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Biomedical subjects

E Steinberger

Publications and source records attributed to E Steinberger.

At least 19 recordsLinked to original sources

The relationship of serum androgens and ovulatory status to blood pressure in reproductive-age women.

The objective of this cross-sectional study was to determine the relationship between hyperandrogenemia and blood pressure in women with menstrual irregularities seen at an endocrinology clinic. Women with serum testosterone levels (T) > or = 30 ng/dL were more likely to have general obesity (odds ratio [OR] = 6.8, 95% confidence intervals [CI] = 2.2-27.2) and central obesity (OR = 14.5, 95% CI = 6.1-38.7) than euandrogenemic women. Hyperandrogenemic women (HA) had an OR of 2.4 (95% CI = 1.0-6.2) for elevated SBP and an OR of 2.7 (95% CI = 0.8-8.8) for elevated DBP, independent of age and ovulatory status. Obese HA had an OR of 4.7 (95% CI = 2.3-10.4) for elevated SBP and an OR of 2.9 (95% CI = 1.9-9.9) for elevated DBP. In conclusion, T is associated with an increased risk for obesity and central adiposity. T predicts BP elevation independent of age and ovulatory status. There was a synergistic relationship between obesity and androgens in their affect on BP.

Abdomen↗

Retreatment with nafarelin for recurrent endometriosis symptoms: efficacy, safety, and bone mineral density.

OBJECTIVE: To assess the efficacy, safety, and effect on bone mineral density of a 3-month course of retreatment with intranasal nafarelin acetate for recurrent symptoms of endometriosis. DESIGN: Multicenter, open-label, nonrandomized clinical trial. SETTING: Eleven hospital-based and private practices. PATIENT(S): Thirty-six women with endometriosis symptoms recurring after 3 or 6 months of treatment with nafarelin. INTERVENTION(S): Nasal nafarelin 200 micrograms twice daily for 3 months. MAIN OUTCOME MEASURE(S): Assessments for dysmenorrhea, dyspareunia, pelvic pain, tenderness, and induration. Measurement of bone mineral density of the lumbar spine. RESULT(S): Improvements from admission to the end of retreatment were significant for dysmenorrhea, pelvic pain, tenderness, induration, and dyspareunia. Three months after retreatment ended, mean symptom scores for dysmenorrhea and pelvic tenderness, although worse than at the end of retreatment, were still significantly better than scores at admission. Mean bone mineral density 3 months after retreatment was 0.56% lower than before retreatment and 1.94% lower than before initial treatment. CONCLUSION(S): Three-month nafarelin retreatment for recurrent endometriosis symptoms was effective and safe.

Administration, Intranasal↗

Ontogeny of testosterone production from immature mouse testes in vitro.

A dynamic superfusion system was developed to study the ontogeny of testosterone production from immature mouse testes. Testes obtained from 6-day, 12-day and 18-day old mice superfused in vitro. Their basal testosterone productivity were match to their in vivo chronic age. Superfused testes responded to pulsatile stimulation of human chorionic gonadotropin (HCG) for 42 days. Pulsatile HCG stimulation significantly enhanced testosterone production than bolus stimulation. Pulsatile FSH stimulation could significantly increase the testosterone production. Elevation of fluid pressure in culture chamber showed increase testosterone production but it was not significantly different.

Animals↗

Prolactin response to thyrotropin-releasing hormone in normoprolactinemic patients with ovulatory dysfunction and its use for selection of candidates for bromocriptine therapy.

It has been suggested in the past that some normoprolactinemic patients with amenorrhea or infertility respond to treatment with bromocriptine. However, the beneficial effect of this therapy in normoprolactinemic women remains controversial. Some authors have suggested that the responders suffer with "reactive" hyperprolactinemia and that this may be detected with thyrotropin releasing hormone (TRH) stimulation. In this study, we performed TRH stimulation tests in 538 patients with ovulatory dysfunction. Only those patients showing a peak prolactin response after TRH which exceeded 40 ng/ml were treated with bromocriptine. A direct correlation between peak prolactin level after TRH and a favorable response to treatment was observed. Serum testosterone and DHEA-sulfate levels did not correlate with prolactin response to TRH. A majority of patients with prolactin hyperresponse to TRH did not show a hyperresponse of TSH to TRH. This study suggests that incidence of beneficial response to bromocriptine therapy in normoprolactinemic women with ovulatory dysfunction is significantly higher in subjects exhibiting excessive prolactin response to TRH stimulation.

Adult↗

Glucocorticoid therapy in hyperandrogenism.

Hyperandrogenism is a common disorder in the reproductive age female. It is associated with cutaneous manifestations and ovulatory dysfunction. The degree of hyperandrogenaemia is directly related to the severity of ovulatory dysfunction. The ovulatory dysfunction frequently leads to infertility. The most common form of hyperandrogenism is idiopathic glucocorticoid-suppressible hyperandrogenism (IGSH). The management of this disorder involves appropriate use of physiological doses of glucocorticoids. This treatment leads not only to normalization of serum androgen levels but also to amelioration of cutaneous symptoms and improvement in ovulatory function. In infertile women with ovulatory dysfunction secondary to IGSH, occurrence of pregnancy after treatment with glucocorticoids is directly related to the degree of the suppression of serum androgen levels. In other words, this treatment does not 'induce ovulation', but its effectiveness in improving ovulatory function is a result of a correction of the hyperandrogenic state. At physiological doses glucocorticoid therapy does not appear to be associated with significant side-effects. With appropriate management, androgen levels can be maintained within the normal range indefinitely. Furthermore, in a majority of patients, androgen levels remain within the normal range for a long time (years) after discontinuation of chronic glucocorticoid therapy.

Androgens↗

Effects of cefamandole on spermatogenic development of young CD rats.

The testicular toxicity of cefamandole, a beta-lactam antibiotic with an N-methylthiotetrazole side chain, was evaluated in neonatal rats. Cefamandole caused delayed maturity of the germinal epithelium of neonatal rats when given on Postpartum Days 6 through 36. In rats given daily subcutaneous injections of 1000 mg/kg during this period, the most mature germinal cells were acrosome phase spermatids, whereas control rats had spermatids in the maturation phase. In studies of specific developmental phases, the effect of 1000 mg/kg daily cefamandole was primarily on the initial waves of spermatogonia during the period of rapid development (Postpartum Days 4 through 13). In animals treated from birth to Postpartum Day 8 and evaluated sequentially on Postpartum Days 5 through 9, there were no morphologically discernible effects on the transformation of gonocytes to immature spermatogonia, but there were slight degenerative changes in the first waves of developing spermatogonia. Cefamandole, 1000 mg/kg daily, given Postpartum Days 14 through 18 during the initial phase of spermatocyte development, also caused a slight degenerative change of the initial waves of pachytene spermatocytes. The significance of the findings in neonatal rats is unknown because differences in spermatogenic development between rat and human preclude direct extrapolation of the effects of cefamandole in neonatal rats to effects in humans.

Aging↗

Annual variation in semen characteristics and plasma hormone levels in men undergoing vasectomy.

Prevasectomy levels of plasma luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone (T), estradiol (E2), and 20 alpha-dihydroprogesterone (20 alpha-DHP), as well as semen analyses including semen volume, sperm count, and sperm motility from 260 healthy men were evaluated for annual changes. A statistically significant (P less than or equal to 0.015) high-amplitude seasonal variation with the peak in April to May was detected in semen volume, sperm count, and sperm motility. A statistically significant (P less than or equal to 0.04) annual change of moderate T to large FSH amplitude was detected in each of the five plasma endocrine variables as well. Plasma LH, T, and E2 peaked in autumn, while FSH and 20 alpha-DHP peaked in summer. Analysis of postvasectomy LH, FSH, E2, 20 alpha-DHP, and T blood levels for the 3 years following vasectomy revealed loss of seasonal rhythmicity as a group phenomenon in LH, E2, and T. The amplitude of the seasonal variation in FSH was decreased and that in 20 alpha-DHP was unchanged compared with before-vasectomy baselines. For those annual rhythms which persisted following vasectomy, the peak time was unchanged. Compared with the prevasectomy group annual mean, that for each of the endocrine values was unchanged, except for that of LH and T, which was slightly, yet statistically significantly, elevated. The existence of prominent annual variation implicates their consideration in the design of research protocols involving investigation of reproductive phenomena in human beings.

20-alpha-Dihydroprogesterone↗

In vitro steroid secretion by intact bovine ovarian follicles in a superfusion system.

A superfusion system for single intact follicles is described. Bovine follicles were superfused for 5 to 10 hours. Progesterone and testosterone secretion was stable after an adaptation period of 150 min. A 5-minute stimulation with hCG resulted in a 2-fold increase in progesterone secretion. Superfusion for 450 minutes of 3 small follicles of similar size and in the same ovary next to each other showed different secretion patterns of progesterone and testosterone. Superfusion for 150 minutes of follicles obtained from 2 pairs of ovaries showed that follicular size is not a sufficient criterion to predict the progesterone and testosterone secretion pattern. Closeness of follicles (big or small) to a corpus luteum did not impair their ability to secrete progesterone and testosterone. It is concluded that a superfusion system as has been described in this report is an effective and desirable method to study the physiology and pathophysiology of single intact follicles.

Animals↗

Acne and hyperandrogenism.

Elevated serum androgen levels have been reported in patients with acne resistant to conventional dermatologic therapy. This study was designed to investigate the relationship between serum androgen levels and the presence of acne in an unselected population of women seen consecutively by a dermatologist for various dermatologic complaints. Elevated serum testosterone levels were associated with acne regardless of whether this was the presenting complaint or an incidental finding. Women with both acne and hirsutism had higher serum testosterone levels than those with acne alone. Higher incidence of irregular menstrual cycles was noted in women complaining of acne. Normal serum testosterone levels were found only in those patients with regular menstrual cycles and the absence of acne or hirsutism. In conclusion, this study suggests that elevated serum testosterone levels are related to the presence of acne. Attention is called to the possibility that acne may be a clinical manifestation of a disorder with systemic and reproductive consequences.

Acne Vulgaris↗

Acne and hyperandrogenism: impact of lowering androgen levels with glucocorticoid treatment.

The impact of lowering androgen levels with glucocorticoid treatment in a group of consecutive female patients presenting to the Department of Reproductive Medicine and Biology, University of Texas, with a chief complaint of acne has been studied. One hundred fifty-eight patients, ages 16 to 40, who received prednisone at a maximum daily dose ranging from 7.5 to 15 mg for a period of at least 6 months were selected for the study. These patients were not taking other systemic medication affecting androgens or acne. Only thirty patients (19%) had pretreatment testosterone levels below the upper limits (40 ng/dl) of our normal range; while on treatment 146 patients (92.4%) had testosterone levels below 40 ng/dl. In sixty-three patients (39.9%) the acne completely cleared, in eighty patients (50.6%) it significantly improved, and in only fifteen patients (9.5%) was the acne not affected by the medication. There was a highly significant difference between the mean testosterone levels during treatment of those who cleared or improved, versus those who did not (p less than 0.05), the percentage drop in testosterone being greatest in those who cleared. Pretreatment testosterone levels were not significantly different in those who cleared, improved or did neither. It is concluded that glucocorticoid treatment frequently results in a lowering of androgen levels in hyperandrogenic women with acne and that this is associated with clearing or improvement of the acne.

Acne Vulgaris↗

Pituitary binding of 3H-labeled Sertoli cell factor in vitro: a potential radioreceptor assay for inhibin.

We have previously demonstrated that binding of partially purified, 3H-labeled Sertoli cell factor (SCF) to rat anterior pituitary homogenates was tissue specific, saturable, time and temperature dependent, and competitively inhibited by unlabeled SCF. The present study further characterized the binding of [3H]SCF to rat anterior pituitary in vitro and explored its potential use as a radioreceptor assay for SCF and other inhibin preparations. [3H]SCF was synthesized by rat Sertoli cells cultured in the presence of [3H]leucine (5 mu Ci/ml) and was then partially purified by Sephadex gel filtration and high pressure liquid chromatography. The purified [3H]SCF had a specific activity of approximately 20,000 dpm/micrograms protein and was biologically active in pituitary cell cultures. The binding was carried out in 0.5 ml buffer, containing one pituitary equivalent and, wherever appropriate, various unlabeled competing substances. The binding was optimal at pH 7.4 and was decreased by pretreatment of [3H]SCF with trypsin (0.25%; 37 C; 30 min) or heat (100 C; 10 min). Storage of the pituitary glands at -20 C for several months and differences in animal age did not affect total binding per pituitary, but the amount of radioactivity bound per mg pituitary tissue declined progressively between 18-90 days of age. Over 90% of the bound [3H]SCF was competitively inhibited by excess unlabeled SCF and several other inhibin preparations of testicular origin: high mol wt fraction of ram testis fluid (mol wt, greater than 10,000), low mol wt fraction of ram testis fluid (mol wt, less than 5,000), ovine testicular lymph, and aqueous rat testicular extract. The degree of inhibition was dose dependent, and except for the low mol wt fraction of ram testis fluid, the displacement curves were parallel (slope, 0.95). In contrast, various noninhibin substances tested [rat androgen-binding protein, bovine LH, BSA, native GnRH, or GnRH agonist analogs D-Ser-(tBu)6-des-Gly10-GnRH-N-EA and D-Ala6-des-Gly10-GnRH-N-EA] did not significantly compete for the [3H]SCF binding. The binding ability correlated well with inhibin biological activity in vitro. These results provide additional evidence for the presence of SCF-binding sites in the rat anterior pituitary which interact with several different inhibin preparations of testicular origin but appear to be distinct from GnRH-binding sites. Our results also indicate that the pituitary binding may be used as a rapid radioreceptor assay for SCF and various other inhibin preparations.

Activin Receptors↗

Testosterone, dehydroepiandrosterone, and dehydroepiandrosterone sulfate in hyperandrogenic women.

Serum levels of testosterone (T), dehydroepiandrosterone (DHEA), and DHEA sulfate (DHEA-S) were measured in a group of 285 women with clinical signs of hyperandrogenism (hirsutism and/or acne). Levels of T were elevated in 75.8% of the patients, DHEA in 57.5%, and DHEA-S in 20%. Normal levels of all 3 androgens were found in 13.3%. Significant correlations were demonstrated among levels of all androgens. Only 7.7% of the patients had elevated levels of DHEA in the presence of normal T, and 3.2% had elevated DHEA-S and normal T levels. Subdivision of the study population on the basis of presence of acne, hirsutism, or both demonstrated no significant differences in androgen levels. Amenorrheic women had higher serum T levels than those with menstrual cycles. Women with laparoscopically demonstrated polycystic ovaries had significantly higher serum androgen levels than hyperandrogenic women with no laparoscopic evidence for polycystic ovarian disease. All 285 patients were treated with chronic low dose prednisone therapy. Overall suppression of all 3 androgens occurred in a large proportion of the patients. The pretreatment levels of DHEA or DHEA-S did not predict the responsiveness of T to chronic glucocorticoid therapy. On the other hand, a 2-day dexamethasone (DEX) suppression test quantitatively predicted the degree of T suppression achieved by chronic therapy. An overnight DEX suppression test was considerably less precise for this purpose. In conclusion, chronic low dose prednisone therapy resulted in suppression of serum T levels in a large proportion of women with hyperandrogenism of undetermined cause. The response to therapy could not be predicted on the basis of pretreatment serum DHEA or DHEA-S levels, but was predicted with a 2-day DEX suppression test.

Acne Vulgaris↗

Effect of acute and chronic androgen suppression by glucocorticoids on gonadotropin levels in hirsute women.

Hirsute women may have increased serum LH levels and increased ratios of LH to FSH in serum as well as increased serum androgen levels. Glucocorticoid therapy lowers serum testosterone (T) levels in some hirsute women, but no significant effects on gonadotropin levels have been reported. Sixty hirsute women had serum T, LH, and FSH levels measured before and after acute and chronic glucocorticoid administration. Both acute and chronic treatment resulted in significant suppression of T levels. Serum LH levels significantly decreased after chronic therapy. Significant direct correlations were found between T and LH or T and the LH to FSH ratio, both before and after therapy. In 11 women with normal T levels, acute or chronic glucocorticoid treatment did not produce a significant change in LH levels or LH to FSH ratios. Women (n = 26) with elevated T levels that were suppressed more than 50% during treatment had significant decreases in their mean LH levels and LH to FSH ratios. No significant change in mean LH or LH to FSH ratio occurred in women (n = 23) with elevated T levels that were not suppressed by 50%. These results demonstrate that chronic, but not acute, glucocorticoid-induced suppression of T levels in hyperandrogenic hirsute women results in lowering of LH and LH to FSH ratios.

Adult↗

Biphasic effect of gonadotropin-releasing hormone and its agonist analog (HOE766) on in vitro testosterone production by purified rat Leydig cells.

GnRH and GnRH agonists have stimulatory and inhibitory effects on testicular testosterone secretion both in vivo and in vitro. To determine whether they are exerted directly on the Leydig cells and to explore the temporal relationships, we examined the effects of acute (3 h) and chronic (24-72 h) exposure of purified (greater than or equal to 80%) rat Leydig cells to GnRH and its agonist analog HOE766 (D-Ser-t-BU6,des-Gly-NH2 10LHRH ethylamide; Hoechst, Frankfurt, Germany) on testosterone production. GnRH and HOE766 enhanced basal testosterone secretion by freshly isolated or cultured Leydig cells. HOE766 was at least 100 times more potent than GnRH. However, exposure of Leydig cells to HOE766 for 24 h or longer lead to a significant reduction in hCG responsiveness without altering basal testosterone secretion. Both the stimulatory and inhibitory effects were dose related, with a maximal response elicited by 10(-9) M HOE766. HOE766 reduced Leydig cell sensitivity to hCG (ED50) stimulation, but did not alter the slope of the dose-response curves. Thus, GnRH and its agonist appear to have a dual and biphasic effect on the Leydig cells. Acute exposure stimulates basal testosterone secretion (and occasionally the hCG response), whereas chronic exposure decreases the response to hCG stimulation. These data provide additional evidence that GnRH has a direct effect on Leydig cell steroidogenesis.

Animals↗

The prognostic value of acute adrenal suppression and stimulation tests in hyperandrogenic women.

A group of 106 consecutively seen hyperandrogenic women were subjected to an acute adrenal suppression and stimulation test. The results of these tests were analyzed with respect to androgen suppression achieved after chronic glucocorticoid therapy in the same patients. The data suggested that an acute dexamethasone test may identify the group of hyperandrogenic women who respond poorly to chronic glucocorticoid therapy. This group of patients were found to have elevated luteinizing hormone (LH) levels and LH/follicle-stimulating hormone (FSH) ratios, suggesting the possibility of an LH-related hyperandrogenism. In patients whose elevated testosterone levels were suppressed by dexamethasone, adrenocorticotropic hormone (ACTH) induced a prompt return of the testosterone levels to baseline, suggesting an ACTH-dependent hyperandrogenism. In these patients, the degree of testosterone suppression after dexamethasone was not quantitatively related to the degree of testosterone suppression after chronic glucocorticoid therapy. In all cases chronic therapy resulted in a greater suppression of androgen levels than the acute dexamethasone test. In conclusion, an acute dexamethasone suppression test appears to be of clinical value in the management of the hyperandrogenic female, particularly in identification of women who will not respond to chronic glucocorticoid suppression therapy.

Adrenocorticotropic Hormone↗

Response of the adrenal to adrenocorticotropic hormone (ACTH) in hyperandrogenic women treated chronically with low doses of prednisone.

A group of 43 women of reproductive age with clinical signs of hyperandrogenism was treated with a low dose (7.5 mg daily) of prednisone. An acute dexamethasone (DEX) suppression-adrenocorticotropic hormone (ACTH) stimulation test was performed before and after a minimum of 2 months of prednisone administration. The therapy produced a significant decrease of plasma testosterone (T) levels in a majority of patients. During the treatment period DEX failed to induce further suppression, while ACTH caused a significant rise in plasma T levels. The cortisol (F) levels were suppressed during treatment, but their response to ACTH stimulation was similar to that observed prior to initiation of therapy.

Adolescent↗