Diabetes is associated with a higher incidence of secondary hypogonadotrophic amenorrhoea. In amenorrhoeic women with insulin-dependent diabetes a derangement in hypothalamic-pituitary-ovary axis has been proposed. No data exist on hypothalamic-pituitary-adrenal function in these women. Gonadotrophin releasing hormone (GnRH), corticotrophin releasing hormone (CRH), metoclopramide and thyroid releasing hormone (TRH) tests were performed in 15 diabetic women, eight amenorrhoeic (AD) and seven eumenorrhoeic (ED). Frequent blood samples were taken during 24 h to evaluate cortisol plasma concentrations. There were no differences between the groups in body mass index, duration of diabetes, insulin dose and metabolic control. The AD women had lower plasma concentrations of luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin, oestradiol, androstenedione and 17-hydroxyprogesterone (17-OHP) than the ED women. The responses of pituitary gonadotrophins to GnRH, and of thyroid stimulating hormone (TSH) to TRH, were similar in both groups. The AD women had a lower prolactin response to TRH and metoclopramide, and lower ACTH and cortisol responses to CRH, than the ED women. Mean cortisol concentrations > 24 h were higher in the amenorrhoeic group. Significant differences in cortisol concentrations from 2400 to 1000 h were found between the two groups. Insulin-dependent diabetes may involve mild chronic hypercortisolism which may affect metabolic control. Stress-induced activation of the hypothalamic-pituitary-adrenal axis would increase hypothalamic secretion of CRH. This would lead directly and perhaps also indirectly by increasing dopaminergic tonus to inhibition of GnRH secretion and hence hypogonadotrophic amenorrhoea. Amenorrhoea associated with metabolically controlled insulin-dependent diabetes is a form of functional hypothalamic amenorrhoea that requires pharmacological and psychological management.

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Objective: To evaluate the role of thyroid hormones in maintaining early pregnancy and to examine the association between thyroid physiological functions and immunological parameters.Methods: Forty-five pregnant women with a clinical diagnosis of threatened abortion and a live fetus and 30 normal pregnant women were included in the study. Blood samples were taken on admission to the hospital. The patients were divided retrospectively into two groups on the basis of outcome: 1) 31 women who did not miscarry (positive outcome) and 2) 14 women who miscarried (negative outcome). Plasma TSH, free triiodothyronine (fT3), free thyroxine (fT4), hCG, immunoglobulin (Ig) G and IgM concentrations and blood counts were determined in each patient.Results: Human chorionic gonadotropin was significantly higher in women who did not abort (39.4 ؎ ؎ ؎ 16.9 IU/mL) than in women who miscarried (17.6 ؎ ؎ ؎ 14.8 IU/mL, P < < < .001). Free thyroxine but not fT3 was lower in patients with negative outcome (1.25 ؎ ؎ ؎ 0.26 ng/mL compared with 1.98 ؎ ؎ ؎ 0.22 ng/mL, P < < < .001) and IgG and IgM plasma levels were higher (780 ؎ ؎ ؎ 500 ng/mL compared with 470 ؎ ؎ ؎ 300 ng/mL and 930 ؎ ؎ ؎ 400 ng/mL compared with 650 ؎ ؎ ؎ 280 ng/mL, respectively, P < < < .05). Plasma TSH levels were higher in patients with negative outcomes (1.72 ؎ ؎ ؎ 0.84 mIU/mL compared to 1.01 ؎ ؎ ؎ 0.41 mIU/mL, P < < < .001). Plasma concentrations of hCG and thyroid hormones were significantly correlated with peripheral blood lymphocyte and neutrophil counts only in the group of women who aborted.Conclusion: Our results indicate that maternal immune response, trophoblast function, and maternal thyroid function are somehow correlated. The presence of low concentrations of hCG and fT4 and high levels of TSH and gamma globulins in women with threatened abortion suggests a negative outcome for the pregnancy. (Obstet Gynecol 1998; 92:206 -11. © 1998 by The American College of Obstetricians and Gynecologists.)Maternal thyroid function in pregnancy is influenced by many factors. High estrogen levels induce increased liver synthesis of thyroxine binding globulin, leading to reduced availability of iodine. Other factors include hCG and human chorionic thyrotropin. The thyrotropic activity of hCG has been the subject of many studies because it has the same ␣-subunit and a similar ␤-subunit to TSH. Many studies have found a positive correlation between hCG and thyroid stimulating activity during pregnancy, 1,2 and it is interesting that hCG activates the signal transducer system for iodine uptake and cyclic adenosine monophosphate increase in FRTL-5 rat cells. [3][4][5] Thyroid hormones probably play an important role in the control of ovarian and trophoblast function. It has been shown that thyroid hormones act as amplifiers of granulosa cell and trophoblast function and stimulate the functional differentiation of these cells. 6 They also play important roles in embryogenesis and fetal maturation. 7 The fetal hypothalamo-pituitary-thyroid axis develops at about the tenth week ...

Prolactin (Prl) and growth hormone (GH) responses to different pharmacologic probes acting at the central nervous system (CNS) or the anterior pituitary (AP) level were evaluated in patients with distinct neuroendocrine disorders. Thirteen patients with Prl-secreting tumours (PST), 10 acromegalics (A) and 8 patients with

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