Gonadotropin-releasing hormone deficiency in men: diagnosis and treatment with exogenous gonadotropin-releasing hormone

Article Abstract:

The gonadotropins, luteinizing hormone (LH) and follicle-stimulating hormone (FSH), are secreted by the pituitary gland and stimulate the sex organs (gonads) to produce eggs or sperm. Their secretion is controlled by gonadotropin-releasing hormone (GnRH, also called LHRH), manufactured in the hypothalamus (a part of the brain). Part 2 of the November 1990 issue of the American Journal of Obstetrics and Gynecology presents papers from a symposium devoted to pulsatile GnRH, a method of hormone delivery that makes it possible to treat a variety of clinical disorders associated with testicular dysfunction. One of these is idiopathic hypogonadotropic hypogonadism, a condition associated with failure to undergo puberty, lack of fertility, and low levels of GnRH. This disorder is not a single entity; rather, it is associated with different inheritance patterns, a variety of other abnormalities, and different degrees of responsiveness to GnRH administered as part of the diagnostic procedure. The characteristics of subgroups of GnRH-deficient patients are reviewed. Although the inheritance pattern of the defect has been characterized, abnormalities of the gene that encodes GnRH have not been demonstrated. Normally, GnRH stimulates the secretion of LH, which causes testosterone production by cells in the testes. Studies were performed of LH secretion patterns in 50 men with idiopathic hypogonadotropic hypogonadism. Results showed that the majority (42) had no signs of LH or FSH pulsations. After similarly afflicted men underwent treatment with exogenous pulsed GnRH, improvement was noted in testicular growth, gonadotropin output by the pituitary, steroid secretion by the testes, and, in many, the appearance of sperm in the ejaculate. Eight children were fathered by nine of the men who wanted to become fertile, in one study. In some cases, treatment for more than six months was necessary to achieve the best results. Long-term administration of pulsatile GnRH can help many men with idiopathic hypogonadotropic hypogonadism. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Infertility, Male, Male infertility, Hypogonadism

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Practical aspects of pulsatile gonadotropin-releasing hormone administration

Article Abstract:

The gonadotropins, luteinizing hormone (LH) and follicle-stimulating hormone (FSH), are secreted by the pituitary gland and stimulate the sex organs (gonads) to produce eggs or sperm. Their secretion is controlled by luteinizing hormone-releasing hormone (LHRH, also called gonadotropin-releasing hormone or GnRH), manufactured in the hypothalamus (a part of the brain) and secreted in a pulsatile fashion. Women who do not ovulate can now be treated with pulsatile GnRH (which uses a small pump that pulses preset quantities of the drug intravenously or subcutaneously), a method of drug delivery that offers important advantages over previous approaches. A review is presented of the factors that should be taken into account when deciding whether to prescribe pulsatile GnRH for a patient. Patients who lack natural pulsatile GnRH are ideal candidates for the treatment. Currently, the Food and Drug Administration has approved GnRH in the pulsatile form only for patients with primary hypothalamic amenorrhea (lack of menstruation), but other conditions, such as mild polycystic ovarian disease (associated with production of male hormones and infertility), will also respond. Safety, efficacy, convenience and cost must be considered by physicians before they include pulsatile GnRH in their practices. These factors are discussed. Appropriate patient selection is critical for optimal outcomes; if done properly, pulsatile GnRH may be almost 100 percent effective in inducing ovulation. The advantages and disadvantages of intravenous versus subcutaneous administration are compared. Subcutaneous administration is easier and is not associated with infection; however, the lower concentrations of GnRH needed for the intravenous route result in significant financial savings. In addition, intravenous treatment leads to a higher ovulatory rate, and treatment for a shorter time. Other important concerns include dosages, patient monitoring and methods of evaluating the success of the treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Drug delivery systems, Fertility, Human, Human fertility, Anovulation

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Treatment of advanced refractory ovarian carcinoma with a gonadotropin-releasing hormone analogue

Article Abstract:

Leuprolide acetate, a synthetic agent similar to gonadotropin-releasing hormone, has been shown to inhibit the growth of some tumors. Gonadotropin-releasing hormone stimulates the release of other hormones which act on the ovaries. Leuprolide acetate was given to five patients with advanced ovarian cancer not responding to other anticancer agents. Patients must meet certain physical criteria before becoming eligible for hormone therapy as an anticancer treatment, and they are assessed to determine whether their type of tumor will be receptive to this treatment. All five patients in this study had different types of ovarian tumors thought to be resistant to hormone therapy. However, leuprolide acetate treatment provided some beneficial effects from tumor regression in each patient. Although the use of this treatment as a curative therapy is not recommended, it has some value in treating patients having no other therapeutic alternative. It is also recommended that eligibility criteria for new hormonal therapy for similar ovarian cancer patients be reviewed.

Ovarian cancer, Tumors, Chemotherapy, Leuprolide

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