Clinical findings and hormonal response in patients with polycystic ovarian disease with normal versus elevated LH levels
The clinical features, ovarian pathology, and hormonal responses to dexamethasone (Dex), Dex + ethinyl estradiol (EE), and Dex + hCG were compared in 5 women with polycystic ovarian disease (PCOD) who have normal 24-hr urinary luteinizing hormone (LH levels to 5 who had elevated urinary LH levels. No differences were noted in the clinical features. There was no correlation between ovary size and LH levels. Three in the normal-LH group had hyperthecosis. Plasma androstenedione (A) was more frequently elevated in the high-LH group. Dex + EE markedly increased LH secretion in the high-LH group, suggesting increased responsiveness of the positive feedback control mechanism of LH secretion in the high-LH group. There was a greater response of A, testosterone (T), and 17-ketosteroids to Dex + hCG in the normal-LH group. Those with high-LH levels did not exhibit a significant increase in A, T, and 17-KS with hCG. The limitations and usefulness of the Dex + hCG test are discussed. The hypothesis is advanced that the increased LH secretion in the high-LH group is due at least in part to positive feedback resulting from the increased A levels. The amount of 17beta-oxidoreductase activity in the ovary may influence LH secretion in PCOD.
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ABSTRACT: Pelvic ultrasonography was employed in the evaluation of 57 pediatric and adolescent patients with disorders of sexual development or differentiation. It provided a rapid and accurate method for: (1) detection of the presence of a uterus and its stimulation by estrogen; (2) detection of ovaries in children over the age of two years and assessment of their size and symmetry, and (3) identifying ovarian pathology such as cystic areas. Its value as an additional diagnostic modality in the approach to the infant with ambiguous genitalia, the child with precocious puberty, and the adolescent with amenorrhea, hirsuitism, or virilization was demonstrated.Journal of Pediatrics 07/1978; 92(6):897-902. DOI:10.1016/S0022-3476(78)80356-4 · 3.79 Impact Factor
Article: Hyperandrogenisme bij de vrouw /[Show abstract] [Hide abstract]
ABSTRACT: Proefschrift Rotterdam. Lit. opg.: p. 171-192. - Samenvatting in het Engels.
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ABSTRACT: Human pituitary LH (1200 i.u.) was infused for 4 h (from 10.00 to 14.00 h) into six women with anorexia nervosa and into five women with polycystic ovarian disease (PCO). Plasma dehydroepiandrosterone sulphate (DHAS), androstenediol sulphate, dehydroepiandrosterone (DHA), androstenediol and testosterone were estimated by gas-liquid chromatography in blood samples taken every 2 h from 10.00 to 20.00 h. The values were compared with those obtained at the same times on the previous control day. There were no significant changes in the plasma levels of DHAS and androstenediol sulphate in response to LH at any of the sampling times in either the anorexia nervosa or the PCO patients. In the anorexia nervosa women, plasma DHA levels were significantly increased at 16.00 (P less than 0.001), 18.00 (P less than 0.001) and 20.00 h (P less than 0.05) after LH infusion. In the PCO women, DHA levels increased significantly at 14.00 (P less than 0.01), 16.00 (P less than 0.001), 18.00 (P less than 0.001) and 20.00 h (P less than 0.001) in response to LH infusion. Plasma androstenediol levels increased significantly in the anorexia nervosa patients at 12.00 (P less than 0.001), 14.00 (P less than 0.01) and 16.00 h (P less than 0.01) in response to LH. Similar increases were also found in the PCO patients at 12.00 (P less than 0.01), 14.00 (P less than 0.001) and 16.00 h (P less than 0.01). Plasma testosterone decreased progressively in the anorexic women in response to LH, becoming significant at 16.00 (P less than 0.05), 18.00 (P less than 0.05) and 20.00 h (P less than 0.01). A similar progressive decrease in plasma testosterone was seen in the PCO women, the levels being significantly lower than controls at 16.00 (P less than 0.05), 18.00 (P less than 0.05) and 20.00 h (P less than 0.05). The results represent the first experimental evidence for a direct regulatory role for LH on androgen secretion in women. In addition, the data have a significant bearing on the pathogenesis of the PCO syndrome and the development of hirsutism which may be directly related to the high androgen levels in PCO women in whom the levels of LH are normally raised. The data may also offer an explanation for the mechanisms responsible for the low androgen levels in anorexia nervosa patients in whom there is a gonadotrophin deficiency.Journal of Endocrinology 09/1983; 98(2):201-10. DOI:10.1677/joe.0.0980201 · 3.72 Impact Factor
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