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QUANTITATIVE AND QUALITATIVE CHANGES IN LH SECRETION FOLLOWING PULSATILE GnRH THERAPY IN A MAN WITH IDIOPATHIC HYPOGONADOTROPHIC HYPOGONADISM
Author(s) -
TSATSOULIS A.,
SHALET S. M.,
TALBOT A.,
ROBERTSON W. R.
Publication year - 1989
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/j.1365-2265.1989.tb03738.x
Subject(s) - hypogonadotrophic hypogonadism , endocrinology , medicine , pulsatile flow , testosterone (patch) , gonadotropin , gonadotropin releasing hormone , luteinizing hormone , hormone
SUMMARY The pattern of bioactive and immunoreactive LH secretion before and during pulsatile GnRH therapy (18 μg/90 min) in a hypogonadotrophic hypogonadal male has been studied. Before treatment the patient was azoospermic and had low testosterone (1.2 nmol/1) with low and apulsatile immunoreactive LH (1.9 ± 0.2 IU/1) and FSH (1.4±1.9 IU/1) levels. There was no detectable LH bioactivity. During the first 24 h of GnRH therapy there was a small increase in immunoreactive (5.4±0.8 IU/1) and bioactive (6.7±1.3 IU/1) LH, with an irregular pattern and little effect on testosterone production (2.2 nmol/I). Within 1 week of treatment both bioactive (30.5±6.8 IU/1) and immunoreactive (13.6±1.5 IU/1) LH levels were above the normal range and the pattern of secretion was pulsatile. The bioactive to immunoreactive (B:I) LH ratios within the pulses (2.6±0.3) were higher ( P < 0.01) than between pulses (1.97 ± 0.1) and the testosterone concentration (17.8 ± 2.1 nmol/1) was now normal. At one month LH secretion was similar and testosterone pulses of high amplitude were evident corresponding to high‐amplitude bioactive LH pulses. By 3 months mature spermatozoa (1.3 × 10 6 /ml) were seen in the patient's semen. The pattern of LH secretion was pulsatile but the levels of bioactive (131 ± 36 IU/1) and immunoreactive (9.5±1.3 IU/1) LH decreased towards the normal range reflecting maturation of the testicular feedback control at the pituitary level. This effect was more pronounced on bioactive rather than immunoreactive LH secretion (57% vs 32% relative decrease). At 6 months LH levels were similar and the sperm count was normal (34 × 10 6 /ml).