心因性無月経の新しい鑑別法

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The clinical use of SU 4885 (2-methyl-1, 2-bis- (3-pyridy1) -1-propane) furnishes a new diagnostic test for the indirect evaluation of ACTH pituitary function, provided the adrenal can be assumed to be normal. An increment of 17-ketosteroids is the final result of the enzymic block artificially produced by administration of SU 4885. This is the normal response in a normal pituitary adrenal axis. On the other hand, if a pituitary lesion exists with anatomic destruction of the pituitary, the increment in ACTH levels following administration of this drug is absent or diminished when compared with that in a normal individual. The urinary excretion of 17-ketosteroids is only slightly elevated or not elevated at all during the test performance. Amenorrhea due to psychogenic or neurogenic factors is frequently associated with laboratory findings indicative of total pituitary insufficiency and is in no way different from those associated with destructive pituitary lesions. The SU 4885 test for pituitary reserve function might serve as a diagnostic aid under these circumstances. Three patients having amenorrhea of undetermined central etiology were given a test for pituitary reserve function using SU 4885. Case reports : (1) Y.K. This patient is a 21-year-old unmarried woman complaining of primary amenorrhea. Since September 1962, she had been treated by hormone (once a week, total 15 times), but she had not menstruated. The family history was noncontributory ; there are 5 brothers and sisters with no history of amenorrhea or menstrual irregularities. As for her past history, she suffered from chicken-pox at the age of 3 years. The physical examination showed a normally developed, rather poorly nourished thin woman weighing 44 Kg, 160 cm, with normal axillary and minimal pubic hair, slight hirsutism of the limbs and no facial acne. The breasts were poorly developed. The pelvic examination showed hypoplastic external genitals. The uterus was small. The x-ray showed a normal sella. The protein-bound iodine was normal (6.0 mg per dl.). Basal temperature records were monophasic. (2) M.H. This patient is a 34-year-old unmarried woman complaining of primary amenorrhea. The family history was noncontributory in that there are 4 brothers and sisters with no history of amenorrhea or menstrual irregularities. As for her past history, she suffered from idiopathic thrombopenic purpura and was in the hospital under treatment. The physical examination showed a hypoplastic woman weighing 33.7 Kg, 136 cm, with no pubic hair and minimal hair on other parts, and no acne. The breasts were poorly developed. On pelvic examination, the external genitals, vagina and uterus were hypoplastic. The x-ray showed a normal sella turcica. The protein -bound iodine was normal. Basal temperature records were monophasic. (3) K.N. This patient was a 21-year-old unmarried woman whose major complaint was secondary amenorrhea. The family history was noncontributory. Her past history was insignficant. Since she had trouble with her marriage on May, 1963, she has been becoming amenorrhea. The physical examination showed a normally developed, moderately nourished woman weighing 46.5 Kg, 154 cm, without hirsutism except for slight hirsutism on the lower limbs and with scarce facial acne. The breasts were moderately developed. On pelvic examination the external genitals were normal, the uterus was anteverted, normal in size. The total urinary 17-ketosteroids were 6.4 mg. per 24 hours and the protein-bound iodine was high ; 8.5 mg. per dl. Basal temperature records were monophasic. Methods and results of experiments : A SU 4885 test was performed 750 mg. every 6 hours during 24 hours. Several methods have been reported for the determination of total urinary 17-keto-steroids. Of these, the Drekter method was chosen, which made it possible to determine simply and rapidly with a small amount of urine.
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心因性無月経の新しい鑑別法

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