成年男性癫痫患者血清性腺激素水平的变化

目的： 探讨癫痫发作和ＡＥＤｓ 治疗对垂体一性腺激素平衡的影响。方法： 利用ＲＩＡ法测定了诊断明确的７３ 例成年男性癫痫患者血清ＬＨ、ＦＳＨ、Ｐ、Ｅ２、Ｔ水平, 并比较了ＡＥＤｓ 治疗组与未治疗组和健康对照组病人的血清性腺激素水平。同时,观察了其中的３１ 例癫痫患者癫痫发作前后血清性腺激素水平的变化。结果：癫痫发作前后血清性腺激素水平无明显差异。ＡＥＤｓ 明显影响血清性腺激素水平。在所有ＡＥＤｓ 治疗中, 血清Ｅ２ 水平明显升高, ＬＨ水平明显减低, Ｔ／Ｅ２ 的比较明显低于正常对照和病人对照组, 在ＡＥＤｓ 单一和联合治疗组中有３９．７％ 的病例性功能低下。结论： 癫痫发作不影响血清性腺激素水平。ＡＥＤｓ明显影响性激素平衡和性功能     

Physical and hormonal profile of male sexual development in epilepsy

PURPOSE: This study was designed to investigate the effect of epilepsy and antiepileptic drugs (AEDs) on both the physical and hormonal aspects of the sexual development of male patients with epilepsy. METHODS: One hundred thirty male subjects with epilepsy, their age ranging between 8 and 18 years (mean, 14 +/- 2.9 years), entered the study; all were taking AEDs. Anthropometric measurements [height, weight, and body mass index (BMI)], testicular volume, penile length, and pubarche were assessed in the studied groups, as well as measurement of the levels of testosterone (T), free testosterone (FT), estradiol (E2), lutenizing hormone (LH), follicle-stimulating hormone (FSH), and prolactin (PRL), and the results were compared with those of a control group. RESULTS: In this study, male patients older than 16 years were significantly shorter than their matched controls. The mean values of testicular volume and penile length were significantly lower in the patients in the different age subgroups, and the pubic hair staging (pubarche) was delayed in the patients older than 16 years. The mean values of total testosterone, estradiol, LH, and FSH serum levels were significantly higher, whereas the mean values of free testosterone, total-T/E2, total. T/LH, and FT/E2 ratios were lower in the patient subgroups compared with their age-matched controls. There were no significant changes in the mean basal PRL serum levels in the patients compared with the controls. The present study demonstrated a reduction in the testicular volume and penile length, significantly lower mean values of free testosterone and total-T/E2, and a higher mean value of E2 in the patients receiving polytherapy in the age subgroup older than 16 years compared with those on monotherapy; however, there was no demonstrable effect of seizure control or the duration of illness in any of the studied parameters. CONCLUSIONS: There is a delay in the sexual development of male patients with epilepsy in the different age subgroups, with endocrine changes in the form of increase in the total testosterone, but the free testosterone is lower, and an increase in estradiol, with lower T/LH levels. Patients receiving polytherapy, especially those older than 16 years, were more likely to have delayed gonadarch and disturbances in their hormonal profile.     

男性痴呆患者血清性激素的变化

目的:观察阿尔茨海默病(AD)和血管性痴呆(VD)男性患者血清性激素及促性腺激素的变化。方法:老年男性共114人,其中AD 3 2例;VD 3 0例;无痴呆正常老年人5 2名。采用化学发光法测定血中黄体生成素(LH )、促卵泡成熟素(FSH)、雌二醇(E2 )、催乳素(PRL)、睾酮(T)的含量,并计算E2 /T的比值。结果:AD组及VD组患者血清T水平较正常对照组低,差别有显著意义(P <0 .0 5 ,P <0 .0 1)。VD组患者血清E2 /T较正常对照组显著升高;也较AD组明显升高(P <0 .0 1,P <0 .0 5 )。AD、VD组患者血清E2 、LH、FSH、PRL与正常对照组比较,差别均无显著意义(P >0 .0 5 )。结论:老年男性AD及VD患者血清T水平降低。     

Effects of Carbamazepine Therapy on Serum Sex Hormone Levels in Male Patients with Epilepsy

The effects of carbamazepine (CBZ) therapy and epilepsy on sex hormone plasma levels in male patients with epilepsy were evaluated by measuring the levels of testosterone (T), free testosterone (FT), sex hormone binding globulin (SHBG), estradiol (E2), luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin (PRL), and dehydroepiandrosterone sulfate (DHEAS) and by calculating the free androgen index (FAI) in 23 male patients with epilepsy receiving CBZ medication, in 18 untreated male patients with epilepsy, and in 19 healthy age-matched control subjects. No significant differences in the mean T or FT levels were found between the three groups, but the CBZ-treated patients had significantly higher SHBG levels and their FAI values and DHEAS concentrations were lower. The LH, FSH, PRL, or E2 levels in CBZ-treated and untreated male patients with epilepsy did not differ from the controls. CBZ monotherapy does not significantly change the serum balance of sex hormones; however, CBZ clearly affects the serum levels of SHBG and DHEAS.     

Neuroendocrine aspects of primary endogenous depression VIII. Pituitary-gonadal axis activity in male patients and matched control subjects

To determine the extent of hypothalamo-pituitary-gonadal (HPG) axis dysfunction in endogenous depressed men, we measured nocturnal and diurnal serum luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone (T), and estradiol (E2) concentrations, and their responses to gonadotropin releasing hormone (LHRH) and dexamethasone administration, in 16 Research Diagnostic Criteria primary, definite endogenous male depressives and 16 individually matched male normal controls. Compared to their controls, the patients showed no differences in basal nocturnal or diurnal gonadotropin or gonadal steroid hormone concentrations, and no differences in hormone concentrations either post-LHRH or post-dexamethasone. Age was negatively correlated with baseline serum T in the patients but not in the controls, and it was modestly positively correlated with baseline serum LH in both groups of subjects. In the patients, the presence of DSM-III melancholia was modestly negatively correlated with baseline and post-LHRH concentrations of both LH and FSH and was positively correlated with baseline serum T, but it bore no relation to serum E2. None of the other subject characteristics or specific dimensions of depressive symptomatology were significantly related to the HPG axis measures. The HPG axis measures also were unrelated to pre- and post-dexamethasone cortisol concentrations in both groups of subjects. The results of this study suggest that, in contrast to the hypothalamo-pituitary-adrenal cortical and thyroid axis abnormalities frequently found in endogenous depressives, HPG axis function in male depressives is relatively normal.     

Hypothalamic-pituitary-gonadal axis in major depressive disorders

The baseline LH, FSH and testosterone levels and the LH and FSH response to TRH-LHRH administration (delta LH, delta FSH) were investigated in 28 patients meeting the RDC criteria for an acute major depressive disorder, and in 20 healthy persons. Twenty-two patients were also reinvestigated in a state of complete or partial clinical remission. Cross-sectional and longitudinal comparisons were made between the groups divided according to sex and menopausal status. After mathematical correction for age differences, the depressed males with an abnormal DST response showed significantly (P less than 0.03) higher delta FSH in the acute state compared to the controls. No relation could be established between the HPG axis hormone levels and the nocturnal serum melatonin levels or the PRL or TSH response to TRH-LHRH administration. In the longitudinal part of the study, the depressed males with an abnormal DST response showed decreased (P less than 0.03) testosterone levels and increased delta FSH (n.s.) in the acute state compared to remission, in contrast to the males with a normal DST. The present results do not support a hypothesis regarding a stimulus-induced down-regulation of the pituitary LHRH receptors in our patients. The possible mechanisms by which HPA axis activation (as revealed by an abnormal DST response) could influence the HPG axis in depressed patients remain to be elucidated.     

Circulating testosterone in pure motor stroke

Serum LH, FSH and testosterone were quantitated in 9 patients with pure motor stroke within 24-48 h of its reported onset. High circulating LH with normal or low testosterone was noted in 8 of them. In response to an intravenous bolus of GnRH, the LH responses were exaggerated in all, but the FSH responses in 7 of them were comparable to those in eugonadal age matched controls. The rise in testosterone following 2000U hCG daily for 3 consecutive days was insignificant in the patients group compared to the controls. The data suggest normally operative pituitary testicular feed-back but decreased Leydig cell response in pure motor stroke.     

Studies using releasing factors in Klinefelter's Syndrome: The responses of LH and FSH to luteinizing hormone-releasing hormone and of prolactin and TSH to thyrotropin-releasing hormone before and after testosterone

(1) During an investigation of their pituitary function, the TSH prolactin (PRL) and gonadotropin, (LH, FSH) response to TRH was measured in four patients with documented euthyroid Klinefelter's syndrome. (2) In all four patients, the serum testosterone was low, the gonadotropins were elevated and thyroid antibodies undetectable. (3) The identical study was repeated after each patient had received intramuscular testosterone cypionate 200 mg bi-weekly for three doses. This raised the serum testosterone at least four-fold. (4) Basal TSH was normal in all four patients but its response to TRH was blunted (mean peak TSH 9.6 μU/ml), compared with normal controls (mean peak TSH 18 μU/ml). Following testosterone this response to TRH was further suppressed to a mean peak of 3.4 μU/ml TSH. (5) Basal PRL levels were also normal and the mean peak response to TRH, 28 ng/ml. When repeated after testosterone, TRH produced a mean peak PRL of 58 ng/ml. (6) LH and FSH, both elevated basally, did not change with TRH administration, but both were stimulated by LHRH 100 μg i.v., LH briskly, FSH more variably. (7) FSH was suppressed sharply but LH only partially with testosterone therapy. (8) Our studies indicate that the TSH response to TRH in Klinefelter's syndrome is blunted and further suppressed with short term testosterone replacement. The PRL response to TRH under these same circumstances, however, is enhanced. Previous reports of abnormal LH feedback control are confirmed. (9) Klinefelter's syndrome is associated with subtle abnormalities in hypothalamic pituitary regulation not expected in typical primary hypogonadism.     

Hormonal changes in headache patients.

Seventy-three patients with headache underwent serum and cerebrospinal fluid (CSF) radioimmunoassays of follicle-stimulating hormone (FSH), luteinizing hormone (LH), cortisol and prolactin. Serum FSH showed significant increases in all headache patients while serum LH increased only in females. Such a rise of serum FSH and LH is attributed to disturbances of the sleep-wake cycle. On the other hand, serum cortisol was significantly decreased in the male headache patients, probably due to altered circadian rhythm. Serum prolactin remained within normal limits. CSF prolactin, FSH and LH showed detectable levels in all headache sufferers compared to undetectable levels in control subjects, while CSF cortisol was significantly reduced.     

精神分裂症患者性激素与认知功能的关系

目的:探讨精神分裂症患者性激素与认知功能的关系。方法:精神分裂症患者95例,使用利培酮治疗6周,分别于治疗前和治疗后进行雌二醇(E2)、孕酮(Prog)、睾酮(T)、催乳素(PRL)、促卵泡激素(FSH)、黄体生成素(LH)检测、简明精神病评定量表(BPRS)评定和瑞文标准推理测验。结果:男性患者的E2、T、FSH、LH水平与瑞文测验正确题数、知觉辨别、类同比较、比较推理、系列关系正确题数均正相关;治疗后E2、T水平不再与瑞文推理测验相关。女性患者的E2、Prog、T、FSH、LH水平与瑞文测验正确题数、智商数、类同比较、比较推理、系列关系、抽象推理正确题数均正相关;治疗后E2、LH水平仍与瑞文测验正确题数、智商数、类同比较、比较推理、系列关系、抽象推理正确题数正相关,T水平与瑞文测验正确题数及所有因子正确题数负相关。结论:男女精神分裂症患者性激素对认知功能有不同影响。     

绝经后妇女脑梗死患者性激素变化与胰岛素抵抗的关系

目的：为探讨绝经后妇女脑梗死患者性激素水平变化及与胰岛素抵抗的关系。方法：对３３例绝经１年以上妇女脑梗死患者（Ａ组）与２１例绝经１年以上无脑梗死健康妇女（Ｂ组）的血清雌二醇（Ｅ２）、促卵泡刺激素（ＦＳＨ）、促黄体生成素（ＬＨ）、睾酮（Ｔ）、血浆葡萄糖（Ｇ）、血浆胰岛素（ＩＮＳ）及胰岛素敏感指数（ＩＳＩ）进行检测。结果：Ａ组Ｅ２水平较Ｂ组明显降低,ＦＳＨ、ＬＨ、Ｔ水平显著增高。相关分析发现,Ｅ２与ＩＳＮ是显著负相关,而Ｅ２与ＩＳＩ呈显著正相关;Ｔ与ＩＮＳ呈显著正相关,与ＩＳＩ是显著负相关。结论：绝经后妇女脑梗死患者存在严重的性激素失调,且与胰岛素抵抗并存,可能参与绝经后妇女脑梗死发生和发展。     

万拉法新对抑郁症患者血清性激素的影响

目的 探讨万拉法新对抑郁瘟患血清性激素的影响。方法 用放免法测定42例抑郁症患治疗前和治疗后1、6周末血清催乳素(PRL)、促滤泡成熟激素(FSH)、促黄体生成素(LH)、睾酮(T)、雌二醇(E2)，并与30例健康对照。结果 抑郁症组男性LH、E2和女性PRL、FSH与对照组比较明显升高。治疗后1、6周末男性患PRL、T、E2和女性PRL、T有显差异。结论 抑郁症患存在下丘脑—垂体—性腺轴内分泌异常，万拉法新可引起抑郁症患性激素分泌变异。     

Gonadal steroid and gonadotropin response to dexamethasone: A study in sexual dysfunction and normal controls

Summary Numerous investigations have reported an alteration of hormonal response to dexamethasone in depressive disorder. No such data are available in psychogenic sexual dysfunction. Pre- and postdexamethasone levels of testosterone, estradiol, LH and FSH were studied in 20 male patients with sexual dysfunction and 20 male healthy controls. Dexamethasone had no influence on testosterone, estradiol, LH and FSH in normal controls. The patients showed an increase in testosterone and LH but not in FSH levels in the morning after dexamethasone administration. When compared with basal levels, the increase in postdexamethasone levels in sexual dysfunction was significant for testosterone (T) but not for LH (LH). The altered gonadal steroid and gonadotropin response to dexamethasone in sexual dysfunction might be due to disturbances of dexamethasone metabolism and glucocorticoid receptor density comparable to similar findings in depressive disorder.     

抑郁症患者的性激素分析

目的　研究抑郁症患者垂体促性腺激素及外周性激素的功能状态,探讨性激素水平改变与性有关症状和药物治疗的关系。方法　采用放射免疫法测定３０ 例（ 男１１ 例,女１９ 例） 抑郁症患者血清促卵泡激素（ Ｆ Ｓ Ｈ） 、黄体生成素（ Ｌ Ｈ） 、催乳素（ Ｐ Ｒ Ｌ） 、睾丸酮（ Ｔ） 、雌二醇（ Ｅ２） 等激素水平,并与２０ 例（ 男女各１０ 例） 正常人对照。结果　试验组男性 Ｌ Ｈ 和女性 Ｆ Ｓ Ｈ、 Ｒ Ｐ Ｌ 明显高于对照组,其他性激素水平两组间无显著性差异。药物治疗前后男性患者 Ｐ Ｒ Ｌ、 Ｔ、 Ｅ２ ,女患者 Ｐ Ｒ Ｌ、 Ｔ 等激素分泌改变非常显著。结论　提示抑郁症患者性腺轴存在功能失调。性有关症状与性激素水平改变无关。抗抑郁治疗可导致性激素分泌紊乱。     

Effects of Carbamazepine on the Hypothalamic-Pituitary-Gonadal Axis in Male Patients with Epilepsy: A Prospective Study

The effects of carbamazepine (CBZ) monotherapy on serum sex hormone levels and on pituitary responsiveness to various stimuli were evaluated in a prospective study with 21 male patients with epilepsy. The serum levels of testosterone (T), free testosterone (FT), sex hormone binding globulin (SHBG), estradiol (E2), luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin (PRL), and dehydroepiandrosterone sulfate (DHEAS) were assayed, and the free androgen index (FAI) values were calculated for each patient before and after 2-month CBZ treatment. The pituitary PRL, LH, and FSH responses to luteinizing hormone-releasing hormone (LH-RH), thyrotropin-releasing hormone (TRH), and metoclopramide (MC) were also measured before and after CBZ treatment. The baseline serum hormone and SHBG levels were measured and the FAI values calculated in 16 healthy male control subjects of similar age. The mean E2 level was higher in patients before CBZ treatment than in control subjects, and untreated patients had greater variances for FAI values, PRL levels, and LH levels than control subjects. No other significant differences were found between untreated patients and control subjects. The FAI values and DHEAS levels of patients decreased during 2-month treatment with CBZ. The PRL response to MC was higher after CBZ treatment than before. The baseline levels of other hormones and SHBG, as well as the LH and FSH responses to LH-RH, remained unaltered. The results indicate that during the first 2 months of CBZ treatment the androgen balance in male epileptic patients changes: Serum DHEAS levels and FAI values decrease, although FT levels remain unchanged. The clinical relevance of these hormonal changes is obscure.     

Estrogen positive feedback on LH secretion in transsexuality

In order to test the hypothesis whether there is variation in hormonal levels or response to hormonal manipulation that could permit a distinction between heterosexuals and transsexuals, we designed the following protocol: Six male-to-female (m-to-f) transsexuals, six heterosexual control females and six female-to-male (f-to-m) transsexuals were given estradiol benzoate (E2B) (4.5 micrograms/kg/12 hr) for five days. In the female population, E2B treatment was initiated on day 5 of the menstrual cycle. In all the subjects blood luteinizing hormone (LH) and follicle stimulating hormone (FSH), estradiol-17 beta (E2) and testosterone (T) levels were measured twice daily. Additionally, LH and FSH responses to LHRH (100 micrograms iv) stimulation prior to and on day 5 of the E2B treatment were evaluated. In the m-to-f transsexuals, T levels decreased sharply and progressively during estrogen treatment, along with a fall in LH and FSH levels. The magnitude of the LH and FSH responses to LHRH stimulation also decreased following estrogen administration. In the heterosexual female controls and in the f-to-m transsexuals, estrogen administration increased LH levels to a minimum of 100% above initial values from day 3 onwards. Interestingly, the magnitude of the LH increase in the f-to-m transsexuals was greater than that of the heterosexual female controls. In both groups, LHRH stimulation resulted in a greater LH response compared to that prior to estrogen treatment. Our present observations, based on blood hormonal levels and responses to hormonal manipulations do not permit a distinction between heterosexual females and f-to-m transsexuals. There was no convincing evidence for the existence of a positive estrogen feedback on LH secretion in m-to-f transsexuals. These results contradict some of the reported hypotheses concerning hormonal alterations in these individuals.     

Sex hormone levels in drug-naïve,first-episode patients with psychosis

Abstract

Aim: Sex differences have long been reported in schizophrenia leading to the hypothesis that sex hormones may be implicated in the pathophysiology of the disorder. We assessed gonadal hormones during the fasted state in drug-naïve patients with psychosis.

Method: Fasting serum concentrations of follicular-stimulating hormone (FSH) and luteinizing hormone (LH), testosterone, free-testosterone, Sex Hormone Binding Globulin (SHBG) and oestradiol (E₂) were compared between a group of 55 newly diagnosed, drug-naïve, first-episode men with psychosis and a group of 55 healthy controls, matched for age, smoking status and BMI. Testosterone, free-testosterone and SHBG were compared between a group of 32 drug-naïve, first-episode females with psychosis and a group of 32 healthy controls matched for age, smoking status and BMI.

Results: Testosterone and free-testosterone levels were significantly lower in the patients’ group and SHBG levels significantly higher in the patients’ group compared to those in healthy controls. The two female groups had similar values in the hormones which were measured.

Conclusion: Our findings provide evidence of lower testosterone and free-testosterone levels and increased SHBG levels in drug-naïve, first-episode males with psychosis.

• KEY POINTS

• Reduced testosterone and free-testosterone levels in drug-naive, first-episode males with psychosis.

• Increased SHBG levels in drug-naive first-episode males with psychosis.

• No difference in FSH, LH and E2 levels between drug-naive first episode males with psychosis and controls.

• No difference in testosterone, free-testosterone and SHBG levels between drug-naive, first-episode women with psychosis and controls.

     

男性癫痫患者服用抗痫药物后血清性激素水平改变及其临床意义

目的 研究抗痫药物对男性癫痫患者性激素水平的影响。方法 应用放射免疫分析法和免疫放射测定分析法测定应用多种ＡＥＤｓ治疗和未经治疗的男性癫痫患者及健康对照组血清睾酮,游离睾酮,性激素结合球蛋白,雌二醇,间质细胞刺激素,滤泡刺激素的水平。结果未治疗组与正常对照组相比,各项指标均无显著差异。各治疗组与对照组相比,ＦＴ水平均显著降低,ＳＨＢＧ水平显著升高;苯妥英钠治疗组的Ｅ２水平升高;而ＴＴ,ＬＨ,ＦＳ     

Gonadal axis hormones in psychiatric male patients after a suicide attempt

Epidemiological and clinical studies support the view that aggressive acts like suicidal and violent behaviors share a common substrate. Certain aspects of violence in males have been related to high testosterone levels, but the relation of testosterone to attempted suicide has not been studied until now. We estimated plasma levels of testosterone (T), LH, and FSH in 80 male subjects after a suicide attempt and in whom a psychiatric assessment was done during their hospitalization. Suicide intent was evaluated in 72 subjects. A group of 56 healthy males in the same age range served as control. As a group, attempters showed significantly lower T levels, marginally higher LH, and normal FSH compared to controls. The attempters who used violent methods (26 subjects) had T levels even lower than the non-violent (drug overdose) subgroup. Comparisons of T levels of subgroups according to the (main) drug ingested (analgesics, benzodiazepines, antidepressants, neuroleptics, or other drugs) did not reveal any significant drug effect. In relation to diagnosis, the lowest T levels were found in the subgroup with schizophrenia (29 subjects). The T levels of this subgroup were also significantly lower compared to those of a group of 31 male schizophrenic patients, hospitalized and treated with neuroleptics. If the influence of post-attempt stress and medical condition on plasma T could be ruled out, low plasma T may prove to be a biological predictor of attempt, at least in male schizophrenic patients. Nevertheless, the findings differentiate suicidal behavior from other aggressive/violent behaviors and do not support the notion that suicidal and aggressive behaviors are manifestations of the same impulse.     

Hyperestrogenemia in neuromuscular diseases

In order to elucidate the relationship between certain neuromuscular diseases and gonadal hormones, we measured the levels of serum estrogens and other sex-related hormones. The values were compared with those for age-matched controls. The cases, comprising bulbospinal muscular disease of the Kennedy-Alter-Sung type, Kugelberg-Welander disease, amyotrophic lateral sclerosis, and Duchenne muscular dystrophy, were all euthyroid males. The baseline levels of serum estrone were significantly higher in all of the patients than in age-matched normal subjects. Serum baseline testosterone, LH and FSH levels were all essentially normal, except low FSH levels in Duchenne muscular dystrophy. Since our patients had no overweight, liver or glandular abnormalities, we presume that the elevated serum estrone levels have resulted from increased peripheral androgen-to-estrogen conversion.