[Hormones and male sexuality]. / Hormones et sexualité masculine.

In the review of the physiological, pathological and therapeutical aspects of the role of hormones in the erectile process four main topics are discussed: gonadotrop axis dysfunction, hyperprolactinemia, impotence and the potential climacteric male deficit. The conclusion for therapy is that only organic lowering of testosterone should be treated with a dosage adapted to the level of the decrease.

Hypersensitivity of the corticotropic axis to the serotoninergic agent clomipramine in obese women.

Serotoninergic control of food intake has been shown to be abnormal in obese persons with a decrease in serotoninergic tone. The neuroendocrine effects of intravenous I.V. administration of clomipramine (CMI), a serotonin uptake inhibitor, were studied in normal-weight (n=7) and obese subjects before (n=12) and after (n=6) dietary restriction. Under double-blind, placebo-controlled conditions, a single 12.5 mg dose of CMI was administered. There was no difference in baseline values of prolactin (PRL), corticotropin (ACTH) and cortisol in non-obese controls, obese before and obese after weight loss. CMI led to significant increases of PRL, ACTH, and cortisol concentrations in the controls as well as the obese group. The ACTH and cortisol responses to CMI in obese subjects were somewhat greater than the responses in normal-weight subjects. The area under the curve AUC for ACTH after clomipramine was 6202 +/- 976 pg/ml x 150 minutes for tile obese before weight loss and 3274 +/- 512 pg/ml x 150 minutes for the controls and the difference was significant at the level of p=0.052. The cortisol peak value after clomipramine was 163.71 +/- 14.31 ng/ml in the non-obese and 214.66 +/- 12.59 ng/ml in the obese (p=0.025). However, there was no difference in the obese subjects before and after weight loss. These data support the assumption that obese women have an abnormal sensitivity to the serotoninergic control of the hypothalamic pituitary adrenal axis (HPA), and that a mild weight loss does not significantly modify their serotoninergic tone.

[Impotence of vascular origin]. / Impuissance d'origine vasculaire.

Between 1977 and 1986, 3,500 patients were examined for the symptom of impotence; 1,250 of them received multidisciplinary investigation permitting the diagnosis of a pure organic or mixed disorder in 85% of cases, including 62% of vascular disease subdivided into arterial (40%) and venous (22%). For 1,062 patients, 1 or several of the following therapies were used: intracavernous infusion of vasoactive drugs (N = 725), auto-injections (N = 235), vascular surgery (N = 357) and prostheses (N = 23). The diagnostic approach, formerly analytical and making use of multiple non-invasive methods, such as nocturnal erection plethysmography (NPT) and invasive methods (artificial erection, arteriography) have been transformed by the use of pharmacological tests associated with visual sexual stimulation (VSS) which enable, together with Doppler velocimetric examination, simple screening of vascular impotence based on the study of 4 parameters: penile pressure index (PPI) when less than 0.91 is always a sign of an arterial problem, the severity of which is directly proportional to the lowering of this index and the association with maintenance insufficiency; the initial intracavernous flow rate (IICF) depends overall on the maintenance flow and the state of erectile tissue, resulting from pharmacological stimulation by a low dose of papaverine (8 mg); penile rigidity attained by the combined action of pharmacological and visual sexual stimulation, reflecting the functional erectile capacity; the duration of the rigidity thus obtained on stoppage of VSS indicating the capacity for maintenance of erection. In the event of suspicion of an isolated venous leak or in association with arterial problems, it is the artificial erection with cavernosography, carried out after pharmacological stimulation, which enables the severity of the leak to be assessed. The following specific investigations are carried out to investigate a specific associated etiology: electromyogram for neurological disorders, hormone assay for endocrine disorders and psychological study using the MMPI questionnaire (Multiphasic Minnesota Personality Inventory). One can thus distinguish several groups of patients suffering from vascular impotence depending on the degree of arterial involvement: minor (PPI between 0.75 and 0.9), moderate (PPI between 0.65 and 0.75) and severe (PPI less than 0.65); depending on the degree of venous leaking: absent (MI less than 0.3 and/or MF less than 25 ml/min), minor (MI between 0.3 and 0.5 and MF between 30 and 50 ml/min), moderate (MI between 0.5 and 75 ml/min) and severe (MI greater than 0.75 and/or MF greater than 75 ml/mn).(ABSTRACT TRUNCATED AT 400 WORDS)

[Role of endogenous opioid peptides in the regulation of pituitary secretions]. / Rôle des peptides opioïdes endogènes dans la régulation des sécrétions hypophysaires.

Identification of modulatory properties of morphine on certain hormonal secretions and that of opiate-receptor specific endogenous ligands has stimulated research in many fields, including role of opioid peptides in hypophysial secretion regulation. Availability of long-acting agonists and of antagonists of opioid peptides has provided data on their pharmacologic effects and possible role in hormonal physiology. The aim of the present report is to provide an update review of the influence of opioid peptides in hypophysial secretion regulation, while accepting that multiplicity of peptides and receptors does not allow formal conclusions to be drawn. At pharmacologic doses, opioid agonists stimulate prolactin and growth hormone secretion whereas that of LH and ACTH is inhibited. Secretion of TSH is little modified and that of ADH is stimulus-related. The opioid peptides are involved physiologically in the multifactorial regulation of gonadotropin secretion, other hypophysial secretions being mainly unaffected. Finally, "hypothalamic" amenorrhea appears to be the only pathologic model for which opioid peptides can be implicated. Finer analysis of physiologic role of endogenous opioid systems and their possible pathologic effects requires availability of selective agonists and notably antagonists.

[Lipoatrophic diabetes with acanthosis nigricans. Prolonged blood glucose normalization by continuous infusion of insulin]. / Diabète lipoatrophique avec acanthosis nigricans. Normalisation glycémique prolongée par infusion continue d'insuline.

Insulin resistance is a permanent feature of lipoatrophic diabetes, the resistance being almost regularly stubborn. We report the case of a 23-year old unmarried woman with generalized lipoatrophy and Acanthosis nigricans. Seven years after a diabetes resistant to all treatments was diagnosed, blood glucose levels were permanently around 25 mmol/l. Multiple and severe micro- and macroangiopathies were present. Partial resistance to insulin was demonstrated. This resistance could not be explained by abnormalities in anti-insulin hormones nor by a decrease in the number or affinity of insulin receptors, which suggested an intracellular abnormality below membrane receptors. Sustained control of glycaemia at a normal level was achieved by continuous infusion of insulin in high doses. It would appear that optimum insulin therapy using an insulin pump would offer hopes of therapeutic success in this particular form of insulin resistance.

[Mediation by opioid peptides of anterior pituitary response to insulin-induced hypoglycemia (author's transl)]. / Médiation par les peptides opioïdes de la réponse antéhypophysaire à l'hypoglycémie insulinique.

A 1.6 mg dose of the specific opiate antagonist naloxone was administered to normal volunteers, either separately or in conjunction with insulin-induce hypoglycemia, in order to study the possible mediation by opioid peptides of the release of adrenocorticotrophin (ACTH), lipotropins (LPH), human growth hormone (GH) and prolactin (PRL). Administered separately, naloxone was associated with a significant fall in PRL levels (p less than 0.01), a significant and unexpected rise in GH levels (p less than 0.02), and a suppression of the circadian decrease of ACTH and LPH levels. The association of naloxone with insulin-induced hypoglycemia significantly reduced the PRL peak (p less than 0.05), did not affect the rise of GH and lowered the ACTH peak, without altering the LPH peak. These data suggest the existence of a positive opioid tone to PRL secretion, as well as an opioid peptide role in the PRL response to hypoglycemia. They argue against the likelihood of an opioid pathway in the GH response to hypoglycemia. Furthermore, the data favor a paradoxical effect of naloxone on ACTH release during insulin-induced hypoglycemia.

[Dopamine and pituitary hormones. Physiology and pathology (author's transl)]. / Dopamine et hormones antéhypophysaires. Physiologie et pathologie.

Dopamine regulates the secretion of pituitary hormones: it inhibits permanently the production of prolactin and blocks the gonadotrophins and the thyroid-stimulating hormone. It stimulates inconstantly the secretion of growth hormone and it does not control corticotropin. Dopamine agonists and antagonists are currently used in the investigation and the treatment of hyper-prolactinemia and acromegaly.