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[Evaluation of hypothalamic-pituitary function in amenorrheic women by utilizing the combined clomiphene-GnRH test
Abstract:
Hypothalamic-pituitary function in 62 women with amenorrhea syndrome was evaluated by comparing the response of gonadotropin to GnRH stimulation before and after clomiphene treatment. Each woman was initially tested with an intramuscular injection of 100 microgram GnRH, and then ingested 150 mg of clomiphene daily for 5 consecutive days followed by GnRH test. Fourteen out of 29 patients with 1st grade amenorrhea showed increased baseline LH, FSH and estradiol, and slightly decreased net responses of LH to GnRH after clomiphene administration, indicating that positive and negative estrogen feedback for gonadotropin release is functioning. In contrast, 8 patients with 2nd grade amenorrhea (17 cases) showed an increase in LH net responses after Clomid treatment. In 5 patients, however, clomiphene induced the increase in baseline LH and FSH values and the decrease in the LH release in response to GnRH as seen in the 1st grade amenorrheic patients. These 5 patients ovulated on that clomiphene dosage. One patient with PCO also had a barely significant decrease in LH responses to GnRH following clomiphene administration, with slightly increased baseline gonadotropins. With one exception, all the 5 patients with primary amenorrhea showed no or poor LH responses to GnRH. Following clomiphene administration, no change in either baseline gonadotropine levels or pituitary responsiveness to GnRH was observed in 4 patients, suggesting that a hypothalamic-pituitary defect appeared most likely to be present. The two patients with streak gonad had significantly high responses to GnRH injection and further increase in the responses following clomiphene administration, accompanied by a slightly decreased baseline gonadotropin levels. On the other hand, in hyperprolactinemic amenorrhea syndrome individual response to GnRH before and after clomiphene use was quite variable. It is likely that this group includes the patients with various pathologic states of the hypothalamic-pituitary system. Thus, syndrome and in diagnosing the degree and the site of the defect.