Christian Lauritzen

The impact of ovarian laser surgery on the gonadotrophin secretion in women with polycystic ovarian disease

To evaluate the effects of ovarian surgery on the deranged episodic gonadotrophin release of women with the poly‐cystic ovarian disease (PCOD), we studied 11 patients with the clinical and endocrinological features of PCOD before and after Iaparoscopic laser coagulations of ovarian surfaces and cysts. During both occasions, blood was collected at 15‐min intervals for 8 h to determine LH and FSH secretory profiles and additionally for 3 h during GnRH Injections (25 pg twice within 2 h) to assess pituitary responsiveness. Serum testosterone, androstendione and oestrogen (oestrone, oestradlol) levels were markedly reduced (P > 0·05 or less) after surgery. Mean LH concentrations declined (P > 0·001), while FSH levels Increased (P > 0·01) following laser treatments. The LH pulse frequencies (by Cluster analysis) did not change after ovarian surgery, but the LH pulse amplitudes were markedly reduced (P > 0·01). Lower (P > 0·05 or less) LH concentrations were attained in response to GnRH challenges, and the stimulated FSH release also tended to decrease after laser treatments. Thus, ovarian surgery In PCOD women resulted in reduced serum sex steroid concentrations and In divergent effects on serum LH and FSH levels. The attenuated pituitary LH responsiveness after ovarian surgery suggests action of sex steroids primarily at the pituitary site, while the Increase In FSH concentrations may be attributed to other factors selectively modulating FSH release.

Gonadotropin Secretion during Aging in Postmenopausal Women

Although chronological aging is known to result in reduced gonadotropin secretion in women, the precise mechanisms to account for this neuroendocrine manifestation are yet obscure. To evaluate the extent to which the pituitary and/or hypothalamus are involved in the process of aging, we aimed at characterizing the unstimulated and GnRH-stimulated gonadotropin secretion in postmenopausal women (PMW) of different ages. Accordingly, 9 younger PMW (mean age: 53.8 years) in their first and 9 older PMW (mean age: 80.3 years) in their 4th decade of life after natural onset of menopause were studied. In both groups, blood was collected at 10-min intervals for 10 h, while GnRH (25 micrograms i.v.) was administered 8 h after initiation of blood samplings. Compared to younger PMW, basal serum concentrations of dehydroepiandrosterone-sulfate were lower (p less than 0.05) in older PMW, while estrogen (estradiol, estrone), androgen (testosterone, androstendione) and sex hormone binding globulin levels were similar. Lower (p less than 0.01) mean LH levels composed of attenuated (p less than 0.05) LH pulse amplitudes and pulse frequencies (as determined by the cluster pulse algorithm) were found in the 8-hour LH secretory profiles of older PMW. Furthermore, the FSH secretion of older PMW was characterized by lower (p less than 0.01) mean FSH levels with lower (p less than 0.05) FSH pulse amplitudes, but not pulse frequencies. The absolute peak concentrations attained and the total amount of LH and FSH released in response to GnRH stimulations were blunted (p less than 0.001) in older PMW.(ABSTRACT TRUNCATED AT 250 WORDS)

The luteinizing hormone pulsatile secretion: Diurnal excursions in normally cycling and postmenopausal women

While numerous investigations have determined characteristics of episodic luteinizing hormone (LH) secretion in women, any diurnal LH rhythmicities during eugonadal and hypogonadal states have not been accurately addressed. Accordingly, blood was sampled at 15-min intervals for 24 h in 45 normally cycling women (16 early follicular (EFP), 14 late follicular (LFP), 15 mid-luteal phase (MLP) women) and in eight postmenopausal women (PMW). Pulse attributes (amplitudes, interpulse intervals) determined in the LH secretory profiles were fitted to cosinor functions to assess diurnal variabilities. In both eugonadal women and PMW, significant (p less than 0.05 or less) diurnal excursions were observed in mean LH levels, with maximal acrophase amplitudes occurring in the EFP and MLP. While these 24-h swings peaked at comparable times (11.00-17.00) during the menstrual cycles, a significant (p less than 0.001) shift in acrophase times to early morning hours (05.30) was noted for PMW. Significant (p less than 0.05 or less) 24-h periodicities were also found for the LH pulse amplitudes. LH pulses were of greater magnitudes during night hours in both cycling women and PMW. A slowing of LH pulses (p less than 0.05 or less) was noted during sleep in EFP and, distinctly, in MLP women. These observations demonstrate diurnal variations in LH secretion and its pulsatile attributes in eugonadal women. Differences in time course and magnitude of these diurnal excursions may be explained by variations in the sex steroid environments. In turn, steroids may modulate other neuroendocrine determinants regulating central time-keepers.

The clinical value of the dehydroepiandrosterone sulfate loading test in normal and pathologic pregnancies

Abstract In 100 normal or pathologic pregnancies in weeks 22 to 45 of gestation the DHA-S loading test was performed by intravenous administration of 50 mg. of DHA-S to the mother and radioimmunologic determinations of unconjugated estrone (E 1 ), estradiol-17β (E 2 ), and estriol (E 3 ), as well as total E 1 and total E 3 . All clinical data obtained from each patient and neonate together with the response curves of all five estrogen fractions were processed by computer analysis and calculated for significant correlations between the test and the course and outcome of the pregnancy. Among the estrogen determinations before DHA-S injection total E 3 correlated best with the condition of the pregnancy and the neonate. The accuracy of prediction was 66 per cent. The highest and most rapid net increases after DHA-S loading were obtained for unconjugated E 2 (mean 482 ± 266 per cent). Both unconjugated and total E 3 showed only minimal rises (mean 76 ± 34.6 and 73.3 ± 35.8 per cent) and were therefore not suitable for evaluation in the test. The best correlations between the DHA-S test and the condition of the neonate were obtained by determination of unconjugated E 1 . The maximal net increase and the percentage increase seemed to be the optimal parameters of the estrogen response curves for evaluation. It is suggested that maternal venous blood be collected before and 15, 60, 120, and 180 minutes after injection of 50 mg. of DHA-S to the mother for determination of unconjugated E 1 . With the help of a score system for easy evaluation of the test a correct prognosis could be made in 82 per cent of our patients compared to only 66 per cent for single E 3 values. It is therefore concluded that the DHA-S loading test is more rapid and reliable in predicting the condition of the fetus compared to one single estriol determination in plasma or urine. The aim of the test is, however, not to replace E 3 determinations but to give additional information in high-risk cases and in unexplained differences between E 3 , HPL, and clinical findings.

Antibodies to human chorionic gonadotropin in humans

Very few observations have been published about the development of antibodies against gonadotropins in the human. Human FSHand hCG-antibodies have been detected in a patient with isolated FSH-deficiency after human menopausal gonadotropin administration [l], or after human menopausal (hMG) and chorionic gonadotropin (hCG) administration in women with hypopituitarism [2]. Recently, antibodies to hCG/LH have been isolated by affinity chromatography from normal human sera, initially detected in post-partum sera. and consecutively found in sera from males, non-pregnant females and children 131. The aim of this investigation was to prove the possible development of antibodies against hCG in some physiological and pathophysiological conditions as well as after application of human chorionic gonadotropin to the female.

The influence of betamethasone on the feto-placental unit: a preliminary report.

RADU IOAN NEGULESCU was born in 1941. 19591965 studies in medicine at the University Medical School Cluj-Napoca, Romania. 1964-1967 internship at the University Clinic Cluj-Napoca and since 1969 resident in obstetrics and gynecology. 1974 Dr. med. sei. after studies on EPH-gestosis. 1975-1976 Humboldtresearch fellow at the Department of Obstetrics and Gynecology, University ofUlm. Current studies on the influence of corticosteroids on the feto-placental unit.

Hyperprolactinemia in anovulatory women. Incidence and endocrine features

This retrospective study covers 496 cases of primary amenorrhea (n = 60), secondary amenorrhea (n = 298), and anovulatory oligomenorrhea (n = 138). The test system for these patients included the determination of basal plasma PRL values, the TRH-test (200 μg TRH i v ), LHRH-test (25 jtig LHRH i v ), antero-posterior and lateral X-ray of the sella, tomography in cases of suspected pituitary tumor and exclusion of other endocrine dysfunctions. In primary amenorrhea, PRL was found generally low at concentrations of 10.6 ± 5.8 ng/ml (mean ± SD) with two exceptions. 230 women with secondary amenorrhea showed normal basal PRL levels (10 ± 5.7 ng/ml), hyperprolactinemia was found in 68 women (23%). From this group, 25 patients (37%) had radiological indications of a pituitary tumor. In these patients, basal PRL levels (mean = 366 ng/ml) were significantly higher than in patients with normal sella findings (mean=92.5 ng/ml, p < 0.005). Hyperprolactinemia was detected in 26 women (19%) with anovulatory oligomenorrhea, but in a significantly lower range than in amenorrhea (p < 0.001). Galactorrhea was found in thirteen women (50%) with milk-leakage in two of them. The TRH-induced PRL release was not discriminative for the diagnosis of prolactinoma. The gonadotropic response after LHRH stimulation evaluated either by comparison to early follicular phase conditions or by the standardized Human-Pituitary-Gonadotropin (HPG)-lndex score showed a significantly higher frequency of “impaired” responses and R 0, R 1 respectively in cases of pituitary tumors and when PRL exceeded 200 ng/ml.

How do androgens affect episodic gonadotrophin secretion in postmenopausal women

In the absence of any significant ovarian oestrogen secretion, as in post-menopausal women, the hypothalamic-pituitary axis may still be influenced by the androgens which continue to be produced. The episodic secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) by postmenopausal women was accordingly assessed following short-term androgen antagonism induced by flutamide, a specific androgen receptor blocker. Blood samples were collected at 10-min intervals for 10 h in nine women before and during flutamide administration (750 mg/day for 6 days) for the determination of gonadotrophin and sex hormone concentrations by radioimmunoassay. On both occasions, 25 micrograms of gonadotrophin-releasing-hormone (GnRH) was injected intravenously 8 h after initiation of the blood collections. Flutamide administration decreased (P less than 0.01 or less) androgen concentrations (testosterone, androstenedione and dehydroepiandrosterone sulphate) in relation to baseline values, but did not alter oestrogen (oestrone and oestradiol) or sex-hormone-binding globulin levels. The LH and FSH pulse characteristics (frequency, amplitude, interpulse interval and transverse mean levels) determined by a cluster algorithm in the gonadotrophin secretory profiles did not differ before and during androgen blockade. By contrast, androgen antagonism increased LH (P less than 0.01) and tended to enhance FSH (P = 0.10) FSH release in response to GnRH stimulation. Hence, short-term androgen receptor blockade with flutamide did not greatly affect episodic gonadotrophin secretion. However, the combined evidence of the enhanced gonadotrophin release observed in response to GnRH stimulation and the unchanged gonadotrophin secretion during androgen antagonism suggests that alterations in the magnitude, but not the frequency, of hypothalamic GnRH release had occurred. Even in the presence of substantial serum androgen concentrations, the gonadotrophin pulse rhythm in hypogonadal women constitutes the maximal-rate GnRH-LH release pattern.

Die gynäkologische Untersuchung

Die Anamnese ist der Schlussel zur Diagnose! Im Rahmen der gesamten Diagnostik kommt ihr sowohl prospektiv als auch retrospektiv ein beachtlicher Stellenwert zu: Prospektiv vermitteln die angegebenen Symptome erste Hinweise fur die Diagnose; retrospektiv lassen sich der objektive Untersuchungsbefund und die subjektiven anamnestischen Angaben um so eher zur Deckung bringen, je genauer die Vorgeschichte erhoben wird. Die dazu notwendige Kooperation der Patientin basiert auf dem Vertrauen zu ihrem Arzt. Dieses Vertrauen hangt aber — das sollte nie vergessen werden — davon ab, welches Urteil sich die Patientin uber ihren Arzt bildet. Fur den Studenten, der in der Ambulanz oder auf einer gynakologischen Abteilung mit der Erhebung der Anamnese betraut wird, bringt gerade diese Tatsache nicht selten Probleme mit sich, weil ihm noch die notwendige Routine und Erfahrung und letzten Endes der Status des Arztes fehlen.

Verletzungen des Genitales

Die 1. Kohabitation (Defloration) fuhrt gewohnlich zu ein- oder mehrfachen Einrissen des Hymenalsaumes, die mit einer leichten Blutung einhergehen konnen, gelegentlich aber so stark bluten, das sie chirurgisch versorgt werden mussen. Einrisse im Bereich des Introitus vaginae und der Klitoris machen infolge der starken Vaskularisation u. U. die Umstechung und Naht erforderlich. Kohabitationsverletzungen bei Vergewaltigung/Notzucht (Stuprum violentum — also Gewaltverbrechen) betreffen am haufigsten die Scheidenwand oder das seitliche Scheidengewolbe und mussen nach Entfernung der Blutkoagula genaht werden. Die vorubergehende Drainage und lokale Applikation von Antibiotika vermindern die Gefahr der Parametritits oder einer aufsteigenden Infektion. Hymenalsaum und Vagina konnen bei einem Stuprum violentum gelegentlich unversehrt bleiben, wahrend der Damm jedoch einreist und der Penis in das rektovaginale Bindegewebe bis zum Rektum unter Zerreisung des Sphincter ani eindringt. Bei Unzucht mit Kindern konnen im Gegensatz zur Notzucht beim Versuch des Koitus Deflorationsverletzungen ausbleiben, da die Dammulde dem Penis nachgibt.