Treatment with dexamethasone of androgen excess in adolescent patients.

Fourteen hirsute girls, ages 12 to 22 years (mean +/- SD: 17.2 +/- 2.6 years), in whom 21-hydroxylase deficiency was excluded by a 1-hour intravenous alpha 1-24 corticotropin test, were evaluated by a 4-day dexamethasone test and then treated with a bedtime dose of dexamethasone (0.5 mg in 10 patients, 0.25 mg in four) for 0.6 to 3.4 years (1.3 +/- 0.8 years). Hirsutism decreased in four patients, did not change in nine, and increased in one. Of the 10 patients with irregular menses, only three developed regular cycles while taking dexamethasone. During long-term dexamethasone therapy, serum levels of testosterone decreased from 102 +/- 22 to 72 +/- 27 ng/dL, free testosterone from 35 +/- 11 to 19 +/- 8 pg/mL, and dehydroepiandrosterone sulfate from 396 +/- 138 to 171 +/- 101 micrograms/dL. Although free testosterone decreased to less than 15 pg/mL in eight of 14 patients with the suppression test, only four patients had free testosterone levels less than 15 pg/mL during therapy. Two of the 14 patients have had no recurrence of hirsutism or increase in serum androgens after 28 and 29 months, respectively, after dexamethasone therapy was discontinued. Oral contraceptives were given to nine patients inadequately responsive to bedtime dexamethasone therapy. The mean percent decrease of testosterone and free testosterone levels during oral contraceptive therapy was significantly greater than during long-term treatment with dexamethasone, and hirsutism lessened in all. We conclude that a single bedtime dose of dexamethasone is satisfactory only in patients who maintain serum free testosterone values less than 15 pg/mL without side effects. For other patients, either another glucocorticoid or, in most cases, ovulation suppression should be prescribed for adolescents with progressive hirsutism and elevated androgen levels.

[Secretion of growth hormone in men and women during the reproductive age, in aged men and menopausal women with or without estrogens or progesterone]. / Secreción de hormona del crecimiento en hombres y mujeres en edad fértil, hombres seniles y mujeres postmenopáusicas con y sin estrógenos o progesterona.

PIP: Apomorphine hydrochloride 0.75 mcg subcutaneously was given to 39 men and 36 women, 18-66 years of age, and the seric concentration of growth hormone was measured. All the men showed a maximal concentration over 6 mcg/l in a total of 61 tests; while in 16 of 58 tests in women, maximal concentration was less than 6 mcg/1. Senile men had a significantly greater response of growth hormone than premenopausal and postmenopausal women. There was no significant correlation between maximal concentration and the age in men and women. There was no significant difference in maximal growth hormone concentration for men ages 24-42 and men 45-66 years of age. However, there was a trend for high levels in young men and a significantly greater concentration 60 minutes after apomorphine administration (but not at 30 and 45 minutes) in young men as compared with older men. There was no difference in secretory response to apomorphine in premenopausal and postmenopausal women. After mestranol administration (0.08 mcg orally, 3 times/day for 3 days) to 6 postmenopausal women, there was a significant increase in the secretory response of growth hormone to apomorphine. Progesterone (250 mg intramuscularly for 3 days) does not antagonize growth hormone secretion induced by apomorphine in postmenopausal women. (author's)^ieng

[Determination of urinary pregnanediol as an ovulation parameter]. / Medición de pregnandiol urinario como parametro de ovulacion

PIP: For women who are not pregnant, the excretion of pregnanediol can be measured to determine if ovulation has occurred. During the preovulatory stage excretion is low, but 3 or 4 days after ovulation it increases greatly. In this study, Klopper's procedure for the study of ovarian function was followed with some modifications by Goldzieher and Nakamura to obtain results fairly quickly. The standardization of the method was arrived at by determining the absorption spectrum and the spectometry of pregnanediol diacetate. The method was evaluated by studying its specification, accuracy, precision, and sensitivity. The menstrual cycles of 6 normal women were studied. In all cases, in the postovulatory phase the excretion of pregnanediol was higher than 1.3 mg in 24 hours of urine, indicating an increase in progesterrone excretion produced by the corpus luteum. The advantages of this method for determination of ovualtion are that no instruments are required, the sensitivity of the method is high, and it can be repeated often without bothering the patient, especially importnt for women with irregular cycles.^ieng

[Participation of 17 alpha-hydroxyprogesterone in the mechanism of ovulation]. / Participación de la 17 alfa-hidroxiprogesterona en el mecanismo de la ovulación.

PIP: Progesterone (P) and 17 alpha-hydroxyprogesterone (17 OH-P) were analyzed daily during the menstrual cycle in women with both ovulatory and anovulatory cycles, without any other endocrine alteration. The plasma levels of 17 OH-P in 65 samples obtained during the follicular phase of the ovulatory cycles were 1.057 ng/ml, consistently higher than the P levels, which were .492 ng/ml, with a 17 OH-P/P ratio of 2.16. On the other hand, the plasma levels of 17 OH-P obtained during the same phase of the anovulatory cycles were .288 ng/ml. The difference between ovulatory and anovulatory cycles was statistically significant (p less than .001). The P levels were .156 ng/ml and the 17 OH-P/P ratio was 2.76. In the 2nd part of the ovulatory cycles, the 17 OH-P/P ratio was .46, and in the same part of the anovulatory cycles the ratio was 2.39. The total values of both steroids and the individual values of 17 OH-P differed between the 2 types of cycles (p less than .001). The findings show that 17 OH-P is an indicator of follicular development and that it could be used to predict the occurrence of ovulation.^ieng

Urinary pregnanediol during the use of different contraceptive methods.

PIP: The behavior or urinary pregnanediol in 5 groups of 172 healthy females using different hormnal oral contraceptives (OCs) and 1 group using IUDs is compared with 1 untreated control group having normal biph asic cycles. In all cases 24 hour urine samples were obtained in the follicular (phase 1) and luteal (phase 2) phases of the cycle using the thin-layer Sulli movici chromatographic method. In the control group the phase 1 mean was .91 mg/ 24 hours (h) and the phase 2 mean was 2.63 mg/24h. There were no variations in the values of phase 1 among all the contraceptive groups while in the IUD group the mean of phase 2 was significantly lower than in the control group. Among combination OCs there were no differences between phases 1 and 2; all cases measured below 1.5mg/24h in phase 2. However, estrogen-free progestogen drugs showed elevated pregnanediol values in phase 2. Although an incidence of low pregnanediol values was exhibited among all contraceptive groups, those low values are constant only in the combined and sequential OCs. In progestogen-only drugs high pregnanediol values compatible with ovulation occurred in the luteal phase at an inversely proportional rate to the dose of the drug. Further studies should be undertaken to establish the correlation of these data with the effects of these compounds on ovarian function.^ieng

Growth hormone secretion in idiopathic precocious puberty: effect of medroxyprogesterone.

PIP: 6 girls and 2 boys with isosexual precocious puberty were treated with 200 mg of medroxyprogesterone acetate (MPA) and studied to determine the drug's effect on plasma growth hormone response to insulin-induced hypoglycemia. There was no clear difference between plasma growth hormone response to hypoglycemia observed in untreated patients, in patients receiving a single injection of MPA, or in patients receiving a longterm treatment with MPA. There was a high frequency of elevated fasting levels (greater than 15 mmcg/ml) of circulating growth hormone prior to injection of insulin in subjects with isosexual precosity, which may have been due in part to apprehension. The high peak levels of growth hormone in children with isosexual precosity seen to be due to excess quantities of circulating gonadal hormones. There was no evidence that 200 mg of MPA or long term treatment with MPA impaired release of growth hormone.^ieng