Occurrence of osteopenia among adolescent girls with oligo/amenorrhea.

The occurrence of reduced bone mineral density (BMD) among adolescent girls with oligomenorrhea or secondary amenorrhea, due to 'pure' dysfunction of the hypothalamo-pituitary-ovarian (HPO) axis (without anorexia nervosa, excessive sport or ballet, slimming diet, etc.) was examined. The study group consisted of 19 adolescent girls (age 16-18 years) with oligo/amenorrhea. Clinical (height, weight, age at menarche, duration of amenorrhea, body mass index (BMI)), hormonal (follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol, progesterone, testosterone, prolactin), and ion (calcium, sodium, potassium, phosphate, chloride) parameters and the BMD of the lumbar spine were investigated. Correlations between BMD and other parameters were also examined. Twenty healthy volunteers (same age and regular cycles) served as controls. Three girls had osteoporosis, with a BMD below -2 standard deviations (SD). Ten showed osteopenia, with a BMD value between -1 and -2 SD. Only six of the study group had a normal BMD within +/- 1 SD. A positive correlation was observed between the BMD and the BMI (r = 0.73; p < 0.05). All the controls had normal hormonal, ion and BMD parameters. 'Pure' dysfunction of the HPO axis in adolescents, causing oligomenorrhea or secondary amenorrhea, might result in reduced BMD and, consequently, lower peak bone mass. Treatment of menstrual cycle disorders is necessary for the prevention of osteoporosis.

[Lower bone density (osteopenia) in adolescent girls with oligomenorrhea and secondary amenorrhea]. / Alacsonyabb csontsürüség (osteopenia) raromenorrhoeás és szekunder amenorrhoeás serdülö lányok körében.

Occurrence of reduced BMD among adolescent girls and young women due to certain specific oligomenorrhea or amenorrhea (anorexia nervosa, excessive sport or ballet, etc.) is well known. However the prevalence of osteopenia among 16-18 years old girls with the cycle disorders mentioned above--caused by "pure" hypothalamo-pituitary-ovarian insufficiency--is not yet sufficiently examined. The hormonal (FSH, LH, prolactin, LH/FSH, estradiol. testosterone, progesterone) and ion (Ca++,PO4(3-),Na+,K+,Cl-) parameters and the bone mineral density (BMD) of the lumbar spine of 19 girls age 16-18 with oligomenorrhea or secondary amenorrhea, due to hypothalamo-pituitary-ovarian axis insufficiency were investigated, and correlation were searched for among them. In 3 of the case significant BMD reduction was found with a value lower than the -2 SD. compared to the age, sex and race matched control values, showing definite osteoporosis. The BMD of 10 girls was between the -2.SD. and -1 SD.: they had osteopenia. Only 6 of them had normal BMD ranging from the -1 SD. to the +1 SD. Neither the ion or hormonal values, nor the clinical parameters (height, weight age, age at menarche, duration of amenorrheic period) showed correlation with the BMD values, except of the body mass index (BMI), which showed a loose positive linear correlation. The measured low BMD values have a significance, referring to a possible reduction in the peak BMD. Patients having low peak BMD have an inclination for earlier, and more sever osteoporosis and fractures in the climacteric decades. These results emphasize the need of effective and early treatment of adolescent bleeding disorders from the point of view of prevention of osteoporosis as well.

[17 beta-hydroxysteroid dehydrogenase defect: female phenotype with 46,XY karyotype]. / 17 beta-hidroxiszteroid dehidrogenáz defektus: nöi fenotípus 46,XY karyotípussal.

Deficiency of the 17 beta-hydroxysteroid dehydrogenase (17b-HSD-d) causes female external genital phenotype in spite of 46,XY karyotype and presence of testes due to disorder in biosynthesis of testosterone. However, marked somatic and genital virilization occurs during puberty. Clinical and laboratory investigation of three cases are presented with typical elevation of the precursor steroid androstenedione, and decrease of product steroid testosterone. All the three patients were reared as girls. During puberty orchidectomy was performed in two cases and vaginoplasty in one case. Estrogen replacement therapy contributed to development of female secondary sex characteristics.

[Analysis of noradrenaline, dopamine and serotonin levels in follicular fluid following superovulatory treatment]. / A tüszöfolyadék noradrenalin, dopamin és szerotonin tartalmának vizsgálata szuperovulációs kezelés után.

The authors measured the noradrenaline (NA), serotonin (5-HT) and dopamine (DA) content of 47 normally maturated and 16 cystically degenerated follicular fluid samples obtained from patients involved in the in vitro fertilisation and gamete transfer program. The patients were given human menopausal gonadotropin (HMG) as a superovulation treatment, and they were given 7500 IE human Chorionic Gonadotropin (HCG) to induce ovulation 34-36 hours prior to the follicular puncture done by laparoscope. The NA content of the normally developed preovular follicles is 11.4 +/- 8.4 micrograms/100 ml on average. For the cystically degenerated follicles the data are following: 1.1 +/- 0.7 micrograms/100 ml (p less than 0.001). 5--HT and DA for the preovulatory follicles are 14.3 +/- 8.9 micrograms/100 ml and 19.3 +/- 8.2 micrograms/100 ml respectively; at the same time for the cystically degenerated follicles they are 12.2 +/- 6.2 micrograms/100 ml, and 12.7 +/- 6.8 micrograms/100 ml respectively. They presume that the higher amount of NA in the follicular fluid might play an important role in the mechanisms of ovulation, the regulation of postovulatory tubal motility, and the release of progesterone from granulosa cells.

Two different methods of prostaglandin administration for cervix priming before interruption of the first trimester pregnancy.

Priming of uterine cervix with PGF2 alpha has been applied to 253 primigravidae before interruption of first trimester pregnancy. Of them, 140 patients were treated with intracervical PGF2 alpha, while 113 other patients with extraamniotic PGF2 alpha. Spontaneous abortion or complete dilatation occurred in 65% of cases in the first group and in 68% in the second one. Side effects were observed less frequently with intracervical application but no serious complication occurred in either of the groups. Intracervical application of PGF2 alpha gel is recommended because of its effectiveness and low rate of side-effects.

Effect of dopamine on the hypothalamo-pituitary-adrenocortical system after injection in the nucleus raphe dorsalis.

Dopamine (DA) injected into the dorsal raphe nucleus (DRN) increased plasma corticosterone (PCS) level as well as serotonin (5-HT) content in the mesencephalon and hippocampus 30 min after the administration. At the same time, 5-HT content of the hypothalamus was decreased. A stress applied 2 min after the injection elevated PCS level but diminished hypothalamic 5-HT content in control, but not in DA-treated animals. PCS level and 5-HT content of the hypothalamus in DA-treated + stressed animals did not differ from the values found in DA-treated rats, but mesencephalic and hippocampal 5-HT content did not increase. It is concluded that DA injected into the DRN suppresses the response to stress of the hypothalamo-pituitary-adrenocortical system.