Late-onset congenital adrenal hyperplasia.
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17-alpha-Hydroxyprogesterone↗
Biomedical subjects
C Panitsa-Faflia
Publications and source records attributed to C Panitsa-Faflia.
Clinical syndromes of primary amenorrhea.
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Adolescent↗
24-hour secretion of growth hormone (GH), insulin-like growth factors-I and -II (IGF-I, -II), prolactin (PRL) and thyrotropin (TSH) in young adults of normal and tall stature.
Studies of the growth hormone (GH) secretory dynamics of children with normal and idiopathic short stature (ISS) have revealed that the regulation of the GH-somatomedin (GHS) axis can differ significantly among normal individuals. Information on the GH secretion in idiopathic tall stature (ITS) is scarce. We previously showed that the GH response to stimulation with GH-releasing hormone (GHRH) in male, late adolescents and young adults with ITS is significantly greater than that of their sex and age-matched controls of average height. In the present study, we studied the 24-hour (hr) GH, insulin-like growth factor-I and -II (IGF-I and -II), prolactin (PRL) and thyroid-stimulating hormone (TSH) secretion by every 30 minutes (min) sampling in 12 young, healthy male Greek army recruits. Group I [n = 6, age 22 + 1.4 years (y.), mean + standard deviation (SD)] had a height of 198.5 + 4.2cm, at least 3 SD's above the mean of the Greek male population. Group II (n = 6, age 20.5 + 1.05 y.) had a height of 169.2 + 3.4cm, within 2SD's of the normal mean. Serum IGF-I levels were determined in both unextracted and extracted samples. Our results indicated that the number of secretory bursts and the circadian panel of GH, IGF-I and -II, PRL and TSH were similar in the two groups. Both the amplitude of the secretory GH peaks (5.08 + 3.07 vs. 3.3 + 0.8 ng/ml, p = 0.19,) and the area under the curve (AUC) of the 24-hour GH secretion (9.8 + 5.5 vs. 6.6 + 1.3 ng/ml/hr, p = 0.2) were higher in group I than in group II, but the difference was not significant. A significant nocturnal increase of both IGF-I and -II levels was found only in extracted human plasma (p < 0.001), whereas measurements of IGF-I in unextracted samples failed to reveal circadian variation (p < 0.1). We conclude that no significant differences were found in this pilot study of the neurosecretory regulation of the GHS axis between individuals of tall and normal stature. A tendency for greater amount of GH secretion per secretory peak was found in persons with tall stature; however, this finding needs to be confirmed in a larger study. IGF-I and -II levels had a significant circadian variation with a large nocturnal surge, when measured in extracted plasma. The latter, might be explained by circadian variation of the circulating IGF-binding proteins and its detection appears to be method of extraction-dependent.
Adult↗
Incidence and characteristics of microprolactinomas (3-5 mm) in 4199 women assayed for prolactin.
Difficulties and controversies still exist in the diagnosis of small (3-5 mm) prolactinomas (micro-PRL-omas). In the present study serum prolactin (PRL) was assayed in 4199 women aged 14-43 years belonging to 4 groups: A: 753 women with normal cycles (NC) and infertility (control group), B: 2523 with menstrual disorders, C: 519 with NC and hirsutism, D: 404 with galactorrhoea. The distribution of PRL values from 1 to 30 ng/ml was almost similar in the subjects of group A, B and C. Within this range the vast majority of subjects (91%, 92.2% and 88% respectively in these 3 groups and 83% in group D) had PRL levels from 1 to 15 ng/ml and together with the proportion of subjects with PRL values 16 to 20 ng/ml they included 96.7% of the entire mixed population. A proportion of scattered outlying PRL values above 30 ng/ml was found in each group (A = 2%, B = 3%, C = 1% and D = 28.7%) and in this subset 117 prolactinomas (PRL-omas) were found, 19 (23%) in the 83 subjects with PRL levels 31-49 ng/ml and 98 (75.3%) in the 130 subjects with PRL values greater than or equal to 50 ng/ml. Of the 117 PRL-omas 9 were bigger than 10 mm and 4 had a size from 6 to 9 mm. In the remaining 104 the size was presumed from direct or indirect radiological evidence to be 3-5 mm.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Increased GH response to GHRH in normal tall men.
The importance of growth hormone secretion to the growth of an individual raises the question of the role that the secretory capacity of this hormone may play in defining the variations of height within the population. To investigate this problem we studied the response of GH to GHRH in 20 normal tall (mean +/- SD height 190.8 +/- 2.4 cm, range 187-196 cm) adult males of the third decade and in 17 age-matched controls of average height (mean +/- SD height 173.8 +/- 1.6 cm, range 171-177 cm). Synthetic GHRH (1-29) NH2 (Kabi, Vitrum, Sweden) was administered at 0800 h after an overnight fast and blood was drawn for GH assay. In the tall subjects basal GH concentrations at -15 and 0 min were not significantly different from those of the controls. However, the tendency to higher basal GH levels and spontaneous peaks was evident in tall individuals. Only three basal GH values were below 1 micrograms/l (0.8-0.9 micrograms/l; 1 microgram/l = 2mU/l) in the tall individuals while 24 of 33 basal GH values in the controls ranged between 0.25 and 0.87 micrograms/l. At +15 and +30 min after GHRH the rise in GH was significantly greater in the tall subjects. Moreover, the integrated area under the response curves was significantly greater in the tall subjects than the controls (P less than 0.01). No differences in the mean serum testosterone and prolactin levels were found in the two groups. It is postulated that if this enhanced pituitary responsiveness is constant and chronic in tall individuals a definite relation of their stature to the GH secretion is to be anticipated.
Adult↗
Results of three-times-per-week long-term administration of a luteinizing hormone-releasing hormone (LHRH) analog, D-Ser-(TBU)6-LHRH-(EA)10 in primary amenorrhea.
The effectiveness of a luteinizing hormone (LH)-releasing hormone (LHRH) analog, D-Ser-(TBU)6-LHRH-(EA)10 (Hoe 766), applied intranasally in a 3 days-per-week regimen, was assessed in four patients with hypogonadotropic or normogonadotropic primary amenorrhea by measuring LH, follicle-stimulating hormone (FSH), and estradiol (E2) levels before and 4 hours after its application and by observing the clinical effects of these hormones on the genital tract. The LH response increased progressively over the first 21 days (nine applications) in three of the four patients; it was subsequently reduced but never abolished throughout the study, which was terminated with the 25th application on the 59th day. Basal values of E2 increased until the 12th to 14th day (fifth or sixth application) and then showed a definite decline despite the continuing increase in LH response. FSH release attained a maximum by the second to fourth application and its magnitude of response remained remarkably stable thereafter. The clinical response did not correspond to the serum levels of E2. It is postulated that the development of LH unresponsiveness is due to desensitization of the receptors by the analog. The poor response of the genital tissues to the normal levels of E2 and the subsequent decrease in E2 levels, which occurred despite increasing LH responsiveness, are attributed to an inhibitory action of the analog on E2 biosynthesis in the ovary and on E2 receptors in the genital organs.
Adult↗
Induction of ovulation and pregnancy in a pituitary dwarf.
Females with pituitary dwarfism of the multiple pituitary hormone deficiency form have ovarian failure due to hypogonadotropism which would be expected to respond favorably to human gonadotropin treatment. This is a description of a pituitary dwarf in whom pregnancy was achieved with gonadotropin therapy; its progress was followed regularly by hormone assays.
Adult↗
Prolactin and placental hormone levels during pregnancy in prolactinomas.
Prolactin (PRL) and the placental hormones, estradiol (E2), estriol (E3), progesterone (PG), chorionic gonadotropin (HCG), and placental lactogen (HPL) were serially measured throughout pregnancy and early postpartum in three patients with prolactinomas in whom pregnancy was achieved by one of the three modalities of treatment: bromocriptine administration (patient I), irradiation of the pituitary (patient II), and human gonadotropin administration after excision of the adenoma (patient III). It was found that PRL in patient I reached the high pretreatment levels in the 2nd month of pregnancy and increased to further abnormal concentrations in the last 2 months, but fell at the onset of labor 1 week after an episode of severe headache. The PRL changes in this patient were attributed successively to tumor expansion and apoplexy. In patient II PRL decreased after irradiation, but was not normalized. During pregnancy it remained moderately increased presenting minor fluctuations. The third patient with postoperative GH and TSH pituitary insufficiency had low pretreatment PRL levels which remained practically unchanged throughout pregnancy. The two last patients gave birth to identical twins. The placental hormones were found normal in all three patients but E2 and PG were relatively increased during the last weeks of pregnancy in the twin pregnancies. Amniotic fluid and umbilical cord PRL and E2 concentrations were normal. The patients presented agalactia and suckling did not induce a PRL increase. We conclude that a) serial PRL measurements during pregnancy reflect the changes occurring in the prolactinomas and are essential in monitoring the patients bearing these tumors; b) maternal hyperprolactinemia or failure of PRL to increase during pregnancy do not influence either the secretion of placental hormones or PRL concentration in amniotic fluid and the newborn; and c) hyperprolactinemia during pregnancy is of maternal pituitary origin.
Adenoma↗
Pituitary function in 8 patients with familial pituitary dwarfism.
Pituitary function was evaluated in four pairs of familial pituitary dwarfs (two sisters, 28 and 20 years old, two brothers 15 and 10 years old, one girl 19 years old and her brother 7 years old, and one girl 9 years old and her brother 3 6/12 years old), who all proved to have multiple pituitary hormone deficiency (MPHD), in order to find out whether a distinct intrafamilial or interfamilial pattern of deficiency existed. The response of FSH and LH to LRH, of TSH to TRH, of growth hormone (GH) to L-dopa, and of prolactin to sulpiride administration was studied. Basal levels of ACTH and cortisol (F) were also measured on two consecutive days. Basal FSH, LH and GH concentrations were below the sensitivity of the assay in all patients (except one who had measurable levels of LH) and showed no change after the appropriate stimulation. Basal TSH was normal in 6 patients and slightly increased in two members of the same family. Both these patients presented an exaggerated response to TRH. Three of the remainder patients showed a small and the other three no response to TRH. Basal prolactin values ranged within the normal limits, but prolactin was not increased during the sulpiride provocative rest. Mean basal ACTH was normal in 5 and low in 3 patients. Mean cortisol levels were normal in 5, near the lower normal limit in 2, and low in one patient. This patient had also a low ACTH concentration. It is concluded that the lack of a common pattern of hormone deficiency in all families indicates a variability in the expression of the hypothalamo-pituitary defect, which suggests that the familial MPHD dwarfism constitutes a genetically and pathogenetically heterogenous group.
Adolescent↗
Pituitary-gonadal function in three relatives presenting with Kallmann's syndrome.
The assumption that abnormalities exist in both the pituitary and gonads was tested in 3 familial cases of Kallmann's syndrome, 2 brothers, aged 16 and 17 years, and their cousin, aged 26 years. Serial serum and urinary LH and FSH titers were measured after subcutaneous administration of 100 micrograms LRH and in the 2 brothers after a second test using 400 micrograms LRH. Serum testosterone and estradiol were estimated before and 60 and 90 min after LRH and also before and on the 3rd and 4th day after daily administration of 5,000 IU of hCG for 3 days. Prolactin was also measured in blood samples of all LRH tests and found normal in 2 cases and increased in 1. Tomograms of the pituitary fossa were normal in this patient. With all procedures used, a distinct stimulatory effect on the pituitary and the testes failed to appear in the patients of the present study.
Adolescent↗
Induction of ovulation and pregnancy in twenty-six patients with primary hypogonadotropic amenorrhea.
The methods and results of treatment with human menopausal gonadotropins (hMG) and chorionic gonadotropin (hCG) in 26 patients (mean age 24 years, range 22-35 years) with hypogonadotropic primary amenorrhea and without chromosomal abnormalities are reported. The usual dose of hMG was 225 IU daily until the karyopycnotic index rose to 40% or more and the other clinical parameters revealed sufficient follicular maturation. A dose of hCG was then administered at the rate of 10,000 IU daily for 4 days. In 60 courses of treatment, we obtained 17 pregnancies (28.3%) in 13 patients (i.e., including some second pregnancies), 35 ovulations without pregnancy (58.3%), and seven patients did not respond (11.6%). Three patients who did not respond and who continued the treatment ovulated and became pregnant. Clinical hyperstimulation occurred in three patients on the first course of treatment. Two of them again presented this complication on repetition of treatment despite the precautions taken. Urinary estrogen and pregnanediol measurements on the 7th-11th day after hCG administration revealed considerable hormonal hypersecretion in 19 of 27 courses of treatment. In eight patients the high output of pregnanediol continued during the first 1-2 months of pregnancy and decreased thereafter. The rate of pregnancies seemed to be higher in patients with hypersecretion whereas clinical hyperstimulation did not correlate with the degree of the hormonal output. Pregnancies were all single and uneventful except for one abortion in a patient who was found to have mycoplasma infection. All patients gave birth to normal children and lactated normally. The increased dosage of hCG used in this series is considered to be a decisive factor in the induction of ovulation and the maintenance of pregnancies through the abundant steroid production it induced.
Adult↗
Pituitary hormonal profile in menopause.
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Aged↗
The clinical features of the menopause and its relation to the length of pregnancies and lactation.
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Age Factors↗
Surgical stress induces a marked and sustained increase of adrenal androgen secretion in postmenopausal women.
We analyzed the secretion of adrenal androgens in response to surgical stress in eight (8) postmenopausal women. ACTH, cortisol (F) and adrenal androgens, such as dehydroepiandrosterone (DHEA), delta 4-androstendione (delta 4-A), dehydroepiandrosterone sulfate (DHEA-S) and testosterone (T) were measured at 08:00 and 20:00 hr the day before and for three consecutive days after operation, as well as at 0, 15, 30, 60, 120 minutes during cholocystectomy. Basal levels of ACTH, F, DHEA, delta 4-A, DHEA-S and T were found within the normal range for this age group before surgery. During surgery the ACTH was significantly increased, reaching a peak value at 30 min after surgery initiation. F, DHEA and delta 4-A were significantly increased during and after surgery, returning to pre-surgery levels by the third day post-surgery. DHEA-S levels did not increase during surgery but was found significantly increased the day after surgery, returning to presurgical levels two days later. We conclude that surgical stress can induce adrenal androgen hypersecretion during and within the early days post-surgery. Because the adrenal androgens levels are declining and respond suboptimally to exogenous corticotropin releasing hormone (CRH) or ACTH bolus injection in aging women, it is conceivable that this remarkable response of adrenal androgens to surgical stress is probably of biological significance and conceivably mediated by a CRH/ACTH-independent mechanism.
Adrenal Glands↗
Vaginal cytology in endocrinopathies.
In order to evaluate the diagnostic significance of vaginal smears in endocrinopathies associated with menstrual disorders, the cytologic pattern of vaginal smears was examined in 703 patients who had a well-established diagnosis of the disorder's origin. The patients were classified into four groups according to their menstrual disorders: primary amenorrhea (159 patients), secondary amenorrhea (116 patients), primary oligomenorrhea (214 patients) and secondary oligomenorrhea (214 patients). Using the maturation index and the maturation value, three cytologic patterns of vaginal smears were distinguished: parabasal cell pattern, intermediate cell pattern and superficial cell pattern. The frequency with which the cytologic patterns occurred in the groups of patients and their subdivisions are presented. As a whole, the 703 patients showed 25.2% with a parabasal cell pattern, 58.3% with an intermediate cell pattern and 16.5% with a superficial cell pattern. Although the cytohormonal pattern of vaginal smears in endocrinopathies with associated menstrual disorders is not diagnostic of a specific endocrinopathy, the cellular patterns may prove helpful in suggesting a range of diagnoses or in excluding some possibilities.
Adolescent↗
Contribution to the problem of hyperprolactinaemia: experience with 4,199 prolactin assays and 117 prolactinomas.
OBJECTIVE: To help define the normal and pathological serum prolactin concentration ranges in adult females. PATIENTS AND METHODS: Serum prolactin was assayed in a mixed population of 4,199 women divided into five groups: (A) 753 with normal menses consulting for infertility (control group); (B) 2,523 with menstrual disorders; (C) 519 with hirsutism and normal cycles; (D) 201 with galactorrhoea and normal cycles; (E) 203 with galactorrhoea and menstrual disorders. RESULTS: In each group, a separate subset (2%, 3%, 1%, 15%, and 42.3%, respectively) was distinguished, with scattered prolactin values above 30 ng/mL, in which 117 prolactinomas were found, with an incidence ranging from 11 to 57% in cases with prolactin of 31-49 ng/mL and from 65 to 87.5% in those with prolactin > or = 50 ng/mL. The frequency distribution of values from 1 to 30 ng/mL was strikingly similar in the 753 subjects of group A and the 2,523 patients of group B: 91% and 92.6%, respectively, between 1 and 15 ng/mL, and 5.5% and 4.7% from 16 to 20 ng/mL. Values > 20 ng/mL were found in 4.4% of the subjects in group A, 5.5% in group B, 5.1% in group C, 21.8% in group D, and 18.7% in group E. CONCLUSIONS: (a) Normal prolactin values can be considered to include 1-15 ng/mL and 16-20 ng/mL, the former corresponding to the vast majority of normal subjects or patients, and the latter being the extreme limit of normal, for which from a clinical point of view repetition of the assay and a follow-up is advocated. (b) Values between 21 and 30 are rare and could be considered as hyperprolactinemia necessitating further investigation. (c) Values between 31 and 49 are suspect, and values > or = 50 ng/mL are suggestive of the presence of a prolactinoma, warranting thorough investigation.
Adolescent↗