Abstract
In an attempt to select the appropriate long-term substitution therapy for ultimately attaining fertility, the inducibility of pituitary gonadotropin (Gn) production by short-term pulsatile administration of GnRH was studied in 9 male adolescents with anterior pituitary deficiencies (APD) including severe hypogonadotropic hypogonadism (HH). Clinical data (ranges): CA 14.3 - 23.3 yrs, BA8.5-18yrs, testisvol. 1.0-10ml. ACTH, TSH and GH deficiency was present in 8, 6 and 9 patients (pts), respectively. Study protocol: (1) Spontaneous nocturnal Gn profile sampled every 20 min, (2) 1st GnRH bolus test, (3) pulsatile GnRH (5 μg every 90 min iv) for 36 h, sampled 30 min after each pulse, (4) 2nd GnRH bolus test. Testosterone (T) determination before (2) and after (3). LH and FSH levels during (1) were prepubertally low in all pts, ranging from 0.9 - 3.2 and 0.9 - 3.0 mIU/ml, respectively. No spontaneous pulses were detected. During (3), mean LH and FSH levels were significantly higher (p<0.00025) in 7 and 9 pts, respectively. Spearman rank correlation of LH and FSH during (3) revealed highly significant increases of LH (p<0.01) in 4 and of FSH (p<0.002) in 5 pts. In all but one pt, T did not increase after (3). It is therefore likely that the HH in 5 out of 9 pts tested is predominantly of hypothalamic, in 4 of pituitary origin. We suggest to use this or a similar protocol applying short-term pulsatile GnRH stimulation in order to select those APD patients whose HH is due to a hypothalamic lesion and thus can be treated by pulsatile GnRH rather than hCG/hMG for achieving fertility.
Article PDF
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Partsch, CJ., Heidemann, P. & Sippell, W. DIAGNOSTIC ADMINISTRATION OF PULSATILE GNRH IN MALE ADOLESCENTS WITH ANTERIOR PITUITARY INSUFFICIENCIES. Pediatr Res 20, 1179 (1986). https://doi.org/10.1203/00006450-198611000-00034
Issue Date:
DOI: https://doi.org/10.1203/00006450-198611000-00034