Leslie I. Rose

Serum androgens and depression in women with facial hirsutism

BACKGROUND Studies 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. OBJECTIVE Our 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. METHODS Twenty 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). RESULTS Significant 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. CONCLUSION There 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.

Corticosteroids and adrenal suppression: characterising and avoiding the problem

SummaryGlucocorticoids are used for a variety of illnesses. One of their major complications is suppression of the hypothalamic-pituitary-adrenal axis, rendering a patient unable to respond to stress. The risk of this suppression may be minimised by the use of short-acting glucocorticoid preparations, administration of the entire daily dose in the early morning, use of topical and intra-articular preparations where appropriate, and the use of alternate-day therapy where appropriate. Most importantly, glucocorticoids should be used cautiously when indicated, and the duration of therapy limited as much as possible.

The partial adrenocortical hydroxylase deficiency syndrome in infertile women.

Eighteen infertile women desiring conception were selected for additional diagnostic studies on the basis of clinical evidence of hyperandrogenism characterized by acne and/or facial hirsutism. These 18 patients underwent stimulation tests with adrenocorticotropic hormone which demonstrated the presence of partial adrenocortical hydroxylase deficiences. All patients were then placed on glucocorticoid suppression therapy. Ten patients conceived and, of these, six required no therapy other than prednisone. Four conceived using a combination of prednisone and clomiphene therapy. Of othe eight patients who did not conceive, seven had other significant infertility factors. Therefore, of the patients without other significant fertility factors, 91% conceived. This study demonstrates that partial adrenocortical enzyme defects play a significant role in some women with clinical evidence of hyperandrogenism, and, in such women, either glococorticoid therapy alone or in combination with clomiphene is indicated.

The effect of E. Coli L-asparaginase on oral glucose tolerance and insulin release in man

SummaryTo study the effect of E. Coli L-asparaginase on glucose tolerance and insulin release, 6 patients with neoplastic disease were subjected to 3 hour oral glucose tolerance tests with simultaneous measurement of serum immunoreactive insulin (IRI) levels before and following the intravenous administration of 5000 I. U. L-asparaginase/day for 4 days. Five of the patients exhibited a significant deterioration in glucose tolerance; however, no change was noted in their fasting glucose and IRI levels. The deterioration in glucose tolerance was associated with a decrease in the amount of insulin secreted in the first 30 minutes after the oral glucose load. The total amount of insulin released during the 3 hour test remained unchanged. These studies suggest that L-asparaginase can cause a deterioration of glucose tolerance without accompanying fasting hyperglycaemia. This may be due, in part, to a decrease in glucose-induced insulin release during the first thirty minutes following oral glucose.

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.

Glucose, insulin and lipid parameters in 10,000 m running

SummaryThirteen conditioned athletes were studied before and 5 min after running 10,000 m. This distance was run in an average of 41±4 min. All runners lost weight and accompanying this weight loss was an increase in the serum osmolality in the six runners in which it was measured. There was a significant increase in serum glucose (96±11 mg-% before run; 170±48 mg-% after run) and this increase was inversely correlated with running time. There was also a small, but significant, increase in serum insulin (15±2 ΜU/ml before run; 19±4 ΜU/ml after run). There was no consistent effect of running 10,000 m on serum cholesterol and triglyceride levels and on plasma lipoprotein electrophoresis patterns.

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

BACKGROUND Measurement 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? OBJECTIVE Our 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. METHODS Twenty-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. RESULTS There 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). CONCLUSION Serum 3 alpha-diol G concentrations have no correlation with degree of facial hirsutism and do not provide additional information over the commonly measured androgens.