F. Bassi

PLASMA ANDROGENS IN WOMEN WITH HYPERPROLACTINAEMIC AMENORRHOES

Cortisol, androstenedione, testosterone, dehydroepiandrosterone sulphate (DHAS) and free dehydroepiandrosterone (DHA) were measured in plasma of ten women affected by amenorrhoea with hyperprolactinaemia and eleven women affected by secondary hypothalamic amenorrhoea; twelve normal women at the second day of the menstrual cycle were used as controls. All subjects were hospitalized and 17‐ketosteroids, 170H‐corticosteroids and total dehydroepiandrosterone were also measured in urine.

Klinefelter’s syndrome: a study of its hormonal plasma pattern

Plasma testosterone (T), dihydrotestosterone (DHT), 17β-estradiol (E2), 17-hydroxyprogesterone (17-OHP), androstenedione (Δ), dehydroepiandrosterone (DHEA), dehydroepian-drosterone sulphate (DHEAS), 5-androstene-3β-17β-diol (A-diol) and Cortisol (F) have been measured in a group of normal males and in a group of patients with Klinefelter’s syndrome (KS) before and after hCG stimulation. Significantly lower baseline levels of T and DHT and significantly higher baseline levels of E2 were found in patients with KS. No significant differences were found between baseline levels of 17-OHP, Δ, DHEA, DHEAS, A-diol, and F. After hCG stimulation plasma T, DHT, E2 and 17-OHP levels showed a significant increase in the two groups of subjects. The percentage variation of T and DHT, however, was much less important in Klinefelter patients, while E2 and 17-OHP did not show a significantly different pattern from that of normal controls. hCG administration did not produce any significant variation of Δ, DHEA, DHEAS, and F in the two groups of subjects, while A-diol levels increased significantly in normal subjects, but not in Klinefelter patients. Our data may be consistent with the hypothesis that testicular steroidogenesis in Klinefelter patients is impaired below the 21-C-steroid level not only at Δ4 but also at the Δ5 pathway.

Precocious puberty: Auxological criteria discriminating different forms

It may be possible to recognize different forms of precocious puberty at the first evaluation. In a group of 26 sexually precocious girls we used Bayley-Pinneau predicted adult height (P.A.H.) to discriminate patients with ‘poor’ or ‘good’ height prognosis. Patients with evidence of impaired height prognosis (P.A.H. <−1 SDS) (Group 1) were immediately treated with LH-RH analogs, while patients with unimpaired height prognosis (P.A.H. >−1 SDS) (Group 2) were followed without therapy. Two yr of treatment significantly improved P.A.H. in Group 1 patients, from a mean of −1.68±0.4 to a mean of −0.57±0.6 (SDS) (p<0.01). After the 2 yr observation period, Group 2 patients showed no significant variation of P.A.H. (from a mean of 0.45±0.8 to a mean of 0.33±0.6). The retrospective analysis of the growth pattern changes in the two Groups seems to indicate that LH-RH agonist treatment improves height potential in girls with initial poor height prognosis and that girls with initial good height prognosis maintain an unimpaired growth potential.

PLASMA DEHYDROEPIANDROSTERONE SULPHATE IN HYPOTHYROID PREMENOPAUSAL WOMEN

Plasma dehydroepiandrosterone sulphate (DHEAS), cortisol (F) and prolactin (PRL) were measured in seventeen premenopausal women with primary hypothyroidism and in fifteen normal premenopausal women. Significantly lower (P < 0·001) DHEAS levels were found in hypothyroid women while F and PRL were in the range of normal controls. No significant relation was found between DHEAS and total thyroxine (T4) and TSH. Our results support the hypothesis that DHEAS secretion is impaired in some women with primary hypothyroidism.

Oxandrolone in constitutional delay of growth: Analisys of the growth patterns up to final stature

In order to evaluate the effects of low-dosage, 6–12 months course of oxandrolone treatment in constitutional delay of growth, we compared the growth responses on treatment, the pattern of sexual development and pubertal growth events, up to final stature of 11 prepubertal boys, aged 10.6–14.1 yr, with those of 11 prepubertal, age-matched untreated controls. Treatment caused a significant increase of height velocity, from 4 to 9 cm/yr, and a significant acceleration of bone maturation, without affecting the timing of onset of puberty, the progression of sexual development or the onset of pubertal growth spurt. On the other hand, oxandrolone induced an earlier skeletal growth arrest but did not affect the expected final height. Treated boys showed an adult stature not significantly different from that of control subjects. Our data suggest that 6 months-1 year, low dosage oxandrolone treatment in constitutionally delayed growth has no significant effect on the pattern of pubertal growth, nor on the rate of sexual maturation or on final height.

Breast development in adolescent girls

Abstract Pubertal breast maturation is usually evaluated according to Tanner stages; however, this morphological appraisal is not strictly related to actual glandular growth. In 48 normal pubertal girls with breast development from B, to B4, comparison of data regarding Tanners stages, mammary dimensions, breast echo-structures, and serum and urinary estrogen levels were studied. Ultrasonography allows an accurate morphostructural study of the developing breast, so that a new ultrasonographic grading of mammary growth emerged that was closely related to growing estrogen levels.

Usefulness of early morning urine estrone-3-glucuronide assay in the monitoring ovarian secretory function in precocious puberty

To evaluate the usefulness of the urinary estrone-3-glucuronide (EI-3-G) in the monitoring of the ovarian function in girls, we studied 11 girls with idiopathic central precocious puberty (ICPP) treated with LHRH analogs (LHRHa) for 2–5 years. Plasma LH, FSH, 17 -ß-Estradiol (E2) levels, early morning urine (EMU) E1-3-G concentrations, were assessed before and 3, 6,12 months after the onset of treatment. As expected, mean basal plasma LH, FSH and E2 concentrations, as well as mean basal EMU E1-3-G levels were significantly (p<0.01) higher in patients studied than in normal, age matched, prepubertal controls. Three out of the 11 sexually advanced girls showed undetectable (<15 pg/ml) basal plasma E2 values. On the contrary, in each patient studied, individual basal EI-3-G levels were higher than in normal age-matched prepubertal girls. LHRHa treatment significantly suppressed both basal and peak stimulated plasma gonadotropins, plasma E2 and EMU E1-3-G. However, while serum E2 levels were below the assay detection limit, not allowing to assess the degree of gonadal suppression, E1-3-G urinary concentrations were detectable in each subject treated, in the range of the normal prepubertal values. EMU E1-3-G determination seems to be a very sensitive and reliable approach to the monitoring of the effectiveness of LHRHa treatment in sexually advanced girls, allowing to detect very low estrogen concentrations and to achieve the desired ovarian suppression.

Steroid secretion by the prepubertal human testis.

It has been demonstrated that the human testis secretes testosterone and, to a smaller extent and less constantly, also androstenedione. Testosterone, progesterone, 17 alpha-hydroxyprogesterone and 20 alpha-dihydroprogesterone have been measured in the spermatic and peripheral venous blood of prepubertal boys undergoing surgery for undescended testis or inguinal hernia repair. The spermatic plasma levels of testosterone and progesterone were significantly higher than peripheral levels. A significant spermatic-peripheral gradient was not found for 17 alpha-hydroxyprogesterone and 20 alpha-dihydroprogesterone. These studies demonstrate that the secretory pattern of the human prepubertal testis is different from that of the adults.