子宫内膜异位症不孕患者血清泌乳素水平分析

目的:探讨子宫内膜异位症不孕患者与非子宫内膜异位症不孕患者血清卵泡刺激素、黄体生成素、雌二醇、睾酮、促甲状腺激素及泌乳素的差异。方法:选取2015~2016年907例子宫内膜异位症不孕患者(观察组),与1579例非子宫内膜异位症的不孕患者(对照组),对比分析两组患者激素水平。结果:两组卵泡刺激素、黄体生成素、雌二醇、睾酮、促甲状腺激素水平差异无统计学意义。观察组泌乳素水平[(17.8±8.8)ng/mL vs.(16.8±8.2)ng/mL]高于对照组,差异有统计学意义(P=0.005)。子宫内膜异位症卵巢型患者血清泌乳素水平为(17.1±7.1)ng/mL,腹膜型为(18.9±11.0)ng/mL,腹膜型高于卵巢型,差异有统计学意义(P=0.009)。结论:子宫内膜异位症不孕患者泌乳素水平升高,针对泌乳素的机制研究与干预可能有助于了解不孕症的发生机制、提高临床诊治效果。     

肿胀吸脂加乳晕下缘小切口腺体部分切除术治疗男性乳房肥大

目的总结肿胀吸脂加乳晕下缘小切口腺体部分切除术治疗男性乳房肥大的方法及临床效果。方法2004年6月-2006年6月,收治40例男性乳房肥大患者。年龄11～41岁。单侧3例,双侧37例。脂肪型10例,乳房区明显凸出,无腺体增生;脂肪腺体混合型30例,其中22例乳房区明显凸出并伴有肿块,8例呈女性乳房形态并伴有结节增生。38例血清催乳素、黄体生成素、血清卵泡刺激素、雌二醇、睾酮、皮质醇水平均正常;2例血清催乳素、黄体生成素、血清卵泡刺激素、雌二醇水平增高,睾酮水平降低。10例单纯采用肿胀吸脂术,30例联合乳晕下缘小切口腺体部分切除术。结果2例分别于术后第1、2天出现皮下血肿和少量积液,经对症处理后达Ⅰ期愈合;其他患者切口均Ⅰ期愈合。3例术后第1天即出现乳头麻木,未予特殊处理,随访6个月乳头感觉部分减退。其余患者无乳头、乳晕坏死及乳头感觉减退等并发症发生。40例患者均获随访,随访时间6～24个月,平均13个月。乳房区外形良好,无复发。结论肿胀吸脂加乳晕下缘小切口腺体部分切除术具有安全、瘢痕小、外观自然、患者满意度高等优点,是治疗男性乳房肥大有效方法之一。     

Hormonal effects of high dose medroxyprogesterone acetate treatment in males with renal or prostatic adenocarcinoma

In 18 patients, 12 with renal and 6 with prostatic carcinoma, the gonadal, pituitary and adrenal functions were studied by measurements of steroid hormones and gonadotrophins, before and after six weeks treatment with medroxyprogesterone acetate (MPA), injected intramuscularly 500 mg per day for 5 days each week. The testosterone-oestradiol-binding globulin (TeBg) was measured and the amount of albumin and TeBg bound and unbound testosterone was calculated. Treatment with high doses of MPA caused a profound decrease in serum concentrations of testosterone, dehydroepiandrosterone sulphate (DHEAS), cortisol and TeBg. There were significant decreases in serum concentrations of luteinizing hormone (LH), follicle stimulating hormone (FSH) and oestradiol-17 beta. The serum concentration of prolactin was significantly elevated. The protein unbound testosterone fraction was lowered by MPA treatment but less than total testosterone. In conclusion, MPA therapy in high dose alters the gonadal, pituitary and adrenal functions suppressing serum concentrations of androgens, gonadotrophins, cortisol and TeBg but elevating prolactin concentration.     

Dose-response effects of gonadotropin-releasing hormone on plasma concentrations of gonadotropins and testosterone in fertile and subfertile stallions.

Five fertile and five subfertile stallions were treated with a single intravenous injection of saline the first week followed by a single intravenous injection of varying doses of gonadotropin-releasing hormone (5, 10, 25, 100, 500 micrograms) given in a randomized fashion over the next 5 weeks during the nonbreeding season. Blood samples were collected periodically before and after treatment for analysis of luteinizing hormone, follicle stimulating hormone, and testosterone content by radioimmunoassay. Before treatment, semen samples were collected every other day for 3 weeks for analysis of volume, concentration, motility, pH, and morphology. Basal plasma levels of luteinizing hormone were higher (P < 0.05) in the subfertile group, follicle stimulating hormone levels tended to be higher (P < 0.10) in the subfertile group, and testosterone levels were similar in the two groups. A significant linear-log dose-response relationship was observed for plasma luteinizing hormone (P < 0.05) and follicle stimulating hormone (P < 0.05) to exogenous gonadotropin-releasing hormone in both the fertile and subfertile group. A linear-log dose-response relationship was also observed for plasma testosterone (P < 0.05) in the fertile group. The magnitude of the luteinizing hormone and follicle stimulating hormone response to gonadotropin-releasing hormone across doses was similar in both groups of stallions. A significant testosterone response to gonadotropin-releasing hormone in the subfertile group of stallions was not observed (P > 0.05). Mean testosterone concentrations after treatment in terms of net increase and percent of baseline were significantly lower (P < 0.05) in the subfertile group compared to the fertile group.(ABSTRACT TRUNCATED AT 250 WORDS)     

Routine hormone load tests are unnecessary in infertile men

A sample of 225 men examined at the Infertility Service Unit of this hospital had spermiograms, standardized in accordance with WHO guide lines, and a hormone stimulation test with injection of gonadotropin releasing hormone, thyrotropin releasing hormone, and ACTH. The serum concentrations of the following hormones were assessed: follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, oestradiol (E), thyroid stimulating hormone, cortisol, 21-desoxycortisol, 17-hydroxypregnenolone, 17-hydroxyprogesterone, dehydroepiandrosterone, dehydroepiandrosteronesulphate, androstenedione, testosterone (T), and dihydrotestosterone. The results of the spermiograms were found to be related to the concentrations of the following hormones: FSH, LH, T, and E. Thyroid and adrenal function in men without signs of endocrinological diseases failed to influence spermatic parameters.     

Clomiphene citrate therapy in idiopathic male infertility

Clomiphene citrate therapy was performed on 30 patients with idiopathic male infertility, who were intractable to non-hormonal therapy. Clomiphene citrate was administered orally at a dose of 25 mg per day for 25 days with 5 days of rest following Paulson' protocol, and we favorable results were obtained: Both sperm count and sperm motility improved in 11 cases (36.7%). Odera's score count decreased in 14 cases (46.7%), which were judged as effective. The wives of 4 patients treated by this therapy became pregnant. After this therapy, the serum levels of luteinizing hormone, follicle stimulating hormone, testosterone and prolactin were 1.90, 1.81, 1.89 and 1.22 times higher, respectively. These findings indicate that clomiphene citrate therapy is an effective for idiopathic male infertility, but we need to consider that the sudden and marked elevation of serum testosterone level by this therapy might affect male accessory sex organs such as the prostatic gland which shows androgen dependency later in life.     

Pituitary and gonadal function in prepubertal boys with hypospadias

Luteinizing hormone releasing hormone and human chorionic gonadotropin tests were performed to examine the pituitary gonadal axis in 31 prepubertal boys with hypospadias. Luteinizing hormone and follicle stimulating hormone responses to luteinizing hormone releasing hormone in these boys with hypospadias were significantly higher than those in prepubertal control subjects (luteinizing hormone, p less than 0.01). follicle stimulating hormone, p less than 0.05). Prepubertal boys with hypospadias had remarkably reduced testosterone responses to human chorionic gonadotropin stimulation compared to controls (p less than 0.01). Hormonal milieus were further analyzed in the subtypes of hypospadias depending on their severity (distal vs. proximal). Nine of the 31 boys with hypospadias were classified as the proximal type. Basal luteinizing hormone levels in the proximal type were significantly higher than in the distal type (p less than 0.05). Luteinizing hormone and follicle stimulating hormone responses to luteinizing hormone releasing hormone and responses of testosterone to human chorionic gonadotropin were not significantly different in the 2 types. Seven of the 31 boys with hypospadias had a history of maternal progestin ingestion. Basal luteinizing hormone levels and responses of luteinizing hormone and follicle stimulating hormone to luteinizing hormone releasing hormone were also significantly higher in these subjects than in controls (p less than 0.005), though basal levels and responses of testosterone to human chorionic gonadotropin were not different from those of controls. Tests conducted to determine luteinizing hormone and follicle stimulating hormone and testosterone levels using luteinizing hormone releasing hormone and human chorionic gonadotropin stimulation revealed no statistical differences between the boys with hypospadias who had a history of maternal progestin ingestion and those without such a history. The majority of prepubertal boys with hypospadias had varying degrees of deficient testicular activity. The testicular function of these patients should be evaluated longitudinally at puberty and thereafter in order to insure the completion of secondary sexual development.     

Changes in the hypothalamic-pituitary-gonadal axis in men after cadaver kidney transplantation and cyclosporine therapy.

A variety of plasma androgens, estradiol, follicle-stimulating hormone, luteinizing hormone, prolactin, cortisol, and thyroid parameters were examined in 10 men followed serially before and after cadaver kidney transplantation. Before transplantation, plasma testosterone levels were below normal in 8 of the 10 men. Free testosterone, follicle-stimulating hormone, and luteinizing hormone were at the lower range of normal values, yet plasma estradiol levels were elevated 3-fold, and prolactin levels were also high. One month after transplantation, all hormones measured were suppressed, probably reflecting high-dose steroids and multiple-drug regimens used in the period following the operation. After 3 months, when other immunosuppressants were reduced and cyclosporine dosage was stabilized, plasma testosterone, androgens, follicle-stimulating hormone, and luteinizing hormone levels were restored toward normal. After 12 months, plasma testosterone levels exceeded pretransplant levels. Plasma estradiol and prolactin levels dramatically decreased after transplantation and remained in the normal range thereafter. These data indicate that abnormalities of plasma estradiol and prolactin levels observed in patients with end-stage renal disease are restored toward normal after cadaver kidney transplantation. Androgen levels that were suppressed in the period immediately after transplantation were restored to normal levels in the succeeding months despite chronic usage of cyclosporine, suggesting that cyclosporine, in currently used doses, does not prevent the restoration of the hypothalamic-pituitary-testicular axis.     

Eight case reports on sex‐hormone profiles in sexually mature male Down syndrome

Down syndrome (DS) is a congenital disorder usually caused by an extra copy of chromosome 21. Although the number of postpubertal patients with DS is increasing, only limited information is available on their gonadal and sexual development. The aim of this case report was to examine sex‐hormone profiles in sexually mature male patients with DS. Eight postpubertal male patients with trisomy 21 (mean age 28 years, range 15–54 years) participated in this study. The serum level of luteinizing hormone and follicle‐stimulating hormone was significantly elevated and testosterone was slightly decreased. The testicular volume was smaller in all eight cases than that observed in healthy male subjects. The elevated luteinizing hormone and follicle‐stimulating hormone levels, the lower testosterone levels and a smaller testicular volume observed in all eight cases suggest a significant degree of germinal cell hypoplasia in mature male patients with DS.     

Circulating 25‐hydroxy vitamin D correlates with serum level of anti‐Müllerian hormone in male patients with chronic kidney disease

This study was designed to assess the relationship between serum levels of anti‐Müllerian hormone and 25‐hydroxy vitamin D in chronic kidney disease male patients. For that, serum 25‐hydroxy vitamin D and anti‐Müllerian hormone along with follicle‐stimulating hormone, luteinising hormone, prolactin, total testosterone and estradiol were assayed in 59 patients with different stages of chronic kidney disease and 21 healthy participants. Compared to controls, serum levels of anti‐Müllerian hormone and 25‐hydroxy vitamin D were significantly decreased in patients with chronic kidney disease. The decreased anti‐Müllerian hormone level correlated positively with estimated glomerular filtration rate and serum levels of testosterone and 25‐hydroxy vitamin D. Meanwhile, it was negatively correlated with age and serum levels of urea, creatinine, follicle‐stimulating hormone, luteinising hormone and prolactin. 25‐Hydroxy vitamin D and luteinising hormone explained the 65.9% variability of anti‐Müllerian hormone in a multiple linear regression model. However, anti‐Müllerian hormone in crude correlation was more strongly associated with serum 25‐hydroxy vitamin D than luteinising hormone. In conclusion, serum level of 25‐hydroxy vitamin D might be a determinant factor of anti‐Müllerian hormone level, and their relationship might explain in part the dysfunction of Sertoli cells and the impaired testicular functions in chronic kidney disease male patients.     

Possible role of serum testosterone,gonadotropins and prolactin in patients with premature ejaculation

Premature ejaculation (PE) is the most common male sexual dysfunction. This study aimed to investigate the role of serum testosterone, gonadotropins and prolactin in patients with PE. In a prospective a case‐controlled study, it was conducted on 90 male patients with PE and 90 male healthy participants as controls. Patients were evaluated by Premature Ejaculation Diagnostic Tool (PEDT) and intravaginal ejaculatory latency time (IELT). Patients with mean IELT values ≤60 s and PEDT total scores ≥11 were considered to have PE. Serum levels of total testosterone (TT), free testosterone (FT), follicle‐stimulating hormone (FSH), luteinising hormone (LH) and prolactin (PL) were investigated in patients with PE and controls. There was no statistically significant difference between patients with PE and controls regarding the serum levels of TT, FT, FSH, LH and PL (p value ?.05). There was no significant correlation between the sex hormones levels (TT, FT, FSH, LH and PL) and (age, body mass index (BMI), IELTS and total PEDT scores of the patients; p value ?.05). This study concluded that there was no disturbance in serum levels of testosterone, gonadotropins and prolactin in patients with PE and controls. These hormones could not relate to pathogenesis of PE.     

Anterior pituitary function in the vegetative state

Anterior pituitary function tests were performed in 33 patients in the vegetative state, and the results were assessed for correlation with various clinical factors. Radioimmunoassays were employed to measure the secretion of growth hormone and cortisol during insulin tolerance testing (regular insulin, 0.15 to 0.20 U/kg), luteinizing hormone and follicle stimulating hormone under administration of luteinizing hormone-releasing hormone (100 micrograms), and thyroid stimulating hormone and prolactin under administration of thyroid-releasing hormone (500 micrograms). Impairment rate, defined as number of abnormal hormone secretions divided by number of hormones examined, was calculated for each patient. The data were statistically assessed by analysis of variance in terms of disease, sex, age, site of lesion, etiology of vegetative state, duration of illness, brain atrophy as demonstrated by computed tomography, and Hockaday's electroencephalographic (EEG) grade. The results were as follows. 1) The levels of growth hormone, luteinizing hormone, follicle stimulating hormone, cortisol, thyroid stimulating hormone, and prolactin were abnormal in 70%, 67%, 45%, 39%, 36%, and 15% of cases, respectively. 2) Anterior pituitary hormone secretion was impaired in all 33 patients, severely in 52%. 3) The impairement rate was significantly increased in patients with ruptured cerebral aneurysms, primary coma, severe brain atrophy, and abnormal EEGs. 4) The impairment rate tended to be higher in long-term vegetative patients. These results suggest that, in the vegetative state, impairment of anterior pituitary function frequently occurs at the onset of disease and worsens over time.     

Effects of α-Interferon on Sperm Production, Concentration, and Motility in the Rat

Background :
We evaluated possible effects of α-interferon (α-IFN) on testicular spermatogenesis and epididymal sperm quality in the nude rat.
Methods :
Nude male rats were administered subcutaneous injections of human α-IFN daily for 3 months. The luminal content of the cauda epididymidis was collected by micropuncture. Daily sperm production was determined by Amann's method and sperm concentrations were determined by microassay. Progressive motility was judged by evaluating the linear distance traveled by the sperm in a diluent. Serum levels of testosterone, luteinizing hormone (LH), and follicle stimulating hormone (FSH) were also measured at the end of the experiment.
Results :
Daily sperm production and epididymal sperm concentrations were significantly increased after administration of α-IFN, while progressive motility of the spermatozoa was not altered. α-IFN significantly increased serum testosterone levels, while it decreased serum LH levels and left serum FSH levels unchanged.
Conclusion :
α-IFN may improve testicular spermatogenesis and increase the epididymal sperm concentration in the rat. These promising results with α-IFN may pave the way for a new approach to treating male infertility.     

Clinical study of hypogonadotropic hypogonadism

Clinical study of eight cases of hypogonadotropic hypogonadism was performed. These cases consisted of five prepubertal cases and three postpubertal cases induced by prolactin-producing hypophyseal tumor. The former five cases had the chief complaints of incomplete development of their external genitalia. The chief complaints in three postpubertal cases were decreased libido in two and infertility in one. The average testicular volumes were 7.8 ml and 20 ml in prepubertal and postpubertal cases, respectively. The basal levels of luteinizing hormone (LH) were within the normal limit in most cases and follicle stimulating hormone (FSH) were low in most cases. There were no differences between the levels of these hormones in prepubertal cases and those in postpubertal cases. The range of basal level of prolactin in blood was 92 mg/ml to 1,070 ng/ml in the postpubertal cases. The basal level of testosterone in blood was low in all cases. Most cases had rather good responses of LH and FSH after the administration of luteinizing hormone releasing hormone. The plasma level of testosterone was elevated after the administration of human chorionic gonadotropin (hCG) in most cases. The appearance of sperm in the semen was observed after the hCG therapy in only one of the prepubertal cases. On the other hand, all the postpubertal cases showed almost normal findings in semen analysis after hormone therapy.     

Hormonal environment and antiandrogenic treatment in benign prostatic hypertrophy

The plasma luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin, testosterone and human growth hormone (HGH) response to insulin-induced hypoglycemia in patients with benign prostatic hypertrophy and age-matched control patients were not different. Although all 6 drugs used were effective for treating these benign prostatic hypertrophy patients the 3 drugs, chlormadinone acetate, oxendrone and allylestrenol, were especially recommended.     

隐睾儿童青春期前内分泌环境和雄激素受体水平的研究

近年来，我们采用放射免疫分析法对４６例年龄为１５个月至１４岁的隐睾儿童的血清ＦＳＨ、ＬＨ、ＰＲＬ、Ｔ和Ｅ２进行了测定，其中１３例在手术时采取外阴部皮肤、进行成纤维细胞培养后，以３Ｈ－Ｒ１８８１为配体，用完整细胞测定法测定雄激素受体的特异性结合量和每个细胞的雄激素受体量。研究结果：（１）隐睾儿童血清ＦＳＨ值升高可能与早期已存在的睾丸曲精小管损害有关，（２）血清Ｅ２显著增高是本组隐睾儿童垂体－性腺轴内分泌功能最突出的改变，（３）隐睾儿童的雄激素受体的特异性结合量和每个细胞的雄激素受体量与正常对照组无显著性差异。研究表明，隐睾儿童存在高雌激素血症，可能是隐睾发生的重要致病因素之一，而靶器官雄激素受体无明显改变，表明隐睾可能不属于雄激素不敏感症的范畴     

Growth related hormones in idiopathic scoliosis. An endocrine basis for accelerated growth

In a total of 95 children with idiopathic scoliosis and 60 controls between the ages of 7 and 17 years, a prospective study of hormones related to growth and maturation was carried out. The pituitary release mechanism for growth hormone was evaluated using the propanolol/L-dopa stimulation test. In addition the blood levels of testosterone, sex hormone binding globulin, oestradiol, thyroxin, prolactin, cortisol, follicle stimulating hormone and luteinizing hormone were determined. The girls were divided into age groups and all results were evaluated according to chronological and skeletal age. The number of boys was too small (25) to allow subdivision into age groups. The girls with idiopathic scoliosis had a significantly higher response to the growth hormone stimulation test than had the controls between the ages of 7 and 12 years whereas no significant difference could be found for the older girls. In girls with a skeletal age between 9 and 12 years a significantly higher mean serum level of testosterone was found (P less than 0.05). No significant differences could be demonstrated for the remaining hormones. Growth hormone and testosterone are the most important growth factors in prepubertal and pubertal children. Thus, the present findings suggest a hormonal basis for the increased stature in children with idiopathic scoliosis which has previously been reported.     

Hypothalamic-pituitary dysfunction in respiratory hypoxia.

Eight hypoxic male patients with stable chronic obstructive airways disease were submitted for combined anterior pituitary function testing. All subjects showed normal growth hormone and essentially normal cortisol responses to adequate hypoglycaemia, two subjects showed delayed responses of thyroid stimulating hormone to administered thyrotrophin releasing hormone and all had basal prolactin levels within normal limits. Basal levels of luteinising hormone were significantly lower than in the group of age-matched controls (p less than 0.02) but there was a normal increment after the injection of gonadotrophin releasing hormone. Basal levels of follicle stimulating hormone were significantly lower than in the controls (p less than 0.01), and there was also a reduced response from the pituitary after injection of gonadotrophin releasing hormone (p less than 0.01). Resting levels of the thyroid hormones thyroxine and tri-iodothyronine were normal while the expected subnormal testosterone level was observed (p less than 0.05). These results show that hypoxia can produce abnormalities of hypothalamic-pituitary function and that these are primarily located in the hypothalamic-pituitary-testicular axis.     

Gonadal function in male heroin and methadone addicts

Gonadal function was elevated in 80 male heroin and/or methadone addicts by measuring basal plasma levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL) and testosterone. In 41 subjects semen analyses were also undertaken. Three groups were distinguished consisting of 15 heroin addicts, 42 undergoing methadone treatment but continuing to take heroin, and 23 taking only methadone. All patients had normal plasma levels of FSH, LH and testosterone. Prolactin levels were normal in all subjects except for the 15 heroin addicts, in whom they were significantly higher than in controls (P less than 0.025). Semen analyses from all of the heroin addicts and from the dual heroin-methadone users were abnormal, whereas only 10 out of 22 (45%) of the methadone takers were pathological. In all cases asthenospermia was one of the abnormalities (100%). Twenty-four per cent also showed teratospermia and hypospermia and 17% showed oligozoospermia. Such seminal pathology, especially of forward motility, even in combination with normal hormone levels, might be an early indication of heroin toxicity to the male reproductive tract.     

Clomiphene citrate in the management of male infertility.

There were 35 hypofertile men who underwent assay of serum follicle stimulating and luteinizing hormones, and testosterone, and were placed in a trial program using clomiphene citrate in a 25-day cycle, with 5-day rest periods. Therapy has been maintained for up to 9 months with a projected termination of 12 months. No relationship could be established between serum follicle stimulating hormone and spermatozoal number in this population. The spermatozoal count improved in 31 men while they were on therapy and 8 pregnancies have occurred. Clomiphene citrate seems to be effective in improving the quanttity of spermatozoa and the spermatozoal motility in these hypofertile men.