Low serum estradiol and high serum progesterone concentrations characterize hypertensive pregnancies at high altitude.

OBJECTIVE: Intrauterine growth retardation and preeclampsia are more common at high than at low altitude. Because altered hormonal profiles have been linked with these disorders, we asked whether placental steroid hormone concentrations were altered during pregnancy at high altitude. METHODS: We measured progesterone, unconjugated estradiol, and estriol (by radioimmunoassay) at weeks 20, 30, and 36 of pregnancy in 18 women at low altitude (1600 m) and 40 women at high altitude (3100 m). RESULTS: Women at 3100 m compared with 1600 m had lower serum estradiol concentrations at week 36 of pregnancy, and lower estriol and higher progesterone concentrations throughout pregnancy. As a result, the progesterone/estradiol ratio was greater in the high- versus the low-altitude women. Estradiol fell between weeks 30 and 36 in women who developed transient hypertension or preeclampsia. The fall in estradiol was accompanied by a marked increase in progesterone concentrations among the preeclamptic women. At 3100 m, estradiol correlated negatively (r = -0.37, P < .05) and progesterone positively (r = 0.46, P < .05) with mean arterial pressure at week 36 of pregnancy. CONCLUSIONS: We speculate that reduced placental oxygen pressure (PO2) at high altitude may decrease placental aromatase activity and thereby lower estradiol and estriol concentrations. The factor(s) responsible for the rise in progesterone is unknown. Possibly, high progesterone relative to estradiol concentrations contributes to the development of preeclampsia at high altitude.

Progestin and estrogen reduce sleep-disordered breathing in postmenopausal women.

Women exhibit sleep-disordered breathing syndromes less commonly than men before but not after the age of menopause, suggesting that female hormones may exert a protective effect. We sought to determine whether combined progestin and estrogen treatment decreased sleep-disordered breathing in healthy postmenopausal women. Nine ovarihysterectomized women [50 +/- 2 (SE) yr of age] were studied after 1 wk of treatment with placebo (lactose) or combined progestin and estrogen (medroxyprogesterone acetate, 20 mg tid, and Premarin, 1.25 mg bid). Subjects showed few respiratory disturbances during placebo treatment. Despite this, combined progestin and estrogen administration reduced the number of sleep-disordered breathing episodes in every subject, decreasing the average number of episodes per subject from 15 +/- 4 to 3 +/- 1. The duration of hypopneas also decreased with hormone treatment. Thus the presence of progestin and estrogen may be involved in protecting premenopausal women against sleep-disordered breathing.

Combined effects of female hormones and metabolic rate on ventilatory drives in women.

Increased resting ventilation (VE) and hypoxic and hypercapnic ventilatory responses occur during pregnancy in association with elevations in female hormones and metabolic rate. To determine whether increases in progestin, estrogen, and metabolic rate produced a rise in VE and hypoxic ventilatory response (HVR) similar in magnitude to that observed at full-term pregnancy, we studied 12 postmenopausal women after 1 wk of treatment with placebo, progestin (20 mg tid medroxyprogesterone acetate), estrogen (1.25 mg bid conjugated equine estrogens), and combined progestin and estrogen. Progestin alone or with estrogen raised VE at rest and decreased end-tidal PCO2 (PETCO2) by 3.9 +/- 0.8 and 3.3 +/- 0.6 Torr, respectively (both P less than 0.05), accounting for approximately one-fourth of the rise in VE and three-fourths of the PETCO2 reduction seen at full-term pregnancy. The addition of mild exercise sufficient to raise metabolic rate by 33-36% produced the remaining three-fourths of the rise in VE but no further decline in PETCO2. Combined progestin and estrogen raised HVR and hypercapnic ventilatory response more consistently than progestin alone and could account for one-half of the increase in HVR seen at full-term pregnancy. Mild exercise alone did not raise HVR, but when exercise was combined with progestin and estrogen administration, HVR rose by amounts equal to that seen at full-term pregnancy. We concluded that female hormones together with mild elevation in metabolic rate were likely responsible for the pregnancy-associated increases in VE and HVR.

Human placenta estrogen synthetase (aromatase) purified by affinity chromatography.

Microsomal estrogen synthetase (cytochrome P-450ES), also known as aromatase, was purified from fresh human placenta microsomes by DEAE-Trisacryl and testosterone-agarose chromatography. Estrogen synthetase assays were done with androstenedione as substrate, NADPH as electron donor, and a partially purified P-450 reductase from human placenta as the electron carrier. The specific cytochrome P-450 content of the purified P-450 was 0.67 nmol mg-1 of protein, and the preparation contained no cytochrome P-420. The absorbance maximum was 448.5 nm. The specific estrogen synthetase activity of the purified P-450ES fraction was 35 nmol min-1 nmol-1 of cytochrome P-450 or 23.3 nmol min-1 mg-1 of protein. The latter value shows a 179-fold purification with a yield greater than 1% in the two-step procedure. Kinetic constants for the reaction were measured with androstenedione as the aromatizable substrate. The Km was 1.4 nM and the Vmax was 37 nmol min-1 nmol-1 of P-450. The purified enzyme aromatized androstenedione and testosterone at identical rates; androstenedione gave only estrone, and testosterone gave only estradiol-17 beta. Dehydroepiandrosterone was not detectably aromatized or otherwise metabolized. Neither 16 alpha-hydroxytestosterone nor 16 alpha-hydroxyandrostenedione was aromatized. No hydroxysteroid dehydrogenase or reductase was detected in direct assays. No free reaction intermediates were detected in aromatization assay incubation mixtures. The purity of the product and the simplicity of the preparation recommend it for use in further studies of the enzyme.

Effects of 17 beta-estradiol on a permanent line of rat endometrial cells grown in vitro and in vivo.

A permanent line of epithelioid cells derived from a primary culture of rat endometrium by spontaneous transformation in vitro was studied as a model for the actions of estrogen on target cells. The cells contained typical cytosol and nuclear estrogen receptors. Estradiol added in vitro increased the accumulation of cells as much as 60% over controls. Cells injected into ovariectomized athymic mice grew into solid tumors whose incidence was increased by treatment of the animals with estradiol.

Clinical use of plasma total estriol measurements in late pregnancy.

A critical review of the clinical use of measurements of plasma total estriol concentration in late pregnancy was done on the basis of one year's experience with the test at one institution which provides tertiary-level care to high-risk obstetric patients. The overall efficiency of the test in discriminating patients at risk was 59%. It appears to be most useful when a negative result provides some reassurance that the status of the fetus is satisfactory.

Failure of tumor promoter 12-O-tetradecanoylphorbol-13-acetate to displace estradiol from its specific receptor.

A permanent cell line derived from rat endometrium which contains a specific, low capacity, high affinity estrogen binding protein in cytosol and nuclear fractions (estrogen receptor) is available. Extracts of cells from this line did not appreciably bind the tumor promoter, 12-0-tetradecanoylphorbol-13-acetate. The result suggests that the action of the promoter does not involve translocation to the cell nucleus via binding to the specific estrogen receptor.

Steroid aromatization by a small particle fraction from porcine ovaries.

Testosterone, 4-androstene-3,17-dione, 19-hydroxy-4-androstene-3,17-dione, 4alpha-5-oxido-5alpha-androstane-3,17-dione and 4beta-5-oxido-5beta-androstane-3,17-dione were compared as substrates for aromatization by the small particle fraction from sow ovaries. Relative conversion rates were: 19-hydroxy-4-androstene-3,17-dione:4-androstene-3,17-dione: testosterone: 4alpha-5-oxido-5alpha- and 4beta-5-oxido-5beta-androstane-3,17-dione; 100:32:20:congruent to O. Apparent Michaelis constants were 4.4 muM for 4-androstene-3,17-dione and 12 muM for testosterone. Maximum velocities were 0.20 pmoles/mg protein per min for androstenedione [1] and 0.16 for testosterone. The substrate preferences of the aromatizing system found in ovary are similar to those of the enzyme found in placenta.

The specificity of the 3beta-hydroxysteroid dehydrogenase activity of bovine ovaries toward dehydroepiandrosterone and pregnenolone: evidence for multiple enzymes.

The 3beta-hydroxysteroid dehydrogenase activity in whole bovine ovaries was systematically studied using dehydroepiandrosterone (3beta-hydroxy-5-androsten-17-one) and pregnenolone (3 beta-hydroxy-5-pregnen-20-one) as substrates, in order to determine whether, in this tissue, the same or different 3beta-hydroxysteroid dehydrogenases metabolize these steroids. The majority of the activity, with both substrates was found in the microsomes. Detergent extraction of the microsomes indicated that more than one enzyme was present in this fraction. A number of experiments on the Triton X-100 extract of the microsomes (the stability of the activity, its nucleotide specificity and kinetic analyses) were most simply explained by a single enzyme metabolizing both steroids. However, the stereospecificity of hydride-ion transfer from pregnenolone to NAD+ (B transfer) was different than that from dehydroepiandrosterone to NAD+ (A and B transfer). Thus, as no single enzyme is known to catalyze the transfer of hydride-ion to both sides of NAD+, it is proposed that there are at least two 3beta-hydroxysteroid dehydrogenases in the Triton X-100 extract.

Specificity and reproducibility of acetone precipitation in identifying surface-active phosphatidylcholine in amniotic fluid.

We show the thoretical and actual variability in the amount of surface-active lecithin precipitated in the acetone-precipitation step of determining lecithin/sphingomyelin (L/S) ratios in the clinical laboratory. Lecithins precipitated may range from 60 to 90% of the total surface-active lecithins present. The range is sufficient to account for the occasional "immature" L/S ratios (less than 2/1) found in amniotic fluid from women bearing mature fetuses.