Adrenal and testicular contribution to plasma oestrogens

The concentration of oestrone (E1) and oestradiol (E2) in plasma was measured by a radioimmunological method. In five premenopausal women, ovariectomy provoked a significant fall in the concentrations of E1 and E2. In 11 subjects of both sexes with cancer, dexamethasone (20 μg/kg/day) caused a significant fall in the levels of cortisol (84 ± 9·5%) and E1 (55 ± 16%), but not in E2 (2 ± 18%). Ninety minutes after administration of tetracosactrin, the increase in concentration of cortisol (80 ± 30%) and of E1 (70 ± 49%) was highly significant: that of E2 (5 ± 12%) was not. Similar results were observed in four subjects during infusion of corticotrophin. In six subjects, plasma concentration of E1, androstenedione and dehydroepiandrosterone was higher in the adrenal vein than in a peripheral vein, but the concentration of E2 and of testosterone was similar in the two samples. In two men, the concentration of androgens and oestrogens was measured in plasma from a peripheral vein and in plasma of mixed origin from the renal and the spermatic vein. The level of E2 was higher in plasma from the renal—spermatic mixture than in that from the peripheral vein, but the concentration of E1 was similar. All these results suggest that: (1) the adrenal secretes only 17-oxo androgens and oestrogens whereas in the testicular secretion, 17β-hydroxylated compounds predominate; (2) in men, nearly all of the E2 is secreted directly or indirectly by the testes, but the main source of E1 is the adrenal; (3) in postmenopausal women, most of the E1 also derives from the adrenal gland.

Metabolic clearance rate and blood production rate of testosterone and dihydrotestosterone in normal subjects, during pregnancy, and in hyperthyroidism

The metabolic clearance rate (MCR) and blood production rate (BP) of testosterone (T) and dihydrotestosterone (DHT), the conversion of plasma testosterone to plasma dihydrotestosterone, and the renal clearance of androstenedione, testosterone, and dihydrotestosterone have been studied in man. In eight normal men, the MCR(T) (516+/-108 [SD] liters/m(2)/day) was significantly greater than the MCR(DHT) (391+/-71 [SD] liters/m(2)/day). In seven females, the MCR(T) (304+/-53 [SD] liters/m(2)/day) was also greater than the MCR(DHT) (209+/-45 [SD] liters/m(2)/day) and both values were less than their respective values in men (P < 0.001). In men the conversion of testosterone into dihydrotestosterone at 2.8+/-0.3% (SD) was greater than that found in females, 1.56+/-0.5% (SD) (P < 0.001). In five pregnant females the MCR(T) (192+/-36 [SD] liters/m(2)/day), the MCR(DHT) (89+/-30 [SD] liters/m(2)/day) and the conversion of testosterone into dihydrotestosterone (0.72+/-0.15%) (SD) were significantly less than the values found in nonpregnant women. In five females with hyperthyroidism, the MCR for testosterone and dihydrotestosterone were similar to those observed in pregnant females, but the conversion of testosterone into dihydrotestosterone (2.78+/-1.7%) (SD) was greater, and similar to that found in men. In men the production of dihydrotestosterone was 0.39+/-0.1 (SD) mg/day, 50% being derived from the transformation of plasma testosterone. In women the production of DHT was 0.05+/-0.028 (SD) mg/day, only 10% coming from testosterone. During pregnancy, the production of testosterone and dihydrotestosterone are similar to that in normal women. In three patients with testicular feminization syndrome (an adult with hyperthyroidism and two children) these two MCRs were greatly reduced compared to the normal females, but the conversion of testosterone into dihydrotestosterone was in the limits of normal male rangeIn the normal subjects the renal clearance of androstenedione was greater than that of testosterone and dihydrotestosterone. Less than 20% of the dihydrotestosterone and less than 10% of the androstenedione in the urine is derived from the plasma dihydrotestosterone and androstenedione.

The effect of clomiphene on the plasma androgens of prepubertal and pubertal boys

Plasma levels of testosterone, androst-4-ene-3,17-dione, dehydroepiandrosterone (DHA) and dehydroepiandrosterone sulphate (DHAS) were estimated both before and after administration of clomiphene citrate to endocrinologically normal boys aged from 2–16 yr and to boys with adrenocortical hypofunction or hypogonadism. A divided daily dose of 200 mg/1·7 m2 of surface area was maintained for 15 days. The unconjugated steroids were measured by means of a double isotope derivative technique and the sulphates by gas-liquid chromatography.

The boys without testicular anomaly who were well established in puberty responded with a rise in plasma testosterone. In contrast, prepubertal boys showed a statistically significant decrease in plasma testosterone levels.

A concomitant finding was a significant rise in the plasma levels of androstenedione, DHA and DHAS. It is concluded that clomiphene does not liberate luteinizing hormone before puberty but it may well diminish its secretion. A secondary effect of clomiphene is the stimulation of adrenal C19-steroid production.

Children with male pseudohermaphroditism: endocrine and metabolic studies

In 22 children with male pseudohermaphroditism, plasma concentrations of testosterone and dehydroandrosterone sulfate were measured before and after HCG stimulation. In ten of them, nitrogen retention was measured both before and during treatment with testosterone-propionate. The results of this investigation allow the patients to be classified in the following groups 1) nine in which both the testicular function and the end-organ sensitivity to androgens were normal; 2) nine patients had an abnormal testicular function; 3) four patients had the testicular feminization syndrome. In addition, in one adolescent patient with familial male pseudohermaphroditism and gynecomastia, the pattern of plasma androgens under basal conditions, after HCG and following gonadectomy, suggest that the patient had an incomplete 17-ketosteroid reductase defect.

Serological assessment of rubella during pregnancy

In 45 patients with rubella-like illnesses during pregnancy serological tests showed that the clinical diagnosis had been accurate in only 20. Since only 16 of these patients had presented for laboratory investigations within a week of the onset of symptoms, the value of haemagglutination-inhibition tests was considerably reduced; the diagnosis in these cases was confirmed by complement-fixation and rubella-specific IgM tests.Of 172 patients exposed to a rubella-like illness, only 17 were seronegative; 105 sought advice within two weeks of exposure, and therefore the haemagglutination-inhibition antibody tests were useful in determining immunity. Since the clinical diagnosis of rubella was proved incorrect in a number of cases, these pregnancies were saved. Hence both doctors and patients should report both exposure to and rubella-like illnesses as early as possible, so that laboratory investigations may be carried out without delay.