Endocrine aspects of anovulation

Jacobs, H. S.

doi:10.1136/pgmj.51.594.209

Cited by 5 publications

(5 citation statements)

References 9 publications

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“…The history (for instance, vasomotor instability) and examination (atrophy o f the skin, breasts and lower genital tract) are helpful, but the condition is more precisely charac terised by measurement of serum gonadotrophin concentrations. In common with other workers (Goldenherg et a l, 1973 a) we have found a four-to fivefold elevation o f serum FSH concentrations in patients with proven primary ovarian failure (Jacobs, 1975). Serum LH concentrations are also elevated ( fig.…”

Section: Serum Gonadotrophin Measurements (Fig 1)supporting

confidence: 70%

“…When the usually recognised forms of this syndrome are excluded, the most striking clinical correlate of this hormonal profile is anorexia nervosa. While this pattern is a familiar finding in tire grossly underweight patient (Jacobs, 1975), we have been impressed by tire large proportion o f patients who have a partially recovered form o f the disease as tire presumed cause o f the amenorrhoea. In a study o f 15 such patients, though tire mean lowest weight was 36 ± 6 kg (SD), the weight at presentation to our clinic was 52 ± 6 kg.…”

Section: Assessment O F Oestrogen Productionmentioning

confidence: 99%

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Therapy-Orientated Diagnosis of Secondary Amenorrhoea

Jacobs¹,

Hull²,

Murray³

1975

Horm Res

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A programme for investigation of secondary amenorrhoea is described, which is based upon a functional classification of the endocrine causes of anovulation. All diagnostic enquiries not directly yielding a therapeutic dividend are excluded from this protocol. Three main categories of amenorrhoea are recognised: primary ovarian disease, hyperprolactinaemia and disorders of gonadotrophin secretion. There are subdivisions of each category, each with its own special diagnostic and therapeutic implications. Initial investigations take 6 weeks to complete and include measurements of follicle-stimulating hormone and prolactin, pituitary radiology and assessment of oestrogen production and of the response to clomiphene. The results of analysis of 75 consecutive cases of amenorrhoea and of 18 patients treated for infertility are presented and a cost benefit analysis applied.

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Section: Serum Gonadotrophin Measurements (Fig 1)supporting

confidence: 70%

Section: Assessment O F Oestrogen Productionmentioning

confidence: 99%

Therapy-Orientated Diagnosis of Secondary Amenorrhoea

Jacobs¹,

Hull²,

Murray³

1975

Horm Res

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“…It was a notable finding that when patients with pituitary tumours were excluded, hyperprolactinaemia occurred very rarely in those in whom a readily identifiable endocrine cause of amenorrhoea could be determined ( Table 2). Only one patient in the post oral contraceptive group had an elevated prolactin concentration, so it is unlikely that prolactin is aetiologically relevant in that condition-the existence of which as a separate nosological entity is, in any case, in dispute (Jacobs, 1975;Jequier e l al., 1975).…”

Section: Discussionmentioning

confidence: 96%

Incidence and Significance of Hyperprolactinaemia in Women With Amenorrhoea

Franks

Murray

Jequier

et al. 1975

Clinical Endocrinology

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207

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Serum prolactin and gonadotrophin concentrations were measured by radioimmunoassay in 106 women with amenorrhoea. Prolactin was normal in those with weight related disorders, primary ovarian failure, those with a variety of systemic diseases and in those in whom amenorrhoea followed treatment with the oral contraceptive and in unexplained primary amenorrhoea. Gonadotrophin concentrations in the above patients were normal except in those with primary ovarian failure. Prolactin was elevated in eight of forty patients (20%) with functional secondary amenorrhoea and was greatly raised in all but one of the thirteen women in this series with pituitary tumours (five of whom were studied only after treatment). Only three patients in each of the last two groups had galactorrhoea. Gonadotrophin levels were normal or slightly raised in all of the hyperprolactinaemic patients apart from those studied after hypophysectomy. Four hyperprolactinaemic patients (three with pituitary tumours and one with functional amenorrhoea) who did not have galactorrhoea have been treated with bromocriptine. Prolactin secretion was reduced in all patients and, in the two with normal gonadotrophins, ovulatory menstruation was resumed. One became pregnant in the second ovulation cycle after starting treatment. We conclude that, despite the rarity of galactorrhoea, hyperprolactinaemia is common in patients with functional amenorrhoea and in those with pituitary tumours. Treatment with bromocriptine in patients with normal gonadotrophins restores ovulation when the infertility is due to prolactin excess.

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“…Moreover in such men, the raised FSH levels are not as high as they are when there is also Leydig cell damage and elevated LIH concentrationis (Bramble et al, 1975;Rosen and Weintraub, 1971). The increased FSH concentration in Case 3 was not as high as the levels in the patients in this study with amenorrhoea and elevation of both gonadotrophins (Table I) or in other women with proven ovarian failure (Jacobs, 1975). We have also seen a similar pattern of gonadotrophin levels develop in women with regular menstrual cycles during cytotoxic chemotherapy for malignant disease (Thomas, Murray and Jacobs, unpublished).…”

Section: Methodsmentioning

confidence: 49%

“…Less than 2% of the delivered dose is transmitted through the lead blocks and the major proportion of the ovarian dose arises from internal scatter from adjacent treated tissues (Lillicrap and Dickens, 1973 (Jacobs, 1975) or as seen in other patients in this series with elevations of both gonadotrophins. The lowest maximum dose of irradiation sustained by individual ovaries of the patients in this group was 500 rad.…”

Section: Methodsmentioning

confidence: 84%

Reproductive and endocrine function in patients with Hodgkin's disease: effects of oophoropexy and irradiation

Thomas¹,

Winstanly²,

Peckham³

et al. 1976

Br J Cancer

113

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Summary.-Reproductive and endocrine function was investigated in 22 women with Hodgkin's disease who had bilateral mid-line oophoropexies performed at staging laparotomy. The operation was followed in 12 cases by " inverted Y " pelvic lymph node irradiation and in 4 cases by para-aortic lymph node irradiation.Pregnancies occurred after the operation in 4 of the 6 patients subsequently found not to require irradiation below the diaphragm. In the other 2 patients in this group the menstrual history was unaffected and normal gonadotrophin concentrations indicated intact ovarian function. In the group receiving para-aortic irradiation, in whom the ovarian irradiation dose was small (about 150 rad to each ovary) menstrual function and gonadotrophin concentrations were normal at the time of review and one patient has subsequently become pregnant. In the group receiving inverted Y irradiation, in whom the ovaries were shielded from the radiation beam by a rectangular lead block, the ovarian dose was much higher (lowest dose 600 rad, highest dose 3500 rad). Nine of the 12 have persisting amenorrhoea with elevated levels of both gonadotrophins. One patient has since become pregnant and one patient has resumed menstrual cycles and has normal basal gonadotrophin concentrations. One patient who has resumed menstrual cycles has a monotrophic elevation of basal serum FSH concentrations.We conclude that bilateral mid-line oophoropexy does not impair ovarian function or gamete transport and should be performed at diagnostic laparotomy in women of child bearing age with Hodgkin's disease, even when it is uncertain whether pelvic node irradiation will be necessary. The results in the patients who received inverted Y irradiation indicate that the technique of pelvic shielding and ovarian transposition used were only partially successful in preserving fertility. Alternative techniques for preserving ovarian function are discussed.

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Endocrine aspects of anovulation

Cited by 5 publications

References 9 publications

Therapy-Orientated Diagnosis of Secondary Amenorrhoea

Therapy-Orientated Diagnosis of Secondary Amenorrhoea

Incidence and Significance of Hyperprolactinaemia in Women With Amenorrhoea

Reproductive and endocrine function in patients with Hodgkin's disease: effects of oophoropexy and irradiation

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