[Frequency and etiology of azoospermia in the study of infertile couples]. / Frecuencia y etiología de azoospermia en el estudio de parejas infértiles.

UNLABELLED: One out of ten couples seek some kind of treatment for infertility of which males are infertile between 30-50%. Azoospermia has been reported in the range of 10 to 20% of cases. MATERIAL AND METHODS: We reviewed 331 cases seen at the clinic of Reproductive Biology of the Hospital Juárez de México, SSA, from January 1993 through February 2000. 66 patients were found with azoospermia (19.93%). Studies performed were: seminogram, testicular and transrectal ultrasonography, cariotype, deferentovesiculography and testicular biopsy. Radioimmunoassay of gonadotropins (FSH, LH) and testosterone was also practiced. RESULTS: Twelve patients (18.18%) were excluded either for desertion or incompletion of studies. The etiology of azoospermia of remainder 54 cases was: secretory (85.19%) of which 41.3% was idiopathic, 10.9% had germ cells aplasia, 10.9% varichocele, 10.9% Klinefelter syndrome. Secondary secreting azoospermia was found in two cases with Kallman's syndrome one patient had excretory and 7 obstructive azoospermia. CONCLUSIONS: Azoospermia was diagnosed in 19.93% (n = 54) with a mean age of 30 years. 85.19% had primary secretory azoospermia with FSH & LH hypergonadotropism in 85.8 and 56.4% respectively (p < 0.05). Obstructive azoospermia was seen in 12.96% and only one case (1.85%) presented excretory azoospermia.

[Insulin resistance index: measurement and potential in human reproduction]. / Indice de resistencia a la insulina: medición y potencial en reproducción humana.

Insulin resistance (IRI) applies to abnormalities of insulin-stimulated glucose metabolism. Biochemical events related to this phenomenon are difficult to search in the absence of overt diabetes mellitus. A simple method to quantify insulin resistance was assessed through the measurement of glucose and insulin (fasting glucose [mmol/L] x fasting insulin [mU/L]/22.5) in patients (n = 50) attending our clinic of human reproduction, including controls (n = 10) and diabetics either unstable or under control (n = 5). Cases with obesity, polycystic ovarian disease, diabetes mellitus, infertility and hypoglycemia showed higher (p = 0.01-0.05) IRI changes, inversely correlated with a decreasing fasting glucose observed in diabetics under treatment with various degrees of control. We conclude that the IRI method used in this work is a reliable estimate of insulin resistance with potential applications for the study of reproductive biology.

[Correlation of 2 formulae to estimate insulin resistance]. / Correlación de dos fórmulas para calcular insulinorresistencia.

UNLABELLED: Insulin resistance (IR) is a central metabolic alteration with impact in human reproduction giving rise to hyperandrogenism, infertility, acanthosis, perimenopausal autoimmunity, obesity, hypertension, diabetes and dyslipidemias. Hence the estimation of insulin resistance is of clinical importance and we seeked to evaluate the correlation between two formulas (formula 1: glucose/insulin; formula 2: glucose x insulin/22.5) for its assessment. MATERIAL AND METHODS: Glucose and insulin was measured to 66 females (age 18-66 years) in whom IR was suspected. RESULTS: Mean age of patients was 23.9 +/- SD 10.9 year. IR was detected through the formulas used in 74%; the correlation coefficient (Pearson) was inversely proportional with both formulas (r = -460; p < 0.02). More than 50% of patients with IR had family background of IR, 81% were obese and 74% had a waist-hip index > 0.85 (central obesity or android), 52% hypercholesterolemia, 56% hypertriglyceridemia, 71% inverse relation of HDL/LDL, 45% had infertility, 71% hyperandrogenism, 65% polycystic ovaries and 4% presented diabetes. CONCLUSIONS: Through the use of two arithmetical formulas we determined the presence of IR in 73% of patients studied albeit with proclivity to IR; the correlation between the two formulas was significant. A high association of obesity, infertility, hyperandorogenism and dyslipidemias with IR was also observed.

[Effects of estrogens and progestogens on the lipid profile in postmenopausal hypogonadism]. / Efecto de los estrógenos y progestágenos sobre el perfil de lípidos en hipogonadismo posmenopáusico.

It is known that postmenopausal hypogonadism is associated to an increase of low density lipoproteins (LDL) and a decrease of high density lipoproteins (HDL) that increases the risk of cardiovascular disease. The hormonal replacement therapy of estrogen with or without a progestin reduces such risk in approximately 50%. This study of a retrospective clinical design was longitudinal, descriptive and comparative of 172 patient grouped for treatment received: a) with estrogen and progestin (E + P: 59.1%, n = 122), and b) estrogen alone (E: 40.9%, n = 50), in whom was determined: lipid profile and aterogenic risk initially and each year until 5 years of follow up. Results obtained were: 172 with average age of 51.5 +/- SD 9.2 years with average 5.5 duration years of postmenopause, in both groups the aterogenic risk was reduced as well as concentrations of serum LDL, while HDL increased. It is concluded that hormonal replacement therapy exerted a substantial effect upon main lipoproteins (HDL, LDL) modifying sensitively the aterogenic risk and consequently ameliorating the risk of cardiovascular disease and atherosclerosis.

Corticotropin-independent Cushing's syndrome caused by an ectopic adrenal adenoma.

Although nonsecreting suprarenal embryonic remnants are frequently found in the urogenital tract, adenomatous transformation resulting in glucocorticoid excess is a rare phenomenon. We report a case of a 63-yr-old woman that presented with new-onset hirsutism, facial plethora, hypertension, centripetal obesity, and a proximal myopathy. The 24-h urinary free cortisol excretion rate was elevated, and the serum ACTH level was suppressed. The patient failed an overnight and low dose dexamethasone suppression test and did not respond to CRH stimulation. In light of the undetectable baseline morning ACTH levels and the blunt response to CRH, the diagnosis of corticotropin-independent Cushing's syndrome was made. Imaging studies revealed normal adrenal glands and enlargement of a left pararenal nodule incidentally observed 4 yr before the onset of symptoms. Dramatic resolution of symptoms was observed after surgical removal of the 3.5-cm mass. Pathological exam confirmed adrenocortical adenoma in ectopic adrenal tissue. The case reported here represents the unusual circumstance in which the development of adenomatous transformation of ectopic adrenal tissue has been prospectively observed with imaging studies. It illustrates the importance of considering ectopic corticosteroid-secreting tumors in the context of corticotropin-independent Cushing's syndrome.

When to treat mild hypothyroidism.

The availability and wide acceptance of TSH assays for primary assessment of thyroid function has led to the recognition that mild thyroid hormone deficiency is characterized by elevation of the serum TSH concentration despite a normal free thyroxine level. Other conditions can also cause isolated serum TSH elevation, and these conditions can be distinguished from mild thyroid failure usually based-on clinical and circumstantial observations alone. Thyroxine treatment of patients with mild hypothyroidism has been shown in most, but not all, clinical trials to lower atherogenic lipid levels and relieve certain somatic and neuropsychiatric symptoms. Such treatment also prevents the progression to overt hypothyroidism, which is particularly likely in patients who are older, who have circulating thyroid autoantibodies, or who have a serum TSH greater than 10 mU/L. After the optimal thyroxine dose has been defined, long-term monitoring of patients with an annual clinical evaluation and serum TSH measurement is appropriate. The high prevalence of mild hypothyroidism, particularly in older women, and its subtle clinical presentation have led some authorities to recommend a low threshold for case-finding or routine population screening for the disorder.

A rare pituitary lesion.

The majority of the sellar masses are pituitary adenomas. Non-adenomatous hypophyseal lesions are rare and include lymphocytic hypophysitis, idiopathic giant cell hypophysitis and granulomatous hypophysitis. The latter include lesions caused by conditions like tuberculosis, sarcoidosis, syphilis, histiocytosis X and mycotic infections. We report a case of a Sudanese woman who presented with a pituitary mass (presumed preoperatively to be an adenoma) and underwent trans-sphenoidal surgery. The final histopathology showed tuberculous hypophysitis. The patient did not have history of prior exposure to tuberculosis nor any evidence of infection elsewhere in the body. We also briefly review the literature on pituitary tuberculomas.

[Prevalence and etiology of secondary amenorrhea in a selected Mexican population]. / Prevalencia y etiología de la amenorrea secundaria en una población mexicana escogida.

Studies performed upon american and european population indicate that secondary amenorrhea is associated to 3 months without menses, despite biases observed in age variation and intervals of apparition; nonetheless a 3 month lapse is the standard of reference to quality patients within mexican females. Hence, we investigated the prevalence of secondary amenorrhea among all females (n = 1099) that consulted in our clinic, grouped by age (15-50 yrs), time (months) of amenorrea and identifying the etiology when possible. The prevalence observed was 4.9% with major incidence of 4-12 months of amenorrhea duration (x 5.7 months) between 26-35 years of age. The three most common causes in order of frequency were: Hypothyroidism (14.8%); hiperandrogenism (12.9%) and pituitary adenoma (11.1%). It is concluded that the prevalence of secondary amenorrhea in our study resembled that found in the literature, although in this instance primary hyperthyroidism was the leading cause.

[Study of the sterile male]. / Estudio del hombre estéril.

The approach on evaluation of the infertile male must be the same used to evaluate other medial problems. It must be obtained a detailed interrogation with emphasis upon areas affecting infertility. Interrogation must be followed evaluation of infertility guide us to the identification of specific abnormalities responsible of infertility. However this is only possible in some cases, in others there are abnormalities of seminal count whose etiology can not be established with accuracy.

Effect of insuflated Nafarelin (D-Nal-6-GnRH) upon uterine leiomyomata.

A nasal spray containing the GnRH analog Nafarelin (D-Nal-6-GnRH) was used to treat 20 patients of reproductive age with clinical and ultrasonographic diagnosis of uterine leiomyomata. Nafarelin showed a high index of efficacy (approximately 65%) in decreasing the volume of myomas. The collateral effects observed were scarce; among these were predominant a decrease of libido and vasomotor symptoms. Although bone pain was not referred, the impact upon osteodensity was not assessed. The effect upon pituitary gonadotropin production as well as that of sexual steroids by GnRH was practically null, and one patient became pregnant. Nonetheless, those symptoms associated with the use of Nafarelin were apparently due to a moderate hypoestrogenism, despite not being substantiated in the laboratory studies. With such disparity, we assume it was given by the route of administration of nasal Nafarelin, which is known to have erratic effects due to limitations in its absorption. Thus, far from being a disadvantage it could be useful in regimes of long term therapy (1-2 years) to avoid the impact of estrogen shortage upon bone turnover. We conclude that Nafarelin through insuflation was highly effective for decreasing the size of uterine leiomyomata.

[Dermatomyositis and eclampsia. Analysis of a case and review of the literature]. / Dermatomiositis y eclampsia. Análisis de un caso y revisión de la literatura.

Dermatomyositis is an inflammatory disease of unknown etiology whose association to pregnancy is uncommon. The impact of dermatomyositis with uncomplicated pregnancy while active is very high for the fetus without major maternal consequences. The monitoring of cases with pregnancy associated hypertension and dermatomyositis, must be performed independently for the mother and the fetus, since fetal prognosis is usually bad and does not modify with treatment. The case presented herein is to our knowledge the first with eclampsia and dermatomyositis which ended in a normal product delivered and the mother decreased.

[The diurnal rhythm of the arterial pressure in normal pregnancy and in hypertension]. / Ritmo diario de tensión arterial en el embarazo normal y con hipertensión.

An alteration upon the daily rhythm of blood pressure in patients with gestational hypertension has been reported, albeit inconsistently. Hence we have evaluated the daily rhythm of blood pressure in women with normal gestation (n = 100) and with pregnancy associated hypertension (n = 111). In an attempt to delineate a possible etiology of the hypertension, patients were subdivided according to a classification of the American College of Obstetricians and Gynecologists. (Group I. Preeclampsia-eclampsia; group II. Chronic hypertension; group III. Chronic hypertension with superimposed preeclampsia; group IV. Late gestational hypertension). Blood pressure quantitation was made with sphygmomanometer and by different observes. Those with normal pregnancy showed a higher increase in both systolic and diastolic pressure in the morning with a peak at 1200 H, that contrasted with a very low level registered at 2400 H. Altogether the hypertensive group exhibited a loss of rhythm; whereas by group: in I. There was absence of rhythm without a predominant pattern; II. & III. An increase of systolic pressure which was accetuated at 0600 H. group IV. Showed the lowest tensional levels without special characteristics. Through these data, it seems that the central nervous system loses control upon daily regulation of blood pressure in preeclamptic women.

[Endothelin: preliminary data on its concentration in normal pregnancies and with arterial hypertension]. / Endotelina: datos preliminares sobre su concentración en embarazadas normales y con hipertensión arterial.

A peptide of endothelial origin derived from blood vessels named endothelin with vasoactive properties has been recently described. Since pregnancy associated hypertension (pre-eclampsia) is a disease of unknown etiology characterized by glomerular vasospasm and altered venous capacitance we decided to investigate the plasma levels of endothelin contained in patients with preeclampsia and normal pregnancy throughout diverse stages of gestation in order to recognize differences of peptide concentration that could explain the appearance of hypertension. Endothelin was significantly increased in preeclamptic women at term; hence, it is possible that it may play a role in the toxemic syndrome.

[Pregnancy toxemia. A multidisciplinary problem]. / Toxemia gravídica. Un problema multidisciplinario.

Gestational hypertensive disease is an important health problem whose real incidence in Mexico remains unknown. The estimate is one case of eclampsia per thousand pregnancies. The knowledge about its etiology is still scarce, hence the treatment provided is mainly symptomatic.