Ovulation induction with pulsatile gonadotropin-releasing hormone (GnRH) or gonadotropins in a case of hypothalamic amenorrhea and diabetes insipidus

Gynecol Endocrinol. 2001 Dec;15(6):421-5.

Abstract

Hypothalamic amenorrhea is a treatable cause of infertility. Our patient was presented with secondary amenorrhea and diabetes insipidus. Cortisol and prolactin responded normally to a combined insulin tolerance test (ITT) and thyrotropin-releasing hormone (TRH) challenge, while thyroid-stimulating hormone (TSH) response to TRH was diminished, and no response of growth hormone to ITT was detected. Both luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels increased following gonadotropin-releasing hormone (GnRH) challenge. No response of LH to clomiphene citrate challenge was detected. Magnetic resonance imaging findings demonstrated a midline mass occupying the inferior hypothalamus, with posterior lobe not visible and thickened pituitary stalk. Ovulation induction was carried out first with combined human menopausal gonadotropins (hMG/LH/FSH) (150 IU/day) and afterwards with pulsatile GnRH (150 ng/kg/pulse). Ovulation was achieved with both pulsatile GnRH and combine gonadotropin therapy. Slightly better results were achieved with the pulsatile GnRH treatment.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Amenorrhea / etiology
  • Amenorrhea / therapy*
  • Clomiphene
  • Diabetes Insipidus / complications*
  • Diabetes Insipidus / physiopathology
  • Female
  • Follicle Stimulating Hormone / blood
  • Gonadotropin-Releasing Hormone / administration & dosage*
  • Gonadotropins / administration & dosage*
  • Human Growth Hormone / blood
  • Humans
  • Hydrocortisone / blood
  • Hypogonadism / etiology
  • Hypogonadism / therapy
  • Hypothalamus / physiopathology*
  • Infertility, Female / therapy
  • Insulin
  • Luteinizing Hormone / blood
  • Magnetic Resonance Imaging
  • Ovulation Induction / methods*
  • Periodicity*
  • Prolactin / blood
  • Thyrotropin / blood
  • Thyrotropin-Releasing Hormone

Substances

  • Gonadotropins
  • Insulin
  • Human Growth Hormone
  • Clomiphene
  • Gonadotropin-Releasing Hormone
  • Thyrotropin-Releasing Hormone
  • Prolactin
  • Luteinizing Hormone
  • Follicle Stimulating Hormone
  • Thyrotropin
  • Hydrocortisone