Enchancement of deficient pituitary response to luteinizing hormone releasing hormone in patients with primary amenorrhea.

Although the absence of pituitary response to the luteinizing hormone releasing hormone (LHRH) test has been considered proof of a lesion primarily localized at the pituitary level, the possibility exists that an absent pituitary response may represent only the effect of a chronic deficiency of hypothalamic secretion. To verify this hypothesis, 4 patients with primary amenorrhea, hypogonadotropic hypogonadism, and deficient or absent responses to a 25 mug LHRH rapid IV test were treated with 400 mug LHRH infused in 7 hours during each of 3 successive days. The finding that patients with deficient LH responses to a rapid LHRH test became normally responsive to a second equivalent test after a slow and prolonged treatment with the decapeptide suggests that, in these patients, besides a lesion at the pituitary level, a primary defect at the hypothalamic or higher centers may also be suspected.