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Biomedical subjects

M G Hull

Publications and source records attributed to M G Hull.

At least 145 records · Page 8Linked to original sources
PubMed1978

Plasma unconjugated oestriol in late pregnancy: circadian variation and the effect of meals and a glucose load.

Plasma unconjugated oestriol (E3) concentrations were determined by radioimmunoassay in 10 normal subjects in late pregnancy, throughout a normal day and night, and after a 50 g oral glucose load. There was a circadian pattern in E3 concentration characterized by an abrupt increase of 15 per cent at night. There was no significant rhythm during the day or night, taken separately. However there was a 10 to 11 per cent reduction in E3 concentrations soon after some meals and after a glucose load, possibly due to expansion of the plasma volume. Excluding the effect of meals, the fluctuation of E3 concentrations in individuals (median of the coefficients of variation) was 11.5 per cent in the day. Overall, it was 13.2 per cent in the day, 12.1 per cent at night and 15.9 per cent over the whole period studied. Since the variation in plasma unconjugated E3 concentrations through 24 hours was no greater than random fluctuations or day-to-day variation there is no need to restrict the time of blood sampling in clinical practice.

Adolescent↗
PubMed1977

Post-"pill" amenorrhoea--cause or coincidence?

The relationship of contraceptive history to diagnostic category of amenorrhoea was analysed in 131 consecutively investigated cases of secondary amenorrhoea. Amenorrhoea occurred in 52 patients immediately after discontinuing the oral contraceptive. Twenty-two had had amenorrhoea before oral contraceptive treatment and 23 patients before the episode of non-contraceptive-related amenorrhoea investigated here. When these cases were excluded from analysis there was no significant difference in the distribution of any of the diagnostic categories between those who had used the oral contraceptive and those who had not. The results suggest that using oral contraceptives does not cause subsequent amenorrhoea.

Age Factors↗
PubMed1977

Amenorrhoea and loss of weight.

Amenorrhoea due to loss of weight was diagnosed in 39 of 170 consecutively investigated patients with amenorrhoea: 24 patients had anorexia nervosa but in the remainder this diagnosis could not be made with certainty. The only difference detected between the two groups was in their lowest weights. Endocrine tests revealed subnormal oestrogen production, low serum LH levels and a failure to ovulate in response to clomiphene. All patients were encouraged to put on weight and 14 resumed ovulatory menstrual cycles. In these patients the mean weight at resumption of ovulation exceeded the mean weight at presentation by 3.6 kg; in contrast, in the patients who remained amenorrhoeic, there was no significant increase of weight by the time of the last visit. Of 8 patients who complained of infertility, 5 ovulated and conceived. Thus dietary treatment of patients with amenorrhoea and loss of weight may replace gonadotrophin therapy for induction of ovulation in a significant proportion of patients with anovulatory infertility.

Amenorrhea↗
PubMed1977

Management of hyperprolactinaemic amenorrhoea.

Results of treatment of 52 patients with amenorrhoea associated with hyperprolactinaemia are presented. All patients had a detailed radiological examination of the pituitary fossa, including lateral tomography in every patient and air encephalography in those in whom a pituitary tumour was suspected. There were 17 patients with untreated pituitary tumours, 5 patients with previously treated pituitary tumours and persisting hyperprolactinaemia, and 30 patients with normal pituitary radiology. Patients with pituitary tumours were treated either by transsphenoidal or transfrontal surgical extirpation of the tumour, followed, if necessary, by external irradiation and/or bromocriptine, Four patients were treated with external irradiation as primary therapy, and three patients who did not wish to conceive were treated with bromocriptine as primary therapy. Patients with normal radiological appearances were treated with bromocriptine as primary treatment. Ovulatory menstrual cycles developed in 42 patients and there were 19 pregnancies. Those ovulating but not conceiving had adequate nonendocrine factors to account for the disparity. Failure of response was seen in 10 patients and was due to inadequate fall of prolactin in response to surgery (2 patients), external irradiation (3 patients) and bromocriptine (1 patient), and gonadotrophin deficiency which developed after surgery in 3 patients but was present pre-operatively in 1. The relative merits of treatment by surgery, external irradiation and bromocriptine are discussed and a policy of treatment outlined.

Adult↗
PubMed1976

Clinical and endocrine features of hyperprolactinaemic amenorrhoea.

The clinical, radiological and endocrine findings in thirty-five women with hyperprolactinaemia and amenorrhoea are described. Twelve patients had radiological evidence of a pituitary tumour and six were tested after pituitary ablation. Seventeen patients with hyperprolactinaemia and normal pituitary X-rays were also studied. None was on any drug known to increase prolactin secretion and all patients were euthyroid when tested. Basal serum prolactin concentrations were high in the group with untreated pituitary tumours and in those with normal X-rays. The levels were variable in the post-ablation cases. The increase of prolactin after TRH was subnormal in all of the groups. Serum oestradiol concentrations were low in most patients and nineteen of twenty-one patients tested had no withdrawal bleeding after treatment with a progestogen. Mean serum gonadotrophin concentrations (basal and after LHRH) were normal in twenty-nine patients but subnormal in four post-ablative cases. Anovulatory responses to clomiphene were obtained in nineteen of twenty patients tested. Fifteen patients were treated with bromocriptine; twelve ovulated and eight became pregnant; two not responding had impaired LH and FSH production. Hyperprolactinaemic amenorrhoea is a common disorder with characteristic endocrine features. Galactorrhoea is unusual (30%). Treatment with bromocriptine lowers prolactin concentrations and rapidly repairs the reproductive defect.

Adult↗
PubMed1975

Urinary total oestrogen values determined by an automated method in normal and abnormal pregnancies.

Urinary total oestrogen values in late pregnancy have been determined by an automated, fluorimetric method based on the Kober reaction and Ittrich extraction. The normal range was obtained from 360 samples from 56 patients. The mean value at 40 weeks gestation was 52.6 mg/24 h and the 95 per cent probability bounds were 29.1 and 95.3 mg/24 h, obtained after initial calculations on logarithm values. "Small for dates" foetuses in good condition at birth were associated with oestrogen values generally below the normal mean. They were usually well discriminated from foetuses that died in the uterus. These were always associated with oestrogen values below or approaching 10 mg/24 h before death except when growth had been normal and death was due to mechanical complications at delivery.

Autoanalysis↗
PubMed1975

Therapy-orientated diagnosis of secondary amenorrhoea.

A programme for investigation of secondary amenorrhoea is described, which is based upon a functional classification of the endocrine causes of anovulation. All diagnostic enquiries not directly yielding a therapeutic dividend are excluded from this protocol. Three main categories of amenorrhoea are recognised: primary ovarian disease, hyperprolactinaemia and disorders of gonadotrophin secretion. There are subdivisions of each category, each with its own special diagnostic and therapeutic implications. Initial investigations take 6 weeks to complete and include measurements of follicle-stimulating hormone and prolactin, pituitary radiology and assessment of oestrogen production and of the response to clomiphene. The results of analysis of 75 consecutive cases of amenorrhoea and of 18 patients treated for infertility are presented and a cost benefit analysis applied.

Amenorrhea↗