Influence of hormonal control on LH pulsatility and secretion in women with classical congenital adrenal hyperplasia.
OBJECTIVE
Women with classical congenital adrenal hyperplasia (CAH) exhibit reduced fertility due to several factors including anovulation. This has been attributed to a disturbed gonadotropic axis as in polycystic ovary syndrome (PCOS), but there is no precise evaluation. Our aim was to evaluate the gonadotropic axis and LH pulsatility patterns and to determine factor(s) that could account for the potential abnormality of LH pulsatility.


METHODS
Case/control study.


METHODS
Sixteen CAH women (11 with the salt-wasting form and five with the simple virilizing form), aged from 18 to 40 years, and 16 age-matched women, with regular menstrual cycles (28 ± 3 days), were included. LH pulse patterns over 6 h were determined in patients and controls.


RESULTS
No differences were observed between patients and controls in terms of mean LH levels, LH pulse amplitude, or LH frequency. In CAH patients, LH pulsatility patterns were heterogeneous, leading us to perform a clustering analysis of LH data, resulting in a two-cluster partition. Patients in cluster 1 had similar LH pulsatility patterns to the controls. Patients in cluster 2 had: lower LH pulse amplitude and frequency and presented menstrual cycle disturbances more frequently; higher 17-OH progesterone, testosterone, progesterone, and androstenedione levels; and lower FSH levels.


CONCLUSIONS
LH pulsatility may be normal in CAH women well controlled by hormonal treatment. Undertreatment is responsible for hypogonadotropic hypogonadism, with low LH pulse levels and frequency, but not PCOS. Suppression of progesterone and androgen concentrations during the follicular phase of the menstrual cycle should be a major objective in these patients.
AP-HP, Department of Endocrinology and Reproductive Medicine, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Pitié-Salpêtrière Hospital (Groupe Hospitalier Pitié-Salpêtrière), Université Pierre et Marie Curie, Site Pitié, 47-83 Boulevard de l'Hôpital, 75013 Paris, France.
Anne
A
Bachelot
Zeina
Z
Chakhtoura
Geneviève
G
Plu-Bureau
Mathieu
M
Coudert
Christiane
C
Coussieu
Yasmina
Y
Badachi
Jérome
J
Dulon
Beny
B
Charbit
Philippe
P
Touraine
D000293:Adolescent; D000312:Adrenal Hyperplasia, Congenital / Q000097:blood* / Q000188:drug therapy / Q000378:metabolism*; D000328:Adult; D000728:Androgens / Q000097:blood; D000735:Androstenedione / Q000097:blood; D016022:Case-Control Studies; D005260:Female; D020249:Hormone Replacement Therapy; D006728:Hormones / Q000494:pharmacology*; D006801:Humans; D007986:Luteinizing Hormone / Q000097:blood* / Q000378:metabolism*; D011374:Progesterone / Q000097:blood; D013739:Testosterone / Q000097:blood; D055815:Young Adult
D000728:Androgens; D006728:Hormones; D013739:Testosterone; D000735:Androstenedione; D011374:Progesterone; D007986:Luteinizing Hormone