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Biomedical subjects

W R Keye

Publications and source records attributed to W R Keye.

52 records · Page 3Linked to original sources
PubMed1977

Detection, evaluation, and treatment of pituitary microadenomas in patients with galactorrhea and amenorrhea.

Over a period of two and a half years, 34 women with galactorrhea or amenorrhea, all with an abnormal sellar polytomogram, underwent transsphenoidal microsurgical exploration of the sella. Eighteen women and microadenomas (less than or equal to 1 cm. in diameter), seven had macroadenomas (greater than than 1 cm. in diameter), and five had unidentified lesions. Only one women had a normal pituitary gland. Three women had cryosurgery without biopsy. Preoperatively, hyperprolactinemia occurred in 24 of 25 women with adenomas and two of five with nonadenomatous lesions. There were no operative deaths. Significant morbidity occurred in only three patients, none of whom had microadenomas. Postoperatively, menses resumed in 16 of the 17 women with microadenomas and in two of the seven with macroadenomas who presented with amenorrhea. Galactorrhea disappeared in 15 of the 17 women with microadenomas and in four of the seven with macroadenomas who presented with galactorrhea. In five patients with unidentified lesions, a return of menses occurred in two of four with previous amenorrhea, and galactorrhea abated in two of three who presented with lactation. We conclude that sellar polytomography in women with hyperprolactinemia is a useful technique technique for the diagnosis of pituitary adenomas, a lesion which may occur more frequently than previously realized. In addition, transsphenoidal microresection of microadenomas is safe and effective.

Adenoma↗
PubMed1976

Hypothalamic gonadotropin releasing hormone: physiologic and clinical considerations.

Despite the efforts of a large number of investigators, the role of GnRH in clinical gynecology is uncertain. At present, its greatest utility is in research directed toward the understanding of hypothalamic-pituitary interrelationships. However, a clear understanding of the hypothalamic control of gonadotropin secretion awaits the actual measurement of the secretion of GnRH by the hypothalamus. In addition, a better understanding of the ability of the pituitary to secrete gonadotropins in various disorders of menstruation and maturation will probably be achieved through the determination of the capacity of the pituitary to synthesize as well as release gonadotropins in response to GnRH. Such determinations will probably utilize repeated or continuous infusions of GnRH rather than the currently more popular single injection technique. Finally, GnRH may be useful in the induction of ovulation. A definition of its role in ovulation induction awaits the results of additional clinical studies. Understanding of the nature of hypothalamic control of the pituitary is as yet incomplete. The availability of hypothalamic releasing factors will make it possible to study in greater detail the mechanisms by which the fine regulation of the endocrine system is achieved.

Adenoma↗
PubMed1976

Changing patterns of FSH and LH response to gonadotropin-releasing hormone in the puerperium.

Gonadotropin responses to synthetic gonadotropin-releasing hormone (GnRH or LRF), as well as basal concentrations of gonadogropins, estradiol, and prolactin, were determined at weekly intervals during the first eight weeks post partum in seven non-nursing, non-steroid-treated women. The results were compared with those of a group of eleven women studied on the second day of the menstrual cycle. In the postpartum group, baseline concentrations of LH and FSH similar to those seen in the early follicular phase of the menstrual cycle occurred by the third week post partum. In response to an iv bolus of 100 mug GnRH, elevations of serum LH: 1) occurred as early as the second postpartum week; 2) were less than those of women during the early follicular phase until the fourth postpartum week; and 3) were exaggerated (when compared with those ob subjects in the early follicular phase) during the fifth through the eighth week post partum. Similarly, the FSH responses to GnRH in the puerperium were similar to those of the subjects during the early follicular phase by the third week post partum, and were exaggerated during the second month post partum. These studies demonstrate that human pregnancy is followed by a period of relative pituitary refractoriness followed by one of increased responsiveness to GnRH.

Adolescent↗
PubMed1976

Amenorrhea, hyperprolactinemia and pituitary enlargement secondary to primary hypothyroidism. Successful treatment with thyroid replacement.

A 22-year-old nulliparous woman presented with primary amenorrhea, primary hypothyroidism, hyperprolactinemia, and radiologic evidence of pituitary enlargement. Investigation demonstrated limited reserves of ACTH and growth hormone. Circulating concentrations of TSH and prolactin were elevated; they increased in response to thyrotropin releasing hormone and decreased following L-dopa administration. After treatment with L-tri-iodothyronine, serum TSH and prolactin levels fell markedly, reserves of growth hormone and ACTH returned to normal, menstrual periods began, and the patient conceived. She experienced an uncomplicated prenatal, intrapartum, and postpartum course. It is thought that this patient represents a distinct clinical entity: a syndrome of amenorrhea, hyperprolactinemia, and pituitary enlargement, all secondary to primary thyroid failure. This syndrome should be distinguished from the Forbes-Albright syndrome, as it is reversible with thyroid replacement therapy. Recognition of this syndrome may thus spare the patient unnecessary, and potentially dangerous, pituitary surgery or irradiation.

Adult↗
PubMed1975

Strength-duration characteristics of estrogen effects on gonadotropin response to gonadotropin-releasing hormone in women. I. Effects of varying duration of estradiol administration.

This study was designed to investigate the effects of increased serum concentrations of estradiol of varying durations upon the gonadotropin responses to synthetic gonadotropin-releasing hormone (GnRH or LRF). Beginning at 8:00 PM on the first day of the menstrual cycle, subjects received im injections of estradiol benzoate (E2B), 5 mug/kg initially, followed by 2.5 mug/kg every 12 h for a total of 3, 5, 7, 9, or 11 injections. Twelve h after the last E2B injection, or 36, 60, 84, 108, or 132 h after the first injection of E2B (2 subjects at each time interval), each subject received 100 mug GnRH, iv. In addition, each subject received 100 mug GnRH iv during one of the seven days of the antecedent (control) menstrual cycle during which no exogenous estradiol was administered. When GnRH was infused 36 h after the initiation of E2B pretreatment, there was no significant LH or FSH increase. In contrast, LH and FSH responses were augmented and prolonged when compared with control cycles when GnRH was administered at 84, 108, or 132 h. At 60 h, responses of LH were augmented, although not to as great a degree. FSH responses were not augmented at 60 h. Expressed as maximal increase from baseline, gonadotropin responses following E2B were 1 1/2 to 9 times those achieved during control cycles (without E2B). Since mean serum estradiol concentrations at 36 h (185.9 +/- 20.0), when gonadotropin responses were absent, were similar to those at 60 (157.7 +/- 31.6), 84 (186.2 +/- 38.1), 108 (181.3 +/- 46.7), and 132 h (128.0 +/- 43.0 pg/ml), when responses were augmented, these results support the concept that the modulating effect of estradiol on pituitary response is dependent upon the duration of exposure of the hypothalamic-pituitary system to increased concentrations of estradiol. It is probable that the duration of the late follicular phase rise in serum estradiol is responsible, at least in part, for the augmented gonadotropin response seen at midcycle.

Estradiol↗
PubMedDate not supplied

The present and future application of lasers to the treatment of endometriosis and infertility.

Conventional approaches to the treatment of endometriosis usually require major surgery, prolonged use of medications or both. The laser has provided an opportunity to treat mild and moderate endometriosis at the time of diagnosis at laparoscopy, thus avoiding delays in attempts to conceive. This review describes the current use of the CO2, argon and Nd:YAG lasers in the treatment of endometriosis. Potential and future uses of the free-electron laser (FEL) are also described.

Argon↗
PubMedDate not supplied

A biopsychosocial model of premenstrual syndrome.

The authors describe the application of a biopsychosocial model to premenstrual syndrome. In this model one assumes that premenstrual syndrome is the result of an interaction between biologic, psychologic, and social factors. A six-point approach to the evaluation of women with multiple premenstrual symptoms is also presented. Finally, the benefits of this model for the clinician and investigator are reviewed.

Attitude to Health↗