title: Circadian rhythm of plasma testosterone in men with idiopathic hypogonadotrophic hypogonadism before and during pulsatile administration of gonadotrophin-releasing hormone.
abstract: OBJECTIVE
  The aim was to investigate whether a pulsatile discharge of LH from the pituitary is necessary to achieve the circadian secretion of testosterone.
  
  
  METHODS
  The daily rhythm of the androgen has been studied in patients with idiopathic hypogonadotrophic hypogonadism (IHH) both in the absence of therapy and during pulsatile administration of gonadotrophin releasing hormone (GnRH).
  
  
  METHODS
  Six patients with IHH and ten normal subjects were analysed. Blood sampling was performed at 2-hourly intervals, for 24 hours. The IHH patients then received synthetic GnRH i.v. at the rate of one pulse every 2 hours (10 micrograms/pulse). On day 11 of treatment, blood samples were taken for the rhythm analysis every 2 hours, for 24 hours.
  
  
  METHODS
  Plasma testosterone and LH were measured in the individual samples by radioimmunoassay. Evaluation of the rhythm was performed by cosinor analysis.
  
  
  RESULTS
  A significant circadian rhythm of plasma testosterone was statistically validated in the normal subjects, whereas no rhythm was detected in the IHH patients in the absence of therapy. On day 11 of GnRH pulsatile administration the IHH patients showed normal testosterone levels and a statistically significant circadian rhythm of the androgen was evident, with acrophase between 0700 and 0800 h. Moreover, the amplitude, acrophase and mesor of testosterone rhythm in IHH patients in the course of treatment were statistically indistinguishable from the corresponding values in the normal subjects. Plasma LH did not show statistically significant circadian variations, either in the control group or in the IHH patients before or during therapy.
  
  
  CONCLUSIONS
  We conclude that a physiological circadian rhythm of plasma testosterone can be obtained, in IHH men, by treatment with GnRH. Since the pulsatile administration of exogenous GnRH at constant doses induced a circadian rhythm in testosterone and no daily variations in LH were evident, we suggest that, although a pulsatile secretion of LH is probably necessary for the synchronization of the circadian rhythm with acrophase in the morning, the testosterone variations might be the results of a local testicular modulation of LH action.
authors.affiliation: Department of Endocrinology, University of Modena, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Simoni
authors.forename: V
authors.initials: V
authors.lastname: Montanini
authors.forename: M F
authors.initials: MF
authors.lastname: Fustini
authors.forename: G
authors.initials: G
authors.lastname: Del Rio
authors.forename: K
authors.initials: K
authors.lastname: Cioni
authors.forename: P
authors.initials: P
authors.lastname: Marrama
mesh_terms: D000328:Adult; D002940:Circadian Rhythm / Q000502:physiology*; D004334:Drug Administration Schedule; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D007006:Hypogonadism / Q000097:blood* / Q000188:drug therapy; D007275:Injections, Intravenous; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D013739:Testosterone / Q000097:blood*
chemical_list: D007987:Gonadotropin-Releasing Hormone; D013739:Testosterone; D007986:Luteinizing Hormone