Sex-hormone-binding globulin (SHBG) in serum in threatened abortion.

The binding capacity of the sex-hormone-binding globulin (SHBG) was determined by means of a new dihydrotestosterone-binding-capacity test in 73 pregnant women admitted to hospital because of vaginal bleeding between the 6th and 18th gestational week. In general, pregnancies ending in spontaneous abortion displayed lower SHBG-levels than pregnancies with a successful outcome, but a great deal of overlap in SHBG values was found between the abortive and the non-abortive cases. In the 6th to 9th weeks of pregnancy 'non-pregnant' SHBG levels were frequently found despite normal levels of oestradiol (E2) in patients continuing pregnancy until delivery. After the 9th gestational week a highly significant positive correlation was found between E2 and SHBG. The lack of correlation between these parameters before this gestational age indicates that the increased SHBG synthesis seen in pregnancy develops later than the rise in E2. Determinations of SHBG were found to be of limited value in evaluation of the prognosis is threatened abortion.

Hypothalamic-pituitary-gonadal function in relation to liver function in men with alcoholic cirrhosis.

Serum concentrations of oestrone, oestradiol, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and sex hormone-binding globulin (SHBG) were significantly (P less than 0.01) raised in men with alcoholic liver cirrhosis (no. = 42) compared with age-matched controls (no. = 20). No significant difference was observed when comparing serum testosterone concentrations. Patients were divided into three groups in accordance with the severity of liver cirrhosis, using biochemical and clinical criteria. Patients with the best-preserved liver function (no. = 11) and patients with moderately affected liver function (no. = 18) had significantly (P less than 0.05) raised serum concentrations of testosterone, FSH, and LH when compared with both controls and patients with severely affected liver function (no. = 13). Serum concentrations of testosterone, FSH, and LH in the latter group showed no significant differences from the controls. Serum concentrations of oestrone and oestradiol were significantly (P less than 0.05) increased in all patient groups, and serum oestrone increased with decreasing liver function. No significant differences were observed concerning SHBG concentrations in the three groups of patients. Dexamethasone suppression did not change the concentration of testosterone significantly, but oestrone and oestradiol concentrations decreased significantly (P less than 0.01) in controls and patients. In patients, but not in controls, a significant (P less than 0.01) increase in FSH and LH concentrations was observed after dexamethasone suppression. The mean percentage increase of FSH and LH was higher the greater the severity of liver cirrhosis.

Sequelae to genital trauma in torture victims.

Possible sequelae to genital trauma were investigated in ten male victims of torture. Two of the victims examined showed testicular atrophy. No significant difference was found in the serum concentrations of follicle-stimulating hormone, luteinizing hormone, testosterone, and prolactin in those subjected to genital torture, when compared with a control group. Serum spermatocoagglutinins were not found to be increased in either of the two groups.

Oral testosterone load related to liver function in men with alcoholic liver cirrhosis.

The relation between liver function and an oral testosterone load was examined in 42 consecutive patients with alcoholic liver cirrhosis. Administration of an oral load of 400 mg micronized free testosterone increased the serum concentration of testosterone (range, 31.9-694.4 nmol/l; median, 140.8 nmol/l) in male patients with alcoholic liver cirrhosis to significantly (P less than 0.01) higher levels than in male subjects without liver disease (range, 25.4-106.6 nmol/l; median, 61.5 nmol/l). The increase of testosterone after the load (log delta testosterone) in patients correlated inversely with galactose elimination capacity (r = 0.54; P less than 0.001), serum albumin (r = -0.53; P less than 0.001), plasma factor II + VII + X (r = 0.62; P less than 0.001), indocyanine green clearance (r = -0.71; P less than 0.001), and hepatic blood flow (r = -0.61; P less than 0.01) and correlated directly with wedged-to-free hepatic vein pressure (r = +0.54; P less than 0.01). The increase of testosterone after the load did not correlate significantly with sex hormone-binding globulin (r = +0.35; P greater than 0.05). It is concluded that the hepatic extraction of testosterone is significantly decreased in patients with alcoholic cirrhosis. This decrease seems to be due to decreased liver function, decreasing hepatic blood flow, and increased portosystemic shunting. Oral testosterone loading may therefore be of prognostic significance in patients with alcoholic liver cirrhosis.

Pituitary-testicular function in patients with alcoholic cirrhosis of the liver.

In forty-two patients with alcoholic liver cirrhosis and without recent alcohol ingestion the pituitary-testicular function was studied in an effort to relate the endocrine abnormalities with the degree of liver cell dysfunction, evaluated on a quantitative basis. Compared with values in twenty-one healthy controls, we found significantly elevated serum oestrone, oestradiol, follicle-stimulating hormone, luteinizing hormone and prolactin (P less than 0.01). Serum dehydro-epiandrosterone and dehydroepiandrosterone sulphate were significantly reduced in the cirrhotics (P less than 0.01), whereas serum testosterone was not significantly different from that in the controls. Raised levels of sex-hormone binding globulin were found in 71% (22/31) of the patients (median 8 x 10(-18) mol/l, range 3-17 x 10(-8) mol/l). The incidence of gynaecomastia (38%), cutaneous spiders (67%), testicular atrophy (24%) and reduced axillary hair (71%) was without significant relation to raised levels of sex-hormone binding globulin or progressively reduced liver function. In the presence of clinical or hormonal hypo-gonadism we found evidence of a state of primary hypogonadism together with an inadequate secretion of gonadotropins. The state of hyperoestrogenaemia and the concentration of gonadotropins were significantly correlated to the hepatic synthesis of coagulation factors.

Clomiphene stimulation test in men with idiopathic hypospermatogenesis.

A standardized clomiphene stimulation test with assay of serum FSH, LH, testosterone and oestradiol and urinary androsterone + aetiocholanolone, dehydro-epiandrosterone and total oestrogens was applied to 23 men with idiopathic hypospermatogenesis as compared with 12 normal controls. In the patients the percentual rise of LH was increased and the percentual rise of testosterone and oestradiol decreased as compared with controls. The study thus showed that abnormalities in the testicular steroid producing apparatus exist in hypospermatogenesis and could be the cause of the spermatogenetic failure. It was further showed that the reserve capacity of the testicular steroid production is highly limited in contrast to the large reserve capacity of gonadotrophin production in the hypophysis.

Sexual and hypothalamic dysfunction in the postconcussional syndrome.

Nineteen males with a well-developed postconcussional syndrome were studied by CT-scan, by psychometric testing and by endocrinological evaluation including a variety of laboratory tests and an assessment of sexual function, 68% had cerebral atrophy on CT-scan and 79% were intellectually impaired, 37% to a severe degree. Sexual dysfunction (reduced libido and/or erective dysfunction) related to the head injury occurred in 58%, and severe intellectual impairment was significantly more frequent in this group. Increased plasma concentration of follicle stimulating hormone was observed in 37%, suggesting a reduced spermiogenesis. The possibility of a primary hypothalamic disorder causing reduced spermiogenesis is raised. Otherwise no radiological or laboratory evidence of major hypothalamic-pituitary dysfunction was demonstrated. The high frequency of cerebral atrophy and intellectual deterioration in postconcussional syndrome suggests organic brain dysfunction, but not causal relationship was established.

Short-term parenteral and peroral testosterone administration in men with alcoholic cirrhosis.

Serum concentrations of testosterone were measured in 24 male patients with alcoholic cirrhosis during testosterone administration. The purpose was to compare serum concentrations of testosterone during peroral with those during parenteral testosterone administration in these patients. Patients who were injected intramuscularly with a combination of short- and long-acting testosterone (Triolandren, 348 mg testosterone) had median peak values of serum testosterone of about 40 ng/ml, which fell to basal levels after a fortnight. During testosterone propionate injections (84 mg testosterone) every other day, rather constant serum concentrations with median values of about 30 ng/ml were reached after 4 days. Peroral testosterone administration (800 mg micronized free testosterone) each day also resulted in fairly constant serum concentrations after 4 days, and the median values were about 50 ng/ml. No side effects were observed.

Follow-up 10 years later of 34 Klinefelter males with karyotype 47,XXY and 16 hypogonadal males with karyotype 46,XY.

A 10-year follow-up study is reported of 50 hypogonadal males, 34 of whom had the karyotype 47,XXY and 16 karyotype 46,XY. The social class of the former group was significantly lower and the frequency of criminal behaviour higher when compared with the latter group and the Danish male population. The frequency of mental illness was higher in the Klinefelter males with karyotype 47,XXY than in the remainder. The aetiology and pathogenesis of deviant mental development in the patient population and various aspects of their treatment are discussed.

Psychiatric examination of all eight adult males with the karyotype 46,XX diagnosed in Denmark till 1976.

Psychiatric examination has been made in all eight adult males with the karyotype 46,XX diagnosed in Denmark til 1976. Apart from emotional immaturity in most probands, no psychopathological traits were found, except in one who had neurotic symptoms. They were all of normal intelligence and socially well adjusted. All had male psychosexual orientation, but weak sexual libido and potency were found in the oldest probands. In several respects males with 46,XX differ from Klinefelter males with the karyotype 47,XXY, and the reasons for this are discussed.

The effect of repeated intramuscular gonadotrophin-releasing hormone injections on luteinizing hormone, follicle-stimulating hormone, testosterone, oestrogens, dehydroepiandrosterone and dehydroepiandrosterone sulfate in normal men.

The endocrine response to three daily intramuscular injections of 500 microgram LH-RH was measured in 9 normal men during a period of 3 days. A marked but declining response in LH was seen in addition to a significant increase in the serum concentration of FSH, testosterone, oestradiol and the urinary excretion of oestrogenic substances. No change could be demonstrated in the DHA, DHAS or cortisol secretion which confirms our previous results of a direct effect of clomiphene on adrenal steroidogenesis.