The Clinical Usefulness of 3a-Androstanediol Glucuronide in Premenopausal Women with Hirsutism

Summary: A biochemical parameter correlating with the clinical assessment of the severity of hirsutism and changing appropriately with the clinical response to treatment would be extremely useful. Preliminary reports of androstanediol glucuronide indicated that it was a peripherally-derived androgen and had a high correlation with clinical gradings of hirsutism. More recent reports have cast doubts on this association. This paper presents an evaluation of the clinical usefulness of androstanediol in 121 consecutive premenopausal patients with hirsutism. Androstanediol had a positive correlation with the clinical grading of hirsutism (p < 0.02) and the BMI (p < 0.01) but a negative correlation with age (p<0.01). After adjustment for the effects of age and BMI there was no significant association between the degree of hirsutism and the level of androstanediol. We therefore feel that the routine measurement of androstanediol does not assist in the assessment or management of patients with hirsutism.     

Hirsutism: diagnosis and management

The majority of women with hirsutism have the idiopathic variety characterized by normal circulating androgens. An index of suspicion should, however, be maintained for that subset of women whose hirsutism is indicative of a systemic hormonal aberration. The psychological consequences of this highly visible condition that can seriously impact quality of life substantiate the need for safer and more effective management options. The advent of a topical medication (eflornithine hydrochloride), devoid of systemic side effects, is one positive step toward this goal.     

人附睾蛋白4在子宫内膜癌中临床价值的评估

子宫内膜癌是女性生殖系统常见的恶性肿瘤,是导致女性死亡的重要因素。近年来世界范围内发病率明显上升,且趋于年轻化,早期诊断和治疗对改善患者预后至关重要。但截至目前仍缺乏敏感而特异的血清学标记物。近来研究发现,人附睾蛋白4（HE4）在子宫内膜癌组织中高表达,而在正常内膜组织及内膜良性病变中不表达或低表达,HE4是否可作为子宫内膜癌的早期诊断和预后的指标备受关注。现就HE4在子宫内膜癌的诊断和预后评估等方面的临床应用价值进行综述。     

Hirsutism and acne in polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is the most common endocrine abnormality affecting reproductive age women. Population-based studies estimate a prevalence of 5-10% [Obstet Gynecol 101 (2003) 995; Aust N Z J Obstet Gynaecol 41 (2001) 202]. The clinical characteristics of PCOS include hyperandrogenism, chronic anovulation, insulin resistance and infertility. Hyperandrogenism is generally manifested as hirsutism and acne. Both these clinical symptoms are treated with similar drug therapies, including oral contraceptive pills (OCPs), topical medications or antiandrogens such as spironolactone, flutamide and finasteride, as well as topical medications. Recent studies have shown that lower doses of these medications are as efficacious as high doses and have the advantage of decreased cost and an improved side-effect profile. Although hirsutism and acne can be considered cosmetic in nature, they cause significant social embarrassment and emotional distress. Physicians should be sensitive to these issues and approach patients in a caring and sympathetic manner.     

梗阻性无精子症患者精子顶体完整性与卵胞质单精子注射治疗结局之间的关系

目的:探讨梗阻性无精子症(OA)患者精子的顶体完整性及其与卵胞质单精子注射(ICSI)治疗临床结局之间的关系。方法:选取梗阻性无精子症患者共37例为试验组,同期进行体外受精治疗且精液常规参数正常的男性33例为对照组,应用荧光标记的豌豆凝集素法(PSA-FITC)检测精子顶体完整性,巴氏染色法分析精子形态,比较试验组与对照组的顶体完整率(AIR)、正常形态率(NFR)、受精率(FR)、卵裂率(CR)及优质胚胎率(OER),并将AIR与FR、NFR与FR进行相关性分析。结果:试验组的AIR、NFR、FR显著低于对照组(P<0.01),CR、OER试验组与对照组相比无统计学差异(P>0.05)。试验组AIR与FR呈显著正相关(r=0.595,P<0.01),NFR与FR显著正相关(r=0.463,P<0.01);对照组AIR与FR显著正相关(r=0.683,P<0.01),NFR与FR呈显著正相关(r=0.205,P<0.01)。结论:梗阻性无精子症患者的精子AIR较低。行皮下附睾抽吸术(PESA)-ICSI的梗阻性无精子症患者精子其AIR高则受精率也会高。     

Preoperative Evaluation of Patients with Suspected Ovarian Cancer

A diagnosis of ovarian cancer should be suspected when a postmenopausal woman presents with a pelvic mass. The presence of ascites, which can be detected clinically or by ultrasound, increases the accuracy of the diagnosis. CA 125, although nonspecific in the premenopausal patient population, is very sensitive in postmenopausal patients when used in combination with clinical impression and an abnormal ultrasound. CAT scan is more sensitive than ultrasound, but may not alter surgical management. Preoperative preparation of the bowels should consist of a polyethylene glycol lavage in combination with oral and systemic antibiotics and is indicated for any woman with a mass adherent to the cul de sac. Preoperative total parenteral nutrition should be reserved for severely malnourished patients as determined by objective criteria. Early surgical intervention is a key component for the treatment of these patients, and extensive diagnostic testing should be used temperately in order to ensure expeditious treatment of these patients. In the future, the most significant impact on the survival of patients with ovarian cancer will be in the development of improved methods of screening and early detection. It is hopeful that clinical trials currently being conducted will bring us closer to that goal.     

Hair Growth in a Patient with Hirsutism: Poor Response to Ovarian Suppression

Summary: Hair growth was studied in a young woman with hirsutism and irregular menstruation by weighing weekly shavings from the thighs for a year. The apparent response to combined oestrogen and progestogen therapy appeared likely to be due to seasonal variations in hair growth. The value of objective measurement of hirsutism is demonstrated.     

Hirsutism and hyperandrogenism associated with hyperreactio luteinalis in a singleton pregnancy: A case report

The incidence of hyperandrogenism during pregnancy is low, although the incidence of some of the ovarian diseases that can cause it is higher. Hyperreactio luteinalis is a rare benign condition that may mimic ovarian and trophoblastic malignancies. A 23-year-old woman at 20 weeks' gestational age presenting with severe hirsutism and ovarian masses was treated conservatively and subsequently gave birth to a healthy female neonate. Final diagnosis was hyperreactio luteinalis. Conservative management with close monitoring of patients with hyperreactio luteinalis represents the best approach in such rare cases. Counseling should be provided to reassure the patient as to the transient effects of hyperandrogenism on the mother and the fetus.