[Gender-specific features of hyperprolactinemia syndrome].

The objective of the present work was to study specific clinical features of hyperprolactinemia in men and women. A total of 148 men and 138 women with hyperprolactinemia of tumorous and non-tumorous etiology were examined. Analysis of medical histories demonstrated that the period between the appearance of the first clinical symptoms and the establishment of diagnosis of hyperprolactinemia in men was longer than in women. The frequency, size, and invasiveness of macroprolactinomas were also different in the two sexes. Prolactin-secreting pituitary tumours in men showed more aggressive growth than in women. All the patients included in the study were examined for the measurement of monomeric prolactin (PRL) by separation of individual fractions in the precipitation reaction with 25% polyethyleneglycol. Macroprolactinemia occurred more frequently in women than in men. Total and monomeric PRL levels were higher in men with hyperprolactinemia of tumorous origin compared with women.

[The diagnostic value of macroprolactin in hyperprolactinemia].

Macroprolactinemia (MP) in which there is a discrepancy between prolactin (P) levels and clinical symptoms has recently generated great interest among physicians of various specialties since not the whole of P is biologically active. The diagnosis of this condition is a topical problem. The purpose of the investigation was to detect high molecular-weight or big big P in patients with hyperprolactinemia (HP) of various genesis and to define its clinical importance. A hundred and one females with HP (P > 700 mU/l) were examined. In each patient, biologically active monomeric P was measured via treatment of polyethylene glycol (PEG) 6000. MP was detected in 23% of the examinees. Among them, only 11 females had clinical symptoms of the disease: 72.7% complained about menstrual irregularities; galactorrhea and headache were observed in 18.3 and 9.0%, respectively. The remaining 12 females had no clinical symptoms of HP. MP in which the clinical symptoms are feebly marked has been found to be not a rare condition. The determination of big big P in HP is of diagnostic value. It is recommended that the serum separation diagnostic technique using PEG should be made routine in the examination of patients with HP, particularly in the discrepancy of biochemical and clinical data and in idiopathic HP.

[Diagnostic value of the determination of total testosterone in the serum and free biologically active testosterone in the saliva in men].

The study was undertaken to provide evidence that the salivary concentration of free testosterone (FT) well correlates with the serum level of unbound testosterone in men. Recent articles demonstrate that the results obtained by the use of especially automatic systems are incorrect. Anew luminescence enzyme immunoassay has been now put into practice. Its high analytical (6.2 pmol/l) and functional (17.3 pmol/l) sensitivities allow the quantification of minor salivary concentrations. In healthy males, the morning salivary concentration was 369 pl/lmo (median) with a range of 263-544 pmol/l, which is statistically higher than that in males with androgen deficiency (215 pl/lmol/I (median) with a range of 51-249 pmol/l. Once-weekly remeasurement of salivary FT during 5 weeks showed the high stability of results over time with a variation coefficient of 9% (range 5-23%). The study indicated that FT in the morning salivary sample well correlates with the calculated FR in the blood of both healthy males (R = 0.754; p = 0.001) and patients with androgen deficiency (R = 0.889; p = 0.0001).

[Comparative analysis of the determination of serum testosterobe levels by different methods].

The serum concentration of total testosterone were measured in 100 male patients aged 19-65 years who had visited the clinic and polyclinic of the Endocrinology Research Center, Russian Academy of Medical Sciences for complaints about different dysfunctions of the endocrine glands. Testosterone was measured by the well-known currently available technologies: automatic Vitros ECi, Architect, and Access multianalyzers, manual Delfia and DRS enzyme immunoassay kits, and radioimmunoassay (RIA) that had been developed within the framework of the WHO Human Reproduction Programme and adjusted by the reference assay (gas chromatography/mass spectroscopy). The closest results were obtained when determining the level of testosterone by RIA and by means of the Vitros ECi multianalyzer (13.1 vs 13.0 nmol/l, medians). All other technologies demonstrated a low correlation with RIS and had positive biases, especially with the use of the Delfia kits (as high as 60 and, at low concentrations, 100%). The positive bias tends to decrease in patients with higher testosterone levels ( > 10 nmol/l) for all studied methods.

[Secretion of biologically active and immunoreactive luteinizing hormone in patients with polycystic ovary syndrome]. / Sekretsiia biologicheski aktivnogo i immunoreaktivnogo liuteiniziruiushchego gormona u bol'nykh s sindromom polikistoznykh iaichnikov.

Basal secretion of immunoreactive and bioactive LH was measured in 24 patients with polycystic ovaries, secretion during LH-RF test in 18 patients. Basal LH level was assessed from in vitro testosterone secretion by murine Leydig's cells. The content of basal LH and basal LH to FSH ratio in patients with the polycystic ovaries syndrome was markedly increased vs. the norm. Three types of gonadotroph responses were observed in the patients in response to LH-RF, these responses differing by increment rate, time course of secretion, and ratio of secreted basal and immunoreactive LH. Gonadotroph response was found related to ovarian morphology and clinical manifestations of the disease. Administration of LH-RF to patients with polycystic ovaries and tecomatosis changed the ratio of secreted basal and immunoreactive LH by reducing basal LH level. In young girls and women aged under 20 the increment of basal and immunoreactive LH noticeably surpassed its values in older patients with longer disease duration.

[Clinical variants of McCune-Albright-Braitsev syndrome in girls]. / Klinicheskie varianty sindroma Mak-K'iuna-Olbraita-Braitseva u devochek.

The authors analyze published data on clinical variants and hormonal parameters in patients with this syndrome and present their own observations of children with this condition. Besides early sexual maturation, they describe the clinical picture of Cushing's syndrome, thyroid nodular hyperplasia. The said disorders do not depend on the tropic effect of the hypothalamohypophyseal system. A hypothesis is put forward about primary activation of adenylate cyclase system in the origin of the disease.

[Atypical clinical variants of hypothyrosis]. / Netipichnye klinicheskie varianty gipotireoza.

Timely diagnosis of hypothyrosis was noted in 34% of patients only. Considerable difficulties in the diagnosis of disease were associated with an atypical course of disease in a number of patients. The authors discuss some problems of a clinical picture of hypothyrosis with arterial hypertension, sympatico-adrenal crises, polyserositis, pituitary adenoma, amenorrhea-lactorrhea, premature puberty in boys; they also discuss pathogenesis of sexual advancement of a number of pubertal features in Van Wyk-Grambooh syndrome. Hennes-Ross syndrome was identified as a separate entity.

[The sexual function of men with acromegaly]. / Sostoianie polovoi funktsii u muzhchin, bol'nykh akromegaliei.

Some acromegalic male patients (50%) have weakened sexual function accompanied by a decrease in the levels of LH, FSH and testosterone. Hyperprolactinemia of various degrees was observed in 11 of 13 patients (84%). The summary index SFM (the male sexual formula) and a PRL level showed negative correlation. There was no significant difference in LH response to LH-RH administration between patients with normal and disturbed sexual function. Radiation therapy, in particular proton-beam therapy, produced no negative influence on male sexual function in a long-term period after therapy.

[The possible sources of hyperandrogenism in hirsutism in girls]. / Vozmozhnye istochniki giperandrogenii pri girsutizme u devochek.

The purpose of the investigation is to elucidate the role of adrenal androgens in the development of the syndrome of polycystic ovaries in girls of pubertal age. Clinical manifestations of disease and hormonal indices, the levels of testosterone, 17-oxyprogesterone and cortisol with ACTH and dexamethasone tolerance tests were investigated. A significant rise of the level of testosterone and 17-oxyprogesterone was revealed in response to ACTH administration in 30% of the examinees indicating the adrenal genesis of hyperandrogenism. A characteristic feature of the development of disease in this group of patients is early development of hirsutism followed by disturbed menstrual function.

[The effect of luliberin and sulpiride on the secretion of gonadotropic hormones and prolactin in patients with obesity]. / Vliianie liuliberina i sul'pirina na sekretsiiu gonadotropnykh gormonov i prolaktina u bol'nykh ozhireniem.

The role of dopamine (DA) in the secretion of gonadotropic hormones was studied in women with obesity and normal body mass. Tests with sulpiride (peripheral antagonist of DA-receptors), sulpiride LH-RH and thyroliberin were made. Basal and LH-RH-stimulated secretion of gonadotropins and prolactin (PRL) was studied to reveal the relationship of their secretion with the status of the hypothalamohypophyseal system. It was shown that the blockade of peripheral DA receptors did not result in an increase in the basal and LH-RH-stimulated secretion of LH either in healthy women or in women with obesity at the normal basal level of gonadotropic hormones. Hyperprolactinemia caused by sulpiride or LH-RH, did not lower LH secretion during the entire period of investigation. There were no differences either in the basal level of gonadotropic hormones or in their ejection in response to LH-RH administration in women with normal and excess body mass. Stimulation of PRL secretion in response to LH-RH was found in patients with exogenous-constitutional obesity and minimum signs of diencephalic pathology. Slight inhibition of PRL secretion after LH-RH administration was noted in women with obesity of hypothalamic type and unstable type of disorder of EEG. The absence of changes in PRL secretion was noted in women with strongly marked hypothalamic signs of the disease.

[Treatment of patients with disorders of the ovulatory function of central etiology with preparations affecting adrenergic mechanisms]. / Lechenie bol'nykh s narusheniemn ovuliatornoi funktsii tsentral'nogo geneza preparatami, vliiaiushchimi na adrenergicheskie mekhanizmy.

A treatment protocol has been proposed for patients with luteal phase inadequacy of central origin employing isodrin stimulation of beta-adrenergic receptors on days 5 to 10 of the cycle and fetanol stimulation of alpha-adrenergic receptors on days 10 to 14. This protocol is recommended for use in ovarian function normalization, both alone and in combination with hormonal therapy.

[Pathogenesis of functional retardation of physical and sexual development in adolescents. Status of somatotropic and gonadotropic function]. / K patogenezu funktsional'noi zaderzhki fizicheskogo i polovogo razvitiia u podrostkov. Sostoianie somatotropnoi i gonadotropnoi funktsii.

A study of somatotropic and gonadotropic functions in male adolescents with functional retardation of physical and sexual development has shown an important role of the deficiency of gonadotropins, especially FSH, in the pathogenesis of this condition. LH secretion in retarded physical development (RPD) is lowered to a lesser degree and positively correlates with testosterone deficiency. The feedback in the hypothalamohypophyseogonadal function in RPD is less frequently affected and to a lesser degree than gonadotropic functions. Of the tested methods (tests with TRH, L-DOPA and bromocriptine) STH reserves are better revealed with L-DOPA and TRH tests, gonadotropic reserves, especially LH,--with TRH and bromocriptine tests. The stimulating TRH effect on the growth hormone is indicative of the versatility and nonspecificity of its action on the pituitary gland in functional developmental disorders.

[Mechanisms of disturbance of the secretion of prolactin in patients with acromegaly]. / Mekhanizmy narusheniia sekretsii prolaktina u bol'nykh akromegaliei.

Metoclopramide (DA-antagonist, M) tests were performed in 21 patients with acromegaly and in controls; the levels of adrenohypophyseal hormones were determined before and after drug administration. Irrespective of the basal level of prolactin (P) all the patients demonstrated a decrease in stimulated P secretion which was more noticeable in patients with hyperprolactinemia. The hyperergic response of TSH to M administration was observed in some of the patients with acromegaly. Such a response indicated an elevated tone of the dopaminergic (DA) system. The results obtained were suggestive of dysfunction of DA regulation of P secretion in all the patients with acromegaly.

[Hormone content of the blood in juvenile osteoporosis]. / Izuchenie soderzhaniia gormonov v krovi pri iuvenil'nom osteoporoze.

Juvenile osteoporosis should be regarded as a polyetiological disease developing against the background of constitutional osteopathy in which endocrine disorders play a certain role. A tendency to a decrease in the levels of calcitonin and parathyroid hormone was found in juvenile osteoporosis; mild signs of hypogonadism (secondary) and a relative decrease in hypophyseal somatotropic activity promoted its detection. Two groups of patients were defined: I--with raised AP activity and a normal or lowered level of serum inorganic phosphorus without hormonal disorders; II--with lowered or normal AP activity and a normal level of phosphorus, mild hormonal disorders. Prolonged multimodality therapy with calcitonin, anabolic steroids, active forms of Vitamin D3, calcium agents, physiotherapy and exercise therapy was found effective in juvenile osteoporosis.

[Lactotropic and thyrotropic functions of the hypophysis in polycystic ovary syndrome]. / Laktotropnaia i tireotropnaia funktsii gipofiza pri polikistoze iaichnikov.

An increase in the prolactin basal level was detected in 8 out of 50 patients with ovarian polycystosis. A test with TRH and a simultaneous determination of the levels of prolactin, TTH, T3, T4 were used in 25 patients, of them a hyperergic reaction of prolactin to TRH was detected in 5. A correlation analysis of function of the thyroid was performed. Positive correlation between the levels of prolactin and TTH in patients with hyperprolactinemia and between a maximum increment in percentage to the initial level of TTH and prolactin in patients with a hyperergic reaction of prolactin to TRH was revealed. A conclusion was made of the common nature of disorder in the mechanisms of regulation of prolactin and thyroid function in patients with ovarian polycystosis.