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Biomedical subjects

W R Butt

Publications and source records attributed to W R Butt.

At least 19 recordsLinked to original sources
PubMed1990

Hormonal studies on women with polycystic ovaries diagnosed by ultrasound.

Eighty-six patients were diagnosed by ultrasound to have polycystic ovaries. Twelve have fairly regular but anovular cycles (P1), 56 had oligomenorrhoea (P2) and eight had primary or secondary amenorrhoea (P3). The remaining 10 patients had raised progesterone concentrations and were excluded from the hormonal studies. Gonadotrophins, steroid hormones and sex hormone binding globulin (SHBG) were measured in all patients and the results were compared with those of 29 normal women who acted as controls. A high LH:FSH ratio was the most frequently found abnormality (raised in 68.4% of patients) followed by LH (65.8%), free testosterone (FT, calculated from total testosterone (T) and SHBG) (59.2%) and 17-OHP (48.7%). Each of these four estimations was above the normal ranges in 25% of patients: proportionally most of the results outside the normal range occurred in group P3 followed by P2 and P1 respectively. To obtain a quantitative measure of the abnormalities, results were expressed as percentages of the mean control value for each hormone and these percentages were then summated. The four measurements, LH:FSH ratio, LH, FT and 17-OHP gave abnormality scores ranging from a mean of 667 in P1 to 1189 in P3 compared with 405 in controls. Twenty-one of the 76 patients were hirsute with significantly higher androgens than the nonhirsute patients. Their mean abnormality score was 1141 compared with 855 in the non-hirsute group and they all had at least one hormonal abnormality. The study demonstrates that there is a relationship between the degree of hormonal abnormality and the menstrual irregularities and hirsutism in women with PCOS suggesting that there may be a progressive nature to the syndrome.

17-alpha-Hydroxyprogesterone↗
PubMed1988

The role of the laboratory in the investigation of infertility.

The incidence and the causes of the various types of infertility in men and women are described. Accurate diagnosis of the cause or causes of a couple's infertility is important as the treatment is often expensive and lengthy. A thorough clinical investigation of the couple will indicate which laboratory tests to embark upon. Endocrine abnormalities may account for about a third of diagnoses in women but are rare in men. Standard immunoassay procedures are used for hormone assays to diagnose endocrinopathies and should be performed in a logical sequence. They help to identify hyperprolactinaemia and to distinguish primary gonadal failure from lesions of the hypothalamic-pituitary axis. The common drugs available for treatment are listed and guidelines are given on management during treatment. Hormone assays are useful, but ultrasonic scanning is efficient and rapid and is becoming the preferred method for monitoring follicular growth.

Female↗
PubMed1988

Gonadotropins in the treatment of infertility.

1. Monitoring of gonadotropin therapy is essential to reduce the risk of hyperstimulation and multiple pregnancies. Biochemical methods for the measurement of estrogen production should be done in conjunction with ultrasonic scanning of the growing follicles. 2. The joint action of clomiphene and gonadotropins has not been adopted for routine gonadotropin therapy but is useful for inducing multiple ovulations in women undergoing in vitro fertilization. 3. Pulsatile administration of gonadotropins has not been shown to avoid multiple follicular development and therefore has no advantage over routine methods of administration. 4. Gonadotropin preparations with a high ratio of FSH to LH would theoretically be more suitable for the treatment of polycystic ovarian disease than the usual preparations with a 1:1 ratio on account of the high basal LH levels in these patients. In experiments so far the results obtained have been no better however.

Clomiphene↗
PubMed1988

Pulsatile GnRH therapy for the induction of ovulation in hypogonadotropic hypogonadism.

Twenty-eight patients with hypogonadotropic hypogonadism resistant to clomiphene therapy were treated with pulsatile GnRH. All the patients ovulated and there were 20 pregnancies in 16 women. Administration of the GnRH sc was successful at inducing ovulation in 19 of 22 patients whereas the treatment was successful in all of the 17 patients treated iv. There was no difference between iv and sc therapy in the rate of ovulation. Treatment was stopped after ovulation and hCG given for luteal support. The follicular phase pulse frequency was usually 90 min. In one patient ovulation only occurred with frequencies of 60 min. Higher pulse doses were usually required with sc therapy for primary amenorrhoeic patients and for those with pituitary lesions. The additional use of clomiphene increased pituitary sensitivity to GnRH resulting in ovulatory cycles in patients refractory to treatment and in ovarian hyperstimulation in a normally responsive patient. Two of the 20 pregnancies were twin--the rest were singletons. None aborted. The median time to conception was 3 ovulatory cycles. Although there were no serious complications with iv or sc therapy, the iv route is now reserved for those patients unresponsive to sc treatment as the sc route is potentially safer and more acceptable to the patient. In correctly selected patients pulsatile GnRH is a highly effective and safe new treatment for the induction of ovulation.

Adult↗
PubMed1987

A clinical trial using danazol for the treatment of premenstrual tension.

Forty women with premenstrual tension received either placebo, 100, 200 or 400 mg danazol daily for 3 months in a pilot study arranged as a double-blind trial. Thirteen patients withdrew by the third month usually because they complained of no improvement. They had significantly higher pretrial symptom scores than those who continued. In patients treated with danazol, symptom scores for breast pain during the second and third months and for irritability, anxiety and lethargy during the third month were significantly (P less than 0.05) lower than scores in those given placebo. Most symptoms improved on placebo in the first month but by the third month only three remained improved. In contrast eight symptoms were improved on 200 mg danazol by the third month. By the end of the trial more than 75% of patients who were still taking danazol were essentially free of breast pain, lethargy, anxiety and increased appetite, but results for other common symptoms were no better than with placebo.

Anxiety↗
PubMed1986

Effect of injection site on the pharmacokinetics and pharmacodynamics of subcutaneously administered luteinizing hormone releasing hormone.

Serum concentrations of LHRH and the subsequent LH responses were compared following s.c. injections of 20 micrograms LHRH into the upper arm and the lower abdominal wall, in 9 hypogonadal women responsive to pulsatile LHRH therapy. Tests were carried out at the two sites in random order. Peak LHRH concentrations were reached by 5 min after upper arm and by 20 min after lower abdominal wall injections, the maximum concentrations being significantly greater following injections into the former. There was no increase in LH until 10 min and then maximum concentrations were reached at 30 min following injection into both sites. There was no significant correlation between the LHRH increments and the LH response but there was a negative correlation between the Ponderal Index of the patients and the LHRH increments following injections into the lower abdominal wall only. There was no significant overall difference between the LH increments related to the site of injection, but the order of injections affected the responses. When upper arm injections were given first the LH responses were significantly greater, but when lower abdominal wall was injected first the subsequent responses to upper arm injections were impaired. A possible reason for this is that the absorption from the lower abdominal wall was delayed so prolonging the exposure of the pituitary gonadotrophs to LHRH, resulting in pituitary desensitization at the time of the second test.

Abdominal Muscles↗
PubMed1985

Study of the effect of estradiol on gonadotrophin levels in untreated male-to-female transsexuals.

This project was an attempt to test Dörner's theory that aspects of gender identity and sexual behavior depend on a defect in a normal imprinting mechanism of testicular testosterone (T) on the male hypothalamus. It has been suggested that such an action by T is incomplete in male-to-female transsexuals and that in this disorder the hypothalamus retains a cyclic pattern of gonadotrophin secretion and a positive feedback response to estrogens, such as is seen in the normal female. Five untreated male-to-female transsexuals and five normal male controls were each given 2 mg IM of estradiol, and T, estradiol, LH, and FSH globulin was measured serially over the following five days. No significant differences were found in the gonadotrophin or any of the other hormone responses in the transsexuals compared to normal controls. If there is a defect in imprinting of the hypothalamus in transsexual men, it does not seem to affect the basal levels of gonadotrophins or the pattern of their response to estrogen, at least in the intact male.

Adult↗
PubMed1985

Prolactin and growth hormone dynamics in epileptic patients receiving phenytoin.

Resting growth hormone and prolactin levels and dynamic responses to bromocriptine and metoclopramide have been measured in epileptic patients before treatment, and compared with a matched group taking phenytoin alone. Mean resting levels of prolactin were higher in patients taking phenytoin (untreated patients 204 mU/l, phenytoin treated patients 302 mU/l), but dynamic responses to metoclopramide and bromocriptine were unaffected. Mean resting levels of growth hormone were also higher in patients taking phenytoin (untreated patients 1.4 mU/l, phenytoin treated patients 6.0 mU/l) and paradoxical suppression was seen following bromocriptine. Phenytoin is unlikely to have any major action on the D2 receptor present on the lactotroph. The abnormalities in growth hormone may explain the well recognized effects of phenytoin on connective tissue.

Adolescent↗
PubMed1985

Hormonal studies in women with premenstrual tension.

Serum hormone concentrations were determined at intervals during the last 17 days of the menstrual cycle in 35 patients with premenstrual tension (PMT) and 11 control subjects without symptoms. The maximum mean concentration of oestradiol occurred 17 days before menstruation in the patients and 14 days before in the controls. The maximum concentrations of progesterone were similar in the two groups but the mean concentrations rose earlier in the cycle in the patients with PMT. These results suggested that the patients tended to ovulate earlier in the cycle than the controls and on the basis of the ovulatory surge in gonadotrophins two groups could be identified, group A who showed signs of ovulation 14 days or less before menstruation (17 patients, 9 controls) and group B who ovulated more than 14 days before menstruation (18 patients, 2 controls). There were no significant differences between the groups in prolactin, thyroid stimulating hormone or testosterone levels, but cortisol concentrations were uniformly higher in both groups of patients compared with those in the controls. Follicular growth was assessed with ultrasound in 18 patients and 16 control subjects. Mean follicular diameters were significantly lower in the patients than in the control group at the time of ovulation. Oestradiol determinations done at the same time correlated with the diameters and were also significantly lower in the patient group. The results suggest that ovulation tends to occur prematurely in women with PMT.

Adult↗
PubMed1984

Effects in man of progabide on prolactin release induced by haloperidol or domperidone.

The effects of progabide, a GABA receptor agonist, on haloperidol-induced and domperidone-induced hyperprolactinaemia have been studied in man. There was a moderate inhibition by progabide of the rise in prolactin after domperidone. No such effect was found after haloperidol. The results support the view that in man, as in animals, GABA agonists have an inhibitory effect on prolactin release, probably at the level of the hypothalamus and anterior pituitary.

Adult↗
PubMed1984

Pulsatile administration of GnRH for the treatment of hypogonadotrophic hypogonadism.

Fourteen patients, aged 22-35 years, complaining of infertility and failing to ovulate on clomiphene, were treated with GnRH administered in pulses at 90 min intervals. Four patients received a total of eight courses of GnRH given subcutaneously and 13 were given a total of 20 months of treatment with GnRH given intravenously. Serum concentrations of immunoreactive GnRH were measured in six patients before administration of the drug and at regular intervals for 60 min after subcutaneous and intravenous injections of 5, 10 and 20 micrograms GnRH. Maximum concentrations of GnRH were reached by 5-10 min after subcutaneous injections and within 2 min after intravenous injections. The peak concentrations were 3.6-6.3 times and the sums of increments were 2.0-3.9 times greater following intravenous injections than after subcutaneous injections. Subcutaneous treatments extended for 15-29 days with doses of 5-20 micrograms per pulse. Only one patient ovulated as judged by the luteal phase progesterone and ultrasonic scanning of the follicle. Intravenous treatments were from 12-22 days with doses of 10 micrograms per pulse and 16 treatments out of 20 were ovulatory with four pregnancies. HCG (5000 i.u.) was given when ultrasonic scanning indicated adequate follicular growth, but in eight of the cycles, including three of the pregnancies, the follicle had ruptured before HCG was given. Pulsatile administration of GnRH proved to be an effective treatment for infertility in hypogonadotrophic hypogonadism. Possible reasons for the better results by intravenous rather than subcutaneous injections are discussed.

Adult↗
PubMed1984

Review of 59 patients with hypergonadotrophic amenorrhoea.

Fifty-nine patients presented with elevated concentrations of gonadotrophins and secondary amenorrhoea before the age of 35 years. Fifty-three underwent laparoscopic examination and primordial follicles were observed in 16. Two others had follicles as they later became pregnant and a third showed biochemical evidence of spontaneous ovulation. There were streak ovaries in 12, two with follicles and three others with chromosomal abnormalities, two being 47XXX and one XO/XX. Two other patients had only one ovary each but no follicles. Chromosomal abnormalities were detected in two further patients one being XO/XX and the other a recombinant. Six patients became pregnant, two of them twice, resulting in four term deliveries and four spontaneous abortions. Three other patients showed biochemical evidence of ovulation; one spontaneously, one after oestrogen therapy and the third after treatment with gonadotrophin releasing hormone analogue.

Adolescent↗
PubMed1983

Effectiveness of pergolide mesylate in long term treatment of hyperprolactinaemia.

Twenty five patients with hyperprolactinaemia were treated with pergolide mesylate, a new dopamine receptor agonist. Twenty three received treatment for six to 20 months, and in all serum prolactin concentrations were considerably reduced. In most patients prolactin concentrations were maintained in the normal range by a low, once daily dose of pergolide and reversal of associated reproductive disorders was observed. Tumour volume as assessed by computed tomography decreased considerably during treatment in three out of four patients with a pituitary tumour. The drug was well tolerated. Side effects were similar to those of bromocriptine, but four out of eight patients who had been forced to stop taking bromocriptine because of untoward effects were subsequently able to tolerate treatment with pergolide. Pergolide mesylate promises to be a useful addition to the currently available long acting dopamine agonists in the management of hyperprolactinaemia.

Adult↗
PubMed1983

Acth function in women with the polycystic ovarian syndrome.

Serum androgen levels, including dehydroepiandrosterone sulphate (DHAS) which is thought to be solely of adrenal origin, are elevated in women with the polycystic ovarian syndrome. We have investigated the possibility that this may be due to a mild form of congenital adrenal hyperplasia by measuring basal and stimulated levels of ACTH in women with this condition and have compared them to levels in normal women. We found no difference in the diurnal rhythm of ACTH between patients and normal subjects nor any difference in stimulated levels achieved after a single-dose oral metyrapone test. Thus there is no evidence from this study to support the idea that these patients might have congenital adrenal hyperplasia. There are two alternative hypotheses to explain the elevated DHAS levels. They may be associated with the high oestrogen levels, which interfere with the enzyme 3 beta-hydroxysteroid dehydrogenase, or there may be alteration of the factors controlling adrenal androgen secretion.

Adolescent↗
PubMed1983

Maternal plasma concentrations of beta-lipotrophin, beta-endorphin and gamma-lipotrophin throughout pregnancy.

Plasma beta-LPH, beta-EP and gamma-LPH concentrations were measured by radioimmunoassay in 10 pregnant women from 12 weeks gestation until term and in nine women in the early follicular phase of the cycle. There was a progressive and significant rise in the concentration of all three peptides throughout pregnancy and by 32 weeks the concentrations of beta-LPH and beta-EP were greater than the corresponding concentrations in the follicular phase: gamma-LPH was greater than in the follicular phase by the end of pregnancy in those women who were delivered after 40 weeks. The ratio of beta-LPH to gamma-LPH did not change significantly throughout pregnancy, but there was a progressive fall in the beta-LPH/beta-EP ratio. The possible presence of a 'big LPH' to explain this finding is discussed.

Adolescent↗
PubMed1983

Maternal and cord plasma concentrations of beta-lipotrophin, beta-endorphin and gamma-lipotrophin at delivery; effect of analgesia.

Maternal venous plasma concentrations of beta-LPH, beta-EP and gamma-LPH were compared in (i) patients undergoing vaginal delivery, 11 with an epidural block and 13 with pethidine and nitrous oxide or no analgesics; (ii) patients delivered by caesarean section, 7 under epidural block and 8 under general anaesthesia. Patients delivered by either method under epidural block had significantly lower levels of all three peptides than those receiving no epidural. There were significant negative correlations between umbilical vein beta-LPH, beta-EP and gamma-LPH concentrations and umbilical artery pH and positive correlations between beta-LPH and beta-EP but not gamma-LPH and cord PCO2 in 29 patients. There was no relation between cord levels of any of the three peptides and the method of analgesia or the route of delivery. Although concentrations of all three peptides were closely correlated to one another in either maternal or cord plasma, there was no relationship between maternal and fetal levels.

Anesthesia, Epidural↗
PubMed1983

Luteinizing hormone releasing hormone analogue in treatment of hypergonadotrophic amenorrhoea.

The effect of a luteinizing hormone releasing hormone analogue (HOE 766) was studied in four patients with hypergonadotrophic amenorrhoea (resistant ovary syndrome). After an initial phase of stimulation, there was a uniform and sustained suppression of gonadotrophin concentrations in all the patients during the 20-24 days of treatment, presumably due to down-regulation of the pituitary receptors. One patient ovulated after stopping treatment.

Adult↗