Gynecomastia after chemotherapy for lymphoma.

Although development of gynecomastia in a patient with cancer may indicate persistence or regrowth of a tumor, we studied three patients with lymphoma in whom development of gynecomastia during or after chemotherapy did not portend a poor outcome. In all patients, serum testosterone levels were normal, serum luteinizing hormone (LH) levels were high-normal or elevated, and serum follicle-stimulating hormone (FSH) levels were clearly elevated. The serum estradiol level of one patient was elevated at the onset of gynecomastia, but it fell to normal as the gynecomastia resolved spontaneously over a three-month period during which the patient received no chemotherapy. In a second patient, gynecomastia resolved over a period of eight months while the patient continued on maintenance chemotherapy, and he remains clinically well in remission 21/2 years after onset of gynecomastia. In the third patient, gynecomastia developed while the patient was in complete remission and off of all therapy, and it remained unchanged for the duration of a 21/2-year remission without therapy. Gynecomastia after chemotherapy for lymphoma is not an ominous prognostic sign and does not necessarily indicate the need for alteration of the treatment regimen.

Serum gonadotropins in rats fed a low-valine diet.

Female rats fed a low-valine diet from the time of weaning have been shown to have delayed puberty compared to growth-matched controls. To explore the mechanism of this delay, serum LH and FSH were measured in rats fed the low-valine diet and in growth-matched control rats at several ages prior to puberty. Hormonal determinations at each time point were made both in the basal state and after LHRH administration or castration. After age 27 days, the mean basal serum FSH was lower in the low-valine group than in the control group. The mean serum levels of LH and FSH after oophorectomy were significantly lower in the low-valine group than in the control group, although the mean serum levels of LH and FSH after LHRH administration to intact animals were similar in both groups. The combination of impaired response to castration with unimpaired pituitary response to LHRH suggests that the low-valine group had a hypothalamic defect which accounts for their delayed sexual maturation when compared to growth-matched animals.

Decreased serum 3,5,3'-triiodothyronine (T3) and abnormal serum binding of T3 in calorie-deficient rats: adaptation after chronic underfeeding.

Both starvation and feeding of a low protein diet have dramatic effects on serum thyroid hormone concentrations and on the serum binding proteins for thyroid hormones in rats. We examined whether similar changes might be seen in another model of undernutrition, namely underfeeding without alteration of dietary composition, and in particular whether such changes would disappear after prolonged alteration in diet (adaptation). Male rats aged 21 days were put on five different levels of intake of a diet of normal composition (18% protein, 70% carbohydrate), and animals from each dietary group (n = 8-10) were killed after 30, 60, or 100 days of underfeeding. After 30 or 60 days of underfeeding, significant direct correlations were observed between growth rate (used as an index of the degree of underfeeding) and serum T3 (RIA), percent free T3 (equilibrium dialysis), and serum free T3 (T3 X percent free T3). When underfeeding was prolonged to 100 days, however, there was no correlation between growth rate and percent free T3, while the correlation between growth rate and serum free T3 was weak (r = 0.33). Qualitatively similar changes were seen when animals given five different levels of food intake were killed at three body weight milestones rather than three separate age milestones. Polyacrylamide gel electrophoresis of serum thyroid-binding proteins revealed that the low percent free T3 in underfed rats seen after 60 days of underfeeding was associated with the development of a thyroid-binding globulin not normally found, but this had disappeared by 100 days of underfeeding. We conclude that nutrition-related changes in serum thyroid hormone variables show adaptation over time. Because of changes in serum binding of thyroid hormones caused by undernutrition, total serum thyroid hormone concentrations may not be an accurate reflection of thyroid status in any investigational study in which an experimental treatment leads to decreased food intake.

Estrogen regulation of the nuclear 1,25-dihydroxyvitamin D3 receptor in rat liver and kidney.

We previously identified a receptor protein for 1,25-dihydroxyvitamin D3 in rat liver nuclei. The present studies were undertaken to investigate the ontogenesis of the hepatic nuclear vitamin D receptor (nVDR) and the estrogen regulation of this receptor in the liver, small intestine, and kidneys. The hepatic nVDR was significantly elevated in adult female rats compared to prepubertal female rats, while in male rats, this increase was not observed. Oophorectomized rats contained significantly less hepatic nVDR than did intact female rats. Administration of estradiol to castrated male or oophorectomized rats increased the hepatic nVDR. Further studies demonstrated that the increase in the hepatic nVDR was observed only after 2 weeks of estradiol treatment and was positively correlated with circulating estradiol concentrations. Castration of male rats did not alter the hepatic nVDR compared to intact male rats nor did testosterone administration to castrated male rats for 4 weeks change the hepatic nVDR concentration. Unlike the liver, intact female rats contained significantly less renal nVDR than did kidneys from intact male or castrated male rats. Estradiol administration to oophorectomized rats significantly decreased the renal nVDR. Renal nVDR concentrations correlated inversely with the serum concentration of estradiol. Castration of male rats had no effect on the renal nVDR. Intestinal nVDR concentrations were unaffected by castration of male rats or by treatment of castrated male rats with estrogen for up to 4 weeks. These results indicate that estradiol increases the nVDR in liver, decreases the nVDR in kidney and does not change the nVDR in the intestine. Physiological concentrations of testosterone do not regulate the nVDR in these tissues. Estradiol regulation of this receptor is organ specific and, therefore, conclusions about the regulation of the nVDR in one tissue cannot be extrapolated to other tissues.

Pituitary-testicular function in protein-deficient rats. Follicle-stimulating hormone hyperresponse to castration and supersensitivity of gonadotropin secretion to androgen negative feedback.

Previous studies have shown that weanling male rats fed a low protein diet ad libitum develop hypogonadotropic hypogonadism. Two unusual features of this state were 1) subnormal serum FSH in noncastrate rats but not in castrate rats, suggesting that FSH was being suppressed by a testicular factor, and 2) serum FSH increases after castration that were greater in protein-deficient rats than in controls. In the current study, protein-deficient rats showed FSH hyperresponse to castration, compared to either ad libitum or pair-fed controls, after periods of low protein feeding from 1-8 weeks and periods of castration from 1-8 weeks. FSH hyperresponse to castration was rapidly induced after the start of low protein feeding and was present whether castration was performed before or after low protein feeding was begun. In none of these circumstances did protein-deficient rats show LH hyperresponse to castration. Inhibin production of Sertoli cell cultures prepared from protein-deficient rats was less (P less than 0.02) than in ad libitum or pair-fed controls, suggesting that inhibin overproduction was not the cause of subnormal serum FSH in noncastrate protein-deficient rats. However, castrated rats fed a low protein diet were more sensitive to the negative feedback effects of testosterone on gonadotropin secretion than were ad libitum or pair-fed controls. We conclude that low serum gonadotropins in protein-deficient male rats may be related to hypersensitivity of these animals to the negative feedback effects of testosterone on gonadotropin secretion. In addition, FSH hyperresponse to castration, without corresponding LH hyperresponse, seems to be typical of protein deficiency, suggesting that protein deficiency may be a useful model for exploring the differential control of gonadotropin secretion.

Hypoandrogenism and abnormal regulation of gonadotropin secretion in rats fed a low protein diet.

The function of the hypothalamic-pituitary-testicular axis was evaluated in rats fed a low protein diet for 4 weeks beginning at 21 days of age. Compared to control, the low protein group had decreased seminal vesicle and prostate weights as well as decreased testicular testosterone output in vitro, although serum testosterone was not different. The low protein group showed no consistent alterations in serum LH (basal, post-LHRH, and postcastration) compared to control although serum FSH (basal and post-LHRH) was lower in the low protein group. Despite this lower basal FSH, the low protein group had supranormal serum FSH after castration. Seminiferous tubule diameter and testicular histology were normal in the low protein group although testicular androgen-binding protein was absent. Testicular androgen-binding protein was also undetectable in a modestly food-restricted control group which had normal testicular size, testicular histology, androgen output, and serum FSH. This finding suggests that loss of testicular androgen-binding protein may be a sensitive sign of undernutrition. We conclude that rats fed a low protein diet have hypoandrogenism, normal testicular histology, and supranormal FSH after castration despite subnormal basal FSH. The latter combination suggests overproduction of an FSH inhibitor of testicular origin.

Relationship between pubertal timing and body size in underfed male rats.

A direct connection has been proposed between body size and sexual maturation by the critical body weight and critical body fat hypotheses. To test these theories in male rats, we compared the degree of sexual maturation in animals with reduced growth rate due to undernutrition with that in weight-matched but normally fed rats. Underfed rats had significantly larger prostate, seminal vesicle, and testis weights than the weight-matched normally fed controls at the three time points studied: the early pubertal period (approximate time of onset of rising serum testosterone), late pubertal period (approximate time of appearance of mature spermatids), and young adult period. At the first time point, testes of underfed rats, but not those of normally fed, weight-matched controls, showed mature step 19 spermatids, and serum testosterone was significantly higher in the underfed animals. At all time points, serum LH levels were similar in both groups, while serum FSH levels were significantly lower in the underfed rats at all points. The Lee index, an index of fatness, was significantly lower in the underfed rats. The current study indicates that underfed rats are more sexually mature than normally fed controls of the same weight despite having a lower percentage of body fat. These findings do not support the critical body weight or critical body fat hypotheses of puberty in male rats.

Serum triiodothyronine in undernourished rats: dependence on dietary composition rather than total calorie or protein intake.

Serum triiodothyronine (T3) in rats did not change if food intake was restricted without altering the composition of the diet. Feeding a hypocaloric low-protein high-carbohydrate diet caused increases in serum T3, while feeding a hypocaloric high-protein low-carbohydrate diet caused decreases in serum T3. These changes were not related to reductions in intake of either calories or protein, and concomitant changes in serum thyroxine (T4) were not observed. Reduction in the dietary content of valine, without changes in the percentage of carbohydrate in the diet, caused increases in serum T3 when compared to growth-matched controls on a diet with normal valine concentration. Serum T3 in undernourished rats depends on the composition of the diet and not on total intake of calories or protein.

Low serum thyroxine and high serum triiodothyronine in nephrotic rats: etiology and implications for bioavailability of protein-bound hormone.

Traditionally, it has been thought that the bioavailable fraction of circulating serum hormones, i.e. that which is available for cellular uptake and is physiologically active, is limited to the free (nonprotein bound) hormone. However, recent evidence, based on acute organ uptake of labeled hormone, suggests that the amount of hormone which is bioavailable in vivo may exceed that which is calculated to be free in vitro. To explore the bioavailability of circulating protein-bound thyroid hormones under steady state conditions in vivo, we altered serum thyroid hormone-binding proteins in rats by inducing nephrotic syndrome with puromycin aminonucleoside. Nephrotic rats (serum albumin, 1.1 g/dl) were found to have a marked reduction in serum T4 [2.1 +/- 0.2 (SEM) vs. 6.5 +/- 0.3 microgram/dl; P less than 0.01] and an elevation of serum T3 [141 +/- 8 vs. 51 +/- 2 ng/dl; P less than 0.01]. Estimated T4 production rate was normal in nephrotic rats, and the 3- to 4-fold increase in T4 MCR appeared to account for the marked reduction in serum T4. By contrast, increased serum T3 levels in nephrotic rats reflected both a reduction (55%) in T3 MCR and an increased rate of peripheral conversion of T4 to T3. A circulating inhibitor of T4 binding to serum proteins appeared to be present in nephrotic rats. The changes in the various serum components of thyroid hormone [T4-binding prealbumin (TBPA)-bound, albumin-bound, free] produced by nephrotic syndrome were compared with the corresponding changes in indices of thyroid hormone bioavailability (MCR, urinary excretion, hepatic content, TSH suppression, single pass extraction by liver). These comparisons suggested that nephrotic syndrome results in increased bioavailability of circulating T4 and decreased bioavailability of circulating T3. The bioavailable fraction of circulating T3 in vivo seemed to include both free T3 and that which is albumin bound in vitro. The bioavailable fraction of circulating T4 resembled free T4 more than non-TBPA-bound T4 (= albumin bound + free), although a nephrosis-induced increase in bioavailability of TBPA-bound T4 was also possible. We conclude that nephrotic rats have low serum T4, which is related to accelerated T4 clearance, and high serum T3, which is related both to decreased T3 clearance and increased peripheral conversion of T4 to T3. Under steady state conditions in vivo, bioavailable circulating T3 appears to include both free T3 and the T3 that is bound to albumin in vitro.

Ketoconazole-induced stimulation of gonadotropin output in men: basis for a potential test of gonadotropin reserve.

The antifungal drug ketoconazole is known to inhibit testosterone biosynthesis and decrease serum testosterone concentrations. To assess whether the ketoconazole-induced reduction in serum testosterone might stimulate LH and FSH output in a manner suitable as a test of pituitary gonadotropin reserve, we gave normal men ketoconazole every 8 h for 1 week in dosages of 300-1200 mg/day. Ketoconazole administration caused a dose-dependent reduction in serum testosterone which correlated inversely with serum ketoconazole (r = -0.82; P less than 0.001). This fall in serum testosterone stimulated increases in serum LH and FSH which were maximal at a ketoconazole dose of 900 mg/day [LH increase, 127 +/- 27% (+/- SEM); FSH increase, 63 +/- 15%]. Ketoconazole tended to blunt the LH and FSH responses to LHRH. Ketoconazole increased serum 17-hydroxyprogesterone, reflecting blockade of 17,20-desmolase by the drug, while having inconsistent effects on serum estradiol. I conclude that ketoconazole administration for 1 week to normal men stimulates LH and FSH output in a fashion that makes it potentially suitable, after additional verification in subjects with normal and abnormal pituitary-testicular function, as a test of pituitary gonadotropin reserve.

Ketoconazole-induced reduction in serum 1,25-dihydroxyvitamin D and total serum calcium in hypercalcemic patients.

Administration of the antifungal drug ketoconazole reduces serum 1,25-dihydroxyvitamin D (1,25-D) levels in normal subjects. To determine whether a similar effect occurs in hypercalcemic patients, ketoconazole (200 mg every 8 h for 7 days) was given to nine patients with confirmed primary hyperparathyroidism, three patients with probable primary hyperparathyroidism who were awaiting surgery, and three patients with mild hypercalcemia of uncertain etiology who were being followed. Ketoconazole administration led to a significant reduction in mean serum 1,25-D levels in the hypercalcemic patients [basal, 64 +/- 7 (+/- SEM) pg/mL (154 +/- 17 pmol/L) vs. 36 +/- 5 pg/mL (86 +/- 12 pmol/L) after ketoconazole; P less than 0.001]. Serum total calcium fell slightly but significantly [basal, 11.05 +/- 0.17 mg/dL (2.76 +/- 0.04 mmol/L) vs. 10.77 +/- 0.16 (2.69 +/- 0.04 mmol/L) after ketoconazole; P less than 0.02], but the falls in total serum calcium and serum 1,25-D after ketoconazole treatment were not correlated with one another. Ketoconazole administration did not alter serum ionized calcium, 25-hydroxyvitamin D, phosphate, alkaline phosphatase, or PTH concentrations or urinary cAMP excretion. The responses to ketoconazole were similar in all three patient subgroups. We conclude that short term administration of ketoconazole to hypercalcemic patients causes a substantial fall in serum 1,25-D and a small fall in total serum calcium. These effects render ketoconazole a potentially useful agent for investigation of the importance of 1,25-D in patients with hypercalcemic disorders and for their treatment.

Ketoconazole-induced reduction in serum 1,25-dihydroxyvitamin D.

The antimycotic agent ketoconazole is known to inhibit several cytochrome P450-dependent enzymes involved in the biosynthesis of steroid hormones from cholesterol. Since 1,25-dihydroxyvitamin D is also a sterol synthesized by cytochrome P450-dependent enzymes, we assessed whether ketoconazole would lower serum 1,25-dihydroxyvitamin D levels. In nine normal men, administration of ketoconazole for 1 week in doses of 300-1200 mg/day led to a dose-dependent reduction in serum 1,25-dihydroxyvitamin D levels (r = -0.64; P less than 0.001). At the highest dose taken by each man (1200 mg/day in six, 900 mg/day in one, and 600 mg/day in two), serum levels of 1,25-dihydroxyvitamin D fell significantly compared to baseline [14 +/- 1 (+/- SEM) vs. 39 +/- 3 pg/ml; P less than 0.001), but there was no change in serum levels of 25-hydroxyvitamin D, PTH, calcium, phosphate, or alkaline phosphatase. Ketoconazole may be potentially useful in exploring the pathogenetic role of 1,25-dihydroxyvitamin D in disorders of calcium metabolism and in treatment of patients with hypercalcemic disorders or renal stone disease.

Effects of delta 1-testolactone on the pituitary-testicular axis in oligospermic men.

Ten men with idiopathic oligospermia were treated with delta 1-testolactone (Teslac), a potent inhibitor of conversion of androgens to estrogens. Teslac therapy caused a fall in serum estradiol and estrone levels of 34% (P less than 0.01) and 41% (P less than 0.01), respectively, and a rise in serum testosterone and androstenedione of 47% (P less than 0.02) and 70% (P less than 0.01), respectively. The testosterone-estradiol ratio increased by 126% (23.5 +/- 2.5 x 10(-1) to 45.2 +/- 5.0 x 10(-1); P less than 0.01) and the androstenedione:estrone ratio increased 231% (4.7 +/- 0.6 x 10(-1) to 12.9 +/- 2.0 x 10(-1); P less than 0.01). Basal and LRH-stimulated serum gonadotropin levels were unaffected by these changes. Sperm density rose from 10.8 +/- 2.5 to 19.8 +/- 4.7 x 10(6)/ml (P less than 0.01) and total sperm count from 26.8 +/- 6.5 to 60.6 +/- 14.3 x 10(6) (P less than 0.001). There was no significant change in motility or semen volume. Three of the wives became pregnant. There were no adverse effects of Teslac administration. These data suggest that Teslac may be an effective treatment for men with idiopathic oligospermia. Though the data do not clearly elucidate the mechanism of this effect, they are consistent with the possibility that Teslac's lowering of estrogen levels may have been responsible for the improvement in spermatogenesis. The findings also suggest that moderate increases in the circulating androgen-estrogen ratio do not affect gonadotropin output in men.

Absent growth hormone response to L-tryptophan in acromegaly.

In acromegaly, regulation of GH secretion by dopamine pathways appears to be qualitatively abnormal. To determine whether regulation of GH secretion by serotonin pathways is also abnormal in acromegaly, we administered L-tryptophan (5 g orally), the initial precursor of serotonin, to 10 patients with active acromegaly (9 treated and 1 untreated), 3 patients with cured acromegaly, and 8 normal subjects. The normal group showed a significant (P less than 0.05) increase in serum GH after L-tryptophan [peak value, 12.3 +/- 4.0 (se) ng/ml], though the magnitude of the response was highly variable. In contrast, subjects with active acromegaly did not show an increase in serum GH after L-tryptophan [mean integrated percentage change in serum GH, -25 +/- 25% (SE); P = NS]. One patient whose acromegaly had been surgically cured did show a GH rise after L-tryptophan. In acromegaly, the GH response to L-tryptophan is absent, suggesting that regulation of GH secretion by serotonin pathways might be qualitatively abnormal.

The hypothalamic-pituitary-testicular axis in thyrotoxicosis.

The hypothalamic-pituitary-testicular axis was evaluated in seven men with thyrotoxicosis due to Graves' disease. Loss of libido and decreased potency were present in 71% and 56%, respectively. All patients had normal testicular volume (25 ml in all) and gynecomastia was detected in two of seven patients. Total sperm counts were less than 40 million in four of the five men tested. There was an inverse correlation between basal serum 17 beta-estradiol (E2) levels and total sperm count (r = -0.87; P less than 0.05). Mean (+/- SE) total testosterone (T) and E2 levels (1008 +/- 104 ng/100 ml and 104 +/- 16 pg/ml) were significantly higher than in normal men (P less than 0.05). Free T (13.6 +/- 2.4 ng/100 ml) was indistinguishable from normal (15.3 +/- 1.5 ng/100 ml). The mean (+/- SE) response of serum T to hCG administration was blunted (80 +/- 40%) compared to controls (193 +/- 19%; P less than 0.02). Basal plasma LH levels (15.5 +/- 1.5 mIU/ml) were significantly higher (P less than 0.05) than in normal men (9.1 +/- 0.6 mIU/ml) and hyperresponded to 100 microgram LRH iv in five of seven patients. Basal plasma FSH levels and the FSH response to LRH were normal. These results suggest that men with hyperthyroidism have 1) partial Leydig cell failure, 2) impairment of spermatogenesis, and 3) blunting of the feedback effects of E2.

Circadian rhythm of serum cortisol in Cushing's disease.

Two women with typical clinical and biochemical features of pituitary-dependent Cushing's disease each underwent hourly blood sampling for 24 h on two separate occasions for measurement of serum cortisol. The 24-h mean serum cortisol concentrations (17.7 and 15.4 micrograms/dl in patient 1; 19.0 and 15.8 micrograms/dl in patient 2) were elevated (normal level, less than 12.5 micrograms/dl), as expected. Cosinor analysis of the patients' serum cortisol patterns revealed statistically significant circadian rhythms on all four profiles. The amplitude of the rhythm on both occasions in patient 1 (5.8 and 6.6 micrograms/dl) and on one of two occasions in patient 2 (7.2 and 10.5 micrograms/dl) fell in the range for the amplitude of the cortisol circadian rhythm in normal subjects (2.2-8.6 micrograms/dl). In contrast to commonly held belief, some patients with Cushing's disease may exhibit circadian variation of serum cortisol.

Testicular dysfunction in untreated Hodgkin's disease.

Gonadal function was examined in 19 young men with Hodgkin's disease before therapy and compared with that of 11 men with other malignancies, 13 men with primary testicular failure, and 19 normal men of similar age. Total (p less than 0.01) and free (p less than 0.05) testosterone levels were decreased in Hodgkin's disease. In those with advanced (stage III + IV) and symptomatic (B), Hodgkin's disease serum testosterone levels were indistinguishable from those in primary testicular failure, yet serum levels of luteinizing hormone were normal. Moreover, the acute response of serum testosterone to exogenous human chorionic gonadotropin (HCG) was significantly greater in Hodgkin's disease than in primary testicular failure (p less than 0.03). These data and the finding that basal serum follicle-stimulating hormone levels are significantly lower than normal in Hodgkin's disease (p less than 0.05) suggest that the cause of pretreatment hypogonadism in Hodgkin's disease is not simple primary testicular failure. Total sperm count was decreased in 40 percent of men with Hodgkin's disease but in none of the men with other malignancies (p less than 0.05), suggesting specific seminiferous tubular dysfunction in Hodgkin's disease. However, motility was abnormal in 69 percent of men with Hodgkin's disease and 60 percent of those with other malignancies, suggesting that this is a nonspecific effect of cancer. Serum prolactin levels were significantly higher than normal in Hodgkin's disease (p less than 0.05) but not in other malignancies. Our findings suggests that the cause of testicular dysfunction that is present before treatment of Hodgkin's disease is complex, perhaps involving both pituitary and gonadal abnormalities.

Androgen receptor abnormalities in identical twins with oligospermia. Clinical and biochemical studies.

Identical twin brothers presented with oligospermia, small testes, normal male phenotypes, elevated serum luteinizing hormone levels, and normal or elevated serum testosterone levels. Both men had low to low-normal cytosol androgen receptor binding capacity in cultured fibroblasts from pubic skin biopsy specimens. Qualitative abnormalities of cellular androgen receptors were suggested by low-normal or low nuclear androgen uptake in fibroblasts from both brothers as well as abnormal thermolability and subnormal molybdate stabilization of androgen receptors from one brother. In vivo androgen sensitivity was assessed in one twin following administration of testosterone or the non-aromatizable androgen fluoxymesterone. Fluoxymesterone suppressed serum luteinizing hormone and serum testosterone/estradiol-binding globulin, and although testosterone suppressed both serum luteinizing hormone and serum follicle-stimulating hormone, the suppression of serum luteinizing hormone by testosterone was subnormal. Both subjects showed marked exaggeration of the serum 17-hydroxyprogesterone increase after administration of human chorionic gonadotropin, despite normal serum testosterone increases, suggesting a block in testicular 17,20-desmolase, which converts 17-hydroxyprogesterone to testosterone. These studies suggest that oligospermia and block of the enzyme 17,20-desmolase may be the earliest manifestations of androgen resistance, and the finding of the syndrome of oligospermia, normal male phenotype, and androgen receptor abnormalities in identical twins indicates a genetic etiology of this disorder.

Gynecomastia.

Gynecomastia is a common finding in men and most often is idiopathic in origin or related to normal puberty. Medications are frequent causes of breast enlargement or tenderness, and hypogonadism of any cause, particularly primary hypogonadism, can lead to gynecomastia. Occasionally, the breast enlargement will reflect an underlying neoplasm that produces steroids or hCG. Underlying systemic disorders (liver disease, renal failure, thyrotoxicosis) can also result in gynecomastia. In most cases, the breast enlargement can be explained by an increased effective estrogen/androgen ratio acting at the breast itself. Therapy should be aimed at correcting any reversible causes, especially when related to medications, and treatment of any serious underlying disorders that are discovered, especially tumors. Medical treatment aimed at reducing the effective estrogen/androgen ratio, particularly with anti-estrogens, appears to be of some effectiveness. Careful surgical removal of excessive tissue can be very helpful, particularly in adolescence and young adulthood.

Hypogonadotropic hypogonadism in nephrotic rats: increased sensitivity to negative feedback effects of testosterone.

Pituitary-testicular function was examined in adult male rats with aminonucleoside-induced nephrotic syndrome as a model for similar disease in humans. Nephrotic rats developed androgen deficiency, as manifested by decreased prostate and seminal vesicle weights, lower serum total and free testosterone levels, and reduced testosterone release from testes incubated in vitro. Despite hypoandrogenism, the weight and histologic appearance of the testes (light microscopy) were not affected in nephrotic rats. This androgen deficiency seemed to be a consequence of decreased gonadotropin output rather than primary testicular failure, since both pituitary gonadotropin content and serum gonadotropin levels (basally and after luteinizing hormone releasing factor; LHRH) were reduced in nephrotic rats. In addition, the percentage increase in testosterone release by testes incubated in vitro after addition of exogenous gonadotropin was similar in nephrotic and control groups. However, gonadotropin output in nephrotic rats was not impaired in the absence of testis, since no reduction was seen in either post-castration serum gonadotropin levels in vivo or gonadotropin release from pituitaries incubated in vitro. This presumed inhibitory effect of the testis on gonadotropin output in nephrotic rats was confirmed directly by demonstrating an increased sensitivity to testosterone-mediated suppression of gonadotropins in castrate animals in vivo. The presence or absence of albumin also seemed to modulate the suppressive effect of testosterone on gonadotropin output from normal pituitaries incubated in vitro. We conclude that nephrotic male rats develop hypogonadotropic hypogonadism secondary to an increase in sensitivity of the pituitary to the negative feedback effects of testosterone.