Effect of four different oral contraceptives on various sex hormones and serum-binding globulins

In a double-blind, controlled, randomized, four-arm, bicentric clinical study, the effect of four oral contraceptives (OCs) on various hormone parameters and serum-binding globulins was investigated. Four groups with 25 volunteers each (18-35 years of age) were treated for six cycles with monophasic combinations containing 21 tablets with either 30 microg ethinylestradiol (EE) + 2 mg dienogest (DNG) (30EE/DNG), 20 microg EE + 2 mg DNG (20EE/DNG), 10 microg EE + 2 mg estradiol valerate (EV) + 2 mg DNG (EE/EV/DNG) or 20 microg EE + 100 microg levonorgestrel (LNG) (EE/LNG). The study was completed by 91 subjects. Blood samples were taken after at least 12 h of fasting on Day 21-26 of the preceding control cycle and on Day 18-21 of the first, third and sixth treatment cycle. The serum concentrations of free testosterone were significantly decreased by about 40-60% in all four groups, while those of dehydroepiandrosterone sulfate (DHEAS) showed a time-dependent decrease during treatment. Except for EE/EV/DNG, which increased prolactin significantly during the third and sixth cycles, no change was observed with the EE-containing preparations. There was a significant increase in the levels of serum-binding globulins during treatment, which differed according to the composition of the OCs used. The rise in sex hormone-binding globulin (SHBG) was highest during intake of 30EE/DNG (+320%) and lowest with EE/LNG (+80%), while the effect of 20EE/DNG and EE/EV/DNG was similar (+270%). The thyroxine-binding globulin (TBG) levels increased significantly, by 50-60%, during treatment with the DNG-containing formulations, while the effect of EE/LNG was less significant (+30%). The rise in corticosteroid-binding globulin (CBG), which occurred in all groups, was most pronounced in women treated with 30EE/DNG (+90%) and least with EE/EV/DNG (+55%), indicating a strong influence of EE and no effect of the progestogen component. In all treatment groups, the frequency of intracyclic bleeding rose in the first treatment cycle and decreased thereafter. Cycle control was significantly better with 30EE/DNG or EE/LNG than with 20EE/DNG or EE/EV/DNG. There was no significant change in blood pressure, body mass index or pulse rate throughout the study. In conclusion, the DNG-containing OCs caused a higher rise in SHBG and TBG levels than the LNG-containing preparation. The effects on CBG suggest a lesser hepatic effect of 2 mg EV as compared to 20 or 30 microg EE. In contrast to EE, the use of estradiol in OCs appeared to increase prolactin release, while the cycle control was better with the OC containing 30 microg EE.     

男性类风湿关节炎患者血浆催乳素水平的变化及其临床意义

目的：为探讨男性类风湿关节炎（ＲＡ）患者血浆催乳素（ＰＲＬ）水平的变化有临床意义。方法：用放射免疫法对６２例男性ＲＡ患者进行了血浆ＰＲＬ、雄激素睾酮（Ｔ）Ｔ、去氢表雄固酮（ＤＨＥＡ－Ｓ）水平测定及其多聚酶链反应（ＰＣＲ）作了ＨＬＡ＿ＤＲ４筛选,并与相庆的临床和实验室指标作对比分析。结果：ＲＡ患者血冰ＰＲＬ水平与正常人比较无显著差异,但在中度以上活动性的患者或ＨＬＡ＿ＤＲ４阳性患者中的血浆ＰＲＬ水平     

氯氮平与氟伏沙明合并治疗精神分裂症的研究

目的 研究氯氯平与氟伏沙明合并治疗精神分裂症时的疗效及副作用,为临床更加合理的用药提供依据.方法 选取符合CCMD-3诊断标准的,有需要合并应用氯伏沙明的症状的精神分裂症病人30例.单一应用氯氮平.逐渐调整剂量到200～250mg/D,稳定一周后于清晨6时采取患者肘静脉血测定血浆胰岛素、泌乳素水平.并于当日加用氟伏沙明50mg/D.在合并用药后的第4周清晨6时采取患者肘静脉血测定胰岛素、泌乳素水平.合并用药前后测定空腹血糖、血脂、肝功能、心电图.结果 合并用药前和合并用药第四周胰岛素、泌乳素异常人数之间无显著差异.合并用药前后空腹血糖异常、心电图异常(除心率)人数无显著差异.合并用药前后肝功能异常、血脂异常、心率异常人数有显著增多.结论 建议合并用药时在动态监测氯氮平浓度的情况下结合临床表现及时调整药物用量.合并用药后肝功能异常、心率异常、血脂异常人数有增加,程度较轻不影响治疗.     

Normoprolactinemia in boys with marked gynecomastia

Pubertal gynecomastia normally occurs as a transient phenomenon of several months duration, whereas marked pubertal gynecomastia (more than 6 cm in diameter) may persist into aduldhood. In the present study the possible involvement of prolactin (PRL) secretion in the development of marked pubertal gynecomastia was investigated. The diurnal variations of PRL, luteinizing hormone (LH), follicle-stimulating hormone (FSH), as well as the basal values of testosterone (T) and estradiol (E₂) were determined in 5 pubertal boys with marked gynecomastia and in 5 age-matched controls. Mean age of all patients was 14.4 years. The pubertal development was classified as P 3–4.In comparison to controls, boys with marked gynecomastia revealed no differences in basal values of PRL, LH and FSH, as well as in peak values of all hormones during sleep. The response of PRL, LH and FSH to LHRH/TRH stimulation was normal for pubertal age in both groups. In comparison to controls, decreased mean plasma T levels (P<0.05) and slightly increased E₂ levels (P<0.05) were found in boys with marked gynecomastia. The E₂/T ratio was also higher in boys with gynecomastia (P<0.005).These data suggest that prolactin, a hormone which may be increased in galactorrhea, is not involved in the development of marked pubertal gynecomastia in boys. The above findings suggest that slightly elevated day-time E₂ levels may be involved in the development of female-appearing breasts in pubertal boys.     

d-Fenfluramine in panic disorder: a dual role for 5-hydroxytryptamine

Rationale: 5-Hydroxytryptamine (5-HT) appears to modulate different forms of anxiety in different ways, but the importance of this in human anxiety disorders is unknown. Objectives: To investigate whether the 5-HT releasing agent d-fenfluramine (dFEN) has different effects on resting and panic anxiety in panic disorder. Methods: Thirteen drug-free patients with DSM-IIIR panic disorder were tested in a double-blind placebo-controlled crossover design. Carbon dioxide 7% (CO₂) was given as a panic challenge 270 min after administration of dFEN or placebo. Results: Compared to placebo, dFEN increased anxiety and arousal, maximal at 120 min, but tended to reduce CO₂-induced anxiety and panic attacks with a significant reduction in Panic Visual Analogue Scale ratings (P=0.040). Anxiety following CO₂, but not dFEN, administration resembled panic attacks (compared to Acute Panic Inventory symptom profile during patients’ usual attacks). Patients with more severe disorders exhibited enhanced behavioural responses and blunted prolactin responses to dFEN. Conclusions: dFEN caused anxiety similar to generalised anxiety in panic disorder patients but reduced anxiety following 7% CO₂ challenge, a laboratory analogue of naturally occurring panic attacks. These findings are consistent with a dual role for 5-HT in pathological anxiety. Patients with more severe symptoms differed in 5-HT function compared to more mildly affected individuals. Received: 4 August 1999 / Final version: 14 November 1999     

Prolactin response to arginine in children with hyperthyroidism and primary hypothyroidism

Plasma prolactin (PRL) response to arginine was examined in 16 prepubertal and 18 pubertal children with constitutional short stature, 5 patients with hyperthyroidism and 4 patients with primary hypothyroidism. The mean basal concentration of plasma PRL was significantly higher (P<0.01) in primary hypothyroidism than in other groups. Arginine infusion elicited significant (P<0.05) rises in plasma PRL in all groups. The maximal increment of plasma PRL above the baseline level after arginine stimulation was significantly larger (P<0.05) in pubertal than in prepubertal females and was significantly smaller (P<0.05) in patients with hyperthyroidism than in age- and sex-matched controls. There was no sex difference in arginine-stimulated PRL secretion. These data suggest that arginine produces a significant increase in plasma PRL and the PRL response to arginine was greater in pubertal than in prepubertal children. Plasma PRL response to arginine is suppressed in children with hyperthyroidism and the basal plasma PRL is markedly elevated in primary hypothyroidism.     

Production and physiological function of granulocyte colony-stimulating factor in non-pregnant human endometrial stromal cells

Effects of granulocyte colony-stimulating factor (G-CSF) on proliferation and differentiation of normal human endometrial stromal cells were investigated in an in vitro decidualization culture of stromal cells. Unstimulated stromal cells secreted little prolactin and G-CSF, whereas 8-Br-cAMP-stimulated stromal cells secreted higher levels. There was no relationship, however, between the levels of prolactin and G-CSF secreted from the stimulated cells. Detectable levels of prolactin secretion were not found in two of six stromal cell cultures stimulated with 8-Br-cAMP; however, these two culture supernatants contained high concentrations of G-CSF. Co-stimulation of the stromal cells with 8-Br-cAMP and G-CSF enhanced prolactin secretion from the stimulated cells in a G-CSF concentration-dependent manner without any change in viable cell numbers. However, G-CSF did not affect prolactin secretion or viable cell numbers of 8-Br-cAMP-stimulated decidualized cells. These results indicate that G-CSF enhances cAMP-mediated decidualization of human endometrial stromal cells in an autocrine or paracrine fashion.     

The effects of chronic ritanserin treatment on sleep and the neuroendocrine response to l-tryptophan

A previous study has shown that acute administration of the 5-HT₂ receptor antagonist ritanserin doubles Slow Wave Sleep (SWS) and increases the prolactin (PRL) response to l-tryptophan (LTP). The present study investigated the effect of repeated ritanserin treatment on sleep, neuroendocrine response to LTP and 5-HT₂ platelet receptor binding. After 2 weeks, ritanserin administration SWS was persistently increased but the PRL response to LTP was unchanged. Platelet 5-HT receptor binding was undetectable at the end of ritanserin treatment but recovered 2 weeks after drug withdrawal. The results suggest that ritanserin causes a sustained effect on the 5-HT mechanisms mediating SWS and on platelet 5-HT₂ receptors. However, adaptation occurs to its effect on 5-HT-mediated neuroendocrine responses.     

Venous plasma nicotine correlates of hormonal effects of tobacco smoking

The present study resolves some of the discrepancies in the literature by correlating the effects of tobacco smoking on hormone release with venous plasma nicotine levels. Cortisol, prolactin, and β-endorphin concentrations were measured. Habitual male tobacco users smoked denicotinized (very low nicotine) and average nicotine cigarettes in the morning after overnight tobacco abstinence. Several venous blood samples were withdrawn before and during the smoking sessions for subsequent analyses. The increases in plasma nicotine correlated well with plasma cortisol and prolactin levels (correlation coefficients r = 0.66 and 0.53, respectively, p < 0.05). This study quantifies the well known increase in plasma cortisol and prolactin after nicotine postsmoking for about 1 h with peak plasma levels up to 35 ng/ml. Contrary to most abused drugs which release dopamine and decrease prolactin, nicotine concentration correlated with increased prolactin release. Increases in maximal plasma β-endorphin levels following tobacco smoking were barely statistically significant with insufficient data to obtain a correlation coefficient.     

加味芍药甘草汤治疗系统性红斑狼疮的初步报告

目的:探讨加味芍药甘草汤治疗泌乳素(PRL)增高的红斑狼疮(SLE)的临床疗效,评价中药替代或减少激素和免疫抑制剂治疗SLE的可能性。方法:将42例PRL增高的SLE患者随机分为中药组和激素组各21例。中药组在常规剂量激素的基础上给予加味芍药甘草汤治疗,不用免疫抑制剂。激素组给予常规剂量激素及免疫抑制剂治疗。比较治疗3个月时和6个月时的疗效。结果:两组在SLE疾病活动性指数(SLE DAI)评分,实验室指标,激素用量比较,差异有显著意义。结论:对PRL增高的SLE亚群病人加用中药加味芍药甘草汤可加快SLE病情的好转,减少激素用量和副作用。