Exogenous Hormone Stimulation Research Articles

124I-PET/CT images of differentiated thyroid cancer patients

SummaryFor an adequate therapy planning and staging of patients with differentiated thyroid cancer (DTC), the correct assignment of thyroid remnants (TRs) and lymph node metastases (LMs) is important. Patients, method: We retrospectively analyzed whether kinetic quantities can help improving LM assignment using serial 124I-PET/CT data. 127 patients with a total of 317 lesions (TR: n = 265; LM: n = 52) received pre-therapy 124I-PET/CT lesion dosimetry using images 24 h and > 96 h after 124I administration. For each lesion, maximum activity concentration (MAC) at 24 h and effective half-life (EHL) were determined. Moreover, the product of MAC and EHL was also investigated as a quantity and is referred to CAQ (cumulated activity proportional quantity). In addition, differences between endogenous and exogenous thyroid-stimulating hormone (TSH) stimulation and between papillary (PTC) and follicular thyroid cancer (FTC) were investigated. Results, conclusion: The median MAC, EHL, and CAQ values in TR were significantly higher than in LM but a clinically relevant cut-off value could not be determined because of high overlapping regions. No significant differences for the three quantities were found for the mode of TSH stimulations, but a significant difference for MAC and CAQ between PTC and FTC.

Secondary amenorrhea in a woman with spinocerebellar degeneration treated with thyrotropin-releasing hormone: a case report and in vitro analysis

IntroductionWhile thyrotropin-releasing hormone is known to be a prolactin-release stimulating factor, thyrotropin-releasing hormone-tartrate and its derivative, taltirelin hydrate, are used for the treatment of spinocerebellar degeneration, a degenerative disease characterized mainly by motor ataxia. We report the case of a patient being treated with a thyrotropin-releasing hormone preparation for spinocerebellar degeneration who developed amenorrhea after a dose increase. Her hormonal background was analyzed and the effect of prolonged exposure to thyrotropin-releasing hormone on pituitary prolactin-producing cells was examined in vitro.Case presentationOur patient was a 36-year-old Japanese woman who experienced worsening of gait disturbance at around 23 years of age, and was subsequently diagnosed as having spinocerebellar degeneration. She had been treated with thyrotropin-releasing hormone-tartrate for four years. Taltirelin hydrate was added to the treatment seven months prior to her presentation, followed by an improvement in gait disturbance. Around the same period, she started lactating and subsequently developed amenorrhea three months later. Taltirelin hydrate was discontinued and she was referred to our hospital. She was found to have normal sex hormone levels. A thyrotropin-releasing hormone provocation test showed a normal response of thyroid-stimulating hormone level and an over-response of prolactin at 30 minutes (142.7 ng/mL). Resumption of menstruation was noted three months after dose reduction of thyrotropin-releasing hormone. In our in vitro study, following long-term exposure to thyrotropin-releasing hormone, cells from the rat pituitary prolactin-producing cell line GH3 exhibited an increased basal prolactin promoter activity but showed a marked decrease in responsiveness to thyrotropin-releasing hormone.ConclusionsPhysicians should be aware of hyperprolactinemia-associated side effects in patients receiving thyrotropin-releasing hormone treatment. Long-term treatment with a thyrotropin-releasing hormone preparation might cause a large amount of prolactin to accumulate in prolactin-producing cells and be released in response to exogenous thyrotropin-releasing hormone stimulation.

Maternal dexamethasone treatment in late gestation induces precocious fetal maturation and delivery in healthy Thoroughbred mares

The foal requires an active hypothalamo-pituitary-adrenal (HPA) axis for organ maturation and post natal survival. Prenatal administration of synthetic glucocorticoids may provide an effective method for inducing fetal maturation safely in the mare. To determine whether dexamethasone administered to late pregnant mares: 1) will induce fetal maturation and precocious delivery; 2) is safe to use and 3) to identify endocrine responses in the mare and foal. Pregnant Thoroughbred mares received either 100 mg dexamethasone i.m. (treated n = 5) or 50 ml saline i.m. (control n = 5) at 315, 316 and 317 days of gestation. Plasma progestagens, cortisol and prostaglandin F(2α) metabolite (PGFM) concentrations were measured before and after treatment. The foals were weighed, the crown-rump length (CRL) measured and an adrenal stimulation test performed on Day 1. Dexamethasone significantly (P<0.01) reduced gestation length in treated mares without apparent adverse effects. Plasma progestagens increased (P<0.05), and cortisol and PGFM (P<0.05) decreased, following dexamethasone treatment compared with control mares. Foals were clinically mature but those from dexamethasone treated mares had reduced (P<0.05) CRL, but not bodyweights, compared with controls. Their cortisol concentrations increased following exogenous adrenocorticotrophic hormone stimulation but 2 foals from dexamethasone treated mares showed evidence of adrenal suppression. Dexamethasone stimulates precocious fetal maturation and delivery in healthy late pregnant mares. However, fetal HPA activity may be suppressed. Dexamethasone treatment could be used to improve foal viability in mares at risk of preterm delivery. The endocrine effects of such a therapy must be evaluated before clinical intervention with glucocorticoids can be recommended.

Adenomyosis: Usual and Unusual Imaging Manifestations, Pitfalls, and Problem-solving MR Imaging Techniques

Adenomyosis is a common nonneoplastic gynecologic disease characterized by the presence of ectopic endometrium within the myometrium. On T2-weighted magnetic resonance (MR) images, typical adenomyosis appears as an ill-demarcated low-signal-intensity lesion with uterine enlargement. However, various physiologic or pathologic states such as amount of functional endometrial tissue, phase of the menstrual cycle, endogenous hormonal abnormality, and exogenous hormonal stimulation may affect the MR imaging appearance of adenomyosis and may result in a tumorlike appearance. Problem-solving MR imaging techniques used in diagnosis of adenomyosis include diffusion-weighted imaging, susceptibility-weighted imaging, hydrogen 1 MR spectroscopy, cine MR imaging, and high-resolution MR imaging at 3 T. Adenomyotic lesions that show high signal intensity relative to the outer myometrium on T2-weighted images mimic malignancies such as leiomyosarcoma and endometrial stromal sarcoma. In these cases, a relatively high apparent diffusion coefficient at diffusion-weighted imaging and a low choline peak at MR spectroscopy are suggestive of a benign lesion. Small hemorrhagic foci suggestive of an adenomyotic lesion are well demonstrated as signal voids at susceptibility-weighted imaging. Cine MR imaging is useful in differentiating transient myometrial contraction from focal adenomyosis. High-resolution MR imaging at 3 T demonstrates anatomically detailed structures and may improve diagnostic accuracy in differentiating adenomyosis from its mimics, such as low-grade endometrial stromal sarcoma.

Ovarielles Überstimulationssyndrom in einer aneuploiden Gravidität

INTRODUCTION: Ovarian hyperstimulation syndrome occurs frequently after hormonal stimulation with human chorionic gonadotropin (hCG). Thus it must be assumed that hCG is a key factor in the pathogenesis of ovarian hyperstimulation syndrome. An association with aneuploid pregnancy and alterations in maternal serum hCG concentration has been described in the literature. CASE REPORT: A 40-year-old patient presented to our clinic with severe ovarian hyperstimulation syndrome at 17 weeks' gestation of a spontaneous singleton pregnancy. The pregnancy had to be terminated shortly thereafter due to the critical condition of the mother caused by incipient amniotic infection syndrome. Karyotype analysis of the aborted foetus showed trisomy 16. At the follow-ups performed by the referring gynaecologist, sonomorphological imaging showed that the polycystic aspect of the ovaries subsided entirely whilst serum hCG levels and infection parameters returned to normal values. CONCLUSIONS: In cases of ovarian hyperstimulation syndrome in a pregnancy that cannot be traced back to preceding exogenous hormonal stimulation, aneuploidy should be considered as a differential diagnosis.

Interpretations: How to use faecal elastase testing

A number of tests of exocrine pancreatic function have been devised over the years, but the search for a simple and yet sensitive and specific test has been elusive until...

Oocyte maturation failure: a syndrome of bad eggs

To show that disruption of meiotic competence results in cell cycle arrest, and the production of immature oocytes that are not capable of fertilization. Through an extensive review of animal studies and clinical case reports, we define the syndrome of oocyte maturation failure as a distinct oocyte disorder, present a classification system based on clinical parameters, and discuss the potential molecular origins for the disease.

A GnRH agonist and exogenous hormone stimulation protocol has a higher live-birth rate than a natural endogenous hormone protocol for frozen-thawed blastocyst-stage embryo transfer cycles: an analysis of 1391 cycles

To compare embryo and birth data in cryopreserved-thawed blastocyst-stage ET cycles between natural endogenous hormone cycles and exogenous hormone stimulation cycles. Retrospective cohort analysis. Large academic assisted reproductive technology center. One thousand three hundred ninety-one patient cycles undergoing frozen-thawed blastocyst-stage ET cycles. Live-birth rate. The synthetic protocol used GnRH agonist followed by estrogen and P. The natural protocol used monitoring and post-transfer P. The patients in the two protocols had similar baseline characteristics. Multiple linear regression showed the synthetic protocol to have a higher live-birth rate (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.02-2.09). In patients having two embryos transferred, the synthetic stimulation protocol resulted in a higher live-birth rate per cycle start (32.3% vs. 20.4%; relative risk [RR], 1.58; 95% CI, 1.22-2.06). Similarly, patients with one or two embryos transferred who had additional cryopreserved blastocysts available also had a higher live-birth rate per cycle start (36.1% vs. 12.1; RR, 2.98; 95% CI, 1.16-7.63). The synthetic hormone protocol was associated with a higher live-birth rate when compared with a natural cycle protocol for frozen-thawed blastocyst-stage ET cycles. This improvement persisted when analysis was controlled for cycle cancellation. The synthetic stimulation protocol for frozen-thawed embryo cycles offers improved outcome results for patients.

Thyroid Hormone Resistance and Pituitary Enlargement After Thyroid Ablation in a Woman on Levothyroxine Treatment

We report a patient with inappropriate secretion of thyrotropin (TSH) and a pituitary mass. Although she had been treated for biochemical hyperthyroidism with thyroid surgery and radioiodine ablation, she had never complained of specific symptoms or demonstrated signs of overt thyroid dysfunction. On evaluation, she had increased free thyroxine and TSH levels, normal serum glycoprotein alpha-subunit levels, and a significant TSH over-response to exogenous thyrotropin-releasing hormone stimulation. Magnetic resonance imaging with gadolinium enhancement showed a pituitary enlargement with suprasellar extension. An indium In 111 pentetreotide scan showed an abnormal focus of radionuclide accumulation in the pituitary area. Sequencing of the TRbeta gene showed that the patient was heterozygous for a new single nucleotide substitution resulting in the replacement of the normal arginine with a serine at amino acid 320 (R320S). We review the difficulties encountered in establishing a correct diagnosis in patients with inappropriate secretion of TSH in combination with pituitary enlargement. Due to its possible false-negative results, we do not recommend the use of indium In 111 pentetreotide as a tool in the differential diagnosis of inappropriate secretion of TSH.

THE MOUSE OVARIAN SURFACE EPITHELIUM IS HETEROGENEOUS AND CONTAINS A POPULATION OF BETACATENIN SIGNALING AND CYTOKERATIN-14 POSITIVE CELLS

Wnts are a family of secreted signaling molecules involved in a number of developmental processes including the establishment of cell fate, polarity and proliferation. Recent studies also implicate wnts in epithelial adult stem cell maintenance, renewal and differentiation. We have shown that a number of wnts are expressed in the ovary, specifically in the membrana granulosa and the ovarian surface epithelium (OSE). Wnts transduce their signal through one of three signaling pathways. The best studied, the wnt/β-catenin pathway, leads to an increase in intracellular β-catenin which acts as a co-transcription factor with members of the Tcf/Lef family. We have used transgenic mice, bearing lacZ-reporter constructs responsive to β-catenin/Tcf binding, to assess wnt/β-catenin-signaling in the ovary. Hence, cells in which wnt/β-cateninsignaling is activated will express β-galactosidase, which can be detected with X-gal staining. Ovaries were obtained from transgenic mice at various ages (1, 5, 10, 15, and 21 days of age), fixed, sectioned and processed for X-gal staining. In addition, sections from adult mice ovaries were assessed for cytokeratin-8 (K8) and −14 (K14) expression using antibodies directed against these microfilaments. Expression of these cytokeratins has been associated with less differentiated (K14) and differentiated (K8) cells in other epithelia. The evaluation of ovarian sections showed β-galactosidase positive cells only in OSE. The proportion of β-galactosidase positive (presumptive wnt/β-catenin-signaling) OSE cells decreased with age. Almost all OSE in new-born ovaries, approximately 40% in 10-day-old but <10% in 21-day-old ovaries were βgalactosidase positive. These age-related changes in staining were confirmed by X-gal staining of intact ovaries. All OSE cells were positive for K8 except for a small population (<10%) that were positive for K14. Interestingly, the K14 positive population was increased by exogenous hormone stimulation of ovulation and, in this case, we also observed cells that appeared to be in transit from K14 positive to K8 positive. We have not determined if the K14 positive and wnt/β-catenin-signaling cells constitute the same population. Based on the fraction of β-galactosidase positive cells and an estimate of the number of OSE cells at each of the ages examined, it appears that the number of wnt/β-catenin-signaling cells remains relatively constant regardless of age. This raises the possibility that the original wnt/β-catenin-signaling cells may give rise to a replacement as well as an expanding population of non-signaling progeny. Taken together, our results indicate that the mouse OSE is heterogeneous and may contain a population of stem/progenitor cells that are needed to generate the definitive OSE and to allow wound repair of this tissue at ovulation. (poster)

Ovarian control for assisted reproduction in the domestic cat and wild felids

Of the 37 felid species, all but the domestic cat are classified as threatened with extinction in all or part of their native range. Additionally, the domestic cat is a valuable model for human biomedical research. Propagating some wild felids as well as domestic cat populations serving as human models is a major challenge primarily due to difficulties in transporting animals between facilities to ensure the pairing of genetically matched individuals, behavioral incompatibility between pairs and low fertility. Artificial insemination (AI) and in vitro fertilization/embryo transfer (IVF/ET) are powerful tools for helping manage rare populations. Developing successful assisted reproductive techniques requires knowledge of the female reproductive cycle and precise control of ovarian activity. Successful ovarian stimulation for AI and IVF/ET has been achieved in at least one-third of all cat species. However, sensitivity to a given gonadotropin treatment appears highly species-specific, and poor responses are common, particularly in felid species that exhibit spontaneous ovulations. Furthermore, current gonadotropin regimens have been demonstrated to perturb female reproductive function often leading to reduced fertility. Overall, ovarian response to exogenous hormonal stimulation has been highly variable, and pregnancy success after AI or IVF/ET remains low (<20%) in most species. Therefore, there is an immediate need to develop improved regimens that would allow more predictable ovarian responses in felids. We contend that recent research involving the use of progestins to control the ovary prior to gonadotropin stimulation shows promise for providing consistent ovarian stimulation in felids.

312. Testosterone secretion in the Australian sea lion

The objectives in this study were to characterize the pattern of testosterone secretion over 24 h in the captive Australian sea lion and to establish whether exogenous hormone stimulation could be used to obtain an index of testosterone secretion in this species. Blood samples were collected from three males at 3-h intervals for 24 h on three occasions at 2-week intervals. Exogenous GnRH, hCG and LH were administered at the end of each 24-h sampling period and changes in circulating testosterone monitored over 5 h. Circulating concentrations of testosterone during 24-h sampling periods were greater (P &lt; 0.01) during darkness than during daylight. Exogenous hCG administered induced a significant rise in circulating concentrations of testosterone. In the 5 h following GnRH, hCG and LH administration, circulating testosterone concentrations reached similar levels to the highest concentrations observed during the respective 24-h sampling periods. These findings have provided evidence of a 24-h pattern of testosterone secretion in the Australian sea lion. This study has also shown that the testis response to exogenous GnRH, hCG and LH in the Australian sea lion can provide an index of the prevailing testosterone biosynthetic capacity of the testes.

Immunohistochemical staining characteristics of the L-selectin ligand in hormonally programmed and natural cycle luteal endometrium

Immunohistochemical staining characteristics of the L-selectin ligand in hormonally programmed and natural cycle luteal endometrium

205A GAME OF CAT AND MOUSE: XENOGRAFTING OF TESTIS TISSUE FROM DOMESTIC KITTENS RESULTS IN COMPLETE CAT SPERMATOGENESIS IN A MOUSE HOST

Loss of genetic diversity due to infertility or the premature death of valuable individuals is a significant problem in the conservation of rare and endangered felid species, as well as in the maintenance of lines of cats used to study inherited feline and human disease. Attempts to overcome loss of genetic diversity have focused on freezing sperm;; however, sperm cannot be collected from immature males. Previously, we reported completion of spermatogenesis in testis tissue from newborn pigs and goats grafted ectopically into host mice (Honaramooz A et al., 2002 Nature 418, 778–781). Xenografting of testis tissue not only serves as a powerful system for the study of spermatogenesis and testicular maturation, but it also provides a previously unavailable system to obtain sperm from immature animals. The objective of the present study was to extend the technique of testis tissue xenografting to the domestic cat as a model animal for felid species. Testes from 1- to 5-wk-old domestic short-haired kittens (n=8) were cut into small fragments (about 1×3mm each), and up to eight fragments were grafted under the back skin of each castrated immunodeficient host mouse (n=12). Histological examination of the testis xenografts was performed between 14 and 36 weeks post-transplantation. From 8 of the 12 recipient mice, 93% of testis tissue grafts were recovered. No grafts were recovered from the remaining 4 mice. At the time of grafting, the seminiferous cords of the donor testis tissue contained only immature Sertoli cells and gonocytes. At 14 weeks after grafting, tubular expansion was evident, caused by the proliferation of Sertoli cells and tubular lumen formation. By 18 weeks after transplantation, the seminiferous epithelium contained spermatocytes, and by 20 weeks, round spermatids were the most advanced types of germ cells. By 36 weeks after transplantation, xenografts of cat testis tissue had completed spermatogenesis and mature sperm were present. In all recipient animals where xenografts were recovered, the weight of the seminal vesicles in the castrated host mice was restored to pre-castration values, indicating that xenografts were capable of releasing biologically active testosterone. These results demonstrate the potential of xenografting to achieve full spermatogenesis in testis tissue from kittens without the necessity of exogenous hormonal stimulation. It was shown previously that sperm recovered from testis xenografts can support fertilization and development (Shinohara T et al., 2002 Hum. Reprod. 17, 3039–3045; Schlatt S et al., 2003 Biol. Reprod. 68, 2331–2335). Therefore, sperm production in a mouse host can provide an alternative for germ line preservation from immature felids where sperm cryopreservation is not an option. Sperm recovered from xenografts can be used for assisted reproduction, thereby making it possible to produce offspring from immature males.

Adrenocortical insufficiency in infants with congenital diaphragmatic hernia: A pilot study

Background/Purpose: Prior reports have documented that premature infants do not have normal serum levels of cortisol. In contrast, full-term infants usually have adequate cortisol levels. The stress response in critically ill infants may be vital to their recovery. The purpose of this pilot study was to determine whether critically ill full-term infants with congenital diaphragmatic hernia (CDH) show a subnormal adrenal stress response.Methods: Random serum cortisol levels in infants with CDH (n = 10) were measured using fluorescent polarization immunoassay. In addition, serum cortisol levels were measured after exogenous adrenocorticotropic hormone stimulation (Cosyntropin stimulation test).Results: Six of the 10 infants studied died. Most (79%) of the cortisol levels were subnormal (<7 μm/dL). Although no significant differences in mean cortisol levels from terminally ill infants compared with surviving infants were detected, survivors tended to have higher cortisol levels. Cosyntropin stimulation resulted in inappropriately low cortisol levels in 2 of the 4 fatally ill patients tested (<30 μgm/dL) and normal responses in the 2 survivors tested.Conclusions: Infants born with CDH may have an inadequate adrenal stress response despite a life-threatening anomaly. A large-scale prospective study may be warranted to confirm this apparent association. Corticosteroid therapy may be beneficial in this population of patients.

Salivary vs. serum cortisol for the assessment of adrenal activity in swine

The efficacy of salivary cortisol analyses for assessment of the hypothalamic-pituitary-adrenal (HPA) response to stimulation is compared to serum cortisol measurement. Matched samples of serum and saliva were collected from pigs (n = 6) subjected to exogenous adrenocorticotrophic hormone (ACTH) stimulation (i.v. 200 IU) and snaring. Salivary cortisol responses to handling and transport (1 h) were measured in a further 10 pigs. Saliva samples were collected before and after handling and transport. There were significant correlations between serum and salivary cortisol values, following ACTH stimulation (r = 0.8813, P &lt; 0.025), and snaring (r = 0.7964, P &lt; 0.05). The overall ratio of saliva to serum cortisol was 9%. The saliva:serum cortisol ratio was concentration dependent. In pre-stimulation samples the ratio was 8.6% and at maximal concentrations was 13.3%. Handling and transport stress stimulated increases in salivary cortisol concentrations. Differences between pre- and post-transport concentrations were significant (P &lt; 0.0001). Variation in the concentration of cortisol-binding globulin (CBG) is an important factor for the interpretation of adrenal response. Salivary "free" cortisol may be a better indicator of stress than "total" cortisol measured in blood samples. Key words: Saliva, cortisol, pig, ACTH, transport, stress

High success with gestational carriers and oocyte donors using synchronized cycles

Our purpose was to determine if exogenous hormone stimulation of the endometrium improves the implantation and pregnancy rate with a host uterus or gestational carrier. Nine couples underwent 14 embryo transfer cycles with a gestational carrier. The median age was 31.3 years for the infertile women donating the oocytes and 36.6 years for the gestational carriers. Eight pregnancies were achieved documented by ultrasound confirmation of cardiac activity. The pregnancy rate was 64.3%, with 1.6 cycles per patient. We show that synchronized exogenous hormone stimulation of the gestational carrier improves the success rate of embryo transfer. When the success rate is compared to a timed embryo transfer with the gestational carrier's natural cycle, from previous reported studies, exogenous hormonal stimulation appears to enhance endometrial receptivity and improve the implantation rate.

Correction of the Growth Defect in Dwarf Mice with Nonautologous Microencapsulated Myoblasts—An Alternate Approach to Somatic Gene Therapy

Most of the currently approved human gene therapy protocols depend on genetic modification of autologous cells. We propose an alternate and potentially more cost-effective approach by implanting genetically modified "universal" cell lines to deliver desired gene products to nonautologous recipients. The recombinant allogeneic cells are protected from rejection after implantation by enclosure within immuno-protective alginate-poly-L-lysine-alginate microcapsules. The clinical efficacy of this strategy is now demonstrated by implanting microencapsulated allogeneic myoblasts engineered to secrete mouse growth hormone into the growth hormone-deficient Snell dwarf mice. The treated mutants attained increases in linear growth, body weights, peripheral organ weights, and tibial growth plate thickness significantly greater than those of the untreated controls. Secondary response to the exogenous growth hormone stimulation also resulted in increased fatty acid metabolism during the first month post-implantation. The microcapsules retrieved after about 6 months of implantation appeared intact. The encapsulated myoblasts retained a viability of > 60% and continued to secrete mouse growth hormone. Thus, implantation of nonautologous recombinant cells corrected partially the pleiomorphic effects of a transcription factor mutation in the Snell dwarf mice and the encapsulated cells remained functional for at least 6 months. This simple method of delivery recombinant gene products in vivo is a benign procedure, obviates the need for patient-specific genetic modification, and is amenable to industrial-scale quality control. It should have wide applications in therapies requiring a systemic continuous supply of recombinant gene products.

Effects of pantoprazole on endocrine function in healthy male volunteers

In a randomized, double-blind, two-period crossover study, pantoprazole 40 mg or placebo were given orally to 12 male volunteers for 2 weeks each. There was a wash-out period of at least 1 week between the two treatment periods. The effects of pantoprazole or placebo on cortisol and testosterone (primary criteria), and tri-iodothyronine, thyroxine, thyroid-stimulating hormone, thyronine-binding protein, parathyroid hormone, insulin, glucagon, renin, aldosterone, follicle-stimulating hormone, luteotrophic hormone, prolactin and somatotrophic hormone were compared. In addition, intragastric 24-h pH, 24-h H(+)-activity, and volume of nocturnal gastric juice were determined by gastric aspiration technique. Pantoprazole did not influence plasma levels of testosterone, circadian cortisol concentrations or plasma cortisol levels after exogenous adrenocorticotropic hormone stimulation, as compared to placebo (P > 0.05, Koch's test). Furthermore, there were no clinically relevant changes with any of the other endocrine parameters. Pantoprazole significantly increased the median 24-h pH (group median 4.3 vs. 1.8; P < 0.001) and decreased 24-h H(+)-activity (4.0 vs. 22.6 mmol/L; P < 0.001). The volume of nocturnal gastric juice did not significantly differ between the two treatments. Pantoprazole was well tolerated and the frequency of adverse events was similar to placebo. No drug-related changes in laboratory values were observed. Pantoprazole did not influence endocrine function in healthy male volunteers during short-term treatment.

Kallmann’s syndrome: pregnancy achieved through gamete intrafallopian transfer

This case report describes the use of GIFT to achieve pregnancy for a man with Kallmann's syndrome who obtained only marginal sperm counts with both the pulsatile GnRH infusion pump and gonadotropin injections. Failure of this man to achieve a pregnancy with hormonal therapy alone and in combination with IUI suggests that assisted reproductive technologies should be considered in male patients with Kallmann's syndrome when suboptimal sperm concentrations are achieved despite exogenous hormonal stimulation.