title: Pulsatile gonadotrophin releasing hormone versus gonadotrophin treatment of hypothalamic hypogonadism in males.
abstract: In this study, pulsatile gonadotrophin releasing hormone (GnRH) therapy and gonadotrophin therapy were compared for male patients with idiopathic hypothalamic hypogonadism. Thirty-six patients, 19 with this condition, and 17 with Kallmann's syndrome, were included in the study. Their mean age was 21.1 +/- 3.0 years (+/- SD). They were divided into two groups of similar age, number and testicular volume. Pulsatile GnRH therapy was started with 4 micrograms GnRH s.c. every 2 h using a portable pump and gonadotrophin therapy with weekly i.m. injections of 3 x 2500 IU human chorionic gonadotrophin (HCG). After 8-12 weeks of HCG treatment, 150 IU human menopausal gonadotrophin (HMG) 2-4 times weekly were added and the dose of HCG reduced if necessary. Testosterone concentrations increased significantly more (P < 0.03) in the gonadotrophin group than in the GnRH group (22.5 +/- 8.1 versus 16.8 +/- 5.5 nmol/l). The rise in oestradiol levels was also significantly higher (P < 0.001) in the gonadotrophin group than in the GnRH group (150 +/- 70 versus 88 +/- 59 pmol/l). Five patients developed gynaecomastia during gonadotrophin therapy. An increased testicular volume (TV) occurred more rapidly (P < 0.001) and was significantly more pronounced (P < 0.001) after GnRH therapy (delta TV = 8.1 +/- 2.0 ml) than with gonadotrophins (delta TV = 4.8 +/- 1.8 ml). Sperm counts were performed in 14 patients given GnRH and in 17 patients given gonadotrophins. Ten patients given GnRH had positive sperm counts, ranging from 1.5 to 14 x 10(6) spermatozoa/ml; eight of those given gonadotrophins also developed spermatogenesis (2-26 x 10(6)/ml).(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Medizinische Klinik, Klinikum Innenstadt, München, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Schopohl
mesh_terms: D006063:Chorionic Gonadotropin / Q000008:administration & dosage / Q000627:therapeutic use*; D004958:Estradiol / Q000097:blood; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007006:Hypogonadism / Q000209:etiology / Q000473:pathology / Q000503:physiopathology*; D007027:Hypothalamic Diseases / Q000150:complications*; D008297:Male; D008596:Menotropins / Q000008:administration & dosage / Q000627:therapeutic use*; D013076:Sperm Count; D013091:Spermatogenesis; D013737:Testis / Q000473:pathology; D013739:Testosterone / Q000097:blood
chemical_list: D006063:Chorionic Gonadotropin; D007987:Gonadotropin-Releasing Hormone; D013739:Testosterone; D004958:Estradiol; D008596:Menotropins