Abstract
Important aims of CAH therapy are normal puberty and gonadal function. To study the hypothalamo-pituitary axis, we applied a combined GnRH/TRH bolus test to 12 patients with SCAH (9♀, 3♂), age 1.3 to 16.8 yrs, and to a group of 135 age and sex matched normal children (GnRH 60 μg/m2, TRH 100 μg/m2 i.v.). Plasma LH (IRP 68/40), FSH (IRP 78/549) and PRL (WHO 75/249) were measured by RIA at 0 and 30min. All except one male CAH pt were medically well controlled as shown by plasma androgens, 17-OHP, PRA, bone age and growth rate. Results: All SCAH pts showed normal LH and FSH levels relative to their pubertal stage. PRL in normal children over 2 yrs of age ranged from 2.1 - 14.8 ng/ml (5.5 ± 2.3; x̄ ± SD) at time 0 and from 7.3 - 48 ng/ml (26.2 ± 8.9) at 30 min with no difference in sex, age or stage of puberty. SCAH pts showed significantly higher (P< 0.001) PRL levels of 7.3 - 24.5 ng/ml (11.4 ± 6.1) at time 0 and of 26.8 - 100 ng/ml (62 ± 24) at 30 min. The highest PRL levels were seen in the postmenarcheal patients. Conclusion: Hyperprolactinaemia and hyperandrogenism so far have been reported in patients with hirsutism but not in patients with CAH. Our patients did show hyperprolactinaemia despite normal androgens. Intermittently increased production of androgens, progestins and/or CRF/ACTH might lead to hypothalamic dysfunction and thus to PRL oversecretion.
(Study supported by the Deutsche Forschungsgemeinschaft)
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Lorenzen, F., Schröder, G. & Sippell, W. Elevated Prolactin (PRL) and normal gonadotropin levels in salt-wasting congenital adrenal hyperplasia (SCAH). Pediatr Res 18, 1226 (1984). https://doi.org/10.1203/00006450-198411000-00153
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DOI: https://doi.org/10.1203/00006450-198411000-00153