LH and FSH in human cerebrospinal fluid.

LH and FSH of cerebrospinal fluid (CSF) and serum were radioimmunologically measured. Samples were obtained simultaneously from 116 subjects of the following groups: A. 22 patients with non-endocrine diseases, B. 18 patients with cranial diabetes insipidus (DI) of whom 4 with metastatic carcinomas, C. 5 patients with primary empty sella syndrome, D. one with hydatiform mole, and E. 70 patients with pituitary adenomas, i.e. growth hormone--or prolactin-secreting or "non-secreting" adenomas, of whom 38 patients with invasive and 32 with enclosed adenomas. LH and FSH are normal constituents of CSF and their CSF levels poorly correlates with the serum ones (LH r = 0.477 p less than 0.01). Enclosed adenomas with SSE showed low levels of LH in CSF. High CSF-gonadotropins concentrations (above 4.0 mIU/ml) with a low serum/CSF ratio (below 3) was frequently, but not constantly found in patients with invasive adenomas and are not indicative per se of this diagnosis. Some patients with brain metastasis from breast carcinoma and DI, or with non-tumoral diseases and DI showed similar high patterns of CSF gonadotropins though the serum levels were within normal range. This suggests that local vascular mechanisms, including the retrograde circulation of gonadotropins from the pituitary to the hypothalamus, influence the blood-brain barrier much more than the release of gonadotropins into the systemic blood circulation.

Beta-2-microglobulin in trophoblastic disease.

Beta-2-microglobulin (BMG) is physically linked to the allo-antigenic HLA chain on the cell surface and is accordingly a marker for the HLA antigens. BMG concentrations were measured in serum and cerebrospinal fluid (CSF) samples from 22 patients with choriocarcinoma, 5 with hydatidiform mole and 17 reference subjects in the first trimester of pregnancy. Serum BMG levels were elevated in the patients with choriocarcinoma, particularly when human chorionic gonadotrophin levels were higher than 50 000 U/l (less than 50 000 U/l--1,6 +/- 0,3 mg/l; greater than 50 000 U/l--2,75 +/- 0,72 mg/l; molar pregnancy--1,42 +/- 0,44 mg/l; reference subjects--1,47 +/- 0,15 mg/l) (mean +/- 1 SD). BMG levels in the serum and CSF were not increased when metastases were present in the cranium. None of the patients had evidence of abnormal renal function as determined by serum urea, electrolyte and creatinine levels and the creatinine clearance rate. These results suggest that BMG and HLA antigens are expressed on the trophoblastic cells in choriocarcinoma, or alternatively that the maternal immunocytes produce increased quantities of BMG.

Radioimmunoassay of hCG as an early diagnosis of cerebral metastases in choriocarcinoma patients.

To determine the early cerebral involvement of choriocarcinoma, the following studies were employed. By comparing hCG titers in measurements of serum and cerebrospinal fluid (CSF) hCG-beta through radioimmunoassay (RIA), serum/CSF ratios of titers were calculated in patients with normal pregnancies and in those with trophoblastic neoplasia. In normal pregnancies, the mean ratio of serum/CSF hCG was more than 45.5 +/- 6.0 (mean +/- SEM):1. In neoplasia without metastases to the brain, the ratio was more than 41.0:1. However, 2 patients with cerebral choriocarcinoma showed low ratios of 23.0:1 and 20.9:1, respectively. This suggests that determination of the beta-hCG concentration ratio of serum to CSF using RIA might give a more reliable evaluation for the early detection of choriocarcinoma metastasized to the brain.