Spinder T, Spijkstra J J, van den Tweel J G, Burger C W, van Kessel H, Hompes P G, Gooren L J
Department of Internal Medicine, Free University Hospital, Amsterdam, The Netherlands.
J Clin Endocrinol Metab. 1989 Jul;69(1):151-7. doi: 10.1210/jcem-69-1-151.
Polycystic ovarian disease (PCOD) is associated with elevated serum LH and (sub)normal FSH levels, while serum androgen levels are often elevated. To clarify the role of androgens in this abnormal pattern of gonadotropin secretion, LH secretion was studied in 1) 9 eugonadal female to male transsexual subjects before and during long term (6 months) testosterone (T) administration (250 mg/2 weeks, im), and 2) in a woman with an androgen-secreting ovarian tumor both before and after surgical removal of the tumor. Finally, we studied the effects of high serum androgen levels on ovarian histology in 3) 26 transsexual subjects after long term (9-36 months) T administration (250 mg/2 weeks, im) to assess whether T-induced ovarian abnormalities are similar to those that occur in women with PCOD. Long term T treatment in the nine female to male transsexual subjects resulted in increases in the mean serum T level from 1.7 +/- 0.8 (+/- SD) to 40.8 +/- 31.9 nmol/L (P less than 0.01), the mean serum dihydrotestosterone level from 0.6 +/- 0.2 to 3.3 +/- 1.5 nmol/L (P less than 0.02), and the mean serum free T level from 9.5 +/- 5.2 to 149 +/- 46 pmol/L (P less than 0.02). Mean serum estrone and estradiol levels were similar before and during T treatment. The mean serum LH level decreased from 6.3 +/- 2.0 to 2.9 +/- 1.1 U/L (P less than 0.01), and the mean FSH levels decreased from 6.6 +/- 2.0 to 3.7 +/- 2.2 U/L (P less than 0.02). Pulsatile LH secretion before and during T treatment was studied in five subjects. Neither the mean nadir LH interval nor the LH pulse amplitude changed significantly in these five subjects. The serum T level in the woman with the androgen-secreting ovarian tumor was 9.6 nmol/L, and it declined to normal after removal of the tumor. Her mean serum LH and FSH levels, the mean nadir LH interval, and LH pulse amplitude were in the normal range before and after removal of the tumor. Studies of ovarian histopathology in 26 transsexual subjects after long term androgen treatment revealed multiple cystic follicles in 18 subjects (69.2%), diffuse ovarian stromal hyperplasia in 21 subjects (80.8%), collagenization of the tunica albuginea in 25 subjects (96.2%), and luteinization of stromal cells in 7 subjects (26.9%). Findings consistent with criteria for the pathological diagnosis of polycystic ovaries, that is 3 of the 4 findings listed above, were present in 18 of the 26 subjects (69.2%).(ABSTRACT TRUNCATED AT 400 WORDS)
多囊卵巢疾病（PCOD）与血清促黄体生成素（LH）升高及促卵泡生成素（FSH）水平（亚）正常相关，同时血清雄激素水平常升高。为阐明雄激素在这种促性腺激素分泌异常模式中的作用，我们对以下情况进行了LH分泌研究：1）9名性腺功能正常的女性至男性变性者，在长期（6个月）睾酮（T）给药（250mg/2周，肌肉注射）前及给药期间；2）一名患有分泌雄激素的卵巢肿瘤的女性，在手术切除肿瘤前后。最后，我们研究了高血清雄激素水平对卵巢组织学的影响，3）26名变性者在长期（9 - 36个月）T给药（250mg/2周，肌肉注射）后，以评估T诱导的卵巢异常是否与PCOD女性中出现的异常相似。9名女性至男性变性者的长期T治疗导致平均血清T水平从1.7±0.8（±标准差）升至40.8±31.9nmol/L（P＜0.01），平均血清双氢睾酮水平从0.6±0.2升至3.3±1.5nmol/L（P＜0.02），平均血清游离T水平从9.5±5.2升至149±46pmol/L（P＜0.02）。T治疗前及治疗期间平均血清雌酮和雌二醇水平相似。平均血清LH水平从6.3±2.0降至2.9±1.1U/L（P＜0.01），平均FSH水平从6.6±2.0降至3.7±2.2U/L（P＜0.02）。对5名受试者在T治疗前及治疗期间的LH脉冲分泌进行了研究。这5名受试者的平均最低LH间期及LH脉冲幅度均无显著变化。患有分泌雄激素的卵巢肿瘤的女性血清T水平为9.6nmol/L，肿瘤切除后降至正常。肿瘤切除前后，她的平均血清LH和FSH水平、平均最低LH间期及LH脉冲幅度均在正常范围内。对26名长期接受雄激素治疗的变性者的卵巢组织病理学研究显示，18名受试者（69.2%）有多个囊性卵泡，21名受试者（80.8%）有弥漫性卵巢间质增生，25名受试者（96.2%）有白膜胶原化，7名受试者（26.9%）有间质细胞黄素化。26名受试者中有18名（69.2%）出现了符合多囊卵巢病理诊断标准的结果，即上述列出的4项结果中的3项。（摘要截取自400字）
