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Biomedical subjects

A Jannì

Publications and source records attributed to A Jannì.

At least 19 recordsLinked to original sources

Extensive clinical experience: relative prevalence of different androgen excess disorders in 950 women referred because of clinical hyperandrogenism.

CONTEXT: We undertook this study to estimate the prevalence of the various androgen excess disorders using the new criteria suggested for the diagnosis of polycystic ovary syndrome (PCOS). SETTING: The study was performed at two endocrine departments at the University of Palermo (Palermo, Italy). PATIENTS: The records of all patients referred between 1980 and 2004 for evaluation of clinical hyperandrogenism were reevaluated. All past diagnoses were reviewed using the actual diagnostic criteria. To be included in this study, the records of the patients had to present the following available data: clinical evaluation of hyperandrogenism, body weight and height, testosterone (T), free T, dehydroepiandrosterone sulfate, 17-hydroxyprogesterone, progesterone, and pelvic sonography. A total of 1226 consecutive patients were seen during the study period, but only the scores of 950 patients satisfied all criteria and were reassessed for the diagnosis. RESULTS: The prevalence of androgen excess disorders was: PCOS, 72.1% (classic anovulatory patients, 56.6%; mild ovulatory patients, 15.5%), idiopathic hyperandrogenism, 15.8%; idiopathic hirsutism, 7.6%; 21-hydroxylase-deficient nonclassic adrenal hyperplasia, 4.3%; and androgen-secreting tumors, 0.2%. Compared with other androgen excess disorders, patients with PCOS had increased body weight whereas nonclassic adrenal hyperplasia patients were younger and more hirsute and had higher serum levels of T, free T, and 17-hydroxyprogesterone. CONCLUSIONS: Classic PCOS is the most common androgen excess disorder. However, mild androgen excess disorders (ovulatory PCOS and idiopathic hyperandrogenism) are also common and, in an endocrine setting, include about 30% of patients with clinical hyperandrogenism.

17-alpha-Hydroxyprogesterone↗

Increased DHEAs levels in PCO syndrome: evidence for the existence of two subgroups of patients.

In 49 patients affected by PCO syndrome the serum levels of dehydroepiandrosterone-sulphate (DHEAs) were determined and correlated with the clinical presentation and the endocrine pattern. Twenty-three patients (47%) had high DHEAs levels (h-DHEAs patients). They presented a milder clinical presentation (low incidence of amenorrhea) than PCO patients with normal DHEAs levels (n-DHEAs patients). In h-DHEAs patients the finding of a normal DHEAs response to ACTH and of slightly increased 170HP serum levels suggested that the elevation of serum DHEAs was not due to an adrenal enzymatic deficiency but to a tonic hyperstimulation of the adrenals. Two subgroups of h-DHEAs patients were identified: in the first subgroup, PRL and estrone levels were increased and probably explained the DHEAs hypersecretion; in the second subgroup, the endocrine pattern was very similar to that observed in n-DHEAs patients and a clear explanation for DHEAs increase was not found, although the possibility of an exaggerated secretion of some pituitary hormones with adrenal androgen stimulating activity must be considered.

Adolescent↗

The prognostic value of thyroid function tests in predominantly non-alcoholic cirrhotic patients: a prospective investigation.

The prognostic value of thyroid function parameters (T3, T4, rT3 and the rT3:T3 ratio) and common liver tests (serum bilirubin, albumin and prothrombin activity) was investigated on hospital admission in 100 consecutive patients with predominantly non-alcoholic liver cirrhosis. Twenty-nine out of 100 patients had a well compensated cirrhosis and their mean values of thyroid tests were similar to those of 40 healthy controls. A low T3 syndrome was found in the remaining 71 decompensated patients. In these thyroid function parameters were correlated with serum bilirubin and prothrombin activity. Moreover mean values of all thyroid and liver tests, except serum albumin, were significantly different between survivors and nonsurvivors at 3 months. To evaluate the best cut-off value which allowed to predict the outcome of patients, the Receiver Operating Characteristics (ROC) curves were generated for each test by plotting the values obtained in survivors at 3 months (true positives) vs nonsurvivors (false positives). By holding the false positive errors within 10%, the highest percentage of true positive results (i.e. patients dead at 3 months) was observed for the rT3:T3 ratio, rT3 and serum bilirubin at a cut-off point of 0.841, 55 ng/dl and 3.5 mg/dl, respectively. According to the above cut-offs the rT3:T3 ratio had the best positive predictive value (74%; 95% confidence limits 60-90%) in comparison to rT3 and bilirubin.

Adult↗

The endocrine pattern of late onset adrenal hyperplasia (21-hydroxylase deficiency).

We describe 5 adult women with severe hirsutism due to late onset 21-hydroxylase deficiency. Diagnosis was performed on the finding of high serum 17-hydroxyprogesterone (17OHP) levels with a marked hyperresponse to an ACTH test. The endocrine study showed in most patients a gonadotropin behavior similar to that observed in classical polycystic ovary (PCO) syndrome. Prolactin levels were slightly increased in basal conditions and presented an exaggerated response to TRH stimulation.

17-alpha-Hydroxyprogesterone↗

Prolactin secretion in polycystic ovary syndrome (PCO): correlation with the steroid pattern.

To evaluate the prevalence of hyperprolactinaemia in PCO patients and its possible correlation with a steroid pattern, we studied prolactin secretion (basal and after TRH stimulation) in 40 women affected by typical PCO. LH, FSH, testosterone, oestradiol, oestrone, DHEA-s and 17-OHP serum levels were also evaluated. Twenty-one patients had prolactin (Prl) values in the normal range both in baseline conditions and after TRH stimulation; 10 patients had normal basal values of Prl but an exaggerated response to TRH stimulation; 9 patients had high Prl basal values and an exaggerated response to TRH. The presence of hyperprolactinaemia was associated with increased serum levels of oestrone (P less than 0.01), DHEA-s (P less than 0.01) and 17-OHP (P less than 0.05). In conclusion, hyperprolactinaemia is as relatively frequent condition which affects almost half the patients suffering from PCO and is probably related to an increase of serum oestrogens, mostly oestrone. Moreover, in patients with PCO and hyperprolactinaemia, the production of some other steroids is also affected.

17-alpha-Hydroxyprogesterone↗

Hypothalamic-pituitary-thyroid axis in acromegaly.

To evaluate the hypothalamic-pituitary-thyroid axis in acromegaly, total and free thyroid hormones and TSH response to TRH were determined in 36 acromegalic patients. In 10 patients, rT3 and thyroxine binding globulin (TBG) were also assayed by radioimmunoassay. In 15 patients the TSH response to TRH was also studied after medical or surgical therapy of the acromegaly. In 34 patients total thyroid hormones were in the normal range whereas two patients had low serum levels of free thyroid hormones. Thirty-two of the acromegalic patients were euthyroid. However, only 43.7% of the euthyroid patients had a normal TSH response to TRH. Nine patients had a reduced TSH rise after TRH, whereas in 4 patients the response was exaggerated and 5 delayed. In all patients studied rT3 and TBG were in the normal range. After medical or surgical therapy of the acromegaly we observed improvement or normalization of the TSH response to TRH. In conclusion, the TSH response to TRH is frequently altered in acromegaly, whereas thyroid function is generally normal. Hypothalamic effects of GH hyperproduction may explain the alterations of TSH secretion in many cases in view of the normalization of TSH secretion after therapy of acromegaly.

Acromegaly↗

Hormones in the seminal plasma. Cortisol.

The data from previous studies on the seminal concentrations of proteic hormones result in the hypothesis that there exists a selective filter for these hormones, which is between the systemic circulation and the male genital canal. Previous data regarding sexual steroids are insufficient to verify if such a filter system also operates in the case of hormones of minor molecular weight. It would appear that the study of cortisol, a non-sexual steroid, will be more useful. The concentrations of this hormone in the peripheric blood (176 +/- 59, mean +/- ds, ng/ml) prove to be much greater than in the seminal plasma (20 +/- 9.6). No significant differences are found between normozoospermic and oligo-azoospermic subjects, either in the blood (173 +/- 184 +/- 53), or in the seminal plasma (21 +/- 12 versus 20 +/- 8). These data would seem to support the hypothesis under discussion.

Humans↗

Male fertility and thyroid hormones.

On the basis of the results in vitro, it seems that the testicle does not respond to the action of the thyroid hormones. The study of the relationship between the blood concentrations of these hormones and the reproductive function of the organ is being made by the Authors as a means of verifying this in vivo. The total blood concentrations of T4, (triioothyronine), and the index of free Thyroxine (IT4L) were therefore evaluated both in normal and infertile subjects. The concentrations of T4 showed a correlation both with the sperm count (r = 0.43, p = less than 0.02), and with the percentage of motile spermatozoa, (r = 0.48, p = less than 0.01). This type of correlation is not found, however, either for the T3 or for the IT4L. These data indicate that the function of the thyroid gland is linked to that of the hypothalamo-hypophyseotesticular axis. It would appear that the peripheric metabolism of the circulating hormones is not involved.

Humans↗

Effect of the acute administration of haloperidol and pimozide on plasma GH levels in acromegaly.

In 11 untreated acromegalic patients the plasma GH levels were determined after the acute administration of bromocriptine, haloperidol, pimozide (only in 8 patients) and of placebo. A 50% or more suppression of the basal GH levels was arbitrarily defined as a positive response to bromocriptine. Five patients displayed a negative response to bromocriptine. Of these, 4 responded to both antidopaminergic drugs. We conclude that the acute administration of antidopaminergic drugs reduces the GH secretion in some bromocriptine-insensitive acromegalic patients. Therapeutical implications will require further studies.

Acromegaly↗

Correlation between pituitary gonadotropin response to GnRH and testicular histology in subjects suffering from dyspermia.

No significant changes of LH in basal conditions and in response to GnRH stimulation were found in any of the subjects studied; the same applies to basal testosterone and testosterone after HCG stimulation. On the other hand, the pituitary response for FSH gonadotropin showed significant variations in the different groups of subjects examined. These variations were closely correlated to the stages at which spermatogenesis was arrested. The earlier the stage of spermatogenetic arrest, the more strongly enhanced the FSH response to GnRH stimulation. Further, the most significant change, and the one most liable to be suited for purposes of diagnosis, was the one observed when passing from the 1st to the 2nd degree arrest (spermatids-spermatocytes). This FSH pattern is a constant finding; so much so that in the view of some authors testicular biopsy can now be avoided in cases with strongly increased pituitary FSH reserve since in these conditions the seminal line has been shown not to go beyond the stage of the spermatocyte.

Adult↗