title: Potential diagnostic utility of intermittent administration of short-acting gonadotropin-releasing hormone agonist in gonadotropin deficiency.
abstract: OBJECTIVE
  To determine if intermittent, low-dose, short-acting gonadotropin-releasing hormone agonist (GnRH-agonist) administration sufficiently up-regulates pituitary-gonadal function in gonadotropin deficiency to be of diagnostic or therapeutic value.
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  General clinical research center.
  
  
  METHODS
  Normal adult volunteers and gonadotropin-deficiency patients.
  
  
  METHODS
  Low-dose leuprolide acetate administered subcutaneously at 4- to 5-day intervals up to 1 year.
  
  
  METHODS
  Levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and sex steroid responses.
  
  
  RESULTS
  In normal men and women, low-dose GnRH-agonist repetitively transiently stimulated gonadotropins in a gender-dimorphic manner. In congenitally gonadotropin-deficient men (n = 6) and women (n = 1), none of whom had a normal LH response to an initial GnRH-agonist test dose, this regimen consistently stimulated LH to the normal baseline range within 2 weeks. Long-term GnRH-agonist administration to a partially gonadotropin-deficient man did not alleviate hypogonadism, however. Women with hypothalamic amenorrhea (n = 2) responded normally to a single GnRH-agonist injection; however, repeated dosing did not seem to induce the normal priming effect.
  
  
  CONCLUSIONS
  The subnormal LH response to GnRH-agonist in patients with congenital gonadotropin deficiency normalized in response to repetitive intermittent GnRH-agonist administration but not sufficiently to improve hypogonadism. Hypothalamic amenorrhea patients lacked the priming response to repeated GnRH-agonist but otherwise had normal hormonal responses to GnRH-agonist. We conclude that intermittent administration of a short-acting GnRH-agonist is of potential diagnostic value in distinguishing hypothalamic from pituitary causes of gonadotropin deficiency.
authors.affiliation: Department of Medicine, University of Chicago, Chicago, Illinois 60637, USA.
authors.forename: Carrie A
authors.initials: CA
authors.lastname: Zimmer
authors.forename: David A
authors.initials: DA
authors.lastname: Ehrmann
authors.forename: Robert L
authors.initials: RL
authors.lastname: Rosenfield
mesh_terms: D000293:Adolescent; D000328:Adult; D004304:Dosage Forms; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006062:Gonadotropins / Q000172:deficiency*; D006801:Humans; D007006:Hypogonadism / Q000175:diagnosis* / Q000209:etiology; D016729:Leuprolide / Q000008:administration & dosage*; D008297:Male; D010507:Periodicity; D011237:Predictive Value of Tests; D011379:Prognosis; D055815:Young Adult
chemical_list: D004304:Dosage Forms; D006062:Gonadotropins; D007987:Gonadotropin-Releasing Hormone; D016729:Leuprolide