Ovulation induction with pulsatile gonadotropin-releasing hormone (GnRH) or gonadotropins in a case of hypothalamic amenorrhea and diabetes insipidus.
Hypothalamic amenorrhea is a treatable cause of infertility. Our patient was presented with secondary amenorrhea and diabetes insipidus. Cortisol and prolactin responded normally to a combined insulin tolerance test (ITT) and thyrotropin-releasing hormone (TRH) challenge, while thyroid-stimulating hormone (TSH) response to TRH was diminished, and no response of growth hormone to ITT was detected. Both luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels increased following gonadotropin-releasing hormone (GnRH) challenge. No response of LH to clomiphene citrate challenge was detected. Magnetic resonance imaging findings demonstrated a midline mass occupying the inferior hypothalamus, with posterior lobe not visible and thickened pituitary stalk. Ovulation induction was carried out first with combined human menopausal gonadotropins (hMG/LH/FSH) (150 IU/day) and afterwards with pulsatile GnRH (150 ng/kg/pulse). Ovulation was achieved with both pulsatile GnRH and combine gonadotropin therapy. Slightly better results were achieved with the pulsatile GnRH treatment.
Georgopoulos
N A
NA
Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Patras Medical School, Rio-2650, Greece.
Markou
K B
KB
Pappas
A P
AP
Protonatariou
A
A
Vagenakis
G A
GA
Sykiotis
G P
GP
Dimopoulos
P A
PA
Tzingounis
V A
VA
D000328:Adult; D000568:Amenorrhea / Q000209:etiology / Q000628:therapy*; D002996:Clomiphene; D003919:Diabetes Insipidus / Q000150:complications* / Q000503:physiopathology; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage*; D006062:Gonadotropins / Q000008:administration & dosage*; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007006:Hypogonadism / Q000209:etiology / Q000628:therapy; D007031:Hypothalamus / Q000503:physiopathology*; D007247:Infertility, Female / Q000628:therapy; D007328:Insulin; D007986:Luteinizing Hormone / Q000097:blood; D008279:Magnetic Resonance Imaging; D010062:Ovulation Induction / Q000379:methods*; D010507:Periodicity; D011388:Prolactin / Q000097:blood; D013972:Thyrotropin / Q000097:blood; D013973:Thyrotropin-Releasing Hormone
D006062:Gonadotropins; D007328:Insulin; D019382:Human Growth Hormone; D002996:Clomiphene; D007987:Gonadotropin-Releasing Hormone; D013973:Thyrotropin-Releasing Hormone; D011388:Prolactin; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone; D013972:Thyrotropin; D006854:Hydrocortisone