Assessment of Hypothalamic-Pituitary Function by Hormonal Pulsatility, Gonadotropin-Releasing Hormone and Thyrotropin-Releasing Hormone Testing in Women with Euprolactinemic Secondary Amenorrhea

激素脈動性分泌、促性腺激素釋出激素與促甲狀腺激素釋出激素評估續發性無月經婦女下視丘腦下垂體機能之內分泌學研究

林國城(Kuo-Cherng Lin) ； 李昭男(Jau-Nan Lee) ； 鍾相彬(Shiang-Bin Jong)

《The Kaohsiung Journal of Medical Sciences》 14卷11期 (1998/11) Pp. 698-705

https://doi.org/10.6452/KJMS.199811.0698

摘要

續發性無月經是婦科常見之內分泌疾病，其致病機轉尚未完全清楚。為了解下視丘腦下垂體機能在此疾病所扮演之角色，本研究以23位無月經婦女為主要對象，並以9位正常月經婦女為對照群(I群)。其中13位無月經婦女為黃體素消退性出血陽性者(II群)，而10位為黃體素消退性出血陰性者(III群)。於月經第五天每15分抽血一次共四小時做血中LH、FSH、PRL脈動性分泌後，再以促性腺激素釋出激素(GnRH)與促甲狀腺激素釋出激素(TRH)做二小時之刺激試驗。研究結果顯示，LH脈動頻率、幅度及LH對GnRH之刺激反應，I群與II群間並無任何差異，但II群之PRL對TRH之刺激竑應，與I群相較，卻顯出過剩反應。III群之LH脈動率、幅度，與I群相較，在統計上顯示有意義的低下。但其LH與FSH對G Nrh之刺激反應卻與I相似。而PRL之脈動頻率、幅度及PRL對TRH之刺激反應，III群與I群間並無任何差異。由以上研究結果顯示，潛在性高秒乳激素分泌現象，及規則性促性腺激素脈動性分泌功能朱調，可能是導致續發性無月經之致病機轉。臨床上分析這些激素動態，對其前瞻性了解、病態生理及評估處理顯然有相當助益。

並列摘要

To evaluate the integrated hypothalamic-pituitary function of euprolactinemic secondary amenorrhea, blood samples of 23 patients were taken every 15 min for 4 hours in examination of pulsatile LH, FSH, PRL secretions and then 2 hours GnRH, TRH tests were performed. Nine normal cycling women (group I) served as the controls. Thirteen amenorrheic women (group II) revealed responsive bleeding to progestin injection and the other 10 women (group III) were nonresponsive. The LH frequency, amplitude, and LH response to GnRH of groups II and I were comparable, whereas ΔPRL after TRH in group II(60.8±18.9ng/ml) exhibited a significantly (P＜0.05) exaggerated response, as compared with that of group I(43.6±11.4ng/ml). The LH frequency (1.3±0.4/4h) and amplitude (1.7±0.4mIU/mL) of group III were significantly lower (P＜0.01) than those in group I (2.4±0.5 and 2.5±0.5, respectively), but their ΔLH and ΔFSH responses to GnRH showed no differences from those of controls. The frequency, amplitude of PRL and ΔPRL response to TRH in group III were no significant difference with those of group I. These results suggest that masked PRL hypersecretion and loss of the regulatory pulsatility of gonadotropin release may be responsible in part for the causes resulting to euprolactinemic secondary amenorrhea. The analysis of these hormonal environments is useful for the understanding of clinical perspectives, pathophysiology and management.

並列關鍵字

LH pulse ； GnRH ； TRH