Relationship between sexual hormones, quality of life and postmenopausal sexual function / Relação entre hormônios sexuais, qualidade de vida e função sexual na pós-menopausa

Abstract Objective To assess the relationship between sexual hormones, sexual function and quality of life in postmenopausal women. Method A cross-sectional study was conducted with a convenience sample of 36 postmenopausal women between the ages of 45 and 65 in follow-up at a climacteric outpatient clinic. Mood, quality of life, sexual function and hormonal profile were assessed. Results With regard to sexual hormones and sexual function, a relationship was found between orgasm and luteinizing hormone (r=0.37), orgasm and sex hormone-binding globulin (SHBG) (r=0.39), SHBG and less pain (r=0.44), dehydroepiandrosterone (DHEA) and desire (r=-0.45), as well as between prolactin and lubrication (r=0.33). Sexual hormones and quality of life were related as follows: progesterone and limitations due to physical aspects (r=0.35), SHBG and social aspects (r=0.35), cortisol and pain (r=0.46), DHEA and social aspects (r=-0.40). Finally, the following relationships were found between sexual function and quality of life: sexual desire and vitality, social aspects, state of general health and mental health (r=0.46, r=0.51, r=0.35, and r=0.38, respectively). Arousal, orgasm and satisfaction with sexual life showed a relationship with less physical pain (r=0.40, r=0.42, and r=0.43, respectively). Satisfaction with sexual life was correlated with vitality (r=0.33). Conclusion Different correlations than expected were found in this study regarding the effect of some hormones on sexual function and some aspects of the quality of life of postmenopausal women.

Resumo Objetivo Avaliar a relação entre hormônios sexuais, função sexual e qualidade de vida em mulheres na pós-menopausa. Métodos Estudo transversal com amostra de conveniência de 36 mulheres na pós-menopausa, com idades entre 45 e 65 anos, em seguimento ambulatorial de climatério. Humor, qualidade de vida, função sexual e perfil hormonal foram avaliados. Resultados Entre hormônios sexuais e função sexual, foi encontrada relação entre orgasmo e hormônio luteinizante (r=0,37), orgasmo e globulina ligadora de hormônios sexuais (SHBG) (r=0,39), SHBG e menos dor (r=0,44), desidroepiandrosterona (DHEA) e desejo (r=-0,45), bem como entre prolactina e lubrificação (r=0,33). Entre hormônios sexuais e qualidade de vida: progesterona e limitações por aspectos físicos (r=0,35), SHBG e aspectos sociais (r=0,35), cortisol e dor (r=0,46), DHEA e aspectos sociais (r=-0,40). Por fim, entre função sexual e qualidade de vida: desejo sexual e vitalidade, aspectos sociais, estado geral de saúde e saúde mental (r=0,46, r=0,51, r=0,35 e r=0,38, respectivamente). Excitação, orgasmo e satisfação com a vida sexual mostraram uma relação com menos dor física (r=0,40, r=0,42 e r=0,43, respectivamente). A satisfação com a vida sexual foi correlacionada com a vitalidade (r=0,33). Conclusão Correlações diferentes das esperadas foram encontradas neste estudo em relação ao efeito de alguns hormônios sobre a função sexual e alguns aspectos da qualidade de vida de mulheres na pós-menopausa.

[Comparison of serum androgens and progesterone in preeclampsia and normal pregnancy]

Androgens are among the causative factors in preeclampsia. This study was done to compare the serum androgens and progesterone in preeclampsia and normal pregnancy. This case-control study was done on 30 preeclamptic and 30 healthy pregnant women in Gorgan, Iran. Higher or equal to 140/90 mmHg and proteinuria equal or more than +1 in dip stick test in the third trimester of pregnancy were considered as the diagnostic criteria of preeclampsia. Progesterone, free and total testosterone, and dehydroepiandrosterone sulphate [DHEA] were measured by ELISA method. Total testosterone level was 1.8 +/- 0.3 ng/ml and 1.3 +/- 0.9 ng/ml in cases and controls, respectively. This difference was not significant. Progesterone was lower in cases [95 +/- 46.9 ng/ml] than in controls [165.4 +/- 75 ng/ml] [P<0.01]. Free testosterone and DHEA were 5.6 +/- 2.3 ng/ml and 1 +/- 0.5 ng/ml in cases, respectively which was significantly higher than the controls [3.2 +/- 1.5 ng/ml and 0.7 +/- 0.4 ng/ml, respectively] [P<0.045]. Serum level of free testosterone, DHEA and progesterone increased and reduced respectively in preeclampsia

A high corticosterone/DHEA-s ratio in young rats infected with Trypanosoma cruzi is associated with increased susceptibility

We have previously established that young male rats are more susceptible to the effects of Trypanosoma cruzi infection than adult rats. To explore underlying age-associated differences in disease outcome, we simultaneously assessed hormone levels and cytokine release throughout the acute infection period in young and adult rats infected with T. cruzi. Young rats were inoculated with 1 x 10(6) and adult rats with 7 x 10(6) blood trypomastigotes, according to their relative body weight. At zero, seven, 14, 21 and 28 days after infection, blood was collected for the determination of gonadal and adrenal hormones, tumor necrosis factor α (TNF-α), interleukin (IL)-10 and specific IgM and IgG subtypes. Young animals displayed significantly higher parasitaemia values and an endocrine pattern that was characterised by elevated values in corticosterone (CT) and the CT/dehydroepiandrosterone-sulfate ratio, which favours immunosuppression and susceptibility. In contrast, adult male rats were able to restrict the parasite burden, which likely resulted from increased IgG antibody synthesis and oestradiol levels. Adult rats also showed a reduced TNF-α/IL-10 ratio and less tissue damage. We conclude that young animals exhibited increased vulnerability to T. cruzi infection compared with adults and this is associated with an unsuitable immunoendocrine milieu.

Serum androgen levels and their relationship to pattern and severity of hair growth in hirsute women presenting at private centre in Hyderabad

To determine the frequency of raised serum androgen levels in hirsute women and their relationship to the pattern and severity of hair growth in patients presenting at private cosmetic center at Hyderabad. In this cross-sectional study, conducted in a private cosmetic and aesthetic centre, Hyderabad, from January, 2007 to December, 2007, 65 consecutive patients of hirsutism attending the centre were enrolled. Twenty normal women of similar ages [mean age 23.60 +/- 2.90 years] without signs of hirsutism and with normal menstrual cycle were also included as control group. Informed consent was obtained from all patients. Duration, pattern, and severity of hair growth [Ferriman-Gallwey score], weight, body mass index, acne and sebhorrhea were also evaluated. Serum testosterone, serum androstenedione and dehydroepiandrosterone sulphate levels were assessed in all patients and controls. Correlation between serum androgen levels and pattern and severity of hair growth was determined. Chisquare test was applied to determine p value. A total of 65 patients were enrolled in study. Their ages ranged from 16 to 45 years [mean age 24.49 +/- 6.44 years]. Thirty nine [60%] patients had normal androgen levels without evidence of significant endocrine abnormality. These were assigned idiopathic category. 26 [40%] patients had modest elevations of serum androgens. Among them, 21 had polycystic ovaries. Patients having modest to greatly elevated androgen levels [serum testosterone] had severe hirsutism with Ferriman-Gallwey scores [F-G score] >/= 8. [p

Salivary Cortisol and DHEA Levels in the Korean Population: Age-Related Differences, Diurnal Rhythm, and Correlations with Serum Levels

PURPOSE: The primary objective of this study was to examine the changes of basal cortisol and DHEA levels present in saliva and serum with age, and to determine the correlation coefficients of steroid concentrations between saliva and serum. The secondary objective was to obtain a standard diurnal rhythm of salivary cortisol and DHEA in the Korean population. MATERIALS AND METHODS: For the first objective, saliva and blood samples were collected between 10 and 11 AM from 359 volunteers ranging from 21 to 69 years old (167 men and 192 women). For the second objective, four saliva samples (post-awakening, 11AM, 4PM, and bedtime) were collected throughout a day from 78 volunteers (42 women and 36 men) ranging from 20 to 40 years old. Cortisol and DHEA levels were measured using a radioimmunoassay (RIA). RESULTS: The morning cortisol and DHEA levels, and the age-related steroid decline patterns were similar in both genders. Serum cortisol levels significantly decreased around forty years of age (p < 0.001, when compared with people in their 20s), and linear regression analysis with age showed a significant declining pattern (slope= -2.29, t= -4.297, p < 0.001). However, salivary cortisol levels did not change significantly with age, but showed a tendency towards decline (slope= -0.0078, t= -0.389, p=0.697). The relative cortisol ratio of serum to saliva was 3.4 - 4.5% and the ratio increased with age (slope=0.051, t=3.61, p < 0.001). DHEA levels also declined with age in saliva (slope= -0.007, t= -3.76, p < 0.001) and serum (slope= -0.197 t= -4.88, p < 0.001). In particular, DHEA levels in saliva and serum did not start to significantly decrease until ages in the 40s, but then decreased significantly further at ages in the 50s (p < 0.001, when compared with the 40s age group) and 60s (p < 0.001, when compared with the 50 age group). The relative DHEA ratio of serum to saliva was similar throughout the ages examined (slop = 0.0016, t = 0.344, p = 0.73). On the other hand, cortisol and DHEA levels in saliva reflected well those in serum (r = 0.59 and 0.86, respectively, p < 0.001). The highest salivary cortisol levels appeared just after awakening (about two fold higher than the 11 AM level), decreased throughout the day, and reached the lowest levels at bedtime (p < 0.001, when compared with PM cortisol levels). The highest salivary DHEA levels also appeared after awakening (about 1.5 fold higher than the 11 AM level) and decreased by 11AM (p < 0.001). DHEA levels did not decrease further until bedtime (p=0.11, when compared with PM DHEA levels). CONCLUSION: This study showed that cortisol and DHEA levels change with age and that the negative slope of DHEA was steeper than that of cortisol in saliva and serum. As the cortisol and DHEA levels in saliva reflected those in serum, the measurement of steroid levels in saliva provide a useful and practical tool to evaluate adrenal functions, which are essential for clinical diagnosis.

Salivary Cortisol and DHEA Levels in the Korean Population: Age-Related Differences, Diurnal Rhythm, and Correlations with Serum Levels

PURPOSE: The primary objective of this study was to examine the changes of basal cortisol and DHEA levels present in saliva and serum with age, and to determine the correlation coefficients of steroid concentrations between saliva and serum. The secondary objective was to obtain a standard diurnal rhythm of salivary cortisol and DHEA in the Korean population. MATERIALS AND METHODS: For the first objective, saliva and blood samples were collected between 10 and 11 AM from 359 volunteers ranging from 21 to 69 years old (167 men and 192 women). For the second objective, four saliva samples (post-awakening, 11AM, 4PM, and bedtime) were collected throughout a day from 78 volunteers (42 women and 36 men) ranging from 20 to 40 years old. Cortisol and DHEA levels were measured using a radioimmunoassay (RIA). RESULTS: The morning cortisol and DHEA levels, and the age-related steroid decline patterns were similar in both genders. Serum cortisol levels significantly decreased around forty years of age (p < 0.001, when compared with people in their 20s), and linear regression analysis with age showed a significant declining pattern (slope= -2.29, t= -4.297, p < 0.001). However, salivary cortisol levels did not change significantly with age, but showed a tendency towards decline (slope= -0.0078, t= -0.389, p=0.697). The relative cortisol ratio of serum to saliva was 3.4 - 4.5% and the ratio increased with age (slope=0.051, t=3.61, p < 0.001). DHEA levels also declined with age in saliva (slope= -0.007, t= -3.76, p < 0.001) and serum (slope= -0.197 t= -4.88, p < 0.001). In particular, DHEA levels in saliva and serum did not start to significantly decrease until ages in the 40s, but then decreased significantly further at ages in the 50s (p < 0.001, when compared with the 40s age group) and 60s (p < 0.001, when compared with the 50 age group). The relative DHEA ratio of serum to saliva was similar throughout the ages examined (slop = 0.0016, t = 0.344, p = 0.73). On the other hand, cortisol and DHEA levels in saliva reflected well those in serum (r = 0.59 and 0.86, respectively, p < 0.001). The highest salivary cortisol levels appeared just after awakening (about two fold higher than the 11 AM level), decreased throughout the day, and reached the lowest levels at bedtime (p < 0.001, when compared with PM cortisol levels). The highest salivary DHEA levels also appeared after awakening (about 1.5 fold higher than the 11 AM level) and decreased by 11AM (p < 0.001). DHEA levels did not decrease further until bedtime (p=0.11, when compared with PM DHEA levels). CONCLUSION: This study showed that cortisol and DHEA levels change with age and that the negative slope of DHEA was steeper than that of cortisol in saliva and serum. As the cortisol and DHEA levels in saliva reflected those in serum, the measurement of steroid levels in saliva provide a useful and practical tool to evaluate adrenal functions, which are essential for clinical diagnosis.

Evaluation o androgen and progesterone levels in women with preeclampsia

Preeclampsia along with its complications seems to be one of the major causes of maternal morbidity and mortality. Despite numerous studies, the pathology of preeclampsia has not yet been fully elucidated. This study, therefore, determines whether maternal serum levels of androgen and progesterone are higher in patients with preeclampsia than in matched control subjects. Serum progesterone, free and total testosterone, and dehydroepiandrosterone levels were measured in 19 women in their third trimester of pregnancy having preeclampsia, as patient group, and in 17 healthy normotensive pregnant women, as control group, with similar maternal and gestational ages. All women were primigravida with singleton pregnancy. There were no significant differences between the two groups in body mass index, maternal and gestational ages. Progesterone and free testosterone levels were significantly lower [P<0.01] in patients [75.1 +/- 8.6 ng/dl and 2.27 +/- 1.74 pg/dl] than of control group [111.6 +/- 9.71 ng/dl and 3.73 +/- 1.31 pg/dl]. Whereas, the levels of total testosterone [1.02 +/- 0.10 ng/dl vs. 1.37 +/- .019ng/dl] and dehydroepiandrosterone [0.99 +/- 0.13 micro g/dl vs. 0.98 +/- 5.15 micro g/dl] of patients and control groups were not significantly different. Levels of progesterone were pathologically and statistically lower in preeclampsia than of control women with similar age, gestational age and body mass index. It seems that accentuate increase sex hormone binding globulin is the cause of deceased free testosterone in preeclampsia

Reference intervals for important serum sex steroid hormones, prostate specific antigen, insulin like growth factor 1 and IGF binding protein 3 concentration in a normal Kuwaiti adult male population

The purpose of this study was to determine the age-specific reference ranges for some important male sex steroid hormones, prostate-specific antigen [PSA], insulin-like growth factor-1 [IGF-1], and IGF binding protein-3 [IGFBP-3], for the Kuwaiti population. Blood samples were taken from 398 consenting, fasting, healthy Kuwaiti males aged 15-80 years between 8.00 a.m. and 12.00 noon. The serum concentrations of total testosterone [TT], dehydro-epiandrosterone sulfate [DHEAS], androstenedione [ADT], sex hormone binding globulin, luteinizing hormone [LH], follicle-stimulating hormone [FSH], prolactin, PSA, IGF-1 and IGFBP-3 were determined. A distribution curve was plotted and age-specific reference levels were determined for each analyte. The reference interval for parameters with a normal distribution [Gaussian] was mean +/- 2 SD, while for the non-normal distribution [non-Gaussian], it was 2.5-97.5 percentile. The reference intervals for the analytes obtained from this study were compared with those suggested by the kit manufacturers and currently used by the Ministry of Health, Kuwait Laboratories [MOHKL]. Serum IGFBP-3 and ADT had normal distribution while other analytes had non-normal distribution. The reference intervals from this study, manufacturers kit and MOHKL were as follows: TT 3-31, 9-60, 8-35 nmol/l; DHEAS 0.9-11, 1.0-7.3, 2.2- 15.2 micro mol/l; ADT 0.5-4.3, 0.8-2.8, 2.0-9.2 nmol/l; LH 1-11, 0.8-7.6, 0.4-5.7 mIU/l; FSH 0.5-11, 0.7-11.1, 1.1-13.5 mIU/l; prolactin 42-397, 53-360, 80-230 nmol/l; IGF-1 41-542, 78-956, 71-261 ng/ml; IGFBP-3 88- 2,090, 900-4,000, 900-4,000 ng/ml, and PSA 0-3.1, 0-4, 0-4 ng/ml, respectively. These data indicate that for Kuwaitis lower reference ranges must be used for serum TT, DHEAS, ADT, IGFBP-3 and PSA. There is no need to change the currently used reference interval for FSH whereas higher values must be used for LH, prolactin, and IGF-1

Early shifts of adrenal steroidogenesis in male patients with liver cirrhosis

Despite its positive effects on the secretion of cortisol, interleukin [IL]-6 suppresses adrenal androgen production. Adrenal androgens, particularly dehydroepiandrosterone [DHEA], may have important regulatory effects on the immune system in humans. It provides an immunostimulatory influence opposing the effect of glucocorticoids. As bacterial infection is likely to recur in cirrhotic patients with increased IL-6 levels, we hypothesized that sustained elevation of IL-6 levels in patients with liver cirrhosis might be associated with dysregulation of adrenal steroidogenesis and defective adrenal DHEA production. Forty-four male patients with hepatic cirrhosis [10 Pugh-Child's grade A, 17 grade B, and 17 grade C], and 10 healthy age-matched control male subjects were included in this study. Enzyme immunoassays were used for measurement of plasma adrenocorticotropic hormone [ACTH], serum cortisol, serum dehydroepiandrosterone sulfate [DHEAS], as a marker of DHEA production, and serum IL-6. Serum C-reactive protein [CRP] concentration was determined immunoturbidimetrically. Serum IL-6 and DHEAS showed significant change [increase in the former and decrease in the later] in cirrhotic patients with grades B and C as compared to healthy subjects [P<0.05]. Increased serum levels of cortisol and the cortisol/DHEAS molar ratio were found in the three groups of patients [grades A, B and C] in comparison to healthy subjects [P<0.05]. Child-Pugh's score was correlated positively with serum IL-6 [r=0.508, P=0.0004]; serum CRP [r=0.431 P=0.0035]; and serum cortisol [r=0.329, P=0.029]; and negatively with DHEAS/IL-6 ratio [r= -0.374, P=0.012]. Our results revealed that the severity of liver cirrhosis is associated with enhanced serum IL-6 and cortisol levels, and a decrease in serum DHEAS in relation to serum IL-6 concentrations. These perturbations accounted for the early shift of adrenal steroidogenesis to cortisol production at the expense of androgen production. This might participate in the increased susceptibility of cirrhotic patients for infectious complications. Future research should, therefore, focus on the evaluation of DHEA replacement in cirrhotic populations

Níveis séricos de hormônios de crescimento, fator de crescimento símile à insulina e sulfato de deidroepiandrosterona em idosos residentes na comunidade: correlaçäo com parâmetros clínicos / Serum levels of growth hormone, insulin like growth factor and dehydroepiandrosterone sulfate in elderly people living in the community: correlation with clinical parameters

O envelhecimento é acompanhado de alteraçöes orgânicas possivelmente relacionadas com o sistema endócrino. O eixo GH/IGF-1 e a produçäo de SDHEA declinam com a idade, caracterizando uma reduçäo de suas atividades, que podem resultar em efeitos deletérios sobre a composiçäo corporal, o sistema cardiovascular e a congniçäo. Avaliamos a concentraçäo sérica basal de GH, IGF-1 e SDHEA em 225idosos de uma comunidade (148 mulheres e 77 homens, 70 a 91 anos), 80 por cento deles com características de envelhecimento bem sucedido (Minimental >/= 3). Tanto o IMC como a pressäo arterial estavam significativamente mais elevados nas mulheres. Os níveis de GH também eram amiores nas mulheres (1,6 +/- 1,7 vs. 1,0 +/- 1,3 ng/ml, X +/- DP, p<0,001), estando acima da faixa de referência em 14 por cento e 19 por cento das mulheres e homens. Já os níveis de IGF-1 eram semelhantes (90 +/- 42 e 101 +/- 40ng/ml, NS), nao sendo elevados em nenhum deles e reduzidos em 35 por cento e 24 por cento, respectivamente. Os níveis de SDHEA eram maiores nos homens (86 +/- 58 e 54 +/- 36µg/dl, p<0,001), porém na faixa de referência em 92 por cento deles. Houve uma surpreendente correlaçäo positiva entre idade e GH nos homens (r= 0,38, p<0,005), mas uma correlaçäo negativa entre IGF-1 e idade nos dois grupos r= -0,24 e r= -0,32). Nas mulheres, houve também uma correlaçäo positiva entre SDHEA e IGF-1 (r= 0,27). Em conclusäo, níveis basais de GH podem estar elevados em uma parcela significativa dos idosos, sendo maiores nas mulheres, enquanto os níveis de IGF-1 encontram-se normais ou baixos nos dois grupos, sugerindo quadro de resistência hormonal. Os níveis de SDHEA encontravam-se na faixa de referência, sendo maiores nos homens, caracterizandoa perda da contribuiçäo oariana. Diferentemente do que se tem especulado, näo encontramos correlaçäo entre os níveis de SDHEA e qualquer parâmetro clínico investigado.

Hormonal parameters of the serum and saliva in patients with androgenetic alopecia

Hair growth and developments are influenced by androgens. Androgens are important in hair growth and patterning in men. Reports on hormone analysis in androgenetic hair loss in females show partly contradicting results elevated as well as normal-range androgens levels have been found. To determine the nature of the hormonal status in patients with AGA and to evaluate the saliva as new clinical tool in hormonal parameters, this study was carried out on 30 subjects with AGA and 20 subjects without AGA as controls. FT and DREA-S in the serum and saliva were measured in all subjects There was significant increase in both hormone levels in the serum of bald men while no significant changes were noted in the serum of bald women. Also saliva FT showed significant increase in bald men and women; while saliva DHEA-S showed significant increase only in the bald women in comparison to control. [1] Men with higher levels of androgens are more likely to have AGA. [2]-increased response of androgen receptors in the skin despite normal androgens levels seems to play a causal role in female patients with AGA [3] The saliva/plasma relationship is not yet sufficiently understood to assess the value of salivary measurements in patients with AGA-Further investigations are recommended to find answers to these problems

Hair count and thickness reduction in laser-assisted hair removal

Currently the medical field is experiencing a sizable increase in laser hair removal technology. Ruby and alexandrite have proved to be important tools in that field. The aim of this paper is to objectively evaluate the results of hair removal by both lasers in darker skin types [III and IV]. This study included sixteen patients treated in the period from August 2000 to March 2001 Hair count was recorded by a graduated grid; while thickness was evaluated by comparing the hair shaft with standard suture materials. Numerical data concerning both the number and the thickness were obtained before and after each session. Excluding the side effects, both lasers were found efficacious in reducing hair count and thickness in skin types III and IV. And numerical data about the anticipated results could be offered to future patients during the initial consultation

Alopécia androgenética feminina: estudo hormonal e avaliaçäo do tratamento com antiandrógenos / Female androgenetic alopecia: hormonal study and evaluation of antiandrogen treatment

O objetivo deste trabalho foi avaliar a eficácia do tratamento com antiandrógenos em mulheres com alopécia androgenética (AA). Realizamos dosagens de testosterona total (T), testosterona livre (TL), sulfato de deidroepiandrosterona (DHEA-S), androstenediona (A), proteína ligadora dos hormônios sexuais (SHBG), androstanediol glucuronídeo (3alpha-diol G), TSH, anticorpo antimicrossomal e as relaçöes T/SHBG (x100) e 3alpha-diol G/SHBG em 30 mulheres com AA, idades entre 14 e 46 anos, e comparamos com grupo controle, constituído por 11 mulheres, idades entre 16 e 27 anos. Quatro pacientes tiveram diagnóstico de doença endócrina: hipotireoidismo primário (n=2), síndrome dos ovários policísticos e hirsutismo idiopático. Nas demais 26 pacientes, a relaçäo 3alpha-diol G/SHBG foi maior (p<0,05), sem diferença na concentraçäo dos androgênios, quando comparamos com o grupo controle. Sete pacientes utilizaram acetato de ciproterona (50mg/dia) associado com etinilestradiol (AC+E) e cinco pacientes utilizaram espironolactona (100mg/dia) por 6 meses. Houve diminuiçao estatisticamente significativa nas dosagens de 3alpha-diol G, SHBG e da relaçäo T/SHBG somente nas pacientes que utilizaram AC+E. Todas as pacientes relataram melhora da queda do cabelo. Observamos, através do tricograma, um aumento estatisticamente significativo dos pêlos anágenos nas pacientes que utilizaram AC e espironolactona (p<0,05) e diminuiçao de pêlos anágenos disäo androgênica que ocorre em mulheres geneticamente predispostas. O tratamento com AC+E acarreta uma melhora no perfil hormonal e na análise do tricograma sendo necessário tratamento mais prolongado para que seja observado aumento na quantidade do pêlo.

Bioquímica del líquido quístico mamario, III: niveles del factor de crecimiento epidérmico, gonadotrofina coriónica y andrógenos conjugados / Biochemistry of breast cyst fluids, III: levels of NA, K, androgens, epidermal growth factor and human chorionic gonadotropin

En la última década se ha implementado una serie de análisis bioquímicos que permiten identificar varios tipos de líquidos quísticos (LQs). En el presente trabajo se confirma la presencia de polipéptidos y esteroides conjugados -como el factor de crecimiento epidérmico (FCE), el sulfato de dehidroepiandrosterona (S-DHEA) y el androstano-3Ó, 17ß-diol glucurónido (3Ó-Adiol G)- a veces en concentraciones muy elevadas con respecto a los niveles encontrados simultáneamente en el plasma circulante. Como contraste, la concentración del cortisol apenas alcanza a un 20 por ciento del normalmente hallado en el plasma. Se demuestra además que la concentración intraquística del 3Ó-Adiol G se correlaciona positiva y significativamente con la del S-DHEA (r = 0,8744, p < 0,0001) y con el FCE (r = 0,8949, p < 0,0001), con amplia variabilidad en los resultados. Se establece también una correlación negativa entre el 3Ó-Adiol G y el cociente Na/K (r = - 0,6592, p = 0,0001). Por último, se determinan los niveles de la gonadotrofina coriónica (hCG), utilizando un sistema automatizado de quimioluminiscencia, demostrándose que esta glicoproteína se encuentra en cantidades determinables (> 1,1 mUI/ml) en el 73,8 por ciento de los LQs analizados. En el 57,4 por ciento los niveles superan a los encontrados normalmente en el plasma que oscilan entre < 1,1 mUl/ml y 5,5 mUl/ml. En un 4,9 por ciento las concentraciones resultan significativamente elevadas, alcanzando hasta las 1.000 mUl/ml. Se demuestra una correlación negativa con alta significación estadística entre los valores normalizados de la hCG con los niveles del S-DHEA, del 3Ó-Adiol G y del FCE y una correlación positiva con el cociente NA/K. Se discute la posibilidad de que el FCE, los esteroides conjugados y la hCG puedan ser sintetizados de novo en el tejido epitelial que recubre las paredes del quiste

Remisión prolongada del hiperandrogenismo femenino después de suspender la terapia con glucocorticoides / Prolonged remission of female hyperandrogenism after discontinuing glucocorticoid therapy

Adrenal androgen hypersecretion either produced by genetic defects or reticular disfunction, is reduced by exogenous glucocorticoid administration and as with any suppression therapy, it should relapse when the therapy is discontinued. However, prolonged remissions of adrenal androgen hypersecretion after discontinuing glucocorticoids have been described. We report 15 patients with adrenal hyperandrogenism and elevated levels of dehydroepiandrosterone sulfate that received treatment with dexamethasone. After 1 month of treatment with dexamethasone 0.5 mg/day, dehydroepiandrosterone sulfate levels returned to normal and remained so during a mean of 19 months receiving dexamethasone 0.25 mg/day. One year after discontinuing therapy, hormone levels continued within normal range in all patients. It is concluded that a long remission period of adrenal hyperandrogenism was achieves after discontinuing glucocorticoid therapy

Dehidroepiandrosterona y preñez en la rata / pregnancy and dehydroepiandrosterone in rats

Se estudió en ratas el efecto de la DHEA sobre la preñez. El esteroide se administró durante los primeros 5 días de la preñez y al decimoquinto día las ratas fueron sacrificadas. Las ratas que recibieron la DHEA en dosis de 5 mg/kg no se inhibió la preñez y en las tratadas con 10 y 20 mg/kg los porcentajes de preñez fueron del 27 por ciento y 0 por ciento , respectivamente. Al 5 día, los niveles séricos de estradiol, progesterona y testosterona, obtenidos en las ratas tratadas con DHEA, fueron más elevados que en las cotroles. El número de blastocistos normales se redujo significativamente. Estos resultados demuestran que la administración de DHEA durante los primeros días de la preñez inhibe la blastogénesis y que este efecto, dosis dependiente, no parece ser debido a una falta de soporte hormonal sino más bien a una acción directa de la DHEA sobre el embrión.

Importância do cateterismo venoso percutâneo na identificaçäo da origem do hiperandrogenismo / Importance of percutaneous venous catheterization in the identification of the hyperandrogenism origin

Cateterismo venoso percutâneo seletivo (CVPS) adrenal e ovariano foi empregado na tentativa de se identificar a origem do hiperandrogenismo em três mulheres (12, 50 e 58 anos) portadoras de síndromes de hirsutismo ou virilizaçäo, nas quais a investigaçäo hormonal e a radiológica näo invasiva (ultra-sonografia e tomografia computadorizada) näo localizaram a origem da produçäo do excesso androgênico. Em todas, os níveis elevados de testosterona (T: 385, 300 e 248ng/dl) näo responderam (326, 252 e 219ng/dl) à administraçäo de dexametasona (2mg x 2d), enquanto os níveis basais de sulfato de deidroepiandrosterona (S-DHEA) (38, 130 e 180 para 21, 53 e 98µg/dl) e cortisol (F: 11,5; 20,2 e 27,5 para 0,9; 2,2 e 2,2 µg/dl) suprimiram normalmente. CVPS com determinaçöes de T e F além da relaçäo T/F) foi realizado antes, em todas, e durante cirurgia na paciente 3. Relaçäo T/F de 152,4 e 71,8 (com um gradiente venoso entre ovário e periferia [GOP] de 637 e 1.173ng/gl) identificou os ovários, esquerdo (F) e direito (D) como as fontes do excesso de andrógenos, respectivamente nos casos 1 e 2, enquanto as relaçöes T/F (87,4 e 97,2) e os GOPs (749 e 1.162ng/dl) estavam elevados em ambos os ovários na paciente 3. Assim, a lateralizaçäo da produçäo androgênica foi evidente nos casos 1 (tumor de células de Leydig do ovário E) e 2) hemangioma do ovário D com luteinizaçäo estromal), enquanto a produçäo bilateral, no caso 3, foi confirmada pela biópsia (síndrome dos ovários policísticos). Localizaçäo pré-operatória da origem do excesso androgênico pelo CVPS é essencial para de definir um tratamento apropriado às pacientes suspeitas de neoplasia androgênica, quando os métodos radiológicos näo-invasivos falham em localizar a origem do hiperandrogenismo. O CVPS näo é um procedimento amplamente disponível, nem isento de riscos, devendo, assim, ser indicdo somente na paciente hirsuta ou virilizada, cujos níveis plasmáticos basais de T e S-DHEA forem considerados "tumorais" (maiores do que 150ng/dl e 700µg/dl, respectivamente)

Funçäo do córtex adrenal em recém-nascidos prematuros de mäes pré-eclâmpticas / Adrenal cortex function in premature infants of mothers with pre-eclampsia

Com a finalidade de avaliar a influência da pré-eclâmpsia sobre a funçäo adrenal fetal, estudaram-se 51 recém-nascidos prematuros, nascidos de parto cesariano, sem uso antenatal de corticosteróides, dosando-se os níveis de cortisol e sulfato de deidroepiandrosterona no sangue do cordäo umbilical. Os recém-nascidos de mäes com pré-eclâmpsia apresentaram diminuiçäo dos níveis de sulfato de deidroepiandrosterona sem alteraçäo significante nos níveis de cortisol. Com base neste achado, sugere-se que a excreçäo urinária subnormal de estriol apresentada pelas gestantes pré-eclâmpticas se deve, em parte, à depressäo da funçäo adrenal fetal