturn flavum is pierced and the extradural space is entered 20 to 30 C.C. of 1.5 per cent LignocaineAdrenaline solution is injected. After 15 to 20 minutes the blood pressure falls to about 80 mm. The patient is then placed in the lithotomy position and the operation commenced. If the blood pressure tends to fall below 100 mm. Hg small doses of norepinephrine are injected. Severe falls in blood pressure occasionally occur but these can be reversed quickly by careful watch of blood pressure and immediate use of norepinephrine intravenously. Total spinal blood block due to injection of a large quantity of local anesthetic into the subarachnoid space is a complication which must be kept in mind. If there is an awareness of the complication, it does not constitute a risk to the patient and cannot be used as an argument against extradural analgesia. The author states that lumbar epidural block is the most satisfactory form of local analgesia for pelvic floor repair. He does not mention the advantage, if any, over caudal analgesia but states that it is no more difficult to adthan a spinal block. Promazine minister (Sparine) seems to have as good a tranquilizing effect as chlorpromazine (Largactil) without the serious falls in blood pressure sometimes seen with this drug. Edward
Solomons
The Journal of Clinical Endocrinology and Metabolism Vol. 20, February, 1960. *Van Wyk, J. J., Dugger, G. S., Newsome, J. F., and Thomas, P. Z.: Effect of Pituitary Stalk Section on Adrenal Function of Women With Breast Cancer, p. 157. “Lipsett, M. B., and Riter, B.: Urinary Ketosteroids and Prcgnanetriol in Hirsutism, p. 180. Van Wyk et al.: Effect of Pituitary Stalk Section on Adrenal Function of Women With Breast Cancer, p. 157. Pituitary stalk section was performed in 26 women with rapidly advancing carcinoma of the breast. A tantalum plate was inserted above the sella to retard revascularization from the hypothalamus. Summarized results of detailed studies of adrenal function both before and after the
operations are given. Many of the patients excreted low or low-normal quantities of 17ketosteroids and 17-hydroxycorticosteroids prior to operation. Following the operation, steroid excretion gradually decreased to the low levels observed in hypopituitarism and characteristic, symptoms of adrenal insufficiency developed. These symptoms were alleviated by the administration of ACTH prednisolone. When substitution therapy was withheld, there was no tendency for urinary steroids to rise and symptoms of adrenal insufficiency recurred. The capacit! of the pituitary-adrenal axis to respond to “stress” was assessed by measurement of the rise in the concentration of plasma 17-hydroxycorticosteroids during an insulin-glucose tolerance test and after the administration of fjacteriaf pyrogen. The response was compared with the response to ACTH. The postoperative response to ACTH was frequently diminished or absent, suggesting that varying dcgreex of adrenal atrophy had occurred. The response to hypoglycemia of pyrogen, however, was usually as great as that obtained by ACTH. J. Edward
Hall
Lipsett
and Riter: Urinary Ketosteroids and Pregnanetriol in Hirsutism, p. 180. The urinary excretion of 17-ketosteroids and pregnanetriol was compared in a group of normal young women and in a group of I1 women whose presenting complaint was hirsutism. Androsteronc, etiocholanolone, dehydroepiandrosterone, 1 1-hydroxyetiocholanolone, 1l-ketoetiocholanolone, and 1 l-hydroxyandrosterone were determined quantitatively by paper chromntography. Among the hirsute women an elevated excretion of androsterone and etiocholanolonc was noted in 6 and of dehydroepiandrosterone in 5. The 1 I-oxyketosteroids tended to be higher in the hirsute group although no statistical significance was attained. Pregnanetriol excretion was normal. Hirsutism may be associated with elevated excretion of ll-deoxyketosteroids, but it is irnpossible to predict clinically which patients will fall into this group. There is little overlap clinically between hirsute women and virilized women. This suggests a qualitative difference iu androgen production. The significance of the association of elevated escretion of androgrn metabolites and hirsutism remains to be determined. J. Edward
Hall
Selected
abstracts
tween T-12 and S-l but the most suitable is generally found to be between L-3 and L-4. As the dura is not punctured there is no risk of damaging the cord. When the ligamenturn flavum is pierced and the extradural space is entered 20 to 30 C.C. of 1.5 per cent LignocaineAdrenaline solution is injected. After 15 to 20 minutes the blood pressure falls to about 80 mm. The patient is then placed in the lithotomy position and the operation commenced. If the blood pressure tends to fall below 100 mm. Hg small doses of norepinephrine are injected. Severe falls in blood pressure occasionally occur but these can be reversed quickly by careful watch of blood pressure and immediate use of norepinephrine intravenously. Total spinal blood block due to injection of a large quantity of local anesthetic into the subarachnoid space is a complication which must be kept in mind. If there is an awareness of the complication, it does not constitute a risk to the patient and cannot be used as an argument against extradural analgesia. The author states that lumbar epidural block is the most satisfactory form of local analgesia for pelvic floor repair. He does not mention the advantage, if any, over caudal analgesia but states that it is no more difficult to adthan a spinal block. Promazine minister (Sparine) seems to have as good a tranquilizing effect as chlorpromazine (Largactil) without the serious falls in blood pressure sometimes seen with this drug. Edward
Solomons
The Journal of Clinical Endocrinology and Metabolism Vol. 20, February, 1960. *Van Wyk, J. J., Dugger, G. S., Newsome, J. F., and Thomas, P. Z.: Effect of Pituitary Stalk Section on Adrenal Function of Women With Breast Cancer, p. 157. “Lipsett, M. B., and Riter, B.: Urinary Ketosteroids and Prcgnanetriol in Hirsutism, p. 180. Van Wyk et al.: Effect of Pituitary Stalk Section on Adrenal Function of Women With Breast Cancer, p. 157. Pituitary stalk section was performed in 26 women with rapidly advancing carcinoma of the breast. A tantalum plate was inserted above the sella to retard revascularization from the hypothalamus. Summarized results of detailed studies of adrenal function both before and after the
operations are given. Many of the patients excreted low or low-normal quantities of 17ketosteroids and 17-hydroxycorticosteroids prior to operation. Following the operation, steroid excretion gradually decreased to the low levels observed in hypopituitarism and characteristic, symptoms of adrenal insufficiency developed. These symptoms were alleviated by the administration of ACTH prednisolone. When substitution therapy was withheld, there was no tendency for urinary steroids to rise and symptoms of adrenal insufficiency recurred. The capacit! of the pituitary-adrenal axis to respond to “stress” was assessed by measurement of the rise in the concentration of plasma 17-hydroxycorticosteroids during an insulin-glucose tolerance test and after the administration of fjacteriaf pyrogen. The response was compared with the response to ACTH. The postoperative response to ACTH was frequently diminished or absent, suggesting that varying dcgreex of adrenal atrophy had occurred. The response to hypoglycemia of pyrogen, however, was usually as great as that obtained by ACTH. J. Edward
Hall
Lipsett
and Riter: Urinary Ketosteroids and Pregnanetriol in Hirsutism, p. 180. The urinary excretion of 17-ketosteroids and pregnanetriol was compared in a group of normal young women and in a group of I1 women whose presenting complaint was hirsutism. Androsteronc, etiocholanolone, dehydroepiandrosterone, 1 1-hydroxyetiocholanolone, 1l-ketoetiocholanolone, and 1 l-hydroxyandrosterone were determined quantitatively by paper chromntography. Among the hirsute women an elevated excretion of androsterone and etiocholanolonc was noted in 6 and of dehydroepiandrosterone in 5. The 1 I-oxyketosteroids tended to be higher in the hirsute group although no statistical significance was attained. Pregnanetriol excretion was normal. Hirsutism may be associated with elevated excretion of ll-deoxyketosteroids, but it is irnpossible to predict clinically which patients will fall into this group. There is little overlap clinically between hirsute women and virilized women. This suggests a qualitative difference iu androgen production. The significance of the association of elevated escretion of androgrn metabolites and hirsutism remains to be determined. J. Edward
Hall