Paul E. Lebech

Testicular feminization syndrome and associated gonadal tumors in Denmark

We studied the incidence of testicular feminization syndrome in Denmark over a 7‐year period and found it to be about 1:20,400. Twenty‐one patients are described in greater detail. Four patients had gonadal tumors, none of these being malignant. Ten patients (47.6%) had inguinal hernias in early childhood. All patients but one were gonadectomized. Eleven patients (52.4%) disclosed signs of partial androgen function. Only 5 of them had their gonads removed immediately.

Metabolic changes during the normal menstrual cycle: a longitudinal study.

Abstract The effect of sex hormones on lipid metabolism and coagulation during the menstrual cycle was studied in 37 women. Each woman had three samples drawn, corresponding to the follicular phase, midcycle, and the luteal phase. Basal conditions were obtained by taking samples in the morning while subjects were still in bed. No changes were found in lipids and lipoproteins during the menstrual cycle. Antithrombin III and factor VII of the coagulation system did not change throughout the cycle. Fibrinogen increased in the luteal phase, and all samples of fibrinogen correlated positively with progesterone concentration. This increase, therefore, could be a progesterogenic effect. In conclusion, these findings suggest that when studied optimally no changes in lipids and lipoproteins are found and that the day of blood samples is of minor importance, for instance, when used as a control in studies of oral contraceptives. For investigations on some coagulation parameters, the days of the cycle may be of importance. (Am J Obstet Gynecol 1990;163:414-416.)

A Study of Endocrine Function in the Treatment of Benign Prostatic Hypertrophy with Megestrol Acetate

According to Flocks (1964) at least 65 per cent of the American male population over 60 years old suffer from Benign Prostatic Hypertrophy (BPH) and, in a selected group of Danish male patients, Lund (1959) found symptoms of BPH in 43 per cent over the age of 65. This will serve to explain the large number of reports published on the use of drug therapy, a great many of which deal with the administration of hormones. Such an approach has been widely advocated on the basis that BPH, to a certain extent at least, is an endocrine disorder. The aetiology of BPH has been the subject of many clinical studies and animal experiments but no final conclusions have been arrived at as yet. According to Price ( 1963) some of the difficulties encountered arise because of the differences in the development and function of the prostate between one species and another, making it impossible to apply the results gained in animal experiments directly to human patients. One feature common to all is, however, the fact that the development, growth and function of the prostate gland is controlled by the sex hormones. The human prostate may, according to the collecting ducts, be divided into 5 lobes: one ventral, two lateral, one median and one dorsal. Andrews (1951 ) has demonstrated that the dorsal lobe is particularly sensitive to androgen, the median lobe to oestrogen, the two lateral to both hormones, while the ventral lobe is non-sensitive. Franks ( 1954) has made a review of the available literature on the etiology of BPH and maintains that undoubtedly it develops in “the inner gland”-the median and the lateral lobes, which comprise that part of the prostate which is sensitive to oestrogen. There is still

The post-operative gonadotropin level in post-menopausal women with epithelial ovarian cancer

Serial estimates of the post-operative hormone levels were made in 15 women subjected to oophorectomy because of ovarian carcinoma. All women were post-menopausal. Pre-operatively, they had significantly lower follicle stimulating hormone (FSH) levels compared with an age-matched control group. Blood samples were collected after a median time of 8 months (139-378 days). After oophorectomy, significantly higher FSH values were found (P = 0.0002), whereas the luteinizing hormone (LH) values were not significantly changed. The inhibin, estradiol and progesterone values were found to be significantly lowered compared with the pre-operative sample. Total and unbound testosterone levels were significantly lower while dehydroepiandrosterone sulphate (DHEAS) and androstenedione levels were unchanged compared with the original sample and compared with controls. Most likely, estradiol and progesterone are produced by the epithelial malignant tumors, as the post-operative values are completely comparable with the primarily included healthy controls. The FSH is suppressed by inhibin and only to a minor degree by the steroid hormones as indicated by the correlation coefficients. Of great interest is the question whether inhibin production is random, or defensive, lowering the gonadotropin levels or influencing tumor growth in some hitherto unknown fashion.

The effects of small doses of megestrol acetate on the cervical mucus.

This paper deals with those factors of the cervical secretion which could be evaluated quantitatively. 17 parous women were examined daily from Days 8 or 10 of the cycle until 1 or 2 days after the rise in basal body temperature. Examinations were done first in a control cycle then in a treated cycle; doses were 1 tablet of .05 mg or megestrol acetate per day. Mucus was aspirated from the cervix into a small capillary tube. PH was determined in the cervical canal by a glass electrode. Viscosity was measured by a specially designed vacuum device. Values varied markedly during the cycles. Sperm penetration into the mucus was measured by a modified Kremen technique. Dry matter and sodium and potassium content were determined. To determine ovulation pregnanediol excretion and typical changes in karyopyknotic index (KI) were determined. Treatment with megestrol acetate caused the secretion of cervical mucus to diminish but the cell count tended to increase. PH continued at about 7. Elasticity of mucus became higher during treatment particularly with the higher dose. This decreased sperm penetration. The content of dry matter was higher than in the control cycle. Sodium content of dry matter remained constant. Potassium content increased slightly with treatment possibly due to increase in cell content. The KI was below normal in treated cycles. These methods are considered needed in establishing the optimum dose of megestrol acetate.

Present Status of Aid and Sperm Banks in Denmark

Twelve years ago only a few births following artificial insemination with donor semen(AID) had been recorded in Denmark(population 5.1 million), while today the number exceeds 1000. Interest in AID continues tc increase and the response may be assessed in different ways. About 33,000 couples of a fertile age marry each year. Almost 10% of them are expected to be infertile and of this percentage the cause is male infertility in about one-third to one-half. On the basis of interviews with such couples, we estimate that about half of them wish to utilize AID which means about 500 couples a year. Furthermore, there must be some accumulation from previous years, and of course a number of couples want more than one child by AID.