The relationship between the immune and endocrine systems

Increasing evidence links the immune and endocrine systems. Cytokines produced by activated immune and immune accessory cells can affect, positively or negatively, the secretion of hormones from the hypothalamic-pituitary-adrenal or hypothalamic-pituitary-ovarian axes. On the other hand, adrenal and ovarian hormones affect the secretion of cytokines by cells of the immune system. The interaction also occurs at a local level in paracrine or autocrine fashion. Cytokines produced by resident ovarian macrophages or ovarian cells can affect the follicle and the corpus luteum and, consequently, ovarian steroidogenesis at both phases of the menstrual cycle. Conversely, the ovarian steroids influence, positively or negatively, the secretion of cytokines from both the resident macrophages and local endocrine cells

Development of a hypoplastic uterus in a patient with testicular feminization syndrome 21 years after gonadectomy

We describe a case of a hypoplastic uterus, identified by transrectal ultrasonography and magnetic resonance imaging, which developed 21 years after gonadectomy for testicular feminization syndrome. Its likely origin was Müllerian-fusion remnant resulting from a deficiency in functional Müllerian inhibiting substance (MIS) and/or desensitization of the Müllerian tract to MIS, caused by diethylstilbestrol administration to the patient's mother during the sensitive period of the 6th and 9th gestational weeks of her pregnancy. This Müllerian-fusion remnant remained latent, due to insufficient estrogen stimulation both endogenously (until gonadectomy) and exogenously during hormone replacement therapy. Initial growth was possibly induced in response to high doses of estrogen that the patient received over the last 3 years for the treatment of osteoporosis

HORMONAL PATTERNS IN A SUCCESSFUL PREGNANCY OF A PATIENT WITH LATE-ONSET 21-OH DEFICIENCY TAKING METHYLPREDNISOLONE - A CASE-REPORT

A successful pregnancy of a young woman with late-onset congenital adrenal hyperplasia (LOCAH) is reported. Exogenous glucocorticoids are the most commonly used regimen in such cases both for suppression of adrenal overstimulation and avoiding masculinization of a female fetus. In our LOCAH patient methylprednisolone has been used for treatment. We present the management and the outcome of this pregnancy, as well as the hormonal follow-up

Cyclic and individualized administration of gonadotropin releasing hormone agonists plus progestogens: An alternative protocol for contraception

Twenty-one women presenting with different diseases, with absolute or relative contraindications to hormonal contraception or the use of intrauterine devices, received 300-600 mu g/day buserelin intranasally from the 1st to the 21st day, and 5 mg/day norethisterone acetate orally from the 16th to the 23rd day of the cycle for a total of 245 cycles. Serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol and testosterone were determined on days 3-5 and 13-15 of the cycle, while progesterone determinations and ovarian sonography were performed during the second half of the cycle. According to progesterone values, 92.7% of the treatment cycles were anovulatory, while in one cycle pregnancy was detected (0.4%). Values of serum LH, FSH and estradiol were low, and in most of the cycles ovarian follicular development was limited to follicles less than or equal to 11 mm. In 21 treatment cycles (9%), statistically significant increases in FSH (p < 0.0001) and LH (p < 0.02), as well as ovarian proliferation to preovulatory follicles or luteinized follicles, were found. It appears that in spite of the high cost of medication and monitoring of patients, this regimen could be useful as an alternative in cases where other forms of contraception are contraindicated or have failed

Gonadotropin ovulation induction and pregnancies in women with Kallmann's syndrome

Only 17 cases of pregnancy in women with Kallmann’s syndrome have been reported in the literature, eight as case reports. In our clinic, we diagnosed seven women with complete Kallmann’s syndrome in a 16-year period. In five cases (unprimed patients) the diagnosis was established for the first time, while in the other two cases diagnosis had been established earlier. The five unprimed patients received hormone therapy (HRT) immediately after diagnosis. The other two patients had already been on HRT. Four patients wanted to bear children. Follicular evolution and maturation was induced with daily human menopausal gonadotropin (hMG) administration. The results were monitored through plasma estradiol (E-2) determinations and ultrasonography. Ovulation was induced with hCG administration. Five pregnancies were achieved in three patients, resulting in four healthy neonates. Two women achieved a second pregnancy. Nausea and vomiting did not occur in any of our five pregnancies. We found no significant differences between the total hMG nose needed for ovulation induction, the number of stimulation days, estradiol plasma concentrations and the number of follicles with diameter greater than or equal to 17 mm, in either conceptional or non-conceptional cycles. In fact, the total hMG dose administered was lower and the days of stimulation were significantly fewer in women on their second pregnancy. There was no difference in plasma estradiol concentrations and the number of follicles with diameter 2 17 mm. In conclusion, ovulation induction and pregnancy in women with complete Kallmann’s syndrome is not such a difficult procedure as was believed in the past. A previous pregnancy seemed to augment ovarian sensitivity to gonadotropins