Jeffrey L. Miller

Serum androgens and depression in women with facial hirsutism

BACKGROUNDnStudies on the psychopathologic aspects of hirsutism are sparse. Attempts to correlate these aspects with either the extent of the facial hirsutism and/or circulating serum androgens are virtually nonexistent. This study evaluates the psychopathologic aspects of hirsutism and correlates these findings with the extent of the facial hirsutism as well as with the circulating serum androgens.nnnOBJECTIVEnOur purpose was to assess the psychopathologic aspects of facial hirsutism and to determine whether any correlation exists between these findings and either the extent of the facial hirsutism or the circulating serum androgens.nnnMETHODSnTwenty consecutive women with facial hirsutism were studied by administration of psychologic tests (DeRogatis Symptom Inventory and the Affects Balance Scale). The results of these tests were correlated with the grade of facial hirsutism as well as serum levels of total testosterone (T), biologically active testosterone (BT), free testosterone (FT), dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEA-S), and androstenedione (A-dione).nnnRESULTSnSignificant levels of depression were found. No correlation was found between the psychopathologic measurements and the extent of facial hirsutism or serum levels of T, DHEA, DHEA-S, and A-dione. Significant correlations were found between depression and serum levels of FT and BT.nnnCONCLUSIONnThere is an increased incidence of depression in facially hirsute women and this correlates with their circulating active testosterone levels and not with the extent of their facial hirsutism.

Failure of Adrenal Scintigraphy to Exhibit 131I Cholesterol Uptake in a CT-Demonstrated, Surgically Proven Aldosteronoma

This is the case of a large 2 x 1.5 cm adrenal tumor demonstrated on CT scan that was proven biochemically and surgically to be an aldosteronoma and that did not concentrate 6-beta(131I)-iodo-methyl-19-norcholesterol (NP-59). Before the publication of this case, all CT-identified aldosteronomas of greater than 1 cm have concentrated NP-59. Previously, an adrenal mass of greater than 1 cm that failed to concentrate NP-59 was excluded from being an aldosteronoma. This concept must be reevaluated with the publication of this case.

Bedtime insulin added to daytime sulfonylureas improves glycemic control in uncontrolled type II diabetes

Background: To evaluate the possible benefits of the addition of intermediate‐acting insulin administered at bedtime to therapy with daytime sulfonylureas in patients with non‐insulin‐dependent diabetes mellitus for whom maximal doses of oral hypoglycemic agents have not been successful.

Low incidence of painless thyroiditis in the Philadelphia area.

Publications from the midwestern region of the United States have demonstrated an incidence of 14-23% of painless thyroiditis in hyperthyroid individuals. This possibly could represent a local phenomenon, and perhaps is not typical for other areas of the country. The 24 hour radioactive iodine uptakes in 152 consecutive hyperthyroid individuals in the Philadelphia area were evaluated. No patient in the series, with clinical and biochemical evidence of hyperthyroidism, had painless thyroiditis. It is concluded that the incidence of painless thyroiditis is markedly lower in the Philadelphia area than in the Midwest regions of the United States.

Testosterone concentrations and oligomenorrhea in women with acne.

Background Androgen excess is frequently associated with oligomenorrhea as well as acne. Oligomenorrhea in hirsute women has been demonstrated to be associated with higher active testosterone levels than found in eumenorrheic hirsute women. This study was designed to evaluate whether similar findings are present in women with acne. Forty‐four consecutive women with acne were evaluated by measuring their levels of total testosterone, biologically active testosterone, and free testosterone. The women with oligomenorrhea and acne had significantly higher levels of biologically active testosterone than those with eumenorrhea and acne. This implies that biological active testosterone should be measured in oligomenorrheic women with acne and, if elevated, consideration should be given to antiandrogen therapy.

Serum androstanediol glucuronide in women with facial hirsutism

BACKGROUNDnMeasurement of serum 5 alpha-androstane-3 alpha, 17 beta-diol glucuronide (3 alpha-diolG) has been proposed as a useful biochemical marker of peripheral androgen metabolism. Is 3 alpha-diol G a useful biochemical marker of peripheral androgen metabolism and does it correlate with degree of facial hirsutism?nnnOBJECTIVEnOur purpose was to assess possible correlation between serum 3 alpha-diol G and degree of facial hirsutism and to compare serum 3 alpha-diol G levels with levels of other commonly measured serum androgens.nnnMETHODSnTwenty-three consecutive women with facial hirsutism were studied, and serum concentrations of 3 alpha-diol G, testosterone (total, free, and biologically active portions), dehydroepiandrosterone sulfate, and androstenedione were measured.nnnRESULTSnThere was no correlation between serum 3 alpha-diol G levels and degree of facial hirsutism. There was a correlation between levels of 3 alpha-diol G and dehydroepiandrosterone sulfate (p less than 0.01), biologically active testosterone (p = 0.01), free free testosterone (p less than 0.02), and androstenedione (p less than 0.05).nnnCONCLUSIONnSerum 3 alpha-diol G concentrations have no correlation with degree of facial hirsutism and do not provide additional information over the commonly measured androgens.

Cost Effectiveness of Routine Gonadotropin and Androgen Measurements in Hirsute Women

Many physicians routinely measure the gonadotropins PRL, LH, and FSH and the androgens dehydroepiandrosterone (DHEA), androstenedione (ADIONE), and testosterone, as well as testosterones biologically active fractions in the evaluation of hirsute women. Is this cost effective? To answer this question, 38 consecutive premenopausal hirsute women were evaluated. Two women each had minor elevations in PRL and FSH, and 11 had minor elevations in LH. Three women had minor elevations in the LH/FSH ratio, and only one was above a ratio of 3, believed to be indicative of polycystic ovarian syndrome. Because these gonadotropin elevations did not correlate with the androgens measured and were of no value in the diagnosis or management of these women, they were not believed to be cost effective. Their routine measurements should be abandoned.

Androgens and oligomenorrhea in hirsute women

A recent study demonstrated that hirsute women with irregular menses had higher levels of serum androgens that hirsute women with regular menses. To investigate this finding, we measured total testosterone, biologically active testosterone, free testosterone, androstenedione, dehydroepiandrosterone, and dehydroepiandrosterone sulfate in 51 hirsute women with regular menses and compared the levels found to those found in 28 hirsute women with oligomenorrhea. There was no significant difference in the degree of facial hirsutism between the two groups. Oligomenorrheic women had significantly higher levels of free testosterone (p less than 0.02) and biologically active testosterone (p less than 0.05). The other androgens did not differ significantly between the two groups. The free fractions of testosterone are the metabolically active forms of the hormone and their levels are a function of the rates of production and clearance of testosterone that are elevated in states of hyperandrogenism. This study confirms that hirsute women with oligomenorrhea have higher levels of free and biologically active testosterone than those with regular menses.

Control of Hyperglycemia with Hyperalimentation Solutions Containing Insulin

T he relationship of hyperglycemia to the chronic complications of diabetes mellitus is a vexing issue, with substantial evidence now linking the degree and duration of hyperglycemia to nephropathy, retinopathy, neuropathy, dermopathy, microvascular disease, and c a t a r a c t s . 1 2 Many of these may not be of concern in short-term hyperglycemia in a critically ill patient. However, osmotic diuresis with resulting dehyxad dration and electrolyte imbalance, impaired wound healing, increased risk of infection, and nutritional compromise are of paramount importance in this acute setting, and may result from uncontrolled hyperglycexad mia. Thus, control of blood glucose concentrations is important in the acute setting. Controversy exists as to what level of hyperglycemia is acceptable; ideally, normal glucose concentrations should be sought. However, in the acutely ill patient the attendant risks of hypoglycemia may cause this goal to be modified. Patients with poorly controlled diabetes mellitus may be malnourished for many reasons. Insulin is required for glucose uptake into the liver, fat, and muscles, and promotes glycogen formation. Insulin promotes anabolism by stimulating protein synthesis and inhibiting proxad tein catabolism. In many patients with hyperglycemia