Wagner T O, Brabant G, Warsch F, Hesch R D, von zur Mühlen A
J Clin Endocrinol Metab. 1986 Jan;62(1):95-101. doi: 10.1210/jcem-62-1-95.
Idiopathic delayed male puberty is defined as a delay of puberty beyond the age of 16, with prepubertal testosterone levels, normal gonadotropin responses to GnRH (excluding pituitary failure), and normal androgen responses to a single hCG injection (excluding testicular Leydig cell dysfunction), in absence of serious disease. Ten boys with this condition were evaluated as to their spontaneous LH, FSH, and PRL secretory patterns during a 24-h sampling period (20-min intervals). After this all patients were treated with pulsatile infusions of GnRH (25 ng/kg . pulse every 90 min for 10 days. Two groups could be distinguished by means of their pretreatment LH secretory pattern. Five patients had nighttime pulsatile elevation of LH levels, as usually occurs in early puberty. The other five patients did not have such a pattern (prepubertal type). The GnRH treatment resulted in increased LH and testosterone levels in both groups. All patients with pretreatment nighttime pulsatile LH secretion had steady pubertal development during the post-GnRH treatment observation period, whereas the other patients did not. In conclusion, among a number of tests, including chronic pulsatile GnRH treatment for 10 days, only the nocturnal LH secretory pattern differentiated delayed puberty from permanent hypothalamic hypogonadism in boys.
特发性男性青春期延迟被定义为青春期延迟至16岁以后，睾酮水平处于青春期前水平，促性腺激素对促性腺激素释放激素（GnRH）的反应正常（排除垂体功能衰竭），对单次人绒毛膜促性腺激素（hCG）注射的雄激素反应正常（排除睾丸间质细胞功能障碍），且无严重疾病。对10名患有这种疾病的男孩在24小时采样期（间隔20分钟）内的自发性促黄体生成素（LH）、促卵泡生成素（FSH）和催乳素（PRL）分泌模式进行了评估。在此之后，所有患者均接受GnRH脉冲式输注治疗（每90分钟25 ng/kg脉冲，持续10天）。根据治疗前LH分泌模式可将患者分为两组。5名患者LH水平在夜间呈脉冲式升高，这通常发生在青春期早期。另外5名患者没有这种模式（青春期前类型）。GnRH治疗使两组患者的LH和睾酮水平均升高。所有治疗前夜间LH分泌呈脉冲式的患者在GnRH治疗后的观察期内青春期发育稳定，而其他患者则不然。总之，在包括10天慢性脉冲式GnRH治疗在内的多项检查中，只有夜间LH分泌模式能够区分男孩的青春期延迟和永久性下丘脑性腺功能减退。
