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Biomedical subjects

J Starup

Publications and source records attributed to J Starup.

At least 37 records · Page 2Linked to original sources

The possible prognostic value of serum prolactin increment during pregnancy in hyperprolactinaemic patients.

In 15 hyperprolactinaemic, infertile patients achieving 17 bromocriptine-induced pregnancies, the presence or absence of prolactin (Prl) increment in the 3rd trimester of pregnancy was correlated to the basal Prl levels before treatment and after pregnancy. The hyperprolactinaemic patients revealed a marked heterogeneity in the Prl increment compared to normal women. Five patients showed a pronounced increase in serum Prl during gestation, whereas Prl levels were unaltered or decreased slightly in 10 patients. In the latter group of patients serum Prl was significantly (P less than 0.01) lower after pregnancy than before treatment. Our study indicates that some hyperprolactinaemic patients may benefit from a pregnancy, and that these patients probably can be identified, as they do not show any significant changes in Prl levels during pregnancy.

Adenoma↗

Tubal surgery and subsequent artificial insemination by donor.

The conception rate of 32 infertile women undergoing tubal microsurgery and subsequent artificial insemination by donor (AID) was compared with that of 71 women undergoing tubal microsurgery alone. The follow-up period ranged from 1 to 6 1/2 years. Nine (28%) of the patients in the AID group conceived, resulting in 8 (89%) live births and 1 (11%) spontaneous abortion. In the normal semen group 42 (59%) of the patients conceived, resulting in 31 (74%) live births, 6 (14%) tubal pregnancies and 5 (12%) spontaneous abortions. In the AID group the following term pregnancy rates were achieved: 40% after bilateral lysis of periadnexal adhesions, 25% after fimbriolysis and 14% after salpingostomy. The corresponding figures in the group with normal semen analysis was 67%, 64% and 29%, respectively. It is concluded that patients who in addition to tubal microsurgery have been treated with AID for 9-12 menstrual cycles seem to have about a 50% poorer chance of achieving a term pregnancy compared with patients whose husbands have normal semen quality.

Adult↗

Results of repeated tuboplasties.

The cumulative conception rate of 31 infertile women undergoing a second tuboplasty using microsurgery was compared with that 71 women undergoing a single microsurgical tuboplasty. The follow-up period ranged from ranged from 1 to 61/2 years. Five (16%) of the patients in the repeat tuboplasty group conceived; there were 3 (10%) live births, 1 (3%) tubal pregnancy, and 1 (3%) spontaneous abortion. In the single tuboplasty group 42 (59%) of the patients conceived, with the result of 31 (44%) liver births, 6 (9%) tubal pregnancies, and 5 (7%) spontaneous abortions. Reocclusion of both tubes occurred in 16% and 7% of the patients in the two groups, respectively. It is concluded that the poor results of repeated tuboplasties mainly are due to mucosal lesions, which in the majority of cases seem to be irreversible.

Adult↗

Two cases of 17 alpha-hydroxylase deficiency--one combined with complete gonadal agenesis.

Two cases of 17 alpha-hydroxylase deficiency are described. Both patients had primary amenorrhoea, total lack of female secondary sexual characteristics, slight hypertension and hypokalaemia. One patient was of male genotype (male pseudohermaphrodite), and in addition this patient had complete gonadal agenesis. The other patient was of female genotype. In both patients the level of plasma corticosterone was markedly increased, whereas the concentration of plasma cortisol was very low and plasma aldosterone low within the normal range. Furthermore, the plasma ACTH level was significantly increased and the plasma renin activity around the lower normal limit. The urinary excretion of corticosterone metabolites was markedly increased, whereas the excretion of both cortisol metabolites and tetrahydroaldosterone was decreased. The patients had no symptoms of glucocorticoid deficiency. Treatment with dexamethasone 0.5 mg daily completely suppressed the abnormal corticosterone production and normalized both blood pressure and serum potassium. In addition, the patient of male genotype has received sequential therapy with oestrogen and gestagen for 3 years, but so far no development of the secondary sexual characteristics has occurred.

17-Ketosteroids↗

Congenital adrenal hyperplasia due to 11 beta-hydroxylase deficiency: final diagnosis in adult age in three patients.

Three patients, one male and two females, in whom the diagnosis of congenital adrenal hyperplasia (CAH) was made in early childhood were studied. The two females were treated with cortisone acetate from the age of 2 and 4 years, respectively, and later they both proved to be fertile. The male patient was only treated sporadically with cortisone acetate until the age of 33 years. He also became fertile when a more consistent treatment with prednisolone was started. The two female patients had a slight hypertension in childhood before the treatment was initiated but became normotensive on treatment. The male patient revealed a blood pressure of180/130 mm Hg at the age of 33 years. In this patient the treatment with prednisolone produced a moderate decrease in the blood pressure, but additional treatment with antihypertensive drugs was needed to make him normotensive. All three patients were originally thought to have a 21-hydroxylase deficiency and the correct diagnosis of an 11 beta-hydroxylase deficiency was first established between the age of 26 and 33 years. It is concluded that an early diagnosis and an uninterrupted treatment with glucocorticoids are important in order to prevent hypertension and infertility problems.

Adrenal Cortex Hormones↗

Monozygotic twins with dissimilar phenotypes and chromosome complements.

A case history of monozygotic twins is presented. Twin A showed gonadal dysgenesis and chromosomal mosaicism (45,X0/46,XX). Twin B was a phenotypical normal female with the karyotype 46,XX. Fifteen previous reports of monozygotic twins with gonadal dysgenesis are reviewed. Dissimilar phenotypes seem to be the rule rather than the exception, and mosaicism is found in the majority of cases with dissimilar phenotype. The assumption is made that the chromosome disorder leading to gonadal dysgenesis arises postzygotically, eigher before or after the process leading to twinning.

Adolescent↗

Oestrogen treatment and subsequent pregnancy in two patients with severe hypergonadotrophic ovarian failure.

This report describes in detail the histological and hormonal findings in a patient with Turner's syndrome (45,XO) and a patient with premature menopause (46,XX), who both conceived after withdrawal or reduction of substitution therapy with oestrogens. The aetiology of severe hypergonadotrophic ovarian failure is discussed, and theories regarding a possible relationship between the oestrogen treatment and subsequent pregnancy are hypothesized.

Adult↗

Hormonal and ultrastructural observations in a case of resistant ovary syndrome.

This report describes in detail the hormonal and ultrastructural findings in a 21 year old woman with secondary amenorrhoea, who fulfilled all the criteria necessary to establish the diagnosis of resistant ovary syndrome. Ovarian biopsies revealed numerous primordial and primary follicles, which both by light and electron microscopy showed a normal morphology. Nevertheless, the follicles could not be stimulated neither by large doses of human gonadotrophins alone nor by simultaneous administration of cortisone acetate and large doses of human gonadotrophins. The association of a decreased target cell response with increased levels of serum FSH and LH might be explained in different ways. The presence of an inhibitor preventing the normal action of gonadotrophins could not be substantiated, because we did not detect any circulating gonadotrophin antibodies. Furthermore the serum prolactin level was normal.

Adult↗

Studies on the mode of action of clomiphene citrate.

In order to further investigate the mode of action of clomiphene citrate, 5 oophorectomized women in the age range 28 to 41 years were followed with weekly determinations of serum FSH and LH for 20 weeks after the operation. They received no treatment during the first 4 weeks but during the next 16 weeks they were given estradiol 2 mg X 2 daily orally, and from the 12th to the 16th week in addition clomiphene citrate 50 mgX2 daily. The high level of FSH after the oophorectomy decreased gradually during the treatment with estradiol alone, but this effect was partly neutralized by clomiphene citrate, as we observed a significant increase in FSH within 1 week of initiating treatment with clomiphene citrate. On the other hand, we did not find any significant changes in FSH within 4 weeks after treatment with clomiphene citrate was discontinued. The high level of LH after oophorectomy did not show any significant changes during the whole treatment period. It is concluded that clomiphene citrate primarily stimulated FSH secretion, most probably by a competition with estradiol for the receptor sites in the hypothalamus or the pituitary. In addition, it is concluded that clomiphene citrate has a prolonged effect, probably because of a tight binding to the receptor sites.

Administration, Oral↗

Histology of the human corpus luteum of early and late pregnancy.

The aim of this investigation has been to examine which histological parameters are of value in the age determination of the corpus luteum of pregnancy. The material comprises representative ovarian biopsies from 16 women from the 10th through 42nd week of gestation. The following histological parameters have been found useful for the age determination of the corpus luteum: 1) the size of the granulosa cells; 2) the number of K-cells, vacuoles and colloid inclusions in the granulosa cell layer; 3) the size of the theca interna cells; (4) the size of the vessels in the theca interna. Futhermore, the differentiation of the corpus luteum of pregnancy from the corpus luteum of menstruation is described, and some indications for a histological age determination of the corpus luteum of pregnancy are mentioned.

Adolescent↗