Correlation of hormones with lipid and lipoprotein levels during normal pregnancy and postpartum.

In a comprehensive study the concentrations of plasma lipids and lipo- and apolipoproteins were measured in 24 nonpregnant women (control) and longitudinally in 42 women throughout gestation and postpartum. The results were correlated with hCG, 17 beta-estradiol (E2), progesterone (PG), human placental lactogen (hPL), and insulin levels by time series analysis. Insulin concentrations were constant until week 25 and increased thereafter. Plasma E2, PG, and hPL as well as plasma lipid levels rose continuously during gestation. Apolipoproteins AI, AII, and B concentrations increased until weeks 25, 28, and 32, respectively, and remained constant until term. Low density lipoprotein cholesterol reached maximum levels at week 36. High density lipoprotein cholesterol exhibited a triphasic behavior, with maximum levels at week 25, a fall until week 32, and maintenance of the level until term. Time series analysis revealed positive correlations with E2, PG, and hPL. These results provide evidence that apoprotein concentrations undergo pronounced serial changes during gestation, which in part might be due to the effect of E2. Furthermore, the importance of hPL as a determinant of the plasma levels of total and free cholesterol, triglycerides, and phospholipids is now documented.

[Value of laboratory parameters in androgenization in the female with special reference to the "free androgen index"]. / Die Wertigkeit von Laborparametern bei Androgenisierungserscheinungen der Frau unter besonderer Berücksichtigung des "freien Androgen-Index".

The degree of androgynism (A) in women can be assessed via clinical data and by determining the levels of testosterone (T), dehydroepiandrosterone sulfate (DHEA-S) and testosterone binding globulin (TBG) in the blood. The determination of the "free androgen index" (FAI), the ratio of total T and TBG, helpful in estimating the level of free T in serum, conveys valuable additional information: in case of FAI below 1, a mild kind of A without elevation of free testosterone can be assumed. However, severe A with elevation of free testosterone and absolute hyperandrogynism is associated with FAI values above 1. In 63 women with signs of A the parameters mentioned above and the FAI were used to determine the degree of severity of A. These data were compared with the corresponding data of a control group. It could be shown that in women whose A was due to idiopathic hirsutism the increased level of bonded T played a causal role. The mean FAI in this group was 0.41. In contrast, in women with POC syndrome and androgynous cycle disturbances, the absolute hyperandrogynism with elevation of free T levels predominated. In these groups the mean FAI was above 1. However, women with male pattern bolding as single sign of A did not exhibit any significant difference in comparison to the control group. In this disease, the increased response of androgen receptors in the skin despite normal androgen levels seems to play a causal role. Two cases of androgen producing ovarial tumours and one case of adrenogenital syndrome were analysed separately.

Fluctuations of plasma lipoprotein-A concentrations during pregnancy and post partum.

The changes in plasma lipoprotein-a Lp-a concentrations during pregnancy were investigated. Out of 42 women with normal pregnancy, 22 reached Lp-a values greater than 10 mg/dL. Plasma levels of Lp-a in addition to total cholesterol, and apolipoprotein B were measured at 4 to 6-week intervals during pregnancy and post partum. The hormones hCG, human placenta lactogen, progesterone, estradiol, and insulin were measured concomitantly. The results can be summarized as follows: Plasma Lp-a concentrations rose steadily during the first trimester of pregnancy and reached a maximum in the middle of the second trimester. Maximal Lp-a values in the 19th week on average were 2.8 times higher as compared to the values of the eight week of pregnancy. Plasma Lp-a fell from the 19th week of pregnancy, reaching a basal value at the time of birth. This value remained virtually unchanged until 6 months post partum. Despite the fact that apolipoprotein-B and total cholesterol rose significantly, exhibiting pronounced maxima during the course of pregnancy, there was no overlap in the shape of their concentration curve with Lp-a. The rise in plasma Lp-a concentration did not correlate with any of the measured hormones at a given time interval. Time shifted analysis of the concentration curve revealed a correlation with hCG, however, with a lag phase of approximately 11 weeks. This study substantiates the independent metabolic control of Lp-a, as compared to plasma apolipoprotein-B and total cholesterol.

[The pulsatile administration of releasing hormone (GnRH) for the treatment of hypothalamic amenorrhea]. / Die pulsatile Releasinghormon-(GnRh-)Gabe zur Behandlung der hypothalamischen Amenorrhö.

12 women with hypothalamic amenorrhoea (degrees II to IIIb) were given pulsatile releasing hormone in 14 treatment cycles. The minipump "Zyklomat" (Ferring Ges.m.b.H., Kiel) with a treatment set giving 0.8 mg LH-RH was used in all cases. In 86% (12 out of 14) of the treated cycles ovulation was recorded. 3 out of 8 women who desired a baby became pregnant. 1 of these pregnancies followed directly on a treatment cycle whilst the other 2 pregnancies resulted from spontaneous biphasic cycles following the treatment cycle. In 4 women pulsatile releasing hormone was used to examine the functional reaction of the pituitary gland and the ovary. In this group 1 spontaneous biphasic cycle was seen following the induced ovulatory cycle.

Hormonal considerations in early normal pregnancy and blighted ovum syndrome.

The hormonal profiles of six pregnancies which terminated in miscarriage with the blighted ovum syndrome have been studied and compared with those of a group of patients similarly studied who had clinically normal pregnancies terminating in live birth at term. The serum chorionic gonadotropin (HCG) values were below normal or at the lowest limit of normal in five of six patients. Three patients had progesterone values within 1 SD of the normal, with normal serum estradiol values. It was concluded that the hormonal profile of early pregnancy is characterized by rising serum HCG and estradiol levels and a declining serum progesterone level from the 5th to the 8th week. The theoretical explanation for the dichotomy seems to be that the fetal adrenal anlagen, even at this early embryonic stage, can produce steroid precursors which are aromatized to estradiol. The production of progesterone, however, does not seem to be possible. Abnormal serum estradiol levels strongly suggest the absence of fetal development and a blighted ovum. However, no single hormonal level will distinguish between blighted ovum and potentially salvagable threatened abortion.