Elmer L. Sevringhaus

Pituitary gonadotropic extracts for treatment of amenorrhea menorrhagia, and sterility

Abstract From an experience with use of genuine pituitary gonadotropic extracts for seven years, we are reporting examples of the results which may be expected in treating women for primary or secondary amenorrhea, for menorrhagia and irregularity of menstrual cycles, and for relief of sterility. All the syndromes presented here are considered to be the result of underactivity of ovarian hormones, dependent presumably upon underactivity of the anterior pituitary in supplying gonadotropic hormones. For accurate diagnoses and conduct of treatment the use of endometrial biopsy and vaginal epithelial samples secured by pipette, as well as of pregnandiol determinations in urine, are shown to be important aids. If these aids fail to show definite response to treatment, even though menstrual flows are occurring at fairly regular intervals, the treatment may well be increased or abandoned. The use of long series of repeated daily doses, extending for five to 15 days at the beginning of each menstrual cycle, seems necessary and is demonstrated to be safe. Results are not achieved in a single month. This study indicates the need for individualization of dose, and for the preparation of more concentrated pituitary extracts.

Endocrinopathic amenorrhea: Causes and treatment

Abstract Amenorrhea may result from failure of the ovaries to respond to pituitary gonadotropic stimulation, or from deficient pituitary secretion. Ovarian failure is characteristic of the menopause, and is to be treated for symptomatic control only, and by the use of estrogenic substances. Pituitary inadequacy may be substituted for by gonadotropic substances obtained from animal pituitary or from serum of pregnant mares. Hypodermic injections of these extracts are advised in series of five to fifteen doses, during the first two weeks of the menstrual cycle, or at intervals beginning not oftener than every four weeks, to attempt reestablishment of cyclic flowing. Determination of the ability of the ovaries to respond is facilitated by the use of vaginal smears showing the estrogenic effects on vaginal mucosa.

The use of folliculin in involutional states

Abstract In a series of 32 menopausal cases hot flashes occurred in all, paresthesias in 16, insomnia in 19, and psychotic pictures in 17. Obesity was found in only 13, and hypertension in 10. Of this series 6 had artificial climacteric produced by radiation or surgery, and there were 3 patients with a spontaneous premature menopausal picture, possibly to be considered as ovarian insufficiency. The use of simple psychotherapeutic procedures and small doses of folliculin daily or oftener has been found very helpful in the psychotic cases as well as in the simpler vasomotor types and the pseudothyrotoxic types previously reported. Disadvantages of large doses of the hormone are pointed out. The refractory nature of the artificial menopause leads to a discussion of the possible relationships of the pituitary and the ovaries at the age of the climacteric.

The management and treatment of habitual abortion

Abstract Habitual abortion is still one of the most discouraging conditions to deal with in the field of medicine. Spontaneous abortion presents a diversity of causes, such as: abnormalities, displacements, and inflammations of the genital tract; infectious diseases; germ plasm defects; tumors of the genital organs; dietary deficiencies; vitamin deficiencies; many alleged causes indicating serious investigation; and, last, the endocrine system in which the thyroid, ovaries, and pituitary gland are so important. Important chemical investigations in endocrinology as related to the thyroid gland, ovaries, and pituitary gland, coupled with recent experimental data upon function, have been responsible for such advances in therapy as the use of progesterone and progestin-like extracts in the treatment of habitual abortion. It has been very well established in the human being that the corpus luteum remains active until about the fourth month of pregnancy, and then begins to degenerate slowly until about the seventh month, when there remains little evidence of its presence or activity. It has been shown experimentally in animals that the corpus luteum substance is necessary for the maintenance of normal pregnancy. There is every reason to believe that this stabilizing factor is present in the human being until the placenta is a controlling factor. Experimental studies by Falls and his collaborators show very clearly in the human being that the estrogenic substance increases uterine irritability and muscle contraction, and the corpus luteum substance is the antagonistic factor. It was also shown that progesterone nullifies posterior pituitary response. These findings are important in relation to habitual spontaneous abortion and its treatment.