Effect of D-leucine-6-luteinizing hormone-releasing hormone ethylamide in patients with hypogonadotropic hypogonadism with anosmia

The treatment of hypogonadotrophic hypogonadism in men by the pulsatile infusion of luteinising hormone-releasing hormone

The effects of chronic subcutaneous infusion of luteinising hormone-releasing hormone (LHRH) have been studied in a group of 17 male patients with hypogonadotrophic hypogonadism (HH). Ten of the patients had primary and seven secondary failure of gonadotrophin release, and all but four had previously been treated with gonadotrophin injections. Treatment was continued for between one and 18 months and was well tolerated by all except one patient who became allergic to LHRH. An increase in the basal gonadotrophin concentrations occurred in all except four patients within one week of the initiation of therapy, and this was associated with a rise in the serum testosterone level in eight patients. Increased spermatogenesis was demonstrated in seven cases and three pregnancies have resulted thus far. Pituitary desensitisation to the effects of LHRH was found in five subjects with primary HH who failed to produce any increase in testosterone secretion despite an initial stimulation of gonadotrophin release. We conclude that chronic pulsatile infusion of LHRH is an effective technique for the treatment of some cases of hypogonadotrophic hypogonadism.

Induction of puberty in men by long-term pulsatile administration of low-dose gonadotropin-releasing hormone

Puberty is heralded by the appearance of episodic gonadotropin secretion. Men with idiopathic hypogonadotropic hypogonadism have an abnormality in gonadotropin release and do not undergo normal puberty. Since idiopathic hypogonadotropic hypogonadism is thought to represent a disorder of gonadotropin-releasing-hormone (GnRH) secretion, we used long-term low-dose subcutaneous GnRH, administered in an episodic fashion by a portable infusion pump, in an effort to establish a normal adult pattern of gonadotropin secretion in six men. All subjects noted spontaneous erections, nocturnal emissions, and breast tenderness, which were associated with elevations of serum testosterone levels (77 +/- 13 ng per deciliter [mean +/- S.E.] before therapy vs. 520 +/- 182 ng after one month of treatment; P less than 0.001). Gonadotropin levels rose to normal adult ranges within one week of therapy and to supraphysiologic levels by 14 days. Testis size increased in four patients, and spermatogenesis was achieved in three patients by 43 weeks of therapy. These results suggest that long-term episodic GnRH administration can reverse idiopathic hypogonadotropic hypogonadism.

Pituitary changes in Kallmann's syndrome: a histologic, immunocytologic, ultrastructural, and immunoelectron microscopic study

Pituitary cytology was studied in a man with untreated Kallmann's syndrome who died at the age of 61. All the adenohypophyseal cells were normal except the gonadotrophs. The identifiable gonadotrophs were scanty and had few and small secretory granules, which gave a weak positivity for beta -follicle-stimulating hormone (FSH) and beta -luteinizing hormone (LH). The tests showed marked hypogenesis, while the adrenals and the thyroid were normal. In the hypothalamus, the lateral tuberal nuclei were undeveloped, and the nucleus subventricularis exhibited nerve cell hypertrophy. The morphologic findings are in accord with the results of endocrine investigations, which showed that the hypogonadism was due to a failure in the secretion of luteinizing hormone-releasing hormone.