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Physiologie und Pathophysiologie der Corpus Luteum-Funktion bei der Frau

Physiology and Pathophysiology of Corpus Luteum Function in Women

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Haut als endokrines Erfolgsorgan Gestagene Geriatrische Endokrinologie des Mannes

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Summary

Recent advances in the development of highly sensitive and more specific assays for plasma FSH, LH and HCG and of rapid protein displacement and radio-immunological methods for the determination of steroids permit further knowledge regarding the corpus luteum function during the menstrual cycle and during pregnancy.

In regard to the physiology and pathophysiology of human corpus luteum function the most significant data are summarized:

- Steroid production -

  1. (1)

    The corpus luteum forms progesterone, 20α-dihydroprogesterone, 17α- hydroxyprogesterone, oestradiol-17β and oestrone.

  2. (2)

    From the quantitative aspect the corpus luteum produces primarily progesterone, 17α-hydroxyprogesterone and 20α-dihydroprogesterone.

  3. (3)

    During pregnancy the corpus luteum secretes progesterone until term. At term, however, the progesterone secretion is several times smaller than in the luteal phase of the menstrual cycle.

  4. (4)

    Androstenedione is formed in ovarian tissue and secreted into the blood. A higher secretion of androstenedione, however, by the ovary bearing a corpus luteum has not yet been proven.

  5. (5)

    Probably dehydroepiandrosterone is also formed by the ovary, but it is not established whether this substance is specifically formed by the corpus luteum.

  6. (6)

    It is suggested that the direct secretion of testosterone by the ovary is quite small. At the present time there is no evidence for a specific formation of testosterone by the corpus luteum.

  7. (7)

    The formation of steroid sulfates in the ovary has not been shown until now.

- Steroid production during various stages of the menstrual cycle and of pregnancy -

  1. (8)

    The majority of recent plasma progesterone data indicates that progesterone is already formed by the Graafian follicle prior to ovulation.

  2. (9)

    Progesterone production increases until the middle of the luteal phase of the cycle. If implantation of the fertilized egg does not occur, the production of progesterone steadly decreases until menstruation. In the case of implantation of the egg, there is an increased production of progesterone by the corpus luteum shortly after this process.

  3. (10)

    The corpus luteum graviditatis forms more progesterone, at least in the first weeks of pregnancy, than the corpus luteum mentruationis. Reliable information regarding the luteal part in total progesterone production in early pregnancy is not available at the present time.

  4. (11)

    The relationship between progesterone and 20α-dihydroprogesterone is changed in pregnancy in comparison to the menstrual cycle.

  5. (12)

    The formation of 17α-hydroxyprogesterone appears to be increased at the time of ovulation and in the luteal phase of the cycle. Furthermore the production of this substance is probably augmented by the early corpus luteum graviditatis.

  6. (13)

    Oestrogens are predominantly formed during the phase of ovulation and in the middle of the luteal phase of the cycle. A reliable differentiation between the luteal and placental part of oestrogen production during early pregnancy is not possible at this time.

  7. (14)

    Available data concerning the question of changes in androgen production during the menstrual cycle and during pregnancy are not sufficient.

- Circadian variations in plasma steroids during the luteal phase of the cycle and during pregnancy -

  1. (15)

    There is no significant change in peripheral plasma progesterone concentration during the luteal phase of the cycle and during early pregnancy. In the last trimester of pregnancy, however, a significant increase in plasma progesterone concentration is observed between 4 p.m. and 8 p.m.

  2. (16)

    In regard to diurnal variations of plasma oestrogens during the luteal phase of the cycle and in early pregnancy, no data are available. In late pregnancy a higher plasma oestriol concentration is observed in the morning.

  3. (17)

    Significant changes in diurnal plasma testosterone concentration do not seem to occur during the luteal phase of the menstrual cycle.

- In vitro steroid biosynthesis -

  1. (18)

    Under in vitro conditions, the synthesis of several steroids including progesterone, androstenedione, oestradiol-17β and oestrone from acetate has been demonstrated in human corpus luteum menstruationis and graviditatis.

  2. (19)

    In vitro steroid biosynthesis appeared to be increased in corpora lutea graviditatis as compared to corpora lutea menstruationis.

  3. (20)

    Under the influence of HCG the in vitro incorporation of acetate into steroids is significantly increased in corpora lutea menstruationis and graviditatis.

  4. (21)

    As shown in many in vitro experiments, the main pathway of steroid biosynthesis in the corpus luteum via progesterone — 17α-hyproxyprogesterone — androstenedione — oestradiol-17β is well established.

  5. (22)

    In addition a second pathway of steroid synthesis in the corpus luteum via 17α-hydroxypregnenolone — dehydroepiandrosterone is discussed.

- Regulation of the corpus luteum function under physiological conditions -

  1. (23)

    Probably there exists a close correlation between the LH peak in the ovulatory phase and the transformation of the Graafian follicle into a corpus luteum.

  2. (24)

    At present it is unknown which factors determine the life span of the corpus luteum during the menstrual cycle.

  3. (25)

    The development of the corpus luteum and its maintenance in early pregnancy appear to be dependent upon the formation of HCG by the trophoblast.

  4. (26)

    It is most likely that HCG stimulates progesterone synthesis in the corpus luteum, at least in the earliest stages of pregnancy.

- Corpus luteum insufficiency -

  1. (27)

    The present knowledge about malformation and functional insufficiency of the human corpus luteum is poor. Some recent results indicate that disturbances in the regulative mechanisms as well as in the production of steroids are associated with corpus luteum insufficiency. The plasma concentration of progesterone and 17α-hydroxyprogesterone is significantly lower in women with short luteal phases.

  2. (28)

    The aim of this presentation was to demonstrate some significant aspects of the physiology and pathophysiology of human corpus luteum function.

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    Josef Zander & Benno Runnebaum

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Zander, J., Runnebaum, B. (1971). Physiologie und Pathophysiologie der Corpus Luteum-Funktion bei der Frau. In: Kracht, J. (eds) Haut als endokrines Erfolgsorgan Gestagene Geriatrische Endokrinologie des Mannes. Symposion der Deutschen Gesellschaft für Endokrinologie in Hamburg vom 4.–6. März 1971, vol 17. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-95216-6_9

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