No abstract

The mean level of plasma testosterone was 2 ng/ml in neonates and 0.4 ng/ml in infants ; it increased to 3 ng/ml during onset of meiosis and reached 10 ng/ml in adults. The profile of testosterone was positively and significantly correlated with the total volume and total number of Leydig cells (P <0.01 and P < 0.02, respectively) and with changes in their cytoplasmic volume (P < 0.0011. Moreover, plasma testosterone levels were positively and significantly correlated with changes in Leydig cell SER content i.e. SER volume density and mean absolute volume per cell (P < 0.001), total SER in the whole testis (P < 0.011. ).Introduction.

Plasma testosterone, 5\g=a\-dihydrotestosterone(DHT), \g=D\4-androstenedione, dehydroepiandrosterone (DHA) and oestradiol-17\g=b\concentrations of crab-eating macaques after birth were analysed by RIA. The profiles of plasma testosterone and DHT exhibited four phases: (1) a neonatal phase (0 to 3\p=n-\4months of age) with considerable synthetic testicular activity; (2) a phase of 'infancy' (generally up to 29 months of age) during which the values of both androgens were low; (3) a prepubertal phase (generally up to 43 months of age) when circulating values oscillated with wider individual variations, and (4) a pubertal phase when the concentrations increased in parallel and concomittantly with the onset of meiosis and the establishment of spermatogenesis. The testosterone values continued to increase, reaching adult values at about 5\p=n-\6 years of age, whereas DHT levels tended to stabilize from 4\p=n-\5 years. Relatively high androstenedione values during the neonatal phase decreased progressively until puberty, then increased again slowly up to the adult stage when they plateaued at about neonatal levels. The DHA levels were high during the first months, decreased at about 1 year, remained stable during infancy and prepuberty and then declined again during puberty. At about 5 years, the values were 28% of those in neonates. There was no evidence of an adrenarche before the first signs of sexual maturity were observed. Oestradiol-17\g=b\concentrations were high at birth and until 3 months, then decreased and remained steady from 1 year of age until adulthood, except at the onset of puberty (27\p=n-\30 months of age) when high values were again noted. Our results show that, during the neonatal period, the testis exhibited considerable secretory activity.

Aims Advances have been made over the last decade in the management of cardiac amyloidosis (CA), but a delayed diagnosis is still common. The aim of this study was to describe the journey to CA diagnosis from initial clinical and to analyse time to diagnosis. Methods and results Between January 2001 and May 2019, 270 consecutive patients with CA diagnosed at Toulouse University Hospital were retrospectively included in this cross-sectional study: 111 (41%) light chain amyloidosis, 122 (45%) wild-type transthyretin amyloidosis, and 37 (14%) hereditary transthyretin amyloidosis. CA onset occurred mostly with dyspnoea (50%) or systematic follow-up (10%). The cardiologist was the first line specialist in 68% of patients, followed by the nephrologist (9%) and neurologist (8%). Patients encountered a median (minimum-maximum) number of two (1-7) physician specialists and performed a median (minimum-maximum) number of three (1-8) tests before diagnosis. Median delay between symptom onset and CA diagnosis was 8 [IQR 5-14], 10 [IQR 3-34], and 18 [IQR 4-49] months, respectively, in light chain amyloidosis, wild-type transthyretin amyloidosis, and hereditary transthyretin amyloidosis subgroups (P = .060). Having performed electromyography or spirometry was associated with a longer delay in diagnosis in the overall population: odds ratio = 1.13; 95% confidence interval 1.02 to 1.24; and odds ratio = 1.13; 1.03 to 1.24, respectively, probably due to non-specific initial symptoms. Conclusions CA is a protean disease with various first line specialists causing a diagnostic wandering despite increasing medical community awareness. It requires a multidisciplinary specialist care networks to educate and manage symptoms and therapies.