Pulsatile gonadotropin secretion in women with hypothalamic amenorrhea: evidence that reduced frequency of gonadotropin-releasing hormone secretion is the mechanism of persistent anovulation.
Pulsatile gonadotropin secretion in women with hypothalamic amenorrhea: evidence that reduced frequency of gonadotropin-releasing hormone secretion is the mechanism of persistent anovulation.
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DOI：
10.1210/jcem-61-5-851
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发表时间：
1985-11
期刊：
影响因子：
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通讯作者：
Nancy E. Reame;Sue Ellyn Sauder;Gary D. Case;R. Kelch;J. Marshall
中科院分区：
文献类型：
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作者：
Nancy E. Reame;Sue Ellyn Sauder;Gary D. Case;R. Kelch;J. Marshall
下丘脑性闭经（HA）是一种病因不明的临床疾病。诊断需排除已知的垂体和卵巢功能异常。为了确定GnRH分泌异常是否可以解释无排卵和闭经，我们在19名HA患者中每20分钟测量一次血浆促性腺激素，持续10至24小时。还测量了卵巢类固醇和促性腺激素对静脉推注剂量的GnRH（25 ng/kg）的反应。并与正常妇女排卵周期的卵泡早期（EF）和黄体晚期（LL）进行比较。血浆雌二醇低于正常妇女（平均值+/- SE，52 +/- 5 pg/ml）。平均血浆LH低于EF值，FSH高于LL值。HA患者LH脉冲幅度与正常妇女相似。LH脉冲频率与LL时相同，但低于EF时（HA，4.7脉冲/12 h; EF，7.7脉冲/12 h; P <0.05）。除了相似的频率，LH分泌的模式在HA类似的LL的LH脉冲的幅度是高度可变的和脉冲发生在不规则的时间间隔。未发现昼夜促性腺激素分泌的一致变化，9项研究中LH分泌在夜间较高，5项研究中LH分泌在白天较高。对3名患者（5-13个月后）进行的重复研究显示，LH脉冲频率是可变的，1名患者没有变化，1名患者增加，第三名患者减少。因此，LH脉冲频率和GnRH脉冲频率在HA中与正常黄体期相似，尽管类固醇环境不同。GnRH脉冲频率从正常周期的黄体期到卵泡期增加，可能对卵巢卵泡成熟的启动很重要。这些数据表明，缺乏周期性促性腺激素分泌和无排卵的HA导致的频率降低和不规则的幅度的GnRH分泌和随之而来的缺乏卵巢卵泡成熟。
Hypothalamic amenorrhea (HA) is a clinical disorder of unknown etiology. The diagnosis is made by exclusion of known abnormalities of pituitary and ovarian function. To determine if abnormalities of GnRH secretion could account for the anovulation and amenorrhea, we measured plasma gonadotropins every 20 min for 10- to 24-h periods in 19 women with HA. Ovarian steroids and gonadotropin responses to an iv bolus dose of GnRH (25 ng/kg) were also measured. The results were compared to those obtained during the early follicular (EF) and late luteal (LL) phases of ovulatory cycles in normal women. Plasma estradiol was lower (mean +/- SE, 52 +/- 5 pg/ml) than either cycle stage in normal women. Mean plasma LH was lower than EF values and FSH was higher than LL values. The amplitude of LH pulses in HA was similar to that in normal women. LH pulse frequency was the same as that present during the LL, but lower than that during the EF (HA, 4.7 pulses/12 h; EF, 7.7 pulses/12 h; P less than 0.05). In addition to the similar frequency, the patterns of LH secretion in HA resembled that of LL in that the amplitude of LH pulses was highly variable and pulses occurred at irregular intervals. Consistent changes in diurnal gonadotropin secretion were not found, and LH secretion was greater at night in 9 studies and during the day in 5 studies. Repeat studies in three patients (5-13 months later) revealed that LH pulse frequency was variable, being unchanged in 1, increased in 1, and decreased in the third patient. Thus, LH pulse frequency and, by inference, GnRH pulse frequency are similar in HA to those in the normal luteal phase despite a different steroid milieu. GnRH pulse frequency increases from the luteal to the follicular phases of normal cycles and may be important in the initiation of ovarian follicular maturation. These data suggest that the absence of cyclical gonadotropin secretion and anovulation in HA result from a decreased frequency and irregular amplitude of GnRH secretion and consequent absence of ovarian follicular maturation.