Rubin Karen
University of Connecticut, School of Medicine, Division of Pediatric Endocrinology, Connecticut Children's Medical Center, Hartford, CT, 06106, USA.
Pediatr Endocrinol Rev. 2005 Jun;2(4):645-52.
Puberty in girls begins with nocturnal pulsatile gonadotropin releasing hormone (GnRH) secretion which increases gradually over a 4 year period and occurs throughout the day. Pulsatile GnRH secretion stimulates pituitary luteinizing hormone (LH) and follicle stimulating hormone (FSH) which induces gonadal steroid secretion, ovulation and oogenesis. Over the past decade, naturally occurring genetic mutations have been identified in a number of genes that impact the onset and progression of puberty and continued progress in this area will lead to earlier diagnosis of hypogonadotropic hypogonadism (HypoH) and potentially improved therapeutic options. Data are accumulating to support the use of more physiological hormone regimens to induce puberty. In addition, our better understanding of how estrogen interacts with the growth hormone - insulin-like growth factor-1 (GH-IGF-1) axis and of differential effects of oral versus non-oral estrogen on various biological parameters have important therapeutic implications for the management of hypogonadal adolescent girls. These implications will be addressed.
女孩青春期始于夜间脉冲式促性腺激素释放激素（GnRH）分泌，这种分泌在4年时间里逐渐增加，且全天都会发生。脉冲式GnRH分泌会刺激垂体促黄体生成素（LH）和促卵泡生成素（FSH），进而诱导性腺类固醇分泌、排卵和卵子发生。在过去十年中，已在一些影响青春期开始和进展的基因中发现了自然发生的基因突变，该领域的持续进展将有助于更早诊断低促性腺激素性性腺功能减退（HypoH），并可能改善治疗选择。越来越多的数据支持使用更符合生理状态的激素方案来诱导青春期。此外，我们对雌激素如何与生长激素-胰岛素样生长因子-1（GH-IGF-1）轴相互作用以及口服与非口服雌激素对各种生物学参数的不同影响有了更深入的了解，这对性腺功能减退青少年女孩的管理具有重要的治疗意义。本文将探讨这些意义。
