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Induction of ovulation with chronic intermittent (Pulsatile) administration of LH-RH in women with hypothalamic and hyperprolactinemic amenorrhea

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Zusammenfassung

Fünf Frauen mit hypothalamischer Amenorrhoe wurden mit LH-RH behandelt (10–15 μg i.v. im Abstand von 90 min über 14–20 Tage). Bei alien Frauen führte diese chronisch-intermittierende LH-RH-Gabe zu einer Normalisierung der Gonadotropinspiegel im Serum. Bei vier Frauen kam es zu präovulatorischen Östradiolspiegeln mit nachfolgenden LH-Gipfeln im Serum. Bei drei Frauen führten die LH-Maxima zu Ovulationen, wie aus den Progesteronwerten im Serum zu schließen war. Bei einer weiteren Patientin mit einer hyperprolactinämischen Amenorrhoe führte die gleiche Therapie ebenfalls zur Ovulation. Diese Ergebnisse weisen darauf hin, daß bei Patientinnen mit hypothalamischer Amenorrhoe durch chronische Gabe von LH-RH eine normale hypophysärovarielle Funktion wiederhergestellt werden kann; sie lassen des weiteren die Vermutung zu, daß bei der Frau — wie bei der Rhesusäffin — die hypothalamische LH-RH-Funktion lediglich einen permissiven Charakter hat und die zyklische Regulation während des menstruellen Zyklus auf den Ebenen von Hypophyse und Ovar erfolgt. Die Amenorrhoe bei einer Hyperprolactinämie wird offenbar durch eine eingeschränkte hypothalamische Sekretion von LH-RH verursacht, wie die erfolgreiche Substitution durch chronisch-intermittierende LH-RH-Gabe zeigt. Erhöhte Prolaktinspiegel per se interferieren offenbar weder mit dem hypophysären positiven Feedback-Mechanismus noch mit der Gonadotropinwirkung auf ovarieller Ebene.

Summary

Five women with hypothalamic amenorrhea were treated with LH-RH (10– 15 μg i.v. at 90 min intervals for 17–20 days). In all women this chronic intermittent LH-RH administration resulted in a normalization of serum gonadotropin levels. Four women exhibited preovulatory estradiol serum levels with subsequent LH peaks. In three women the LH peaks were followed by normal luteal phase serum progesterone levels. One woman with hyperprolactinemic amenorrhea was also treated with the same therapeutic regimen which induced ovulation as judged from normal luteal phase serum progesterone levels. The results indicate that normal pituitary-ovarian function can be established in hypothalamic amenorrhea by chronic intermittent administration of LH-RH. They also suggest that in the human female hypothalamic LH-RH function may be only permissive in that the cyclicity of endocrine events during the menstrual cycle is regulated on pituitary and ovarian levels. Hyperprolactinemic amenorrhea appears to be associated with insufficient endogenous LH-RH secretion which can be substituted by exogenous chronic intermittent administration of LH-RH. Elevated prolactin levels per se do not interfere with the pituitary positive feedback mechanisms nor with the gonadotropin action on the ovarian level.

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Leyendecker, G., Struve, T. & Plotz, E.J. Induction of ovulation with chronic intermittent (Pulsatile) administration of LH-RH in women with hypothalamic and hyperprolactinemic amenorrhea. Arch. Gynecol. 229, 177–190 (1980). https://doi.org/10.1007/BF02108310

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  • DOI: https://doi.org/10.1007/BF02108310

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