Polycystic ovarian disease unmasked by pulsatile GnRH therapy in a subgroup of women with hypothalamic amenorrhea.
OBJECTIVE
To present the observation in six out of 120 women treated with pulsatile GnRH for ovulation induction, who developed hyperandrogenemia and polycystic ovaries during treatment.


METHODS
Clinical observation.


METHODS
Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Austria.


METHODS
A total of 120 women initially diagnosed as suffering from primary or secondary hypothalamic amenorrhea were treated for ovulation induction with pulsatile administration of GnRH for up to 140 days. There was no indication of the presence of polycystic ovaries or hyperandrogenemia before therapy.


METHODS
Pulsatile GnRH therapy using the Zyklomat pump.


METHODS
Ovulatory menstrual cycles.


RESULTS
Initially, all patients responded to pulsatile GnRH administration with ovulation and corpus luteum formation. During continuation of treatment, 6 patients developed an increase in LH and LH/FSH ratio as well as a progressive rise in serum T levels resulting in hyperandrogenemia. This was accompanied by the development of polycystic ovaries and cessation of follicular maturation.


CONCLUSIONS
We conclude from these observations that restoration of normal GnRH stimulation of the pituitary gland can result in the development of hyperandrogenemia and polycystic ovaries, suggesting a pituitary or ovarian defect underlying the pathogenesis of this disorder.
Mattle
Verena
V
Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Innsbruck, Austria. verena.mattle@i-med.ac.at
Bilgyicildirim
Aysen
A
Hadziomerovic
Dijana
D
Ott
Helmut W
HW
Zervomanolakis
Ioannis
I
Leyendecker
Gerhard
G
Wildt
Ludwig
L
D000328:Adult; D000568:Amenorrhea / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D017588:Hyperandrogenism / Q000139:chemically induced / Q000175:diagnosis; D007027:Hypothalamic Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D033162:Incidental Findings; D007247:Infertility, Female / Q000188:drug therapy* / Q000209:etiology; D010062:Ovulation Induction; D011085:Polycystic Ovary Syndrome / Q000139:chemically induced / Q000150:complications / Q000175:diagnosis*; D020551:Pulse Therapy, Drug
D007987:Gonadotropin-Releasing Hormone