Effect of Human Pituitary-follicle-stimulating Hormone and Chorionic Gonadotrophin in Stein-Leventhal Syndrome

Abstract

In the normal ovary two distinct types of endocrine cells seem to exist.These are the cells of the theca interna, which contain all the enzyme systems necessary for conversion of progesterone to oestradiol-17/3; and the granulosa cells, which lack many of these enzymes and therefore produce mainly progesterone (Short, 1962a; Huang and Pearlman, 1962).A change in cell type normally takes place as a result of ovulation.Characteristically ovulation fails to occur in patients with the Stein-Leventhal syndrome, and the multiple small follicular cysts which persist in the ovaries of these patients contain a fluid which is rich in androstenedione but has little or no oestradiol-17,f or oestrone.It has been postulated that this results from a defect in the enzyme systems responsible for converting androstene- dione to oestrone (Short and London, 1961; Short, 1962b).Similar conclusions have been reached by Axelrod and Goldzieher (1962) as a result of in vitro incubation studies, and by Mahesh and Greenblatt (1961) from steroid determinations in ovarian tissue.It is possible that the recovery which often results from surgical trauma of the ovaries in patients with the Stein-Leventhal syndrome is mediated by a change in the type of endocrine cells in the pathological follicles comparable with the changes that occur at ovulation.It is known that such changes occur when large follicles are ruptured mechanically (Harrison, 1946).It seemed to be of interest, therefore, to study the effects of highly potent preparations of human pituitary-follicle-stimulating hormone and human chorionic gonadotrophin (H.C.G.) on the ovarian steroids and pathology in patients with Stein-Leventhal syndrome. MethodsPatients.-Fivepatients were investigated, and their his- tories are given briefly in the Appendix.The nuclear sex, based on the examination of buccal smears, was normal in them all and the urinary excretion of gonadotrophins was in the low normal range.Three were examined by culdoscopy, another had had a laparotomy previously, and one did not have any surgical examination of her ovaries before treatment.These patients were considered to be typical of the Stein-Leventhal syndrome and were waiting for laparotomy to be performed.Dexameth- asone 1 mg.thrice daily was given to the first three patients throughout the period of treatment with gonadotrophins and of operation, but the last two had none.The dosage of gonadotrophins was the same in all, but the time interval between doses and the time of operation in relation to doses varied from patient to