R. Nuran Turksoy

Response of amenorrheic patients with normal serum prolactin to chlorpromazine during administration of human menopausal gonadotropin

To study the effects of graded amounts of estrogens on prolactin (PRL) secretion, PRL response to chlorpromazine (CPZ) during administration of human menopausal gonadotropin (hMG) was determined. A control CPZ test was done prior to initiation of hMG therapy and the test was repeated when endogenous estrogen secretion reached the physiologic range (350 to 400 pg. per milliliter) which stimulates luteinizing hormone surge in the normal ovulatory menstrual cycle. Six euprolactinemic women with secondary amenorrhea were studied. Studies showed that there was no significant change in the mean serum prolactin concentrations during control and repeat CPZ testing procedure (5.8 +/- 2 and 10.8 +/- 2 ng. per milliliter, p less than 0.1). The maximal response of PRL to CPZ was significantly higher during hMG-induced high estrogenic state than during control testing (69.9 and 32.3 ng. per milliliter, p less than 0.01). This findings suggests that endogenous estrogen may play a role in the regulation of serum prolactin concentration during the menstrual cycle.

Further study and characterization of the yellow pigments in follicular fluid that are related to oocyte quality

OBJECTIVE To characterize the 455-nm (yellow) absorbing pigments in human follicular fluid (FF). DESIGN Serum and FF samples obtained from patients undergoing in vitro fertilization were analyzed for carotenoids, bilirubin, and beta-glucuronidase concentrations. Spectrophotometric analysis in the visible spectrum was performed on FF samples, and the delta OD455 absorbance was calculated. RESULTS Thin-layer chromatography confirmed the presence of beta-carotene and bilirubin in FF. The mean (+/- SD) contribution of bilirubin and carotenoids to the FF delta OD455 absorbance was 64% +/- 9.6% and 22.7% +/- 12.1%, respectively. Bilirubin fractions in serum and FF samples were then compared. The median unconjugated bilirubin concentration in FF was lower than that in the serum (0.130 versus 0.288 mg/dL; P < 0.0001). The median conjugated bilirubin concentration was higher in the FF when compared with the serum (0.129 versus 0.101 mg/dL; P = 0.0018). beta-Glucuronidase levels in the FF were significantly lower when compared with serum concentrations. CONCLUSIONS Bilirubin is the major contributor to the FF 455-nm spectrophotometric peak. The higher levels of conjugated bilirubin noted in the FF could in part be explained by the lower levels of beta-glucuronidase.

Testicular Response to Exogenous Gonadotropins in the Syndrome of Feminizing Testes

The steroid response of testes to exogenous gonadotropin administration was studied before castration in a patient with the complete form of the testicular feminization syndrome. Urinary steroid determination were made along with measurements of plasma testosterone during adrenal suppression with dexamethasone and after stimulation with human menopausal gonadotropin (HMG) and HMG plus human chorionic gonadotropin (HCG). Our data provide evidence that the gonads in the testicular feminization syndrome synthesize steroids normally. Estrogens and testosterone are secreted by the testes, and the Leydig cells of the testes are capable of responding to exogenous HMG and HCG stimulation. These findins are consistent with the hypothesis that there is no abnormal testicular steroidogenesis in these genotypic males. Additional evidence is provided that these gonads secrete testosterone in amounts comparable to those of normally functioning testes. Failure of virilization in the presence of androgen secretion as indicated by previous authors is probably the result of a deficiency of androgenic action at the end organs. The presence of sparse pubic and axillary hair in the mother and the finding of the same type of karyotype (46,XY) in a sibling suggest that hereditary factors play a role in this disorder.

Rubella susceptibility of an infertile population

The recent trend reported by the CDC reaffirms that rubella continues to be a health care issue and should be a concern particularly for those who care for women in the childbearing age group. Immunization of all susceptible women will not only offer them protection but reduce the pool of susceptible individuals that can transmit the disease.

Pituitary-Adrenal Responsiveness During Microdose Norethindrone Therapy * †

Tests of pituitary response to metyrapone were administered to 6 healthy females who had been receiving a daily dose (0.350 mg) of norethindrone as an oral contraceptive for 8-12 months. 6 doses of 750 mg oral metyrapone were adminstered every 4 hours. Effect on pituitary response was measured by levels of 17-hydroxycorticoids and 17-ketosteroids excretions in the urine. A significant mean increase (9.4 mg/24 hr) of 17-hydroxycorticoids and an 86% mean increase (7.06 mg/24 hr) of 17-kestosteroids were found 1 day after therapy with normal values (3-10 mg; 6-18 mg) appearing after 2 days. It is concluded that the progestogen norethindrone at minimal contraceptive dose level does not alter the pituitary-adrenal axis.

Diagnostic Evaluation of Hirsutism in Women by Selective Bilateral Adrenal and Ovarian Venous Catheterization*†*Supported in part by General Clinical Research Centers Branch Grant RR-0054.†Presented at the Thirty-Fourth Annual Meeting of The American Fertility Society, March 29 to April 1, 1978, New Orleans, La.

To determine the most significant secretory source of their androgens, 13 hirsute nonvirilized women underwent selective bilateral adrenal and ovarian venous catheterization to obtain effluent blood for the assay of testosterone and delta4-androstenedione. In three patients the testosterone and delta4-androstenedione gradients were significantly greater in the adrenal venous effluents. Testosterone and delta4-androstenedione gradients were significantly greater in the ovarian venous effluents in four patients. In six patients there were no significant differences in the testosterone gradients between the adrenal and ovarian venous effluents. The delta4-androstenedione gradients were greater in the adrenal venous effluents in three of these patients, greater in the ovarian venous effluents in one, and not significantly different in two of these patients. The fact that the measurement of urinary 17-ketosteroid excretion, the suppressibility of peripheral plasma androgens with dexamethasone, and the stimulation of peripheral plasma androgens with human chorionic gonadotropin correlated poorly with the selective catheterization data suggests that the former modalities are imprecise in the diagnostic evaluation of hirsutism in women.