Berga S L, Mortola J F, Girton L, Suh B, Laughlin G, Pham P, Yen S S
Department of Reproductive Medicine, School of Medicine, University of California-San Diego, La Jolla 92093.
J Clin Endocrinol Metab. 1989 Feb;68(2):301-8. doi: 10.1210/jcem-68-2-301.
To further elucidate the neuroendocrine regulation of anterior pituitary function in women with functional hypothalamic amenorrhea (FHA), we measured serum LH, FSH, cortisol, GH, PRL, TSH concentrations simultaneously at frequent intervals for 24 h in 10 women with FHA and in 10 normal women in the early follicular phase (NC). Using the same data, we separately analyzed the cortisol-PRL responses to meals in these women. In addition, the pituitary responses to the simultaneous administration of GnRH, CRH, GHRH, and TRH were assessed in 6 FHA and 6 normal women. The 24-h secretory pattern of each hormone except TSH was altered in the women with FHA. Compared to normal women, the women with FHA had a 53% reduction in LH pulse frequency (P less than 0.0001) and an increase in the mean LH interpulse interval (P less than 0.01); LH pulse amplitude was similar. The 24-h integrated LH and FSH concentrations were reduced 30% (P = 0.01) and 19% (P less than 0.05), respectively. The mean cortisol pulse frequency, amplitude, interpulse interval, and duration were similar in the two groups, but integrated 24-h cortisol secretion was 17% higher in the women with FHA (P less than 0.05). This increase was greatest from 0800-1600 h, but also was present from 2400-0800 h. Cortisol levels were similar in the two groups from 1600-2400 h, resulting in an amplified circadian excursion. In contrast, the 24-h serum PRL levels were markedly lower at all times (P less than 0.0001), the sleep-associated nocturnal elevation of PRL was proportionately greater (P less than 0.05), and serum GH levels were increased at night in the women with FHA (P less than 0.05). Although 24-h serum TSH levels were similar at all times, T3 (P less than 0.05) and T4 (P less than 0.01) levels were lower in the FHA women. The responses of serum cortisol to lunch (P less than 0.01) and dinner (P less than 0.05) and those of serum PRL to lunch (P less than 0.05) and dinner (P = 0.08) were blunted in the women with FHA. Pituitary hormone increments in response to the simultaneous iv administration of GnRH, CRH, GHRH, and TRH were similar in the two groups, except for a blunted PRL response to TRH in the women with FHA (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
为进一步阐明功能性下丘脑性闭经（FHA）女性垂体前叶功能的神经内分泌调节，我们对10例FHA女性和10例处于卵泡早期的正常女性（NC）每隔一段时间同时测定血清促黄体生成素（LH）、促卵泡生成素（FSH）、皮质醇、生长激素（GH）、催乳素（PRL）、促甲状腺激素（TSH）浓度，共持续24小时。利用相同数据，我们分别分析了这些女性进食后皮质醇 - PRL的反应。此外，对6例FHA女性和6例正常女性评估了垂体对同时给予促性腺激素释放激素（GnRH）、促肾上腺皮质激素释放激素（CRH）、生长激素释放激素（GHRH）和促甲状腺激素释放激素（TRH）的反应。FHA女性中除TSH外，每种激素的24小时分泌模式均发生改变。与正常女性相比，FHA女性的LH脉冲频率降低了53%（P<0.0001），LH脉冲间期平均值增加（P<0.01）；LH脉冲幅度相似。24小时整合的LH和FSH浓度分别降低了30%（P = 0.01）和19%（P<0.05）。两组的平均皮质醇脉冲频率、幅度、脉冲间期和持续时间相似，但FHA女性24小时整合皮质醇分泌高17%（P<0.05）。这种增加在08:00 - 16:00时最大，但在24:00 - 08:00时也存在。两组在16:00 - 24:00时皮质醇水平相似，导致昼夜波动放大。相比之下，FHA女性24小时血清PRL水平在所有时间均显著较低（P<0.0001），与睡眠相关的夜间PRL升高幅度更大（P<0.05），且FHA女性夜间血清GH水平升高（P<0.05）。尽管24小时血清TSH水平在所有时间相似，但FHA女性的三碘甲状腺原氨酸（T3）（P<0.05）和甲状腺素（T4）（P<0.01）水平较低。FHA女性血清皮质醇对午餐（P<0.01）和晚餐（P<0.05）的反应以及血清PRL对午餐（P<0.05）和晚餐（P = 0.08）的反应均减弱。两组垂体激素对同时静脉注射GnRH、CRH、GHRH和TRH的增量相似，但FHA女性对TRH的PRL反应减弱（P<0.05）。（摘要截选至250字）
