[Experience with pioglitasone (actos) in the treatment of polycystic ovary syndrome].

The paper presents the authors 'data obtained from examinations of 1 7 patients aged 15 to 36 years who had polycystic ovary syndrome (PCOS) and insulin resistance before and after therapy with pioglitasone in a daily dose of 30 mg, regardless of the time of a meal, for 3 months. The study was undertaken to examine the effects of pioglitasone on carbohydrate and lipid metabolic parameters, as well as on the hormonal parameters of ovarian function and on the basic clinical manifestations in patients with PCOS. Elimination of insulin resistance with the sensitizers of the action of insulin, such as pioglitasone, contributes to the normalization of reproductive function in most patients with PCOS and insulin resistance.

[Pathogenesis and clinical morphology of congenital disorders of sex differentiation]. / Patogenez i klinicheskaia morfologiia vrozhdennykh narushenii polovoi differentsirovki.

Bisexual structure of genitalia presents difficulties for clinical diagnosis. Therefore, knowledge of pathogenesis and clinical morphology of congenital disturbances of sexual differentiation helps to establish earlier hermaphroditism variant, appropriate surgery for complete social-psychological adaptation of this group of patients.

[Serum testosterone level in the diagnosis of virilizing ovarian neoplasms]. / Uroven' syvorotochnogo testosterona v diagnostike viriliziruiushchikh opulkholei iaichnikov.

The paper is concerned with the results of investigation of 15 patients with virile ovarian tumors (VOT). The following methods were employed for instrumental diagnosis: USI, computerized tomography and laparoscopy. Hormonal investigation included the determination of basal levels of serum testosterone (T), excretion with urine of 17-ketosteroids and their time course against a background of suppression tests with dexamethasone and stimulation tests with CG. The results of hormonal investigations were compared with those of similar investigations of 14 patients with stromal ovarian thecomatosis and 8 patients with androgen producing adrenal tumors. Ovarian tumors were detected in 40% by instrumental and clinical methods. Hormonal studies revealed a high level of T in patients with virile ovarian and adrenal tumors exceeding 3-3.8-fold a similar indicator in patients with stromal thecomatosis. All patients with a "tumor" level of T underwent laparotomy after excluding an adrenal lesion. Ovarian tumors of 1.0-2.5 cm in diameter were detected.

[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.

[Diagnostic value of the luliberin test with patients with polycystic ovaries]. / Diagnosticheskaia tsennost' proby s liuliberinom u bol'nykh polikistozom iaichnikov.

Gonadotropic function was investigated and the diagnostic value of the test with luteinizing hormone releasing factor (LHRF) was assessed in patients with polycystic ovaries. For this purpose a 100 micrograms dose of LHRF was intravenously jet injected to 10 patients with nonspecific polycystic ovaries. Levels of luteinizing and follicle stimulating hormones (LH and FSH) were determined before the injection and 15, 30, 60, 90 or 120 minutes after it. Patients with nonspecific polycystic ovaries compared with those who had specific pattern of the disease or with normal women showed elevated basal LH levels which significantly increased in response to LHRF administration. In patients with specific form of the disease the FSH response to the injection was inhibited while LN basal levels as well as its response to LHRF were the same as in healthy women. In 13 out of 15 patients (3 out of 4 amenorrheic females among them) the preparation displayed its ovulatory affect after a single diagnostic dose. Desirability of LHRF use for a differential diagnosis of polycystic ovaries or for therapeutic stimulation of ovulation was suggested.

[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.

[Androgen receptors in the pubic skin and testosterone content of the blood in women with hirsutism]. / Retseptory androgenov v kozhe lobka i soderzhanie testosterona v krovi zhenshchin s girsutizmom.

A study was made of "free" binding sites and the total number of sites binding androgens with the cytoplasmic receptor protein in the pubic skin biopsy specimens and testosterone in the blood serum of patients with hirsutism, degree II-III. A higher mean level of testosterone was found in the blood serum of patients with hirsutism, degree II-III, suffering from hyperandrogenism of ovarian and/or adrenal origin as compared to women with idiopathic hirsutism, degree I-III. "Free" sites of the binding of 5 alpha-dihydrotestosterone (DHT) with receptors were not revealed in most of the patients, however the total number of sites of the binding of DHT with cytoplasmic receptors were found in all the studied skin biopsy specimens. The results obtained show that there are significant differences in the testosterone level in the blood serum and the total number of DHT binding sites in the pubic skin cytosol of women with idiopathic hirsutism and patients with hirsutism, degree II-III, with hyperandrogenism of ovarian and/or adrenal origin.

[Various hormonal interrelations in idiopathic edema]. / Nekotorye gormonal'nye vzaimootnosheniia pri sindrome idiopaticheskikh otekov.

The content of aldosterone and renin activity were examined together with the determination of progesterone, estradiol, gonadotropins and prolactin in the blood of 39 women with idiopathic edemas and in 15 normal women in different phases of menstrual cycle. Women with idiopathic edemas showed a number of hormonal deviations: absolute and relative hyperaldosteronism, particularly demonstrable in the ortho-position, impairment of physiological stability between aldosterone levels in the luteic and folliculin phases; a decrease in progesterone level in the luteic phase; a decrease in the absolute amount of estrogens in the folliculin phase and relative hyperestrogeny in the luteic one; an increase in prolactin content in the early folliculin phase in a considerable number of patients (50%). It is assumed that deviations described might be involved in the formation of edemas.

[Gonadotropic regulation of androgen-producing ovarian tumors]. / O gonadotropnoi reguliatsii androgenprodutsiruiushchikh opukholei iaichnikov.

As a result of the study of the LH, FSH, prolactin and testosterone content in the blood of patients with androgen-producing ovarian tumors and LH-tumor tissue binding in vitro, it was detected that the gonadotropic hormone content may be low, normal and high. The testosterone level does not correlate with LH, FSH and prolactin concentration. LH-receptor binding is disturbed in the androgen-producing tumor tissue and hormone presence is not necessary to maintain androgen secretion by the tumor.

[Use of clomiphene for treating lactorrhea and amenorrhea]. / Primenenie klomifena dlia lecheniia bol'nykh s laktoreei-amenoreei.

The results are presented of clomiphene treatment of 22 patients with functional lactorrhea-amenorrhea. Lower therapeutic effect of this drug in comparison with that of parlodel was demonstrated in hyperprolactinemia. Combined clomiphene-parlodel treatment of lactorrhea-amenorrhea was studied in 12 patients, including 4 subjects with hypophyseal adenomas. It was shown that the combined use of these drugs enhances therapeutic activity without potentiating side effects.

[Specificity of LH binding by interstitial tissues of polycystic ovaries in comparison with their androgenic activity]. / Spetsifichnost' sviazyvaniia liuteiniziruiushchego gormona mezhutochnoi tkan'iu polikistoznykh iaichnikov v sopostavlenii s ikh androgennoi aktivnost'iu.

125I-LH binding by interstitial tissues of 33 polycystic ovaries was studied comparatively to their androgenic activity. It was shown that the disorder of LH binding by the ovary interstitial tissue is peculiar to the polycystic ovaries in ovarian hyperandrogeny. Changes in 125 I-LH binding by the interstitial tissue and the ovary androgenic activity are closely correlated.

[Use of the clomiphene test for evaluation of the functional state of the hypothalamus-pituitary gland-ovarian system in ovarian hyperandrogenia]. / Ispol'zovanie klomifenovoi proby dlia kharakteristiki funktsional'nogo sostoianiia sistemy gipotalamus-gipofiz-iaichniki pri ovarial'noi giperandrogenii.

The authors studied the content of gonadotropins and testosterone in the blood; functional condition of the hypothalamus-hypophysis-ovarian system was characterized in patients with ovarian hyperandrogenia by using the klomiphen test. Testosterone level in all the patients and prolactin level in 70% of the patients proved to exceed the normal values, wheras the LH level could be low, normal or high. With klomiphen test it was shown that both the gonadotropin and estrogen levels rose against the background of action of the preparation; as to testosterone level--it remained unchanged. In induced menstrual cycles estradiol peak preceded the gonadotropin peak. In patients with ovulation testosterone level diminished by the end of the observation period.

[Stromal thecomatosis of the ovaries associated with the syndrome of mixed ovarian dysgenesis]. / Stromal'nyi tekomatoz iaichnikov v sochetanii s sindromom smeshannoi disgenezii iaichnikov.

On the basis of analysis of a case of a combination of mixed dysgenesia of the ovaries with stromal thecomatosis and the clinical picture of the virile syndrome a conclusion was drawn that a) hypertestosteronemia was in such cases connected with the presence in the dysgenetic ovary and the connective tissue band of epitheliod cells forming the foci of stromal thecomatosis, and b) that the appearance of stromal thecomatosis failed to depend on the presence of the follicular apparatus; apparently cells of the interstitial tissue of the cortical layer of the ovaries serve as its source.

[Study of the androgenic activity of the ovaries in various forms of virilism of ovarian etiology]. / Izuchenie androgennoi aktivnosti iaichnikov pri razlichnykh formakh viril'nogo sindroma ovarial'nogo geneza.

The authors present the results of determination of the testosterone level in the blood by the method of competitive fixation by proteins under conditions of a functional test with the depression of the adrenal cortex function with dexamethazone and stimulation of the ovarian function with choriogonin against this background in patients with the virile syndrome of ovarian genesis. Three groups of patients with the ovarian hyperandrogenia were distinguished. Changes in the blood testosterons level under the test conditions confirmed objectively the ununiformity of of this syndrome and permitted one to characterize the hormonal activity of the androgen-producing structures of the ovaries and their sensitivity to choriogonin stimulation in patients of different groups. The functional test with the determination of the blood testosterone level can be applied under clinical conditions for detection of the source and the degree of hyperandrogenia.

[Diagnosis of virilizing ovarian tumors and surgical tactics for their treatment]. / Diagnostika viriliziruishchikh opukholei iaichnikov i khirurgicheskaia taktika pri ikh lechenii.

The authors present the results of study of the basic blood testosterone level and of the 17-ketosteroid urinary excretion under conditions of a test with dexamethasone and choriongonin. The results obtained were compared with the results of analogous examination of a group of patients with the virile form of the Stein-Loewenthal's syndrome. Blood testosterone level served as a significant criterion in the diagnosis of virilizing tumours of the testes. Besides, a study was made of the remote results of sparing surgical tactics in the treatment of virilizing tumours of the testes lasting up to 13 years in 37 patients. Favourable results pointed to the benign course of these tumours and justified conservative therapy.