Abstract
It is still difficult to make an accurate diagnosis of gonadotropin deficiency at prepubertal age. It is important to know in hypopituitary patients if spontaneous puberty will occur or if treatment with sex hormones will be necessary to obtain and adequate response to hGH at pubertal age. Sixteen male patients (chronological age 13.9 - 21.9 years. Bone age 9-18 years) with idiopathic hypopituitarism and 11 normal boys between 14.2 to 16 years (Bone age 11.7 - 13.0 years) with early puberty were studied. Gn-RH infusion (0.83 ug/min) was performed and samples for LH and FSH were obtained at 0, 15′, 30′, 45′, 60′ and 120′. Testosterone levels were determined at the star of the infusion. All hormones were measured by RIA. In the hypopituitary patients group three differents patterns of response were elicited: a) two patients showed a LH response similar to control group (maximal response 18.8 and 31.4 UI/L respectively), b) 8 patients showed an LH response below 5 UI/L (X±SD 1.99±1.44 UI/L). c) 6 patients showed an intermediate LH response (X±SD 7.68±2.97 UI/L). During follow-up patients of group a) underwent normal pubertal progression. No patients of group b) showed pubertal development; In group c) one patient progressed normally into puberty and 3 patients experienced an arrest of pubertal progression. In patients with hypopituitarism the lack of response of LH to Gn-RH infusion at pubertal bone age strongly suggest the diagnosis of gonadotropin deficiency. On the other hand, a normal response excluded this diagnosis. Patients with subnormal LH response to Gn-RH infusion, are probabley affected by a partial gonadotropin deficiency, consequently, a close follow-up and eventually further evaluation is advisable to assure the state of gonadotropin reserve.
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Martínez, A., Domené, H., Heinrich, J. et al. Gn-RH INFUSION, USEFUL TEST IN THE DIAGNOSIS OF GONADOTROPIN DEFICIENCY IN PATIENTS WITH HYPOPITUITARISM. Pediatr Res 28, 419 (1990). https://doi.org/10.1203/00006450-199010000-00027
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DOI: https://doi.org/10.1203/00006450-199010000-00027