17-ketosteroids and Oligomenorrhea

During a 10-year period, 428 women received clomiphene citrate according to a graduated therapeutic regimen in which the dose of clomiphene and the laboratory studies were individualized according to each patient's history, examination and response. Of the 428 patients, 85.3% ovulated and 42.8% conceived. The great majority of those who conceived did so during the first three ovulatory cycles. There was no evidence that clomiphene therapy was associated with the induction of another cause of infertility. Overall, 88.2% of those with no other causes for infertility who ovulated also conceived. However, only 7.8% of those who had one or more factors in addition to anovulation became pregnant. There was no evidence that clomiphene adversely affected the postcoital test, as only 15% of the patients had poor cervical mucus. The low rate of complications of this treatment, 5.1% cyst formation as well as the 14% abortion rate and the 2.6% congenital anomaly rate and the excellent gestational outcome in those who conceived support the use of this treatment regimen.

Topics: 17-Ketosteroids; Amenorrhea; Clomiphene; Drug Administration Schedule; Female; Gonadotropins, Pituitary; Humans; Infertility, Female; Oligomenorrhea; Ovulation Induction; Pregnancy; Thyrotropin

Serum dehydroepiandrosterone sulfate (DHEAS) was measured in 32 infertility patients who were found to be ovulatory, in 37 women with oligomenorrhea, and in 52 hirsute patients under basal conditions. It was also measured in conjunction with adrenocorticotropic hormone (ACTH) stimulation and dexamethasone suppression in 10 of the hirsute women. Serum DHEAS levels were elevated in only 19% of the infertile women with regular ovulation, in 34% of the oligomenorrheic patients, and in 60% of the hirsute women. Of the C-19 steroids (androgens) measured in the 52 hirsute women, ie, total and unbound serum testosterone (T), androstenedione (A), and DHEAS, unbound serum T was most frequently elevated. Eighty-two percent of the hirsute women had either an elevated serum DHEAS level or an increased unbound T level, suggesting 1) that elevations in unbound serum T may be associated with or result from increased serum DHEAS levels and 2) that only a minority of women with so-called idiopathic hirsutism do not have demonstrable androgen excess. Three of 10 hirsute women with elevated serum DHEAS levels had an increased ACTH-induced rise in DHEAS. Dexamethasone given as a single daily dose of 0.5 mg at bedtime resulted in a marked decrease in serum DHEAS in all of the 10 hirsute patients tested within 2 weeks of therapy. Thus, serum DHEAS is a clinically useful indication of adrenal C-19 steroid secretion. When combined with clinical and other hormonal evaluations, its measurement adds an important dimension to the study of gynecologic endocrinology and infertility.

Topics: 17-Ketosteroids; Adrenocorticotropic Hormone; Androstenedione; Dehydroepiandrosterone; Dehydroepiandrosterone Sulfate; Dexamethasone; Female; Hirsutism; Humans; Infertility, Female; Menstruation Disturbances; Oligomenorrhea; Prolactin; Testosterone

Thirteen anovulatory oligomenorrheic, hyperandrogenic, and normoprolactinemic women were treated with spironolactone (aldactone) throughout six consecutive menstrual cycles in a dosage of 100 to 150 mg/day. During this treatment a significant decrease in serum luteinizing hormone (LH), testosterone, prolactin, and 17-ketosteroid values were observed that were accompanied by ovulation in 11 women (85%), according to basal body temperature (BBT) and progesterone values. In addition, improvement of hirsutism was observed in 9 (70%) and restoration of regular cycles in 11 (85%) of the patients. The side effects observed were mild and did not lead to interruption of the treatment. Our data suggest that the antiandrogenic properties of spironolactone render it a suitable agent in the treatment of anovulatory, oligomenorrheic, and hyperandrogenic women.

Topics: 17-Ketosteroids; Androgens; Anovulation; Female; Follicle Stimulating Hormone; Hirsutism; Humans; Luteinizing Hormone; Menstruation Disturbances; Oligomenorrhea; Progesterone; Spironolactone; Testosterone

Forty-two patients ages 15 to 20 years (average 17.3 years) were evaluated for oligomenorrhea. Group I consisted of 19 patients with evidence of androgen excess (hirsutism, clitoromegaly, acne); and Group II included 23 patients without evidence of androgen excess. Sixteen of the 19 patients in Group I had elevated serum LH and normal FSH values. Serum total testosterone concentration was elevated in 12 patients and free T was elevated in one additional patient. In nine patients urinary 17KS excretion was elevated and dexamethasone suppressible. For the purpose of treatment, patients in Group I were divided into three subgroups: IA, polycystic ovary syndrome--12 patients; IB, adrenal block--two patients; IC, combined adrenal and ovarian hyperandrogenism--five patients. Among the 23 Group II patients, four had persistently elevated serum LH and normal FSH values, suggesting PCO; three had menopausal levels of LA and FSH; one had hyperprolactinemia and a depressed floor of the pituitary sella; and the remaining 15 patients had low to normal serum levels of LH and FSH, consistent with hypothalamic suppression. Guidelines for the diagnosis and treatment of adolescents with oligomenorrhea are discussed on the basis of these findings.

Topics: 17-Ketosteroids; Adolescent; Adrenal Gland Diseases; Adult; Endocrine System Diseases; Female; Gonadotropins, Pituitary; Humans; Menstruation Disturbances; Oligomenorrhea; Polycystic Ovary Syndrome; Testosterone

Thirty patients with mild post-pubertal adrenal hyperplasia, characterized by raised urinary 17-oxosteroid levels and variable combinations of irregular menses, hirsuties, infertility, and spontaneous abortion, were treated with 2.5 to 10 mg of prednisone per day and all conceived (55 pregnancies). With this treatment, regular, ovulatory cycles occurred immediately in 25 patients, and after two to six months, in the rest. Treatment reduced raised 17-oxosteroid levels to normal and brought about some improvement in hirsuties and acne. Forty-seven pregnancies ended in the birth of liveborn infants; one of these died of prematurity and another had congenital emphysema. One pregnancy was terminated, two were of unknown outcome and five (9.4%) ended in abortion. Before treatment, 20 out of 22 pregnancies (91%) had ended in abortion.

Topics: 17-Ketosteroids; Adolescent; Adrenal Glands; Adult; Amenorrhea; Female; Humans; Hyperplasia; Infertility, Female; Oligomenorrhea; Prednisone; Pregnancy; Pregnancy Complications

The combined dexamethasone-HCG test was employed in 57 patients with excessive androgen secretion in order to differentiate the Stein-Leventhal syndrome from other disorders associated with increased androgen production. The patients were classified according to the test results. All except two of the patients gave a test result typical for the Stein-Leventhal syndrome.

Topics: 17-Ketosteroids; Amenorrhea; Androgens; Chorionic Gonadotropin; Dexamethasone; Diagnosis, Differential; Endocrine System Diseases; Female; Hirsutism; Humans; Oligomenorrhea; Polycystic Ovary Syndrome; Virilism

Gonadotropin levels and secretory patterns were studied in 28 oligomenorrheic patients with various types of polycystic ovary disease (PCO). On the basis of ovarian morphology and histology, the patients PCOuld be separated into two distinct categories arbitarily designated "typical" (type I) and "atypical" (type II) PCO. Although no differences were noted in symptomatology or 17-ketosteroid, testosterone, or follicle-stimulating hormone levels, the 12 type I patients demonstrated widely fluctuating, but markedly elevated, luteinizing hormone (LH) levels, while the 16 type II patients demonstrated lower and less fluctuating LH levels which were comparable to those found during the normal follicular phase. It is likely that type I PCO is a distinct entity similar to that described by Stein and Leventhal, while type II co represents a heterogenous spectrum of disorders, many of which remain obscure.

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adolescent; Adult; Anovulation; Dexamethasone; Feedback; Female; Follicle Stimulating Hormone; Gonadotropins; Humans; Hyperplasia; Luteal Cells; Luteinizing Hormone; Oligomenorrhea; Ovarian Cysts; Ovarian Diseases; Ovary; Testosterone

Topics: 17-Ketosteroids; Adrenal Cortex Hormones; Amenorrhea; Cysts; Drug Therapy; Female; Hirsutism; Humans; Hypertrichosis; Infertility; Infertility, Female; Oligomenorrhea; Ovarian Neoplasms; Ovulation; Pituitary-Adrenal Function Tests; Radiography; Statistics as Topic; Urine