EPISODIC LUTEINIZING-HORMONE SECRETION IN MAN - PULSE ANALYSIS, CLINICAL INTERPRETATION, PHYSIOLOGIC MECHANISMS
EPISODIC LUTEINIZING-HORMONE SECRETION IN MAN - PULSE ANALYSIS, CLINICAL INTERPRETATION, PHYSIOLOGIC MECHANISMS
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DOI：
10.1172/jci107454
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发表时间：
1973-01-01
影响因子：
15.9
通讯作者：
BARDIN, CW
中科院分区：
文献类型：
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作者：
SANTEN, RJ;BARDIN, CW
垂体促黄体生成素（LH）的释放是间歇性的，而不是恒定的，这一事实提出了关于脉冲式LH分泌的生理控制及其在性腺疾病患者中可能发生的改变的基本问题。为了评价这种LH分泌模式，建立了分析LH脉冲幅度、频率、形状和面积的定量方法，并用于研究正常受试者和促性腺激素分泌障碍患者。在正常男性、月经周期卵泡期女性、促性腺激素过多和过少、多毛症和闭经患者中观察到类似的LH分泌模式（从最低点到最高点的平均脉冲幅度为39-179%，频率为2.7-3.9分泌峰/6 h）。这些观察结果表明，LH分泌的模式是相似的，在这两个正常的个人和在那些与各种病理条件。相比之下，脉冲式分泌的模式似乎在以下条件下不同。高振幅（333±170%）和低频率（1.6±0.24 SEM/6 h）的LH脉冲是女性月经周期黄体期分泌模式的特征，提示性腺激素可能调节LH脉冲。在神经性厌食症患者中观察到低幅度（26±2.1%）和低频率（1.3±0.36/6 h）的LH脉冲，无论是综合测定LH水平还是多个样本的平均LH水平，都比单次测定LH水平更能准确地反映促性腺激素的分泌。在6小时内多次采样，可以将LH估计值的95%置信限从±50-90降至± 12%。这使得正常受试者与LH水平低或中度升高的患者区分开来，其中单个样本中的促性腺激素水平通常在“正常范围”内。研究了LH脉冲分泌的生理控制的几个方面。促卵泡激素（FSH）与LH脉冲的一致性随着LH脉冲高度的增加而逐渐增加（P< 0.01），这表明促性腺激素脉冲可能是下丘脑介导的。LH的“表观半衰期”分泌高峰后的测量显示，半衰期为34-233分钟。这是可能的，这种变异性是由于至少有两种现象：（a）恒定的低水平LH分泌后，继续某些分泌事件，但不是其他人;（B）可变混合新分泌的LH到至少两个池。α肾上腺素能阻断剂氯丙嗪和酚妥拉明在足以导致正常男性收缩压下降30 mm的剂量下未能阻断LH分泌峰。图片
The demonstration that luteinizing hormone (LH) release from the pituitary is episodic rather than constant raises fundamental questions regarding the physiologic control of pulsatile LH secretion and its possible alteration in patients with gonadal disorders. To evaluate this mode of LH secretion, quantitative means of analyzing LH pulse amplitude, frequency, shape, and area were established and utilized to study normal subjects and patients with disorders of gonadotropin secretion. Similar patterns of LH secretion were observed in normal men, in women during the follicular phase of the menstrual cycle, and in patients with hyper- and hypogonadotropism, hirsuitism, and amenorrhea (mean pulse amplitude 39-179% from nadir to peak, frequency 2.7-3.9 secretory spikes/6 h). These observations suggested that the pattern of LH secretion is similar in both normal individuals and in those with a variety of pathologic conditions. By contrast, the pattern of pulsatile secretion appeared to differ in the following conditions. LH pulses of higher amplitude (333±170%) and lower frequency (1.6±0.24 SEM/6 h) characterized the secretory patterns of women during the luteal phase of the menstrual cycle, suggesting that gonadal steroids may modulate LH pulses. LH pulses of low amplitude (26±2.1%) and frequency (1.3±0.36/6 h) were observed in women with anorexia nervosa.Either integrated LH levels or ameanLH level determined from multiple samples provided a more accurate reflection of gonadotropin secretion than the use of single LH measurements. With multiple sampling over 6 h, it was possible to reduce the 95% confidence limit of LH estimates from ±50-90 to ±12%. This allowed normal subjects to be distinguished from patients with low or moderately elevated LH levels in whom gonadotropin levels in single samples were often in the “normal range.”Several aspects of the physiologic control of pulsatile LH secretion were studied. The concordance of follicle-stimulating hormone (FSH) with LH pulses progressively increased as LH pulse height increased (P< 0.01) suggesting possible hypothalamic mediation of gonadotropin pulses. Measurement of the “apparent half-life” of LH after secretory spikes revealed half times of 34-233 min. It is likely that this variability was attributable to at least two phenomena: (a) constant low level LH secretion that continued after certain secretory episodes but not others; (b) variable mixing of newly secreted LH into at least two pools. The alpha adrenergic-blocking agents, chlorpromazine and phentolamine, failed to block LH secretory spikes at doses sufficient to result in a 30 mm drop in systolic blood pressure in normal men.Images