[Nontumoral ovarian hyperandrogenism. Could it be secondary to a pituitary LH microadenoma].
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Biomedical subjects
Publications and source records attributed to R Scholler.
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Blood levels of gonadotropins (FSH and LH) and gonadal steroids (testosterone or estradiol) have been evaluated in 72 children and adolescents with primary gonadal defects (45 agonadal patients, 7 with asymetrical gonadal dysgenesis, 9 with Klinefelter syndrome, 4 with partial testicular dysgenesis and 7 with partial ovarian dysgenesis) and in 17 cases of male pseudohermaphrodism. A LH-RH test has been performed in most cases, and a testicular stimulation test with chorionic gonadotropin in patients with testicular tissue. Agonadal subjects had increased blood and pituitary releasable gonadotropins: very high in infants and young children, much less from 7 to 11 years, a high spurt being observed at 12 years. This diphasic pattern relates to the varying sensitivity of hypothalamic receptors and suggests that adrenal steroids may restrain gonadotropic secretion at 7-8 years. As a diagnostic tool, the increase of gonadotropins may be missing in the 7-11 years group. In the 1-12 years patients with partially defective gonads, blood and pituitary releasable gonadotropins and blood steroids are usually normal, but testosterone response to chorionic gonadotropin may be already blunted. From 13 years the gonadotropic secretion is usually increased, even when testosterone secretion and reserve are within normal range. Most male pseudohermaphrodites showed normal gonadotropic and testicular secretions. But four patients had highly increased responses to LH-RH, suggesting a defect of testicular secretion or of receptors, and demonstrating some heterogeneity in the male pseudohermaphrodism group.
Plasma levels of gonadotrophins, estrone, estradiol, 17-hydroxyprogesterone and progesterone were studied throughout an ovulatory cycle in 11 normal women. For each of these hormones, the initiation of a secretory cycle occured at a different time: on the 10th day after mid-cycle surge for gonadotrophins, on the 3 rd day of menses for estradiol and somewhat later for estrone, on the 8th day of cycle for 17-hydroxyprogesterone and on the day of the LH surge for progesterone. Mean plasma levels and range were reported for every studied hormone. The mid-cycle surges of LH and FSH were found always coincident, after which their concentration decreased simultaneously; during the late follicular phase the increasing LH curve intersected the decreasing FSH curve. A peak of estradiol occured in every subject except one on the day before the mid-cycle surge of LH; a peak of plasma estrone occured either on the day of the LH peak or on the day before. For these two hormones the luteal phase range is always below the peak level. A peak of 17-hydroxyprogesterone occured in every subject on the same day than the mid-cycle LH peak, but the plasma level increased during the luteal phase up to higher levels. Progesterone concentration increased on the day of the LH surge, indicating the initiation of luteinization prior to ovulation.
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Base levels of estrone (E1), estradiol-17-beta (E2) and testosterone (T) were measured by radio-immunoassay. Results were classified according to the stages of puberty (Tanner scale) in 89 normal girls ranging from 1 to 22 years of age. Fourty-three pathological cases were studied. In 22 cases of ovarian agenesis E2 and T were most often low. In 7 cases of isolated breast prococity, 4 cases of isolated pilous precocity, one case of isolated genital hemorrhage and 5 cases of hypopituitarism, E1, E2 and T levels were similar to those of impuberal girls. Levels of oestrogens were increased in 4 cases of true precocious puberty.
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