Larry R. Boots

Adrenocortical secretion of dehydroepiandrosterone in healthy women: highly variable response to adrenocorticotropin.

Excess adrenal androgen (AA) levels are observed in 25--50% of women with the polycystic ovary syndrome (PCOS), and AA excess in PCOS may represent selection bias. Thus, it is possible that AA secretion among the general population is highly variable, and that those women who are predisposed to secreting greater amounts of AA have a greater probability of having PCOS. We now hypothesize that the levels of AAs are highly variable among normal nonhyperandrogenic women, and that this heterogeneity is the result of a variable response of AAs to ACTH stimulation. To test this hypothesis we prospectively studied the response of dehydroepiandrosterone (DHA) and cortisol (F) to a 60-min acute stimulation with ACTH-(1--24) in 56 healthy eumenorrheic nonhirsute healthy women with a mean age of 28.9 yr (range, 20--37 yr.) and a mean body mass index (BMI) of 29.2 kg/m(2) (18.2--46.2 kg/m(2)). Baseline samples and poststimulation samples were assayed for DHA and F. The basal and ACTH-stimulated levels of DHA, but not those of F, were negatively correlated with age, although neither the basal nor ACTH-stimulated responses of DHA and F varied with BMI. After controlling for age, the basal F level was negatively correlated to its net increment (i.e. Delta F; r = -0.54; P < 0.001), whereas there was no significant relationship between basal DHA and Delta DHA. We also compared the intersubject variability (coefficient of variation) for basal and stimulated levels of DHA and F. For basal (DHA(0)), 60 min (DHA(60)), and net increment in (Delta DHA) DHA levels, the coefficients of variation were 67.9%, 61.4%, and 76.0%, respectively; for F(0), F(60), and Delta F, they were 40.4%, 16.9%, and 31.3%, respectively. The variance in Delta DHA was significantly higher, and the variance in F(60) was significantly lower than that in all other variables; DHA(0), DHA(60), F(0), and Delta F had similar variances. In conclusion, in our population of healthy reproductive-aged women we observed that both basal and ACTH-stimulated levels of DHA after ACTH-(1--24) stimulation had significantly greater intersubject variance (approximately 60--70%) compared with the basal and poststimulation levels of F (approximately 15--40%). These data support the hypothesis that among normal women, AA (i.e. DHA) levels are highly variable compared to those of F. In addition, the intersubject variability in DHA levels is at least in part due to a variable response of AAs to ACTH stimulation. Whether the AA excess frequently observed in PCOS is due to the greater risk of those women with higher AA levels, basally and after ACTH stimulation, remains to be confirmed.

Assessment of Pituitary Function in Patients with Serum Prolactin Levels Greater than 100 ng/ml

Twelve women with galactorrhea-amenorrhea and prolactin levels greater than 100 ng/ml were evaluated with dynamic pituitary challenge testing. Forty-two per cent of the patients had positive findings on polytomography and subsequent surgical confirmation of a pituitary tumor. Patients with tumors had a delayed elevation of growth hormone (GH) and cortisol following induction of insulin hypoglycemia. Patients had increased thyroid-stimulating hormone levels after injection of thyrotropin-releasing factor, but showed blunting of prolactin secretion. Patients with tumors had decreased basal levels of GH and showed a blunted response to luteinizing hormone-releasing hormone (LRF) stimulation. These patients had normal elevations of follicle-stimulating hormone after LRF challenge. Patients with tumors showed a delay in elevation of GH levels following l-dopa treatment. They also failed to show prolactin suppression following this treatment. There are consistently predictive changes that occur in pituitary functions in the presence of a pituitary tumor. However, absolute prolactin levels and sellar polytomography are more reliable in diagnosing the presence of a pituitary tumor in the patient with galactorrhea-amenorrhea.

Selected Coenzymes and Vitamin Values in the Female Baboon

Laboratory assessment of folic acid, vitamin B12, ascorbic acid, carotene, vitamin A, thiamin, riboflavin, and vitamin B6 levels in the plasma or erythrocytes of normally cycling female baboons is reported. The laboratory methods are discussed and comparative data from humans are presented.

Endocrinology of the maternal-fetoplacental unit: I. Use of serum estrogens as a practical index of fetal well-being☆☆☆

Abstract A serum estrogen assay was evaluated for use in an indigent population in terms of its practicality as well as accuracy, precision, and other statistical parameters. Seventy patients were chosen retrospectively from the obstetric high-risk clinic at the University of Alabama Medical Center on the basis of delivery of a normal infant (Apgar score of 7 or greater). Twenty-four-hour total urinary estrogen (UE), the estrogen/creatinine ratio (E/C), and serum estrogen (SE) were determined on these patients throughout the third trimester of pregnancy. Correlation coefficients for 218 paired samples were highly significant ( p r = 0.31), SE and E/C ( r = 0.28), and UE and E/C r = 0.72). The over-all means and standard deviations for UE, E/C, and SE, respectively, were 27.5 ± 15.3 mg. per 24 hours, 22.1 ± 11.2 mg. per gram, and 26.0 ± 11.6 ng. per milliliter while the equations for the best-fit regressions were y=−31.94 + 1.79x, −30.37 + 1.57x, and −16.46 + 1.26x, demonstrating that the rise in weekly SE levels is slower than for UE parameters. Since only one case of overscreening existed in 70 patients, it can be concluded that SE is a most useful clinical aid in screening the high-risk obstetric population for indications of possible fetal compromise. This assay system has the necessary practicability to be useful under the conditions presented by an indigent population seen predominantly as outpatients.

Localization of choriocarcinoma by 131I-βHCG antibody

Abstract A patient is presented who was cured surgically of metastatic gestational trophoblastic disease (GTD), of high-risk category, after the localization of tumor by radioactive antibody to HCG. The patient was initially treated with hysterectomy and resection of involved bowel; disease recurred, and conventional triple-agent chemotherapy failed, as well as less established multidrug reginens. Rabbit antibody to β-HCG was labeled with 131 I and injected into the patient. Scintigrams localized the metastatic disease, allowing resection and cure. This methodology may offer a potential means of utilizing surgery to cure select patients who have failed triple-agent therapy and whose prognosis is poor if treated conventionally.