An improved computational method to assess pituitary responsiveness to secretagogue stimuli

OBJECTIVE

The quantitative assessment of gland responsiveness to exogenous stimuli is typically carried out using the peak value of the hormone concentrations in plasma, the area under its curve (AUC), or through deconvolution analysis. However, none of these methods is satisfactory, due to either sensitivity to measurement errors or various sources of bias. The objective was to introduce and validate an easy-to-compute responsiveness index, robust in the face of measurement errors and interindividual variability of kinetics parameters.

DESIGN

The new method has been tested on responsiveness tests for the six pituitary hormones (using GH-releasing hormone, thyrotrophin-releasing hormone, gonadotrophin-releasing hormone and corticotrophin-releasing hormone as secretagogues), for a total of 174 tests. Hormone concentrations were assayed in six to eight samples between -30 min and 120 min from the stimulus.

METHODS

An easy-to-compute direct formula has been worked out to assess the 'stimulated AUC', that is the part of the AUC of the response curve depending on the stimulus, as opposed to pre- and post-stimulus spontaneous secretion. The weights of the formula have been reported for the six pituitary hormones and some popular sampling protocols.

RESULTS AND CONCLUSIONS

The new index is less sensitive to measurement error than the peak value. Moreover, it provides results that cannot be obtained from a simple scaling of either the peak value or the standard AUC. Future studies are needed to show whether the reduced sensitivity to measurement error and the proportionality to the amount of released hormone render the stimulated AUC indeed a valid alternative to the peak value for the diagnosis of the different pathophysiological states, such as, for instance, GH deficits.

Intact adrenocorticotropic hormone secretion but impaired cortisol response in patients with active rheumatoid arthritis. Effect of glucocorticoids

OBJECTIVE

To study the hypothalamic-pituitary-adrenal axis in rheumatoid arthritis (RA) and the influence of glucocorticoid treatment.

METHODS

Consecutive untreated patients with RA with moderately high inflammatory activity were studied and compared with healthy subjects of similar age. Subjects were studied both at baseline and after multiple releasing hormone (MRH) stimulations. Patients were reexamined one week after starting prednisolone.

RESULTS

The baseline cortisol/adrenocorticotropic hormone (ACTH) ratio was significantly lower in patients with RA. After corticotropin releasing hormone (CRH) stimulation, their serum cortisol response was reduced during the later test phases in spite of intact ACTH response. The baseline and stimulated levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), and thyroid stimulating hormone (TSH) were normal. An impaired prolactin response was seen after MRH stimulation. After one week of prednisolone therapy the absolute response of serum cortisol to CRH was decreased and the stimulated prolactin response was normalized.

CONCLUSION

Impaired cortisol secretion in patients with RA in the presence of intact ACTH secretion is consistent with relative adrenal glucocorticoid insufficiency. Adrenal impairment may be secondary to the inflammatory disease process.

Effects of atrial natriuretic factor on anterior pituitary hormone secretion in normal man

The effects of intravenous human atrial natriuretic factor ANF(99-126) administration on anterior pituitary hormone secretion have not been extensively investigated in humans. We repeatedly studied 10 healthy volunteers (5 female, 5 male, aged 28 +/- 2 years) on 2 occasions, 3 days apart. In randomized, single blind order, subjects received pretreatment with either placebo or intravenous ANF(99-126) (bolus 100 micrograms/kg, 30-min infusion of 0.1 micrograms/kg.min). Subsequently on both occasions subjects received a combined intravenous bolus injection of pituitary releasing hormones (200 micrograms thyrotropin releasing hormone, 100 micrograms gonadotropin releasing hormone and 100 micrograms human adrenocorticotropin releasing hormone; Bissendorf, Hannover, FRG). Plasma concentrations of adrenocorticotropic hormone (ACTH), cortisol, luteinizing hormone (LH), follicle-stimulating hormone (FSH), growth hormone (GH), thyrotropin (TSH), prolactin, ANF and cyclic guanosine monophosphate (GMP) were determined by radioimmunoassay. ANF(99-126) treatment induced a significant reduction in basal ACTH plasma concentrations and tended to decrease basal plasma cortisol. The TSH response to combined releasing hormone administration was significantly diminished after ANF(99-126) pretreatment. In women, the releasing hormone induced prolactin increase was reduced after ANF(99-126) pretreatment. With the present study design, ANF(99-126) did not alter the basal or releasing hormone stimulated plasma concentrations of cortisol, LH, FSH and GH. Releasing hormone administration did not affect ANF and cyclic GMP plasma levels. In humans, effects of natriuretic peptides on anterior pituitary hormone secretion may have to be considered with investigational or therapeutic administration of ANF analogues or agents interfering with the ANF metabolism.

Suppressive action of gonadotropin-releasing hormone and luteinizing hormone on function of the developing ovine corpus luteum

Experiments were conducted to examine the effects of exogenous GnRH and LH on serum concentrations of progesterone (P4) in the ewe. Ewes in Exp. 1 and 2 were laparotomized on d 2 of an estrous cycle and ewes with corpora lutea (CL) in both ovaries were unilaterally ovariectomized. Ewes with CL in one ovary only were not ovariectomized. While they were anesthetized, ewes (n = 5) were injected with 25 micrograms GnRH (Exp. 1) or 50 ng GnRH (Exp. 2) into the artery supplying the ovary bearing the CL. Control ewes (n = 5 in each experiment) were injected similarly with saline. In Exp. 3, six ewes were injected i.v. (jugular) on d 2 with 100 micrograms oLH (t = 0) and 50 micrograms oLH at 15, 30 and 45 min; six control ewes were injected similarly with saline. Jugular blood was collected from all ewes at frequent intervals after treatment for LH analysis and on alternate days of the cycle through d 10 or 11 for P4 analysis. Treatment with 25 micrograms GnRH increased serum concentrations of LH at 15, 30, 45 and 60 min postinjection (P less than .001) and reduced serum concentrations of P4 on d 7 through 11 (treatment x day interaction; P less than .05). Injection with 50 ng GnRH caused a slight increase in serum concentrations of LH at 15 min but had no effect on serum concentrations of P4.(ABSTRACT TRUNCATED AT 250 WORDS)

[Pulsatile administration of gonadotropin releasing hormone in the female. Diagnostic and therapeutic indications]

Prolonged pulsatile exogenous GnRH allows differentiation between hypothalamic and pituitary causes of hypogonadotrophic hypogonadism and is able to induce ovulation and pregnancy in most of women with hypothalamic amenorrhea (HA). When compared with human menopausal gonadotropin, GnRH appears to be a more efficient therapy of HA but yields inferior results in chronic anovulatory patients with persistent LH secretion. Pulsatile GnRH following a GnRH-analog suppression represents a new promising treatment of infertile women with polycystic ovarian syndrome. However such a combined therapy is time-consuming and only permits to attempt 3 to 4 stimulated cycles during a year. Therefore the successful preliminary reports need to be confirmed by a further randomized study.

[Therapeutic use of a gonadotropin releasing hormone analogue in breast cancer]

Superagonistic analogues of Gn-RH given chronically produce a paradoxic inhibition of pituitary gonadotropin secretion and consequently decrease the peripheric hormones estradiol and progesterone to a postmenopausal level. For curative purposes buserelin (SuprefactR, Hoechst) treatment has been performed by the authors in two cases of breast cancer. The patients--one with NED (no evidence of disease) and the other with pulmonary and osseal metastases--in addition to low hormonal levels developed amenorrhoea. A group of climacteric complaints were observed without any toxic side effects, however. The treatment of premenopausal women suffering from breast cancer with chronic administration of Gn-RH analogues may constitute a valuable alternative to surgical oophorectomy.

Follicle cysts after menstrual versus midluteal administration of gonadotropin-releasing hormone analog in in vitro fertilization

The incidence and behavior of follicle cysts after different timing of gonadotropin-releasing hormone analog (GnRH-a) administration was studied in 321 in vitro fertilization (IVF) cycles. Group M included 198 cycles in which GnRH-a was injected at menstruation. Of these, 171 (88.6%) were without cysts (group M1) and 27 (13.6%) with cysts (group M2). Group L comprised of 123 cycles in which GnRH-a was administered in the midluteal phase. Of them, 70 (56.9%) were without cystic finding (group L1), 19 (15.4%) with follicle cysts (group L2), and 34 cases (27.6%) with visible corpus luteum at the time of GnRH-a initiation (group L3). Both groups with follicle cysts demonstrated a higher luteinizing hormone peak and continuous elevated estradiol (E2) levels. In group M2, the E2 rise and the cysts persisted longer compared with group L2. Gonadotropin treatment was accordingly postponed until the cysts regressed spontaneously. Only two cases of group M2 required aspiration of the cysts. Follicle cyst formation is not related to the timing of GnRH-a administration and their occurrence did not have adverse effects on IVF outcome.

LH responses of female naked mole-rats, Heterocephalus glaber, to single and multiple doses of exogenous GnRH

To investigate possible differential pituitary secretion of LH in breeding and non-breeding female naked mole-rats, the LH responses to administration of exogenous GnRH were measured in 55 females from 20 captive colonies. Single doses of 0.1, 0.5 or 1.0 micrograms GnRH produced a significant rise in plasma LH concentrations 20 min after s.c. injection in breeding and non-breeding females at all doses (P less than 0.001). While at the highest dose of 1.0 microgram there was no difference in the LH response between breeding and non-breeding females, as the dose was lowered there was a progressive decline in the LH response in non-breeding females such that, at the 0.1 microgram dose, GnRH produced only a small, but significant, increase in plasma LH (1.3 +/- 0.2 to 2.9 +/- 0.5 mi.u./ml, N = 5) compared with breeding females (3.4 +/- 0.8 to 9.6 +/- 2.0 mi.u./ml, N = 6). The LH responses of the latter were not significantly reduced at the lower doses of GnRH. The apparent lack of sensitivity to low doses of exogenous GnRH in non-breeding females was reversed by 4 consecutive 1-h injections of 0.1 microgram, which produced a rise in LH from 1.2 +/- 0.2 to 9.0 +/- 0.2 mi.u./ml (N = 4), comparable to that of breeding females given a single injection of 0.1 microgram GnRH. These results suggest that the anterior pituitary in non-breeding female naked mole-rats is less sensitive to low doses of exogenous GnRH than in breeding females, possibly due to a lack of priming by endogenous GnRH. Therefore, the socially-induced block to ovulation in non-breeding female naked mole-rats may be due to inhibition of hypothalamic GnRH secretion.

Long term growth hormone (GH)-releasing hormone and biosynthetic GH therapy in GH-deficient children: comparison of therapeutic effectiveness

Twenty-five GH-deficient children were treated with GHRH (1-44), once daily sc for 6-24 months. At the 6th month of therapy, 40% of our patients showed a catch-up growth (responders), while the remaining 60% did not (nonresponders). No differences in auxological and biological variables at inclusion were found between the two groups. However, integrated GH secretion elicited by iv GHRH at inclusion was significantly (p less than 0.025) higher in responders than in non responders. During GHRH therapy, no significant increase in IGF 1/SmC was found in both groups. In all patients treatment was discontinued after 6-24 months, when its effect on growth rate failed. After a wash-out period of at least 6 months, patients were submitted to biosynthetic GH therapy. After 6 months of GH treatment a significant catch-up growth was found in both responder and non-responder children. Although the majority of GH-deficient children have hypothalamic rather than pituitary dysfunction, GHRH therapy is found to be less effective than GH treatment. Other methods of GHRH administration are worth investigating.

Use of gonadotropin-releasing hormone for hastening ovulation in transitional mares

Natural GnRH and its analog have potential for hastening ovulation in mares. A study was conducted to evaluate the efficacy of a GnRH agonist given either as an injectable or s.c. implant for induction of ovulation in mares. Forty-five seasonally anestrous mares (March) were assigned to one of three groups (n = 15/group): 1) untreated controls; 2) i.m. injection of the GnRH agonist buserelin at 12-h intervals (40 micrograms/injection for 28 d or until ovulation) and 3) GnRH agonist administered as a s.c. implant (approximately 100 micrograms/24 h for 28 d). Six mares per group were bled on d 0, 7, 14 and 21 after injection or insertion of implant. Samples were taken at -1, -.5 and 0 h and at .5, 1, 1.5, 2, 4, 6 and 8 h after GnRH. Additional daily samples were drawn for 28 d after injection or until ovulation. Samples were assayed for concentration of LH and FSH. Progesterone concentrations were determined in samples collected on d 4, 6 and 10 after ovulation. Number and size of follicles and detection of ovulation were determined by ultrasonography. Number of mares induced to ovulate within 30 d was 0 of 15, 7 of 15 and 9 of 15 for groups 1, 2 and 3, respectively. During treatment, follicle sizes were smaller for mares in group 3 (implant). The LH response to GnRH agonist (area under curve) was similar among groups at d 0 but was greater (P less than .05) for mares in group 3 on d 7 and 14 and groups 2 and 3 on d 21 than for controls. A similar pattern was detected for peak concentrations of LH after GnRH on d 0, 7, 14 and 21. Daily concentrations of LH remained low in untreated control mares compared with GnRH-treated mares throughout the sampling period. Concentrations of LH for mares in group 3 that ovulated were elevated greatly above those for group 2 mares, whereas concentrations of FSH were similar in both treatment groups prior to ovulation.

Changes in plasma inhibin levels following pulsatile gonadotrophin-releasing hormone therapy in a man with idiopathic hypogonadotrophic hypogonadism

Changes in circulating inhibin levels were related to changes in testosterone (T) and the gonadotrophins luteinizing hormone (LH) and follicle-stimulating hormone (FSH) in a hypogonadotrophic hypogonadal man before and during pulsatile gonadotrophin-releasing hormone therapy which resulted in normal spermatogenesis. Before treatment, the plasma inhibin levels in the patient (210 +/- 50 U/l; mean +/- SD of four samples) were lower than in normal controls (552 +/- 150 U/l; p less than 0.01), as were T (1.1 nmol/l) and gonadotrophin (less than 1.0 IU/l) levels. Within 1 week of gonadotrophin-releasing hormone treatment, plasma LH (14.1 +/- 0.7 IU/l) and FSH (14.4 +/- 0.6 IU/l) reached supraphysiological levels. In response, T and inhibin concentrations increased progressively to reach high normal levels (27.7 +/- 1.6 nmol/l and 609 +/- 140 U/l) at 4 weeks, by which time the gonadotrophin levels stared to decline and gradually returned to the normal range between 12 and 24 weeks of treatment. There was a concomitant decrease in T and inhibin levels which remained within the normal range. The decline in the FSH level following the rise in testicular hormones was earlier and steeper than that of LH (37.5% decrease at 4 weeks vs. 30.4% at 12 weeks), suggesting that T and inhibin may act together to inhibit pituitary FSH secretion as opposed to LH secretion which is primarily controlled by T. It is concluded that, in man, during maturation of the pituitary-testicular axis, changes in circulating inhibin parallel those of T, and quantitatively normal inhibin secretion is dependent on gonadotrophin stimulation. FSH secretion may be regulated through negative feedback control, by both T and inhibin.

Frequency of administration of growth hormone--an important factor in determining growth response to exogenous growth hormone

Growth hormone (GH) secretion in man occurs in a pulsatile manner with a dominant periodicity of 200 min. Animal studies and growth hormone-releasing hormone therapeutic studies in man demonstrate the importance of the frequency of GH pulses on the growth response observed. Daily injections of GH produce effective growth. More frequent regimens may be beneficial to prevent waining of the growth spurt induced by GH therapy.

[Treatment of functional infertility, caused by luteal deficiency, with pulsatile perfusion of gonadotropin releasing hormone]

The prehistory of cyclical development of corpus luteum goes back to early follicular phase. Reduced secretion or defective rhythm of gonadotropin releasing hormone (GnRH) can later cause unperfect ovulation or corpus luteum insufficiency. The authors carried out a low-dose pulsatory GnRH-treatment on eight patients with luteal insufficiency, who were earlier treated unsuccessfully with other ovulation-inductive methods (clomiphene, hCG, bromocryptin). As a result of GnRH administration hypertherm period expanded, plasma progesteron level increased and three pregnancies occurred. In their opinion exogenic administration of GnRH results in an improvement of luteal function.

Pituitary-testicular axis in obese men during short-term fasting

To investigate whether short-term fasting affects the pituitary-testicular axis in obese subjects, 9 massively obese men (Body Mass Index 39.0 +/- 1.3, mean +/- SEM) were given two identical iv GnRH tests, the first (control) after an overnight fast, the second after 56 h of food deprivation. Short-term fasting augmented the GnRH-induced LH incremental area by 26% (1317 +/- 251 vs 1661 +/- 297 U.l-1.min-1, p less than 0.05), but failed to affect the corresponding testosterone incremental area. Eight non-obese normal men (Body Mass Index 22.2 +/- 0.5) were investigated for comparison. All of them were studied according to the same protocol as the obese group. Short-term fasting increased the GnRH-elicited LH response by 67% in the non-obese group (LH incremental areas 2147 +/- 304 vs 3581 +/- 256, p less than 0.01), and the corresponding testosterone response by 180% (testosterone incremental areas 111 +/- 61 vs 311 +/- 49 micrograms.l-1.min-1, p less than 0.01). These results imply that food deprivation affects the pituitary-testicular axis differently in obese and non-obese men.

Hypothalamic hypogonadism in congenital adrenal hypoplasia

Congenital adrenal hypoplasia (CAHP) in its X-linked form is associated with hypogonadotropic hypogonadism (HH). A 23 year old man with this disorder received substitution therapy with gluco- and mineralocorticoids starting one week after birth and, recently, pulsatile subcutaneous GnRH treatment via a miniature infusion pump with stepwise increasing doses from 50 to 200 ng/kg body weight/2 hours for a total of 394 days. Testosterone levels increased from prepubertal levels to 409 ng/dl after 2 weeks and to 626 ng/dl after 3 months of treatment. The results of pulsatile GnRH therapy in our patient prove the hypogonadotropic hypogonadism to be of hypothalamic origin. Pulsatile GnRH substitution is a successful therapeutic regimen in patients with CAHP leading to pituitary and gonadal maturation.

Participation of arachidonic acid metabolism in gonadotropin-releasing hormone stimulation of goldfish gonadotropin release

Two intraperitoneal injections of a mammalian gonadotropin-releasing hormone (GnRH) analog, [D-Ala6, Pro9-N-ethylamide]-GnRH (mGnRHa; 0.1 micrograms/g), at 12-hr intervals increased serum gonadotropin (GTH) levels in sexually mature and sexually regressed female goldfish 2 and 6 hr after the second injection. This serum GTH response was decreased by the coinjection of a lipoxygenase enzyme inhibitor, nordihydroguaiaretic acid (NDGA: 0.1 to 10 micrograms/g) at the time of the second mGnRHa application. In static cultures of dispersed goldfish pituitary cells, 1-100 microM arachidonic acid (AA) and 0.1-1000 nM [Trp7, Leu8]-GnRH (salmon GnRH, sGnRH) and [D-Arg6, Pro9-N-ethylamide]-sGnRH (sGnRHa) caused dose-dependent increases in GTH release. Additions of 1-40 microM NDGA reduced the sGnRH-stimulated GTH release in a dose-dependent manner, and completely inhibited the GTH response to increasing concentrations of AA. NDGA 40 microM also decreased the elevated GTH levels induced by sGnRHa treatment. Exposure to 10 microM 5,8,11,14-eicosatetraynoic acid, an inhibitor with mixed action on lipoxygenase and cyclooxygenase enzymes, reduced the dose-dependent GTH response to sGnRH and AA. In contrast, coincubation with another cyclooxygenase blocker, indomethacin, at 10 microM, did not alter AA and sGnRH-induced GTH release. These results provide in vivo and in vitro evidence for the participation of AA metabolism in mediating GnRH-stimulated GTH release in the goldfish. The importance of AA metabolism through the lipoxygenase pathway is also indicated.

Ovulation induction with intravenous gonadotropin-releasing hormone

The efficacy of ovulation induction with the use of pulsatile gonadotropin-releasing hormone (GnRH) therapy was examined in 21 infertile women. Seventeen had hypothalamic amenorrhea (HA) and 4 polycystic ovary syndrome (PCO). All patients were treated as outpatients. GnRH was infused in a pulsatile mode by means of portable auto-infusion pumps connected to an indwelling intravenous catheter inserted into a forearm vein. The doses varied from 1.8 to 5 micrograms/pulse with a frequency of 90 minutes. Ovulation occurred in 52 out of 64 cycles (81.2%). Ten (47.6%) of the 21 patients became pregnant. Seven patients had normal term deliveries and 3 aborted spontaneously. With regard to the 17 patients with HA, ovulation occurred in 93.7% of treatment cycles and 6 women became pregnant. In the case of the PCO patients, ovulation was achieved in 6 out of 15 cycles (40%) and 2 women became pregnant. There was no overstimulation or any other serious complication. In conclusion, therapy with GnRH provides an elevated probability of therapeutic success, especially in HA.

Closed intravenous administration of gonadotropin-releasing hormone: safety of extended peripheral intravenous catheterization

The use of pulsatile gonadotropin-releasing hormone is an effective means of inducing ovulation, but requires prolonged intravenous (IV) or subcutaneous administration. We hypothesized that the use of self-contained infusion pumps using fluids maintained in a closed system would permit safe peripheral IV administration of gonadotropin-releasing hormone, and possibly other hormones, over prolonged intervals. Thirty-eight female patients undergoing pulsatile IV gonadotropin-releasing hormone therapy were followed for 1958 catheter days (230 catheters). Catheters were removed for signs of local inflammation, at the completion of a treatment episode or, initially, at routine intervals of 7-10 days. There were no episodes of fever (temperature over 37.5C) and three episodes of local inflammation. The incidence of significant catheter-tip cultures was 11%, and none were associated with local inflammation. There were four positive blood cultures (2%), none associated with local or systemic signs of infection. We conclude that the use of a closed system of prolonged peripheral IV cannulation is relatively safe when combined with fastidious care of the catheter site and careful outpatient monitoring for long-term administration of pulsatile gonadotropin-releasing hormone.

Acute dexamethasone suppression of ACTH secretion stimulated by human corticotrophin releasing hormone, AVP and hypoglycaemia

In order to obtain more insight into the mechanisms regulating endogenous ACTH secretion in humans we studied the inhibitory effect of acute i.v. dexamethasone administration on ACTH release under various conditions. Six male volunteers were subjected to six different protocols. After combined i.v. injection of 100 micrograms corticotrophin releasing hormone (CRH) and 100 micrograms growth hormone releasing hormone (GRH) there was the expected rise in ACTH (area under the curve, 1053 +/- 204 (SE) (pmol/l) min) and cortisol (59788 +/- 10098 (nmol/l) min) rise which was suppressed by prior i.v. injection of 2 mg dexamethasone (ACTH: 444 +/- 63 (pmol/l) min; cortisol: 28528 +/- 2152 (nmol/l) min). Insulin hypoglycaemia (IH) led to a more pronounced ACTH and cortisol rise compared with CRH (6307 +/- 817 (pmol/l) min and 82080 +/- 21934 (nmol/l) min, respectively) which was not completely suppressed by prior pretreatment with dexamethasone (ACTH, 580 +/- 103 (pmol/l) min; cortisol: 55649 +/- 5821 (nmol/l) min). Combined AVP/CRH injection (10 IU/100 micrograms) after pretreatment with dexamethasone (344 +/- 41 (pmol/l) min for ACTH; 32832 +/- 3173 (nmol/l) min for cortisol) could not reproduce the ACTH secretion following IH after pretreatment with dexamethasone (579 +/- 103 (pmol/l) min for ACTH and 55649 +/- 5821 (nmol/l) min for cortisol). In all subjects a saline control with 2 mg dexamethasone was performed. These findings confirm the acute inhibitory effect of glucocorticoids on CRH-stimulated ACTH secretion. Since CRH-induced ACTH secretion is almost completely abolished by administration of dexamethasone the ACTH rise following IH after dexamethasone can not be mediated by endogenous CRH alone. Moreover, since the addition of AVP to CRH (after dexamethasone suppression) could not reproduce the ACTH rise during IH after dexamethasone pretreatment, an additional, yet unknown factor stimulating ACTH secretion may be involved. In the same protocols, no significant difference could be observed comparing IH and GRH induced GH secretion (4948 +/- 1172 (mU/l) min vs 3596 +/- 820 (mU/l) min, NS); furthermore, in contrast to results obtained by chronic steroid administration, acute i.v. dexamethasone pretreatment did not affect IH or GRH-induced GH secretion (4110 +/- 666 (mU/l) min vs 2916 +/- 462 (mU/l) min, NS). The GRH-stimulated GH secretion (3596 +/- 820 (mU/l) min) was not suppressed by prior intravenous treatment with dexamethasone (2916 +/- 504 (mU/l) min, NS).

The effects of pulsatile GnRH infusion upon the diurnal variations in serum LH and testosterone in pre-pubertal and pubertal boys

The aim of the present study was to determine the effects of exogenous GnRH pulsatile infusions on the diurnal variations of LH and testosterone secretion which occur in late pre-puberty and early puberty. GnRH infusions were administered to 12 short stature males in pre-puberty or early puberty, over 6-day periods. In 6 patients, GnRH doses of 2.5, 7.5 and 15 micrograms/pulse were used and 24-h profiles of serum LH and testosterone were measured before and at the end of the infusions. In the remaining 6 patients GnRH was administered at a dose of 7.5 micrograms/pulse and profiles between 21.00 and 06.00 h the following day were determined. Pre-infusion profiles demonstrated nocturnal LH and testosterone rises in all patients. Median pre-infusion serum LH prior to midnight was 2.2 U/l (range 1.0-5.4) rising to 3.7 U/l (range 1.9-10.7) during GnRH administration (p less than 0.005). After midnight, median pre-treatment serum LH concentration was 4.3 U/l (range 2.7-7.5) which remained unaltered by GnRH administration (median 4.8 U/l, range 2.9-7.9, p greater than 0.05). Median pre-therapy serum testosterone before midnight was 0.8 nmol/l (range 0.1-7.1) rising significantly (p less than 0.05) to 4.1 nmol/l (range 0.2-8.0). Following therapy, post-midnight median serum testosterone rose from 4.8 (range 0.4-9.4) to 7.0 nmol/l (range 0.5-13.9, p greater than 0.05). Diurnal variation in LH and testosterone secretion, therefore, is maintained during exogenous GnRH administration to pre-pubertal and pubertal boys. Response to exogenous GnRH pulses may be significantly influenced by endogenous GnRH.

Induction of ovulation with gonadotrophin-releasing hormone--life-table analysis of 50 courses of treatment

Ovulation induction by means of the pulsatile subcutaneous administration of gonadotrophin-releasing hormone by way of an infusion pump is described. The clinical outcome in 50 courses of treatment, which totalled 116 treatment cycles, was analysed and was compared with the pregnancy rates that were obtained with the administration of human pituitary gonadotrophins. We found that the pregnancy rates for these two treatments were similar. We also have shown that for those women who ovulated as a result of such treatment the conception rates were similar to those in ovulatory women who had discontinued contraception. We conclude that gonadotrophin-releasing hormone has an important place among the ovulation-induction agents.

[Changes in the prolactin level under the effect of pulsatile infusion of gonadotropin releasing hormone]

Plasma prolactin levels were measured in 18 GnRH loading tests and, in 24 cycles involving treatment with GnRH. During 17 GnRH loading tests the prolactin levels production remained virtually unchanged, the individual GnRH pulses not raising the prolactin level. In one case the GnRH loading test led to a considerable rise in prolactin level, which is considered to be a pathological prognostic sign as concerns subsequent GnRH treatment. During unsuccessful pulsatile GnRH treatment, the prolactin secretion in monotonous, while treatment resulting in ovulation, even in hyperprolactinaemia cases, is accompanied by higher prolactin levels in the preovulation and luteal periods than in the early follicular phase.

Recovery of hormone secretion after chronic gonadotropin-releasing hormone agonist administration in women with polycystic ovarian disease

Persistent suppression of gonadotropin and ovarian steroid production can be achieved in women with polycystic ovarian disease (PCO) by daily administration of a long-acting GnRH agonist (GnRHa). This study was designed to determine the patterns of recovery of clinical responses and hormonal secretion after chronic GnRHa administration in women with PCO. Six women with PCO were treated with daily sc injections of [D-His6(imBzl),Pro9-NEt]GnRHa (100 micrograms) for 6 months. Blood samples were obtained at the time of and three times weakly for 90 days after discontinuation of agonist therapy. In five women who did not ovulate, the suppressed serum FSH levels rose to pretreatment values within 10 days. In contrast, a gradual and progressive increase in serum LH (as measured by bioassay and immunoassay) was apparent by day 18. The LH increase coincided with progressive increases in serum estrone (E1), androstenedione, and testosterone. Serum estradiol (E2) began to rise on day 28. All hormones returned to their pretreatment baseline values within the 90-day recovery interval, with the exception of E2. Trend analysis of the slopes of recovery revealed that the incremental secretion patterns of E1, E2, androstenedione, and testosterone differed significantly from that of FSH, but not from those of bioactive or immunoactive LH. Serum progesterone, dehydroepiandrosterone sulfate, and cortisol did not change after withdrawal of GnRHa. One woman ovulated spontaneously on day 52 before which her hormone secretion patterns were indistinguishable from those of the other women. In summary, 1) during recovery after discontinuation of chronic GnRH agonist therapy the patterns of FSH and LH release suggested resumption of endogenous GnRH action on the pituitary with greater release of FSH than LH, a pattern that would be expected in the absence of ovarian steroid influence; 2) the lack of early estrogen production despite the increase in serum FSH concentrations suggests inadequate FSH secretion, abnormal ovarian responsiveness to FSH, or impaired FSH bioactivity; 3) androgen secretion was provoked by the increase in LH secretion; 4) per unit LH measured by bioassay, greater ovarian androgen secretion was stimulated in PCO than ovulatory women; and 5) the likelihood of spontaneous ovulation during recovery was minimal.

The effect of long-term pulsatile GnRH administration on the 24-hour integrated concentration of GH in hypogonadotropic hypogonadic patients

Measurement of integrated concentration of GH by means of continuous withdrawal sampling is a method of evaluating physiological hormonal secretion. Integrated concentration of GH was evaluated in 5 subjects with idiopathic hypogonadal hypogonadism (range 19-27 years) and in a 17-year-old male with idiopathic delay of puberty (5 males, 1 female) before and 30-240 days after the start of pulsatile GnRH administration. Gonadotropins and testosterone or 17 beta-estradiol were restored, whereas 24-h integrated concentration of GH (before therapy 5.4 +/- 1.3 IU/1; during GnRH 8.1 +/- 2.0 IU/1; P less than 0.05) was increased by GnRH therapy. However, no correlation was found between GH levels and sex steroid concentrations during GnRH pulsatile administration. These data further confirm that a physiological increase in gonadotropins and sex steroids can modulate GH synthesis and/or release.

Gonadotropin release by clinically nonfunctioning and gonadotroph pituitary adenomas in vivo and in vitro: relation to sex and effects of thyrotropin-releasing hormone, gonadotropin-releasing hormone, and bromocriptine

We studied in vivo hormone levels and in vitro hormone and subunit release in a group of 22 patients who were operated upon because of a clinically nonfunctioning or gonadotroph pituitary adenoma. In vivo, 5 of the 22 patients, all men, had hypersecretion of FSH, LH beta, or alpha-subunit. An elevated ratio of serum alpha-subunit to LH and FSH was found in 6 of 8 women in vivo, although in all 6 women serum LH, FSH, and alpha-subunit levels were low. LH, FSH, alpha-subunit, LH beta, or a combination of these glycoprotein hormones could be demonstrated in 19 of 22 cultured adenomas. We conclude that 1) virtually all clinically nonfunctioning adenomas contain or release gonadotropins or their subunits in vitro; 2) in vivo hypersecretion of these hormones and subunits occurs infrequently, and in this series only in men; 3) an elevated ratio of alpha-subunit to LH and FSH is frequently found in women and may prove to be a useful diagnostic tool; 4) responses to TRH and bromocriptine do not depend on baseline gonadotropin levels, either in vitro or in vivo, implying that the distinction between gonadotroph adenomas and adenomas without hypersecretion of gonadotropins in vivo is absent where hormone dynamics are concerned.

Pulsatile GnRH-therapy in oligozoospermic men does not improve seminal parameters despite decreased FSH levels

In order to evaluate GnRH administration for the treatment of infertile men with elevated serum FSH levels we administered GnRH in pulses via portable electronic infusion pumps initially to seven patients with low sperm counts and high FSH values over 12 weeks and later to nine further patients over 24 weeks who also underwent testicular biopsies. Fifty microlitres containing 5 micrograms GnRH were infused subcutaneously for 1 min every 120 min in the short-term study and every 90 min in the long-term study. Although FSH levels could be lowered in both groups of patients, none showed any improvement in sperm count or other seminal parameters. Therefore, pulsatile GnRH treatment cannot be recommended for therapy of severe oligozoospermia with elevated FSH levels.

[Increased incidence of ovarian hyperstimulation syndrome following combined GnRH agonist/hMG therapy]

In the present paper we examined, whether the combined GnRH-agonist/hMG therapy implies an increased risk of the ovarian hyperstimulation syndrome (OHS). In a retrospective analysis, 525 GnRH-a/hMG cycles were compared with 643 cycles of hMG stimulation, which were simultaneously performed at the Department of Gynecology and Obstetrics of the University of Hamburg. Two different GnRH-agonists were used: Buserelin (Hoechst) given intranasally (410 cycles) and Triptorelin (Ferring) intramuscularly (115 cycles). The clinical results of hMG "only"-therapy revealed an OHS incidence of 7% for grade II and 0.2% for grade III. In contrast, significantly higher incidences were observed after GnRH-a/hMG treatment. In Buserelin/hMG cycles in 23% OHS grade II and in 1.0% OHS grade III occurred, in Triptorelin/hMG cycles in 40% OHS II and in 5.2% OHS III, respectively. The increased incidence of OHS correlated with higher ovarian estrogen production as well as a higher number of follicles following the GnRH-a/hMG stimulation. Furthermore, in GnRH-a/hMG cycles a prolonged duration of follicular maturation occurred due to an increase of the active phase; in addition the amount of hMG-ampoules needed for ovarian stimulation was higher. After GnRH-a/hMG treatment, an endogenous LH-surge was not detected, whereas in 34% of hMG stimulated cycles irregular LH-fluctuations were observed. There was a higher pregnancy rate in GnRH-a/hMG cycles (15%/525 cycles), as compared to hMG stimulation (8%/643 cycles), but the abortion rate was similar (23%, GnRH-a/hMG, versus 13%, hMG). The demonstration of an increased ovarian response leading to better pregnancy rates but also higher risks of OHS is well known from earlier data of hMG stimulation in patients with hypogonadotropic amenorrhoea (WHO group I). This implies that GnRH-agonist pre-treatment shows similar endocrine conditions in normogonadotropic patients.

Pregnancy following administration of GNRH by means of portable pump: hormonal evaluation before and during therapy

In a group of three patients affected by severe hypothalamic amenorrhea, gonadotropins behaviour before and during pulsatile GNRH therapy, was investigated with more accuracy for seven cycles. The treatment was administered intravenously with a dosage of 5 ug/90 min. The number of cycles for pregnancy was of 1.75 with a pregnancy rate of 57.1%. The gonadotropins response to an acute test with 100 ug of GNRH performed in the three patients at the 7th day of their first treatment cycle was compared with response to the same test done before the beginning of the pulsatile therapy. Some considerations about the results were suggested.

Pituitary and ovarian responses of post-partum acyclic beef cows to continuous long-term GnRH and GnRH agonist treatment

Post-partum acyclic beef cows received continuous long-term treatment with GnRH (200 or 400 ng/kg body wt/h) or the GnRH agonist buserelin (5.5 or 11 ng/kg body wt/h) using s.c. osmotic minipumps which were designed to remain active for 28 days. All treatments increased circulating LH concentrations whereas FSH remained unchanged. Ovulation and corpus luteum (CL) formation as judged by progesterone concentrations greater than or equal to 1 ng/ml occurred in 0/5 control, 4/5 200 ng GnRH, 4/4 400 ng GnRH, 4/5 5.5 ng buserelin and 3/5 11 ng buserelin cows. The outstanding features of the progesterone profiles were the synchrony, both within and across groups, in values greater than or equal to 1 ng/ml around Day 6, and the fact that most CL were short-lived (4-6 days). Only 3 cows, one each from the 400 ng GnRH, 5.5 ng buserelin and 11 ng buserelin groups, showed evidence of extended CL function. Cows failed to show a second ovulation which was anticipated around Day 10 and this could have been due to insufficient FSH to stimulate early follicular development, or the absence of an endogenously driven LH surge. The highest LH concentrations for the respective groups were observed on Days 2 and 6 and by Day 10 LH was declining, although concentrations did remain higher than in controls up to Day 20.(ABSTRACT TRUNCATED AT 250 WORDS)

Quantitative and qualitative changes in LH secretion following pulsatile GnRH therapy in a man with idiopathic hypogonadotrophic hypogonadism

The pattern of bioactive and immunoreactive LH secretion before and during pulsatile GnRH therapy (18 micrograms/90 min) in a hypogonadotrophic hypogonadal male has been studied. Before treatment the patient was azoospermic and had low testosterone (1.2 nmol/l) with low and apulsatile immunoreactive LH (1.9 +/- 0.2 IU/l) and FSH (1.4 +/- 1.9 IU/l) 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/l) and bioactive (6.7 +/- 1.3 IU/l) LH, with an irregular pattern and little effect on testosterone production (2.2 nmol/l). Within 1 week of treatment both bioactive (30.5 +/- 6.8 IU/l) and immunoreactive (13.6 +/- 1.5 IU/l) 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 less than 0.01) than between pulses (1.97 +/- 0.1) and the testosterone concentration (17.8 +/- 2.1 nmol/l) 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 x 10(6)/ml) were seen in the patient's semen. The pattern of LH secretion was pulsatile but the levels of bioactive (13.1 +/- 3.6 IU/l) and immunoreactive (9.5 +/- 1.3 IU/l) 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 x 10(6)/ml).

Gonadotropin-releasing hormone-induced luteinizing hormone release in heifers: effect of nutrition during gestation

The effects of nutrition during the last two trimesters of gestation on GnRH-induced LH release were assessed in crossbred heifers. Heifers (n = 58) were allotted at 90 d gestation to one of three levels of an experimental diet fed at 1, 1.5 or 2% of BW to attain maternal BW loss, BW maintenance or BW gain, respectively, at parturition. Twenty-two heifers were injected (i.m.) once with 100 micrograms GnRH between d 14 and 1 before parturition, and 32 heifers were injected (i.m.) once with 100 micrograms GnRH between d 8 and 21 after parturition. Jugular blood samples were collected before and at 30-min intervals after GnRH for 4 h. Least squares means for BW change differed (P less than .01) among BW loss (-17.6%), BW maintenance (-6.0%) and BW gain (7.0%) heifers. Basal plasma LH concentration was not influenced by nutritional treatment and was similar before and after parturition for all groups. However, in response to GnRH, peak plasma LH concentration was greater (P less than .10) for prepartum than for postpartum heifers. Mean LH peak amplitude in prepartum heifers was approximately twofold greater (P less than .10) in the BW loss and maintenance groups compared with the BW gain group. Prepartum LH release was related inversely (r = -.64) to change in heifer BW and increased (P less than .01) as BW loss increased during gestation. After parturition, mean LH peak amplitude and area under the response curve averaged 50% less (P less than .10) in the BW loss and maintenance groups than in the BW gain group.(ABSTRACT TRUNCATED AT 250 WORDS)

Endocrine dynamics during pulsatile GnRH administration in patients with hypothalamic amenorrhea and polycystic ovarian disease

The LH secretory patterns and ovarian endocrine responses have been determined during pulsatile gonadotropin-releasing hormone (GnRH) administration for induction of ovulation in patients with hypothalamic amenorrhea (HA). However, until now these endocrine dynamics during GnRH therapy have not been thoroughly investigated in patients with polycystic ovarian disease (PCOD). Seven patients with HA and 4 patients with PCOD have therefore been studied to determine changes in LH pulsatile activity and in serum sex steroid levels in response to chronic intermittent GnRH stimulation. GnRH was administered intravenously (5-10 micrograms/90 minutes) by means of a portable infusion pump. Blood samples were obtained at 15-minute intervals for 4 hours on the day before the start of GnRH stimulation (control day) and on treatment days 5, 10 and 15. LH was determined in all samples and FSH, serum androgens and estrogens were measured in baseline samples by RIA. While 8 (62%) ovulations and 5 conceptions were observed in 13 treatment cycles in patients with HA, no ovulations were achieved during 9 treatment cycles in patients with PCOD. On the control day significantly (p less than 0.05) higher basal LH and testosterone (T) levels and significantly (p less than 0.05) lower FSH levels were found in the PCOD patients. The LH pulsatile profiles of the PCOD patients showed significantly (p less than 0.05) higher pulse amplitudes and areas under the curve (integrated responses). Pulsatile GnRH administration induced a significant (p less than 0.05) increase in LH pulse amplitudes in both HA and PCOD patients, and also increased (p less than 0.05) the integrated responses in patients with HA. During the GnRH stimulation, the LH interpulse intervals of both HA and PCOD patients were found to be similar to the frequency in which exogenous GnRH was administered. FSH levels rose continuously (p less than 0.001) during stimulation in patients with HA, but remained unchanged in patients with PCOD. In HA patients, T, androstenedione (AD) and estrone (E1) did not change during the GnRH treatment, but estradiol (E2) rose so that the ratios of aromatized estrogens to non-aromatized androgens (E1/AD, E2/T) increased. In contrast, T and AD increased significantly (p less than 0.05 or less) and E2 remained unchanged during stimulations in PCOD patients, which resulted in decreasing ratios of estrogens to androgens. These observations confirm that pulsatile GnRH administration can successfully induce ovulation in patients with HA by restoring the ovarian physiology. The data also demonstrate that pulsatile GnRH administration can influence the LH secretory patterns in PCOD patients.(ABSTRACT TRUNCATED AT 400 WORDS)

[The course of ovulation in gilts after the use of two GnRH injections for ovulation stimulation]

The status of ovulation and amount of ovulated follicles in 410 gilts which had received differentiated pretreatment produced evidence to the feasibility of substitution of HCG by Gn-RH vet. "Berlin-Chemie" to stimulate ovulation. Yet, 2 injections are necessary with an adequate interval between them and with appropriate dosage. The highest synchronisation effect in all experimental variants was obtained from 350 and 750 micrograms of Gn-RH with 50 minutes in between or 750 plus 750 micrograms of Gn-RH with an interval of 40 minutes. Ovulation was most reliably stimulated by 500 I.U. of HCG.

Gonadotropin--releasing hormone agonist as an adjunct in conservative surgery for uterine leiomyomas

Preoperative treatment of a large uterine leiomyoma with a gonadotropin-releasing hormone agonist resulted in a volume reduction of 45%.

Effect of active immunization against estrogen on gonadotropin response to testosterone propionate treatment in ovariectomized pony mares

An experiment was conducted to determine whether partial neutralization of estrogens via active immunization alters testosterone propionate (TP)-induced increases in FSH secretion after GnRH administration in ovariectomized pony mares. Twenty mares were used in a 2 X 2 factorial arrangement of treatments (n = 5/group). Factor 1 was long-term active immunization against either bovine serum albumin (BSA) or estrone-17-oxime-BSA. Factor 2 was 11-d administration of either vehicle (vegetable oil) or TP (175 micrograms/kg BW). Plasma concentrations of FSH were not affected (P greater than .1) by either factor. As expected, the FSH response to exogenous GnRH was threefold greater (P less than .05) in BSA-immunized mares treated with TP than in BSA-immunized mares receiving oil. However, immunization against estrogens reduced (P less than .05) this TP-induced increase in FSH response by 52%. Plasma concentrations of LH were decreased (P less than .08) by TP; this effect was not altered (P greater than .1) by immunization against estrogen. The LH response to exogenous GnRH was not affected (P greater than .1) by either factor. We conclude that aromatization of testosterone to estrogen is partially responsible for the increased FSH response to exogenous GnRH in TP-treated mares. In contrast, suppression of LH concentrations by TP appears to involve only the androgenic effect of TP.

Dynamics of gonadotropin release following ovariectomy and injection of gonadotropin-releasing hormone in early postpartum dairy cows

The influence of the ovary and of injection of low doses of gonadotropin-releasing hormone on secretion and gonadotropin-releasing hormone-induced release of gonadotropins in early postpartum cows was examined in a 2 x 2 factorial design (6 cows/group). Twelve cows were ovariectomized 2 d postpartum (calving = d 0; groups 1 and 2) and 12 cows were left intact (groups 3 and 4). Groups 1 and 3 received gonadotropin-releasing hormone (5 micrograms) every 120 min for 70 h from d 6 to d 9; groups 2 and 4 received saline by the same regimen. All animals received 50 micrograms gonadotropin-releasing hormone on d 9. Mean concentrations of FSH were higher following ovariectomy compared with those of intact cows 6 to 8 d postpartum, whereas no differences in FSH were observed between cows receiving gonadotropin-releasing hormone or saline during this period. Concentrations of LH were similar in intact and ovariectomized cows on d 6 to 8 but were increased in cows receiving gonadotropin-releasing hormone compared with cows receiving saline. Ovariectomy did not alter the gonadotropin-releasing hormone-induced release of gonadotropins on d 9. Injection of gonadotropin-releasing hormone on d 6 to 8 resulted in a decreased gonadotropin-releasing hormone-induced release of gonadotropins on d 9. It was concluded that removal of ovarian influence resulted in increased secretion of FSH but did not affect gonadotropin-releasing hormone-induced release of LH and FSH during the early postpartum period.

Metabolic regulation of the growth hormone independent insulin-like growth factor binding protein in human plasma

This study examines the regulation of circulating GH-independent insulin-like growth factor binding protein, BP-28. Commencing at 22.00 h, BP-28 in 5 normal adults rose 11-fold to peak values of 120 +/- 12 micrograms/l, remained elevated between 01.00 and 08.00 h, then fell rapidly following a meal. If meals were omitted, BP-28 remained at peak levels throughout the day. The fasting BP-28 level was higher in women (141 +/- 22 micrograms/l, N = 5) than men (59 +/- 14 micrograms/l, N = 7), and pregnancy caused a further 2-fold elevation. Oral glucose rapidly lowered BP-28 in diabetic and nondiabetic pregnant women, nonpregnant women, and men. In a heterogeneous group of 18 subjects, insulin (0.1 U/kg iv), with or without simultaneous administration of GnRH and TRH, elicited a 3- to 4-fold rise in BP-28, commencing 60 min after the nadir of plasma glucose, and independent of the response in GH, PRL, TSH, LH or cortisol. We conclude that BP-28 levels in adults are metabolically regulated, and postulate a role for this protein in the maintenance of glucose homeostasis.

Use of pulsatile intravenous administration of gonadotropin-releasing hormone to induce fertile estrus in bitches

The pulsatile IV administration of gonadotropin-releasing hormone (GnRH) was evaluated as a method to induce fertile estrus in 8 anestrous Beagle bitches. Bitches received 1.25 micrograms of GnRH every 90 minutes for 11 to 13 days. Gonadotropin-releasing hormone was delivered by use of an automatic pump. Reproductive history was known for all bitches, 4 of which, on the basis of 3 or 4 preceding cycles, had an interestrous interval of 219 +/- 14 days (mean +/- SEM). Estrus induction was attempted during early anestrus in 6 bitches (ie, 148 +/- 10 days since the preceding estrus) and late anestrus in 1 bitch (ie, 260 days since the preceding estrus); another bitch had not had an estrous cycle for nearly 2 years before GnRH administration. Signs of estrus were seen within 16 days after the start of GnRH administration in the bitches with regular estrous cycles (group 1, n = 7), and within 23 days in the bitch (group 2) with prolonged anestrus. All bitches were bred, and 7 of 8 (87.5%) became pregnant, with a mean litter size of 4.5 +/- 0.75. A normal hormonal response pattern was observed in group-1 bitches--a peak increase in plasma estrogen concentration of 22.3 +/- 2 pg/ml immediately before the onset of estrus. Peak plasma progesterone concentration (17.3 +/- 3 ng/ml) was observed 1 to 14 days after the onset of diestrus in the group-1 bitches that ovulated, and adequate plasma progesterone concentration was maintained throughout gestation.(ABSTRACT TRUNCATED AT 250 WORDS)

Pulsatile gonadotrophin releasing hormone therapy in patients with hyperandrogenaemia or hypothalamic amenorrhoea

From 1984 to 1985, 18 patients with infertility and oligomenorrhoea were treated with pulsatile GnRH administration (Zyklomat). According to the hormone levels and the ultrasonographic observation of the ovaries, they could be divided into two categories, group A (n = 11), patients with hyperandrogenaemia, and group B (n = 7), patients with hypothalamic amenorrhoea. As in hyperandrogenaemic patients a pathological LH-secretion pattern was suspected, assessment of LH-pulsing (5 ml blood samples at 10 min intervals over 6 h) was performed in this group of patients followed by an oestrogen-gestagen (E-Ge) suppression. One day before discontinuation of this medication, the GnRH pump was applied intravenously. Ovulation induction was more successful in group B than in group A. Hyperandrogenaemic women, in whom ovulation could be induced by the GnRH pump, exhibited higher basal concentrations of FSH, LH, LH/FSH ratio, oestradiol- 17 beta and testosterone (T) than the women not responding to pulsatile GnRH administration. The suppression of T and LH/FSH ratio with E-Ge treatment was more pronounced, while the non-responders had higher basal prolactin concentrations as well as after E-Ge therapy and a significantly greater body weight. The results indicate that GnRH therapy in hypothalamic amenorrhoea is more successful than in hyperandrogenaemia. Overweight hyperandrogenaemic patients appeared to be unsuitable for GnRH treatment, even after previous suppression of the hypothalamic pituitary ovarian axis with E-Ge.

Pituitary receptors for gonadotropin-releasing hormone in relation to changes in pituitary and plasma gonadotropins in ovariectomized hypothalamo/pituitary-disconnected ewes. II. A marked rise in receptor number during the acute feedback effects of estradiol

Ovariectomized (OVX), hypothalamo/pituitary-disconnected (HPD) ewes were used to ascertain the short-term effects of estradiol on the number of gonadotropin-releasing hormone (GnRH) receptors in the pituitary gland. The time course of the study was such that measurements were made during the period of short-term negative feedback and positive feedback. Groups of 4 OVX-HPD ewes were given 250-ng pulses of GnRH each hour and an i.m. injection of oil (Group 1) or 50 micrograms estradiol benzoate in oil (Groups 2-4). Blood samples were collected from each ewe prior to treatment with estradiol or oil and again immediately before slaughter. Groups 2, 3, and 4 were killed 6, 16, and 20 h, respectively, after administration of estradiol. Amplitudes of luteinizing hormone (LH) pulses and average plasma concentrations of LH were reduced 6 h after estradiol treatment. Sixteen and 20 h after injection, the average plasma LH levels were elevated, but pulse amplitudes were similar to preinjection values. The number of GnRH receptors was significantly (p less than 0.01) increased within 6 h of estrogen treatment and further increased 16 and 20 h after treatment. Pituitary content of LH was similar in all groups. These data indicate that the number of GnRH receptors in the pituitary gland of ewes can be acutely influenced by a direct effect of estradiol. However, the magnitude and direction of the change in receptors number does not account for the changes in pituitary responsiveness to GnRH, suggesting estradiol also modifies post-receptor mechanisms that influence secretion of LH.

Pulsatile GnRH treatment of the ovariectomized rat and release of LH and FSH

The effect of pulsatile GnRH administration on the levels of LH and FSH was investigated in rats that had been ovariectomized 2 weeks earlier. Also the asynchronous occurrence of endogenous and GnRH-induced LH and FSH pulses was analysed. A small pulse dose of GnRH (1.25 ng/100 g) was given iv at a frequency of once every 60 min or once every 120 min during 24 h. A larger dose of 5 ng/100 g was given once every 60 or 120 min during either 24 h or 96 h. Blood was sampled arterially every 5 min around the two first and last GnRH injections and LH and FSH were measured. Only the treatment with the larger GnRH pulse dose resulted in a change of LH and FSH plasma levels. LH levels declined under all circumstances, whereas FSH was found to be increased temporarily after 24 h of treatment. The pituitary LH response to pulses of GnRH (5 ng/100 g) decreased irrespective of the frequency or duration with which GnRH was administered. There was a marked asynchronicity between LH and FSH pulses and almost every injection of GnRH (5 ng/100 g) resulted in clear LH pulses but not in FSH pulses.

Successful GnRH treatment in a patient with Kallmann's syndrome, who previously failed HMG/HCG treatment

A successful GnRH treatment for hypogonadotropic hypogonadism is described. A 40 year old infertile patient due to Kallmann's syndrome, associated with obesity and NIDDM, was treated with HCG (5,000 IU/week) for 8 years. In an attempt to induce spermatogenesis HMG (75 IU/daily) was added for 2 years. During the combined gonadotropin treatment semen analysis indicated an improvement from azoospermia to 2 x 10(6) sperm/ml. Since semen quality remained poor and obviously no pregnancy was achieved, the last regime was replaced by a pulsatile GnRH treatment (5 mcg/90 minutes). Following 6 months sperm count increased up to 15 x 10(6) associated with normal motility and morphology. Patient's wife conceived after the second intrauterine insemination and delivered a full term healthy baby.

Pharmacodynamics of gonadotropin-releasing hormone (GnRH). II. Pattern of GnRH delivery alters pituitary luteinizing hormone secretion in women

The pulse frequency, amplitude, and mode of administration of GnRH all influence gonadotropin secretion and, ultimately, pituitary-gonadal function. We studied plasma LH responses to repetitive iv administration of GnRH given hourly for 5 h as a 2-microgram rapid (less than 15 s) bolus dose or a 2-microgram dose infused for 15 min of each hour in seven women deficient in endogenous GnRH and sex steroids. Plasma LH levels, measured at 10-min intervals throughout the 5-h period, rose more briskly (pattern X time course interactions: F = 3.33; P less than 0.0001) to higher levels overall (F = 11.7; P = 0.014) after rapid bolus GnRH administration than after GnRH infusion. Plasma FSH levels increased during both modes of delivery, with higher responses to rapid bolus GnRH administration (P = 0.005). Plasma estradiol levels did not change during either 5-h study. We conclude that the pattern of delivery of GnRH is a determinant of pituitary LH and FSH secretion in untreated hypogonadotropic women, and therefore, that alterations in the GnRH wave form and/or peak plasma GnRH concentrations consequent upon different rates of GnRH entry into the blood-stream may explain the different responses that occur when GnRH is given by different routes.

Growth, growth hormone and sex steroid secretion in girls with central precocious puberty treated with a gonadotrophin releasing hormone (GnRH) analogue

We have treated 14 girls with central precocious puberty for a mean period of 2.3 years (range, 0.5-3.9) with intranasal (D-Ser6) GnRH analogue administered in a mean dose of 28 micrograms/kg/day (range, 15-56). With the onset of treatment there was an initial increase in sitting height compared to subischial leg length, but overall there was no significant change in height standard deviation score for bone age. In this respect our results were indistinguishable from untreated children with central precocious puberty. There was a decrease in physiological GH secretion, associated with decreased sex steroid secretion, which probably accounts for the growth deceleration which has been described during GnRH analogue therapy. The effect of this growth deceleration combined with slowing of the rate of epiphyseal maturation may explain the absence of alteration in height prognosis.

Economic modeling of the use of gonadotropin-releasing hormone at insemination to improve fertility in dairy cows

Economic and sensitivity analysis methods were used to evaluate financial returns from use of gonadotropin-releasing hormone (GnRH) at the time of insemination to enhance fertility of dairy cows. A computer spread sheet was used to determine the best service(s) for GnRH treatment, the increase in conception rate required for economic benefit from treatment, and how profits from GnRH treatment are affected by drug cost, herd reproductive efficiency, and production costs. Financial returns increased from use of GnRH at insemination under most herd conditions. Herds with conception rates less than or equal to 45% benefited from GnRH treatment at any 1 or 2 inseminations. Herds with conception rates greater than or equal to 60% benefited from GnRH treatment only at second or later services. Selection of second and/or third insemination as the GnRH treatment service usually resulted in the greatest total return. The enhancement of fertility necessary to achieve the break-even point with GnRH treatment at third service was 2% for low- and 5% for high-conception-rate herds. Base-line herd conception rates, estrus detection efficiency, replacement costs, value of excess days not pregnant, and cost of treatment had the greatest effect on returns from treatment. Herds with high conception rates and low replacement costs were likely to realize the least benefit from GnRH treatment at insemination. On the basis of our findings, we concluded that GnRH treatment at insemination is a profitable procedure under most herd conditions. Optimal treatment regimens for specific herds may best be determined by using herd performance and management data for calculating returns.

Progesterone does not inhibit the increase in pituitary content of luteinizing hormone after removal of estradiol in the ewe

During late gestation in the ewe, the pituitary content of LH is reduced by about 95%, presumably due to the presence of high concentrations of ovarian steroids. The aim of this study was to determine whether the pituitary content of LH in the ewe can increase after long-term administration of ovarian steroids, when only estradiol (E) is removed or if both E and progesterone (P) must be withdrawn to allow synthesis of LH to occur. Ten ovariectomized ewes were treated with implants containing E and P. After 3 weeks of treatment, the E implants were removed from 5 ewes (-E+P) and both steroid implants were removed from the remaining 5 ewes (-E-P). Five ovariectomized ewes received P implants at the beginning of the experiment and these implants were left in place for the duration of the study; 5 ovariectomized ewes served as controls (C). All animals were injected with 100 micrograms GnRH iv 3, 6 and 9 weeks after the initiation of treatment. The area under the LH-response curve was used as an indication of the pituitary content of LH. All steroid treatments markedly reduced basal levels of LH. LH levels increased only in -E-P ewes, beginning 6 weeks after initiation of the study. After 3 weeks, -E+P and -E-P ewes released less LH (P less than 0.05) in response to GnRH than did C ewes, whereas P animals did not differ from controls. LH release in response to GnRH in -E+P and -E-P groups had increased by 6 and 9 weeks and was not different from that of C ewes.(ABSTRACT TRUNCATED AT 250 WORDS)