Ultrasonic and endocrinologic relationships in spontaneous and induced follicular phase.

To correlate ovarian growth and follicular size with 17 beta-estradiol (E2) and androstenedione (A) peripheral levels, 20 induced cycles, 6 spontaneous ovulatory cycles and 6 spontaneous anovulatory cycles from 32 women during follicular phase were examined in order to obtain a better insight in the events involved in multiple folliculogenesis. In spontaneous ovulatory cycles, a significant correlation was obtained between E2 plasma levels and volume of the dominant follicle (p less than 0.05) as well as total follicular volume (p less than 0.01). Plasma A was significantly related with sonographic features likely related to ovarian stroma as well as preantral and antral subordinated follicles, which usually fail to ovulate. Significant correlation between E2/A peripheral ratio and volume of the dominant follicle(s) was also found (p less than 0.01). In anovulatory cycles, inverse significant correlation between E2 and sonographic aspects of degenerating antral follicles (p less than 0.001) was found, whereas a positive significant correlation between E2 and ovarian stroma was obtained (p less than 0.001). No correlation between peripheral A and any ovarian sonographic compartment was evident. However in the anovulatory cycles group a significant correlation between A v E2 peripheral levels was found, too. During HMG regimen, all the ovarian compartments seemed to be responsible for E2 peripheral levels. Ovarian stroma as well as preantral and multiple antral follicles were related to A levels. E2/A peripheral ratio did not result to be a good indicator of the large follicles. During "pure" FSH therapy, exclusive correlations between estrogen and large follicles as well as total follicular volume were found.(ABSTRACT TRUNCATED AT 250 WORDS)

Successful induction of ovulation and conception with combined gonadotropin-releasing hormone agonist plus highly purified follicle-stimulating hormone in patients with polycystic ovarian disease.

Five women (group A) with polycystic ovarian disease (PCOD) and sterility for at least 3 yr were treated for 1 cycle for ovulation induction with a combined regimen of GnRH agonist (GnRH-A) plus highly purified FSH. The patients received GnRH-A (Buserelin; 200 micrograms, sc, twice a day) for 6 weeks and then GnRH-A combined with FSH highly purified (2 ampules a day; 75 IU FSH and less than 0.11 IU LH in each ampule). Ovarian response was evaluated by plasma estradiol (E2) assay and ultrasound examination, performed daily. Furthermore, plasma FSH and LH levels were assayed 3 times a week. Once a follicle was considered sufficiently developed, the combined regimen was withheld, and 24-48 h later hCG (5000 IU, im) was given. The results are compared with those of 31 ovulatory cycles induced by im FSH highly purified (group B) in PCOD patients with the same FSH administration, clinical, and monitoring protocols. Ovulation was achieved in all cycles treated by GnRH-A plus FSH. Two singleton and a twin pregnancy resulted. Multiple follicular development occurred in all cycles. Plasma E2 levels were generally in the normal range. Echographic and endocrine features in the 2 groups were as follows. 1) basal ovarian volume and ovarian enlargement were similar. 2) Group A had a greater number of follicles than did group B (P less than 0.01), while E2 to number of follicles and E2 to ovarian volume ratios were greater (P less than 0.01) in group B. 3) The linear correlations between plasma E2 levels and ovarian volume were markedly different in groups A and B (P less than 0.01). The regression line for group B had a steeper slope than that for group A. This finding indicates that at a fixed ovarian volume plasma E2 levels were significantly lower in group A than in group B. We conclude that the combined GnRH-A and FSH regimen may constitute an alternative and promising tool for the induction of ovulation in patients with PCOD.

Elevated serum levels of creatine kinase BB in breast cancer.

Creatine kinase BB serum levels were evaluated by radioimmunoassay in patients with benign or malignant breast pathology. Elevated enzyme levels were observed in 6 out of 20 (30%) patients with primary breast cancer. After surgery the levels fell to normal values only in patients without nodal involvement. Six out of 28 (21%) patients with benign breast lesions and 4 out of 38 (13%) patients with metastatic breast cancer also showed increased levels of the enzyme. Most of the patients with high creatine kinase BB serum levels were found to have estrogen and progesterone receptor-positive tumors. These findings suggest that creatine kinase BB can barely be considered a marker of malignancy in breast pathology, but rather an indicator of hormone dependency in breast cancer.