Adrenocortical function of patients using oral contraceptives.
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Sixteen healthy women users and nonusers of oral contraceptives (OC) volunteered to document a set of circadian rhythms. Nine were taking OC providing ethynyl estradiol (0.03-0.05 mg/24h, 21 days/month) combined with DL- or L-norgestrel or norethisterone. There was no group difference (p > 0.05) in median age (22 years), weight (57 kg), and height (162) cm). Data were obtained at fixed hours, 5 times/24h, during a 48-h span, in November. (Day activity from approximately 08:00 to approximately 23:00 h and night rest). Environmental conditions were controlled, using air-conditioned rooms of constant temperature (26 degrees +/- 0.5) and relative humidity 45% +/- 1. Both cosinor and ANOVA were used for statistical analyses. All circadian rhythms were validated with one exception: that of salivary melatonin was not detected in OC users. The 24h mean (M) exhibited group differences for certain variables: M was greater in OC than non-OC users for systolic blood pressure (p < 0.0001), heart rate (p < 0.01), skin blood flow (p < 0.04), and transepidermal water loss (p < 0.02). M was lower in OC than non-OC users in salivary cortisol (p < 0.04) and skin amino acids (p < 0.003). No group difference was detected in any other documented rhythms: diastolic blood pressure, grip strength of both hands, oral temperature, self-rated fatigue, and the skin variables of urea, lactate, triglycerides, and acid phosphatase activity.
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In discussing the possible vascular complications of oral contraception, one must differentiate between venous and arterial effects. Different estrogen-progestogen combinations have different effects on the hemostatic system.
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A method is reported for the measurement of the urine excretion rates of tetrahydro-11-deoxycorticosterone (3 alpha,5 beta-THDOC), an important metabolite of 11-deoxycorticosterone (DOC). Quantification using gas chromatography/mass spectrometry (GC/MS) was achieved by comparing the ion fragment response for the molecular ion (m/z 507) of the analyte (as methyloxime trimethylsilyl ether derivative) to that of a fixed amount of an isomer of THDOC added to urine as internal standard. To improve the specificity of measuring THDOC in clinical samples, an additional Sephadex LH-20 chromatography step was introduced to separate 11-deoxycortisol and some progesterone metabolites. In the luteal phase of the menstrual cycle, THDOC excretion was higher than in the follicular phase; it was also higher than in women taking oral contraceptives. The correlation of THDOC with progesterone production, independent of a constant cortisol output, supports an ovarian or peripheral conversion of progesterone to DOC. The assay proved useful (1) in monitoring for the recurrence of a mineralocorticoid-secreting tumor and (2) when adrenal production of DOC was not fully suppressed in congenital adrenal hyperplasia due to 11 beta-hydroxylase deficiency. Under the latter circumstances, the renin-angiotensin system seemed to be an important regulator of DOC production.
Immunologic and biologic activity of oxytocin (OT) were studied by simultaneous monitoring of plasma OT measured by radioimmunoassay (RIA) and uterine contractility measured by recording of intrauterine pressures during the step-up rate of infusion of synthetic OT. The results in 11 patients with midtrimester pregnancy and step-up increase of OT infusion by 20 mU. showed a positive correlation of the increase of plasma OT and uterine contractility only at the plasma OT levels of 20 to 60 muU. per milliliter and only with hypertonic contractility but no correlation at plasma levels below and above this range. The lack of correlation of "dose and response" either prior to OT infusion or during low or very high rate of infusion suggests that other factors than merely the quantity of plasma OT are involved in determining the degree of uterine response.
Twelve Brazilian men were treated with gossypol for 1 year. The treatment schedule consisted of oral administration of 20 mg gossypol daily for 4 months, followed by a maintenance dose of 20 mg on alternate days (3 days a week), totaling 60 mg weekly for 8 months. Ten men became azoospermic at the end of the fourth month of treatment, and the two others developed marked oligospermia with necrospermia. Except for one man who complained of transient listlessness and fatigue, the subjects reported no side effects during treatment. No changes in libido or potency were reported, and plasma testosterone remained unchanged. Blood chemistry values, which included complete blood cell count, cholesterol, glucose, triglycerides, acid phosphatase, urea, transaminases, sodium, and potassium, were not changed significantly during treatment. The response of the pituitary to gonadotropin-releasing hormone stimulation and the response of the testis to gonadotropin stimulation appeared normal in men treated with gossypol. After treatment, the sperm counts reverted to essentially normal levels in 8 of 12 men. In four men, azoospermia continued 1 year after discontinuation of gossypol treatment. Retrograde phlebography carried out in three of the four men who remained azoospermic after discontinuation of therapy revealed subclinical varicocele.
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A community-based controlled trial of iodine supplementation comparing oral or intramuscular iodized oil with oral potassium iodide has been carried out in 23 severely iodine-deficient villages in Eastern Zaire. The overall goitre prevalence in the population (n = 5999) was 61% and mean urinary iodine excretion in sample of 57 women 10.9 (SD 6.8) micrograms/g creatinine. All adults in three groups of four villages were given single doses of potassium iodide of 0.5 g, 1.0 g, and 2.0 g respectively. A fourth group was given oral iodized oil (2 ml) and a fifth placebo-treated. A further three villages were given intramuscular iodized oil (2 ml). The effectiveness of supplementation was assessed by measurements of bloodspot thyroxine (T4) concentration in women of reproductive age in the villages. The effects of iodide were small and inconsistent. Eight months after supplementation with oral iodized oil the distribution of T4 concentrations was similar to that seen with intramuscular oil. We conclude that oral iodized oil is an effective alternative to injected oil and would be feasible for iodine supplementation in remote areas with untrained people.
This study compares the accuracy of the free thyroxine index and free serum thyroxine radioassay in evaluating the metabolic status of 36 euthyroid women, 17 of whom were taking oral contraceptive drugs. Results indicate that the free thyroxine index does not uniformly compensate for estrogen-induced elevations in total serum thyroxine concentrations and that the free serum thyroxine is the test of choice in assessing the functional thyroid status of women taking oral contraceptive drugs.
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