Adrenal steroids in post-menopausal women: relation to obesity and to bone mineral content

Basal levels and ACTH-induced increments of serum 17 alpha-hydroxyprogesterone (170HP), cortisol, 4-androstene-3,17-dione (A-4), dehydroepiandrosterone (DHA), and dehydroepiandrosterone sulphate (DHAS) were related to the degree of obesity and to trabecular bone mineral density in 29 postmenopausal women. The ACTH-induced increment of 170HP (delta 170HP) was negatively correlated to basal DHA and delta DHA. Positive correlations were found between obesity, expressed as Broca's index, and delta DHA and the delta DHA/delta 170HP ratio. Bone mineral density was positively correlated to basal DHAS, delta DHA, delta DHAS and the delta DHA/delta 170HP ratio, and negatively correlated to delta 170HP. DHA and 170HP represent a crossroad in adrenocortical steroid biosynthesis, leading to delta 5-androgens and glucocorticoids as main products. Besides age, obesity may also influence the intra-adrenal distribution between these two main steroidogenic pathways. The results suggest that differences at a very early stage of the adrenal steroidogenesis may influence calcium homeostasis in the post-menopausal woman.     

Cytological diagnosis of endometrial cancer and preinvasive endometrial lesions. A comparison of the Endo-Pap sampler with fractional curettage

The value of the Endo-Pap endometrial cell sampling device in the cytological assessment of the endometrium was compared with fractional curettage. 318 symptomatic women were studied consecutively, among whom were 42 with malignant tumors of the uterus. Satisfactory material for cytological diagnosis of the endometrial state was obtained in 96%, whereas only 91% of the histopathological material was suitable for interpretation. 35 of 36 women with primary cancers of the corpus uteri had atypical endometrial cytology (sensitivity 0.97). Of 42 uterine cancers, including one metastatic ovarian carcinoma, two adenocarcinomas and three squamous carcinomas of the cervix, 40 were detected by endometrial cytology (sensitivity 0.95). All 5 cases of high grade cytological atypia in endometrial polyps or endometrial hyperplasia could be diagnosed by abnormal endometrial cytology and 4 of 5 patients with adenomatous endometrial hyperplasia were diagnosed correctly. Endometrial cytology obtained with the Endo-Pap sampler is a simple and cheap diagnostic method with which to detect endometrial cancer. It is also effective for diagnosis of preinvasive endometrial lesions with highgrade cytological atypia. Clinicians should recognize that out-patient investigation of the endometrial state by endometrial cell sampling with the Endo-Pap is reliable and can usually replace fractional curettage.     

Beitrag zur Kenntnis der Leberrhythmik

Ohne Zusammenfassung     

Eustachian tube function measured as pressure equilibration and sound transmission capacity. A comparison in healthy ears

In a series of 68 healthy ears the muscular opening function of the Eustachian tube was assessed in two different ways. A pressure equilibration capacity of +/- 100 mm H2O was tested by a quantitative impedance technique using a pressure chamber and compared to sound transmission capacity recorded by sonotubometry at frequencies of 6, 7 and 8 kHz. In contrast to the pressure equilibration test, sonotubometry does not allow a quantitative assessment of Eustachian tube function and furthermore, sonotubometry yields false-positive as well as false-negative results due to the great variations in sound pressure generated by the deglutition maneuvers themselves.     

Dehydroepiandrosterone sulfate in postmenopausal women: lack of influence of parity

Serum concentrations of dehydroepiandrosterone sulfate (DHAS) were analyzed in 251 healthy, medicine-free postmenopausal women 46-65 years of age. Twentyfour of the women were nulliparous and 227 parous (1- to 7-parous). There was no association, whatsoever, between parity and DHAS levels. The data are at variance with previous findings in menstruating women of higher DHAS levels in nulliparous than in parous women. This difference between menstruating and postmenopausal women may reflect an influence of age per se on DHAS metabolism. It may also reflect the exclusion in this study of women with i.e. endometrial hyperplasia/cancer, diseases often associated with elevated DHAS levels and increased risk for nulliparous women.     

Skeletal remineralization after surgery for primary and secondary hyperparathyroidism

Bone mineral was measured by photon absorptiometry before and after parathyroid surgery in patients with primary or secondary hyperparathyroidism (HPT). The mean bone mineral density of lumbar vertebrae was 0.82 +/- 0.04 (SEM) gm/cm2 in primary HPT (n = 7) and 0.86 +/- 0.05 gm/cm2 in secondary HPT (n = 11). These values are significantly lower than for age-matched normal subjects. After successful parathyroid surgery, the bone mass of the distal radius and lumbar vertebrae increased by approximately 10% within 3 months after operation and then remained stable during the first postoperative year. In conclusion, parathyroid surgery is followed by a significant increase of bone mass in primary and secondary HPT. The substantial increase in bone mass in parts of the skeleton consisting predominantly of trabecular bone, as well as in sites with predominantly cortical bone, indicates that remineralization after operation involves a generalized increase in bone mass.     

Serum sex hormone binding globulin (SHBG), testosterone/SHBG index, endometrial pathology and bone mineral density in postmenopausal women

Serum levels of sex hormone binding globulin (SHBG) and testosterone (T) and bone mineral density (BMC) in the non-dominant forearm were determined in 28 postmenopausal women aged 44-62 years. Significant correlations (Spearman's rank correlation test) were found between BMC and SHBG (negative) and between BMC and the T/SHBG index on biologically active androgen (positive). Significant correlations were also found between endometrial pathology (Kruskal-Wallis test; 0 = atrophic, 1 = hyperplasia, 2 = cancer) and SHBG (negative) and the T/SHBG index (positive). It is suggested that SHBG may act as one common denominator in the pathogenesis of postmenopausal osteoporosis and endometrial disease by regulating the levels of unbound, biologically active androgens and estrogens.