Induction of male puberty by long-term pulsatile subcutaneous LH-RH therapy

Prolonged low dose LH-RH treatment was given to induce puberty in a 17.8-year-old male with hypogonadotrophic hypogonadism. The patient had developed panhypopituitarism after transcranial surgery of a craniopharyngioma at the age of 16.8 years. One year after the operation he had no signs of pubertal development and was of short stature. A small portable automatically-timed infusion pump, connected to a subcutaneous (s.c.) catheter, was used for the 328-day-long treatment, which was given in periods of between 16 to 185 days. Twenty micrograms of LH-RH s.c. was given every 90 min. Growth hormone therapy, 8 IU intramuscularly (i.m.) twice weekly, was instituted at the same time. During the prolonged LH-RH treatment the gonadotrophin secretion normalized. The serum concentration of testosterone increased to the normal range of adult males. Rapid pubertal progression occurred with development of pubic hair to adult type and increase in size of the penis. Testicular volume increased from 2 to 12 ml. Nocturnal emissions occurred after 30 weeks of pulsatile LH-RH treatment and sperms were found in the ejaculate after 43 weeks. The height of the patient increased from 162 to 176 cm. Thus, chronic pulsatile low dose LH-RH treatment can induce normal pituitary - gonadal function with pubertal maturation and spermatogenesis in primary male hypogonadotrophic hypogonadism.