Search

A total of 129 women with the neuroendocrine syndrome were examined. A clinico-biochemical heterogeneity of the disease was revealed. One group included patients with the android type of fat deposition, manifest hyperandrogenism, polycystic ovaries, and carbohydrate metabolism disorders (hyperinsulinemia, impaired glucose tolerance, insulin resistance). Severity of carbohydrate metabolism disorders in these patients was unrelated to obesity degree. The other group included patients with the gynoid type of fat deposition, weakly manifest hyperandrogenism signs, and body mass-dependent shifts in carbohydrate metabolism. It is possible that carbohydrate metabolism shifts contribute to the pathogenesis of the clinical picture of the neuroendocrine syndrome.

ACTH, prolactin, hydrocortisone, 17 OH-progesterone, androstenedione, dehydroepiandrosterone C, and testosterone were measured in the blood of 36 androgenic women and 8 healthy ones before and after adrenal stimulation. The findings evidence that various mechanisms are responsible for the development of androgynism of an adrenal origin. In patients with congenital virilizing adrenocortical hyperplasia and 21 hydroxylase deficiency excessive androgen production results mainly from activation of delta-4 route of androgen synthesis; in patients with adrenal androgynism and insufficiency of enzymic systems of steroidogenesis the androgen production is explained by functional hyperactivity of the bundle and retinal zones of the adrenal cortex and hyperreactivity to stimulating factors. Hyperproduction of androgens is related to ovarian hyperproduction of not only androstenedione and testosterone, but, in some patients, of dehydroepiandrosterone C as well. Elevated basal blood level of this enzyme cannot be regarded as a sufficiently reliable criterion in the differential diagnosis of the adrenal or ovarian origin of androgynism.

Parlodel (2.5-50 mg/day) has been given for 1 to 7 days to 33 patients with the polycystic ovary syndrome (POS). The ovulatory menstrual cycle returned in 10 (30%) patients and 4 of them conceived. Pretreatment cycle disturbance persisted in 6 (18%) patients. Parlodel reduced mid-follicular mean blood LH levels to values of normal women. Some decrease in blood testosterone levels occurred only in the second phase of the cycle. Estradiol test in 6 patients showed normal positive and negative feedbacks in the hypothalamic-pituitary-ovarian axis. Parlodel treatment reduced basal and estradiol stimulated pituitary gonadotropin secretion. It is suggested that parlodel may be used in ovulation induction in a proportion of POS patients.

The authors carried out studies on 28 women with the syndrome of Stein-Leventhal with obesity. It was established that patients with hypothalamic genuine obesity of III degree predominated. The number of patients with liver steatosis was the largest among accompanying metabolic disturbances, followed by those with arterial hypertension and asymptomatic hyperuricemia. Menarche occurred on time, but it was succeeded by various menstrual disturbances. There was increased level of testosterone in sera of 12 out of 20 examined women patients, of LH-in 17, of 17-ketosteroids-in 8, of estrogens-in 6, of prolactin-in 8 patients. These data in parallelism between menstrual disturbances and hirsutism were interpreted by the authors as an expression of primary disturbances in hypothalamic-hypophysial-gonadal interrelationships with secondary changes in the ovaries. The role of fatty tissue in the metabolism of steroid hormones is discussed as well as the possibility for participation of genetic factors in the development of the syndrome of Stein-Leventhal and obesity.