Fred Benjamin

Plasma levels of fractionated estrogens and pituitary hormones in endometrial carcinoma

Plasma levels of estrone (E1), estradiol-17beta (E2), and estriol (E3), as well as follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin were measured in 30 control subjects and in 20 postmenopausal patients with adenocarcinoma of the endometrium. Within the sensitivity of the assay (5 to 10 pg.), no E3 was found. Mean levels of E1 and E2 in the patients with carcinoma (42.64+/-3.8 (S.E.M.) and 17.3+/-1.7 (S.E.M.) pg. per mililiter) were significantly higher than those measured in the control subjects (E1=26.97+/-2.4 (S.E.M.) pg. per mililiter, p less than 0.001; E2=12.08+/-1.2 (S.E.M.) pg. per milliliter, p less than 0.02). Effects of age, diabetic status, and obesity were taken into consideration. Significant differences in FSH and marginally significant differences in prolactin levels were observed between the two groups. Mean levels of FSH, LH, and prolactin in the control group and the group with adenocarcinoma, respectively, were as follows: FSH=152.3+/-7.0 (S.E.M.) versus 98.1+/-8.9 (S.E.M.) mI.U. per milliliter, p less than 0.001; LH=64.7+/-3.1 (S.E.M.) versus 66.5+/-5.2 mI.U. per milliliter, difference not significant; and prolactin=14.3+/-0.9 (S.E.M.) versus 17.8+/1.7 (S.E.M.) ng. per milliliter, p less than 0.06. These results, as well as previously reported alterations in human growth hormone secretion, suggest aberrations in hypothalamic function in endometrial carcinoma.

The correlation of serum estrogens and androgens with bone density in the late postmenopause

A pilot group of 16 women in the late postmenopause were evaluated for bone density by computerized axial tomography (CT) scanning and for hormonal milieu. A highly statistically significant positive correlation between lumbar‐3 spongiosum density and both dehydroepiandrosterone‐sulfate (DHEA‐S), r = 0.67; P < 0.005 and androstenedione (A), r = 0.56; P < 0.03 was found. No such correlations were observed with estradiol (E2), estrone (E1) or an array of other hormones. The results of this preliminary report indicate a clear association of weak androgens with bone density in the late postmenopause.

Prevalence of and markers for the attenuated form of congenital adrenal hyperplasia and hyperprolactinemia masquerading as polycystic ovarian disease

To determine the prevalence of the attenuated form of congenital adrenal hyperplasia (CAH) and hyperprolactinemia (HPPN) relative to polycystic ovarian disease (PCOD), 100 consecutive women presenting with the classic clinical features of PCOD were evaluated by basal hormonal profiles and subsequent adrenocorticotropic hormone (ACTH) stimulation tests. The study also sought biochemical markers for CAH other than ACTH stimulation. The prevalences were found to be as follows: PCOD, 65%; PCOD with HPPN, 9%; HPPN, 3%, end-organ hypersensitivity (EOH), 4%; homozygotic CAH, 4%; and heterozygotic CAH, 15%. Other than the differential response to ACTH, the only other biochemical markers observed for homozygotic CAH were significantly higher basal levels of testosterone (T) and 17 alpha-hydroxyprogesterone (17-OHP). Luteinizing hormone/follicle-stimulating hormone ratio, androstenedione, and dehydroepiandrosterone sulfate all showed no significant differences between homozygotic CAH, heterozygotic CAH, HPPN, PCOD, and EOH. This study establishes the relative prevalences of the syndromes commonly mimicking PCOD. We also conclude that the observed low incidence of CAH does not justify routine ACTH testing on all patients presenting with features of PCOD--however, our data suggest that patients with basal serum levels of T and 17-OHP greater than 50% above the upper limit of normal should undergo this dynamic test, especially if there are also certain clinical features suggestive of CAH.

Solid ovarian teratoma with peritoneal and abdominal wall implants, progressive in vivo maturation, and probable cure

Abstract Progressive in vivo maturation from immature to mature tissue occurred in a case of solid ovarian tumor with peritoneal and abdominal wall implants. Apparent cure occurred after conservative surgery without irradiation or chemotherapy. The history and therapy of such tumors is discussed.

Management of the abnormal cervical smear and carcinoma in situ of the cervix during pregnancy

Abstract A series of 286 abnormal cervical smears and 42 cases of carcinoma in situ of the cervix during pregnancy is presented. Multiple biopsies were performed on all the patients with abnormal smears, and, additionally, conizations were done when the biopsy yielded carcinoma in situ. Three cases of invasive carcinoma were found, all having been diagnosed by biopsy alone. In this series of 286 abnormal smears, subsequent conization did not yield any invasive carcinomas that had not been diagnosed from the biopsies. These data suggest that even when colposcopy is available multiple biopsies rather than conization should be the routine procedure when abnormal smears are found during pregnancy. Because of the serious complications associated with conization during pregnancy, this procedure should seldom be done and should be limited to carefully selected and specific cases.

Immunoreactive Plasma Estrogens and Vaginal Hormone Cytology in Postmenopausal Women

The vaginal hormone cytology and the serum estrogen levels (as determined by radioimmunoassay) of 39 postmenopausal patients were compared. All cytologic parameters showed high statistical correlations with radioimmunoassay values, but these general associations could not be applied to individual patients. A more detailed analysis showed that an atrophic smear (eg, karyopyknotic index [KI], <10%; parabasal level, >20%; maturation value [MV], <40%) indicate estrogen deficiency in the postmenopause. When the KI is 20%‐40%, the parabasal cells less than 20% or the MV 40%‐60%, the evaluation of estrogen status, on the basis of hormone cytology alone, is indeterminate. The three cytologic indices studied seem much more useful for detecting estrogen deficiency than estrogen excess in the postmenopause. The fact that immunochemical characteristics are not always related to biologic behavior must also be considered when interpreting these findings.

The influence of maternal human growth hormone secretion on the weight of the newborn infant

Abstract Human growth hormone (HGH) secretion, as determined by the response to insulin-induced hypoglycemia, was studied in a large series of patients who had been delivered of babies of different birth weights. Only patients who were strictly comparable were used in the final tabulation of the results. The latter consisted of 22 patients whose infants weighed less than 8 pounds, 20 patients with infants of 8 to 9 pounds, and 19 patients with infants of more than 9 pounds. The fasting and poststimulation serum levels of HGH were not significantly different in the 3 groups. This study supports the view that maternal HGH does not play a role in the birth weight of the newborn infant.

Comparison of the adrenocorticotropic hormone stimulation test with and without prior dexamethasone suppression in the diagnosis of congenital adrenal hyperplasia

A comparison was made of the ACTH stimulation test with and without prior dexamethasone suppression in 10 patients, each of whom served as her own control. It was found that it is not necessary to administer DEX before the test, the specificity and sensitivity of both tests being the same in the diagnosis of CAH, although the calculated values are lower when DEX is given. Further investigation with HLA typing and ACTH stimulation testing is necessary to establish whether either or both types of ACTH stimulation tests are capable of discriminating between the heterozygotic and homozygotic varieties of CAH.

Cesarean hysterectomy in the treatment of carcinoma in situ of the cervix diagnosed during pregnancy.

Abstract A series of 42 cases of carcinoma in situ of the cervix during pregnancy is presented. Hysterectomy was the mode of treatment in 24, and 7 of these were cesarean hysterectomies. The use of cesarean hysterectomy in the treatment of carcinoma in situ of the cervix during pregnancy is discussed. A simple technique for performing this latter type of operation is described which allows complete removal of the cervix and helps to diminish complications. No complications were encountered in this series. This suggests that cesarean hysterectomy, performed by the technique described in this report, warrants more consideration as one of the methods of treating selected cases of carcinoma in situ of the cervix during pregnancy.

Use of l-dopa (l-dihydroxyphenylalanine) to stimulate ovulation

This study was prompted by previous experimental data which suggested that l -dopa may be useful clinically in treating anovulation and oligoamenorrhea due to hypothalamic-pituitary hypofunction of nonorganic origin. Six such patients, who had failed to respond to clomiphene therapy but who had previously ovulated and become pregnant following the administration of human pituitary gonadotropins, were treated with 2 Gm. of l -dopa daily for 3 months. There was no response in 3 patients. The remaining 3 patients showed evidence of increased gonadotropin and estrogen activity. However, follicular maturation did not reach the level necessary to trigger ovulation, even with the addition of human chorionic gonadotropin. These data indicated that in the manner used in this study l -dopa is not useful clinically in hypogonadotropism.