Polycystic ovaries: do these represent a specific endocrinopathy?

234

Cifotions ,from lhe Literature

treatment suppressed menstrual activity in all patients. Serum T and estrone were significantly elevated after treatment with oral T undecanoate. The parameters of the pulsatile secretion of LH were not affected by androgen administration. Levels of FSH, estradiol, and progesterone also did not change significantly.

sulin acts on the ovary to stimulate androgen production, they may be because of the short time course of insulin elevation that occurs during an IVGTT. Probing genomic deoxyribonucleic acid for gene rearrangement in 14 patients with aodrogen insensitivity syndrome

DiLauro SL; Behzadian A; Tho SPT; McDonough PG Detection of premature lutehdzation with scram progesterone levels at the time of the postcoital test

Departmeni of Obstetrics and Gynecology. Medical College of

Taney FH; Grazi RV; Weiss G; Schmidt CL

FERTIL STERIL 1991, 55/3 (481-485) Androgen insensitivity appears to, involve mutations in the X-linked androgen receptor (AR) gene in genetic males. In this study; 14 patients with androgen insensitivity syndrome (unrelated patients (n = 6); related patients (n = 8)) were studied. Ten patients had complete and 4 had partial insensitivity to androgens. Deoxyribonucleic acid samples from controls and study subjects were examined with probes specific for the AR gene domains (hAR1, hAR2, hAR3). In one subject with complete androgen insensitivity syndrome, a reduction in size of the 2.4 kilobase band hybridizing to hARl was noted. Southern blot analysis of these subjects, however, did not detect deletions or gene rearrangement. These results suggest that deletions detectable by Southern method are infrequent mutants of the AR gene in patients with androgen insensitivity syndrome.

Deparrment of Obstetrics and Gynecology, UMDNJ-New Jersey Medical School, 150 Bergen Sireet, Newark, NJ 07103-2757. USA

FERTIL STERIL 1991, 55/3 (513-515) Poor cervical mucus (CM) may be caused by a number of factors, including premature luteinization, local cervical effects, and inadequate folliculogenesis. In an attempt to distinguish between these causes of poor CM, we obtained progesterone (P) levels at the time of postcoital tests (PCTs) in infertile women during spontaneous or clomiphene citrate (CC)stimulated cycles. The amount.of CM, viscosity, ferning, spinnbarkeit, and cellularity were each scored from 0 to 3 points on the day after detection of the urinary luteinizing hormone surge (luteal day 1). The charts of 46 such patients were retrospectively reviewed. Eleven control patients with good CM scores (> 10) had low P levels (2.5 ng/mL. Overall, 94.4% of CCstimulated cycles versus 64.3% of spontaneous cycles had abnormal CM scores (< 9). On the basis of these inappropriately elevated P levels, premature luteinization can be cited as the cause of poor mucus quality. In fact, premature luteinization may be responsible for some of the purported antiestrogenic effects of CC. Therefore, it is appropriate to draw a P level at the time of a poor PCT, particularly in cycles stimulated by CC. Aodrogen

responses

to acutely

levels in hyperandrogenic

increased

endogenous

insulin

and normal cycling women

Elkind-Hirsch KE; Valdes CT; McConnell TG; Malinak LR Methodisi Hospital, 6565 Fannin, Houston, TX 77030, USA

FERTIL STERIL 1991, 55/3 (486-491) We examined androgen responses in hyperandrogenic (polycystic ovarian disease (PCOD)) and normal women after an acute endogenous insulin elevation. Standard intravenous glucose tolerance tests (IVGTTs), modified to include a tolbutamide injection 20 min after IVGTTs, were performed. Polycystic ovarian disease patients were studied in the untreated state, after 6 weeks of ovarian androgen suppression with leuprolide acetate, after a 6-week rest period, and after 6 weeks of antiandrogen therapy with spironolactone. Normal menstruating women were studied during the early follicular, midcycle, and luteal phases of a single cycle. An acute rise in insulin did not alter serum testosterone or androstenedione levels in PCOD or normal women. A significant rise in dehydroepiandrosterone sulfate after modified IVGTTs was found in both hyperandrogenic and normal cycling women. Although these results are not supportive of the theory that inInt J Gynerol Ohstet 37

Georgia, Augusta, GA 30912, USA

GYNECOLOGICAL

ENDOCRINOLOGY

Polycystic ovaries: Do these represent a specific eodocriwpathy? Abdel Gadir A; Khatim MS; Mowafi RS; Alnaser HMI; Alzaid HGN; Shaw RW Department ofObstetrics and Gynaecology, Faculty of Medicine, Kuwait University Health Sciences Centre. Kuwait, KWT

BR J OBSTET GYNAECOL 1991 9813 (300-305) Serum pituitary gonadotrophins, oestradiol, testosterone and insulin pulse patterns were examined at 15-min intervals for 6 h in 40 women with a previous diagnosis of polycystic ovarian disease (PCO) based on clinical, endocrinological and ultrasound data. Age, duration of symptoms, body mass index (BMI) and ovarian volume showed no correlation with the 6-h mean value of any hormone and testosterone blood levels did not correlate with those of insulin. Some patients had high and others low LH pulse pattern components, and few had an inverted LH:FSH ratio. Morphological polycystic ovarian changes may be a reflection of various rather than a single pattern of gonadotrophin Oestrogen

secretion.

and androgen states in oligo-amenorrhoeic

women

with polycystic ovaries

Fox R; Corrigan E; Thomas PG; Hull MGR University Department of Obstetrics and Gynaecology, Bristol Maternity Hospital, Southwell Sireet, Bristol BS2 8EG. GBR

BR J OBSTET GYNAECOL 1991 98/3 (294-299) Oestrogen and androgen states have been studied in relation to ovarian morphology defined by ultrasonography in 65 women with oligo-amenorrhoea. Of the 48 women with