In 4 patients with hypothalamic amenorrhea, the pituitary responsiveness to an intravenous challenge of 20 µg synthetic gonadotropin-releasing hormone (GnRH) was evaluated before and following a 3-days treatment course with GnRH (100 µg/per day i.m.) or ethinyl estradiol, (100 µg/day orally). The amenorrheic patients all had normal or reduced levels of serum gonadotropins, no evidence of galactorrhea and no other endocrine abnormality. Following GnRH treatment basal luteinizing hormone levels as well as the luteinizing hormone and follicle-stimulating hormone responses to GnRH were markedly reduced when compared with responses to GnRH before the treatment. Responses to GnRH were significantly augmented after treatment with estrogens. In patients with previous treatment with GnRH the augmented estrogen-induced LH response to GnRH was abolished. These preliminary results support the pathophysiological concept that in amenorrheic patients with hypothalamic dysfunction long-term administration of GnRH does not result in an improvement but rather in a deterioration of pituitary gonadotropic function.
The levels of five enzymes were examined in the urine and the serum of pregnant women. They included leucine aminopeptidase (LAP), alkaline phosphatase (AP), N-acetyl-Β-glucosaminidase (ABG), lactic acid dehydrogenase (LDH) and glutamic-oxalo-acetic transaminase (GOT). After establishing the normal curve and upper confidence limits in healthy pregnant patients (138 examinations in 52 women), the enzymes were examined in the urine and the serum of 21 severe and 23 mildly toxemic cases. The mean urinary levels of ABG, AP and LAP in the severe cases were significantly higher than in the normals, and by examining all three enzymes, at least one of them was found to be above the upper confidence limit in 95% of the severely ill women. The changes did not show up early enough to form a good diagnostic and prognostic sign in moderate pregnancy-induced hypertension, but severe kidney damage may be revealed earlier than by the regular kidney function tests, and patients with a bad remote prognosis can be singled out by this method.
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