Howard R. Nankin

Paternal Transmission of Maleness in XX Human Beings

Abstract Phenotypic maleness was observed in a 7 1/2-year-old child and his father with an XY karyotype. Two brothers and a paternal uncle were found to have an XX sex-chromosome constitution. The ...

Serum prolactin in patients with inappropriate lactation

Abstract Serum prolactin (HPRL) was evaluated with a specific double-antibody radioimmunoassay in 50 women with inappropriate lactation. The results allowed classification of patients on the basis of the basal prolactin values. Nineteen of the patients (38 per cent) had elevated serum HPRL values, and all 19 had amenorrhea. In this group there was increased incidence of endocrine dysfunction. In 31 patients (62 per cent), serum HPRL was normal, and in one half menstruation was occurring. It follows that elevated HPRL levels should be an indication for extensive investigation and follow-up. Synthetic thyroid-releasing factor was given to 6 selected individuals (5 with elevated basal HPRL levels). An exaggerated HPRL response was found in 3, and a poor response occurred in one of the patients tested. These findings appear to be related to the degree of pituitary reserve and hypothalmic control.

Pituitary Gonadotropin Response in Women with Idiopathic Hyperprolactinemia

Inappropriate lactation and idiopathic hyperprolactinemia are frequently associated with amenorrhea. In these individuals, peripheral levels of follicle-stimulating hormone (hFSH) are usually normal, and luteinizing hormone (hLH) levels are often found in the low-normal range. The present study was undertaken to evaluate the functional capacity of the pituitary by the response of hFSH and hLH to synthetic gonadotropin-releasing hormone (Gn-RH). Six women with amenorrhea, inappropriate breast secretion, and idiopathic hyperprolactinemia (prolactin levels ranged from 45 to 355 ng/ml) were given 100 mug of Gn-RH intramuscularly. Serum hFSH and hLH levels were assessed in samples obtained at 15-minute intervals over the next 2-hour period. Initial hFSH levels were normal in all women, with a mean of 242 +/- 72 ng/ml. The absolute increase after Gn-RH administration averaged 486 +/- 193 ng/ml. Serum hLH was below normal in three of the six women, and normal in the remaining three women initially. The absolute increase averaged 1308 +/- 315 ng/ml. The greatest percentage increase in hLH was found in the women with the subnormal basal titers. In these women, hLH rose from a mean of 22 ng/ml to a mean of 1092 ng/ml. These data demonstate an exaggerated increase in hFSH and hLH levels after exogenous Gn-RH administration. This suggests that the amenorrhea associated with elevated serum prolactin levels is principally of hypothalamic origin.

Correlation between sexual maturation and serum gonadotropins: comparison of black and white youngsters.

Clinical staging of maturation in 487 white (232 male) and 239 black (166 male) youths was compared with serum gonadotropin levels. Gonadotropin patterns were similar in both male groups. Luteinizing hormone (LH) rose progressively with maturation. It is uncertain if LH plateaus in pubertal males. Mean follicle stimulating hormone (FSH) titers plateaued by mid to late puberty in both races. In both female groups mean LH concentrations reached a plateau by midpuberty. No female (more than 65 were menstruating) had LH titers in the range found during midcycle surges of adult women. FSH average titers in the white females rose until midpuberty and subsequently plateaued at lower concentrations. In contrast, in the black females there were no statistical differences between mean FSH titers at all pubertal stages. Pubertal black females seemed to have higher FSH titers during maturation than did pubertal white females. There was considerable overlap of ranges of both gonadotropins, in both races, in both sexes, at all stages of maturation. Except for LH in males, gonadotropins plateaued during puberty, suggesting that titers of FSH in both sexes and LH in females reach adult levels before full maturation.

Assessment of Gonadotropin Therapy in Infertile Males

Although human follicle-stimulating hormone (FSH) has been demonstrated to be effective in the initiation or restoration of human spermatogenesis (1), its use in the treatment of male infertility has had variable results (2). Various reports indicate that FSH has no effect on steroid biosynthesis in the testis (3,4) while others suggest a stimulating effect on testosterone and estrogen production (5). The present investigation was carried out to test the effect of a human FSH preparation on males with infertility of varying pathogenesis. In addition to following the response of the sperm count, the study included assay of pituitary and gonadal hormones in blood and urine and investigation of bio-synthetic pathways in small amounts of testicular tissue obtained at biopsy. Criteria were sought for grouping infertile patients in relation to response to therapy.