Ehrmann D A, Rosenfield R L, Cuttler L, Burstein S, Cara J F, Levitsky L L
Department of Pediatrics, University of Chicago, Pritzker School of Medicine, Illinois 60637.
J Clin Endocrinol Metab. 1989 Nov;69(5):963-7. doi: 10.1210/jcem-69-5-963.
There is evidence that the capacity to synthesize gonadotropins is less in teenage boys with gonadotropin deficiency (GD) than in those with constitutional delay of puberty (DP). We hypothesized that this might predispose the latter group to have a greater pituitary-testicular response to the potent long-acting GnRH agonist nafarelin. We evaluated GD patients 14.3-24.0 yr of age (n = 8) and prepubertal DP boys 14.8-17.6 yr of age (n = 3). In most subjects the response to nafarelin was compared to that of frequent nocturnal blood sampling for LH and testosterone levels. All subjects received a single dose of nafarelin (1.0 micrograms/kg, sc), and blood was then sampled at 0.5- to 4.0-h intervals for 24 h. Patients with GD could not be distinguished from those with DP by pubertal staging criteria or by baseline values of LH, FSH, or testosterone. Patients with GD exhibited no rise in plasma LH levels during sleep, in contrast to those with DP. All GD patients had LH and FSH responses distinctly less than those of the DP group between 3-24 h postnafarelin. The peak incremental responses of GD and DP to nafarelin were, respectively: LH, 5.5 +/- 2 3 (+/- SEM and 77.2 +/- 8.6 IU/L (P less than 0.02); FSH, 2.7 +/- 1.2 and 9.4 +/- 0.8 IU/L (P less than 0.005). Testosterone peak responses were lower as well (0.26 +/- 0.2 vs 1.6 +/- 0.5 nmol/L, P = 0.05). This pilot study suggests that the response to a single test dose of nafarelin distinguishes GD from DP in the teenage years as well as does measurement of nocturnal LH levels. The testosterone response to the GnRH agonist adds a new dimension to GnRH testing. Nafarelin also allows assessment of the bioactivity of endogenous gonadotropin, is a more potent stimulus of pituitary-testicular function than endogenous GnRH secretion, and is more cost-effective than nocturnal sampling.
有证据表明，患有促性腺激素缺乏症（GD）的青少年男孩合成促性腺激素的能力低于体质性青春期延迟（DP）的男孩。我们推测，这可能使后一组对强效长效促性腺激素释放激素（GnRH）激动剂那法瑞林产生更大的垂体 - 睾丸反应。我们评估了14.3 - 24.0岁的GD患者（n = 8）和14.8 - 17.6岁的青春期前DP男孩（n = 3）。在大多数受试者中，将那法瑞林的反应与频繁夜间采血测定促黄体生成素（LH）和睾酮水平的反应进行比较。所有受试者均接受单次剂量的那法瑞林（1.0微克/千克，皮下注射），然后在24小时内以0.5至4.0小时的间隔采血。根据青春期分期标准或LH、卵泡刺激素（FSH）或睾酮的基线值，无法区分GD患者和DP患者。与DP患者相比，GD患者在睡眠期间血浆LH水平没有升高。在那法瑞林给药后3 - 24小时内，所有GD患者的LH和FSH反应明显低于DP组。GD和DP对那法瑞林的峰值增量反应分别为：LH，5.5±2.3（±标准误）和77.2±8.6 IU/L（P＜0.02）；FSH，2.7±1.2和9.4±0.8 IU/L（P＜0.005）。睾酮峰值反应也较低（0.26±0.2对1.6±0.5 nmol/L，P = 0.05）。这项初步研究表明，对单次试验剂量那法瑞林的反应在青少年时期可区分GD和DP，与夜间LH水平测量的效果相同。对GnRH激动剂的睾酮反应为GnRH检测增添了新的维度。那法瑞林还可评估内源性促性腺激素的生物活性，是比内源性GnRH分泌更强的垂体 - 睾丸功能刺激剂，并且比夜间采样更具成本效益。
