Autoimmunity to endometrium and ovary in endometriosis.

Antibody titres to whole ovary, theca cells, granulosa cells and endometrium were determined by passive haemagglutination and immunofluorescence assays in sera and in cervical and vaginal secretions from 13 patients with endometriosis. Antibody titres to endometrium (mean log2 +/- s.e.m., 7.08 +/- 0.80; P less than 0.0001), ovary (3.58 +/- 0.87; P = 0.0092), theca cells (4.42 +/- 0.73; P less than 0.0001) and granulosa cells (3.33 +/- 0.63; P = 0.0024) were significantly higher in the patients' sera than in sera from 15 normal non-pregnant females. Antibody titres to granulosa cells were elevated (7.97 +/- 1.46; P = 0.0424) in their cervical secretions. Antibody titres to all tissues tested were similar in vaginal secretions of patients and controls. Immunofluorescent antibody assay of biopsied endometrial tissue and sera from the patients revealed the antibodies to be primarily IgG and IgA. The results suggest that autoantibodies to endometrium and ovary are present in patients with endometriosis.

Hirsutism and menstrual patterns in women exposed to diethylstilbestrol in utero.

Hirsutism and menstrual patterns were evaluated in 32 female patients with documented diethylstilbestrol (DES) exposure in utero. Nine nonhirsute regularly menstruating and nine consecutive hirsute oligomenorrheic women with no known DES exposure served as controls. Hormone measurements included follicle-stimulating hormone, luteinizing hormone, prolactin, cortisol, testosterone, androstenedione, dehydroepiandrosterone, sex hormone-binding globulin, and estradiol. Hirsutism was present in 72% and irregular menses occurred in 50% of DES-exposed patients. The mean age of the DES-exposed group was 26.8 +/- 0.7 years (mean +/- SEM). The mean age of mildly hirsute DES-exposed patients (24.7 +/- 1.4 years) was significantly lower (p less than 0.05) than that of severely hirsute DES-exposed patients (28.8 +/- 1.1 years). Mean testosterone, androstenedione, sex hormone-binding globulin, testosterone/sex hormone-binding severely hirsute DES-exposed group but higher than in nonhirsute control subjects. Mean testosterone, androstenedione, sex hormone-binding globulin, testosterone/sex hormone-binding globulin, and luteinizing hormone levels in hirsute DES-exposed patients were similar to those in hirsute control subjects but significantly higher than those in nonhirsute control subjects. Mean DHA levels as well as the clitoral indices were comparable in all groups. Our data suggest that DES exposure in utero may result in hypothalamic-pituitary-ovarian dysfunction.

Sex-hormone-binding globulin in clinically hyperandrogenic women: association of plasma concentrations with body weight.

The relationship of sex-hormone-binding globulin (SHBG) with actual body weight (ABW), ideal body weight (IBW), ABW as percentage of the IBW (% IBW), Quetelet index (weight/height2) and plasma concentrations of various androgens and 17 beta-estradiol (E2) were studied in 9 normal and 57 hirsute patients (group 1). In hirsute patients, plasma levels (ng/dl, mean +/- standard error of the mean [SEM]) of testosterone (T; 77 +/- 4), dihydrotestosterone (DHT; 26 +/- 2), androstenedione (delta 4A; 184 +/- 16), and SHBG (0.91 +/- 0.05 micrograms DHT/dl) but not of dehydroepiandrosterone (DHA; 608 +/- 55) and E2 (6.1 +/- 0.1) were significantly different from those in controls. A negative correlation was observed between SHBG and ABW, both in controls (P less than 0.05) and hirsute patients (P less than 0.01). The hirsute patient population was subdivided into two groups: nonobese (group 2; 60 +/- 1 kg; n = 35) and obese (group 3; 96 +/- 2 kg; n = 22). Plasma androgens, T/SHBG (an index of free T) and E2 in groups 2 and 3 (T: 75 +/- 4, 81 +/- 7; DHT: 24 +/- 2, 28 +/- 3; T/SHBG: 85 +/- 7, 105 +/- 11; delta 4A: 203 +/- 13, 155 +/- 16; DHA: 663 +/- 83, 521 +/- 49; E2: 6.1 +/- 1.0, 5.8 +/- 0.9) were similar; yet SHBG in group 3 (0.75 +/- 0.04) was significantly lower than in group 2 (1.0 +/- 0.01). Inverse correlations between SHBG and ABW, % IBW, and ABW/H2 were observed in group 2 but not in group 3. We conclude that a negative relationship exists between SHBG and the body size in nonobese women and that in hirsute patients, obesity leads to a further lowering of SHBG through mechanism(s) probably independent of androgens.