Biomedical subjects
Publications and source records attributed to F Stahl.
The present state of modern methods for the determination and some data for secretion and plasma levels of the principal circulating androgens (testosterone, dihydrotestosterone, 5 alpha-androstane-3 alpha,17 beta-diol, androstenedione and dehydroepiandrosterone) in men and women under normal and pathological conditions are described.
Endokrine active tumours of the adrenal cortex are rare diseases in man. Benign as well as malignant tumours of the adrenal cortex can alone excrete cortisol, aldosterone, androgens or oestrogens. More frequent are, however, tumours with a mixed incretion. Publications about tumours forming sexual hormones are above all descriptions of individual cases. After a short explanation of the most important clinical, diagnostic and therapeutic aspects on androgen-producing tumours of the adrenal cortex four own cases are discussed.
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Ethinylestradiol sulphate (J 96) is a depot estrogen which in a dosage of 2 mg per week has clearly antigonadotropic effects and evokes a suppression of the free testosterone in bilaterally orchiectomized patients with carcinoma of the prostate. The good compatibility in oral application and the possibility for the controlled intake recommend its use for the long-term therapy of the carcinoma of the prostate.
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Total and free cortisol and cortisol binding globulin (CBG) levels were measured in plasma of 7 fetuses during 22 to 34 weeks of pregnancy and 80 infants aged 1 day to 30 months. In comparison with normal adults, total cortisol levels were significantly diminished (p less than 0.001) both in fetuses and newborn infants aged 2 to 8 days. However, low total cortisol levels were accompanied by extremely low CBG concentrations especially in prenatal but also in early postnatal life. Consequently, free cortisol levels during pre- and postnatal life were not significantly different from those of normal adults except the values immediately after birth, which were evidently elevated. With advanced age of the infants CBG values increased and reached the mean values of adults at 46 to 80 days of age. However, in infants aged 8 to 30 months CBG values were even significantly higher (p less than 0.01) than those of adults.
A non-chromatographic competitive binding assay (CBA) using horse transcortin has been employed in the routine measurement of cortisol in plasma, urine and amniotic fluids. Comparing the values with those of a radioimmunoassay (RIA) or a fluorimetric method (FM) an excellent correlation between the three methods both in plasma and urine has been calculated in normal subjects and in patients with various endocrine disorders. In amniotic fluids, however, there were discrepancies between CBA and RIA. Whereas CBA showed no differences, RIA gave significantly higher values in amniotic fluids of female than of male fetuses. Elevated free plasma cortisol levels observed in patients with prostatic cancer after diethyl stilboestrol diphosphate therapy did not correlate with unconjugated urinary cortisol concentration as measured with CBA and FM. In newborns, a relatively high plasma level found 12 hours after birth was followed by a nadir on the 2nd and 3rd day of life and by an increase until levels of adults on the 5th day of life were reached.
A radioimmunoassay for the measurement of 11-deoxycortisol in plasma is described. Antiserum against 11-deoxycortisol was produced by immunizing rabbits with the 21-hemisuccinate of 11-deoxycortisol coupled to bovine serum albumin. The method does not require chromatography but instead makes use of a simple extraction procedure which, in combination with the antibody characteristics, is relatively specific for the 11-deoxycortisol determination. The smallest amount measurable is 5 pg. The intra-assay coefficient of variation was 6.3% before metopirone and 7.2% after metopirone. The inter-assay coefficient of variation was 12.5% before metopirone and 10.3% after metopirone. Pituitary-adrenal reserve was evaluated in control and hypopituitary subjects by a simple midnight metopirone test.
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Determinations of the 11-hydroxycorticosteroids (11-OHCS) in intervention evoking stress proved as advantageous method for the estimation of the ACTH-reserve. After pneumencephalography or transethmoidal-transsphenoidal operations of the hypophysis intensive increase of 11-OHCS in the plasma and urine were observed, when the ACTH-reserve was intact. The investigations give the possibility of renouncing additional special functional tests.
Tests testosterone reserve capacity of 6--15 year-old boys was estimated after operative correction of testicular maldescensus by a maximal stimulation test. Subnormal plasma testosterone levels were found in only 2 out of 14 patients with bilateral and 4 with unilateral orchidopexy. Prepubertal boys with unilateral anorchia had normal basal testosterone values and a normal testosterone rise after stimulation. In prepubertal boys with bilateral testes atrophy there was observed a diminished rise after stimulation. The basal testosterone levels were normal. The testosterone basal levels of pubertal boys with unilateral anorchia or bilateral atrophy were subnormal and the stimuation of testosterone production was reduced. The testicular volume of patients without atrophy or anorchia after orchidopexy was normal in prepuberty. During puberta a progressive relative decrease of the testicular volume was observed as compared to normal development. In conclusion, the results demonstrate that the endocrine function in most patients with unilateral or bilateral orchidopexy is in the normal range--a regular puberty can be expected.
Plasma basal levels of FSH, LH and total as well as apparent free testosterone were determined in homosexual and heterosexual males. Significantly higher FSH concentrations (mean +/- SD = 6,89+/-5.00 mlU/ml; P less than 0.01) and LH concentrations (28.2+/-30.7 mlU/ml; P less than 0.002) were found in plasma of 50 homosexual males compared with those of 24 or 40 heterosexual males 4.17 +/- 2.34 mlU/ml and 12.6 +/- 7.6 mlU/ml, respectively). Significantly lower free plasma testosterone was observed in 35 homosexual males (10.7 +/- 3.3 ng/100 ml; P less than 0.01) than in 38 heterosexual males (13.3 +/- 4.5 ng/100 ml), whereas total testosterone in plasma of homosexual males (590 +/- 148 ng/100 ml) showed no significant difference in comparison with the heterosexual control group (562 +/- 126 ng/100 ml). The tendency to higher FSH and LH values as well as to lower free testosterone concentrations in plasma compared with the heterosexual control group was more evident for effeminized than for non-effeminized homosexual males. FSH and LH concentrations in plasma of 5 transsexual males were also significantly higher (11.74 +/- 5.06 and 18.3 +/- 3.4 mlU/ml, respectively; P less than 0.02) than those of the heterosexual control group. Our findings may be explained by the possible existence of a prenatal testicular androgen deficiency in homosexual males that is widely compensated by increased gonadotrophin secretion in adult life.
TG and unconjugated testosterone levels were found to be significantly increased but FSH levels significantly decreased in amniotic fluids of male foetuses as compared to those of female foestuses between week 16 and 26 of pregnancy.
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In male rats, androgen deficiency during a critical hypothalamic organizational period was shown to give rise to a predominantly female-differentiated brain, homosexual behavior, and demonstration of a positive estrogen feedback effect. A positive estrogen feedback effect was also induced in intact homosexual men in contrast to intact heterosexual and bisexual men. Thus in 21 homosexual men an intravenous injection of 20 mg Presomen (Premarin) produced a significant decrease of serum LH levels followed by an increase above initial LH values. In 20 heterosexual and in five bisexual men, by contrast, intravenous estrogen administration, while producing a significant decrease of the serum LH level, was not followed by an increase above the initial LH values. Using a radioimmunoassay, plasma testosterone levels and 24-hr urinary excretions of unconjugated testosterone of adult homosexual men were found to be in the normal range as observed in heterosexual men. This finding suggests that homosexual men possess a predominantly female-differentiated brain which may be activated to homosexual behavior by normal or approximately normal androgen levels in adulthood.
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