Derangement of pituitary gonadotropin release with different GnRH pulsatile patterns in chronic intravenous or subcutaneous delivery.

The efficacy of iv and sc chronic GnRH administration with different pulsatile patterns (15 micrograms every 90 min and 7.8 micrograms every 90 min with minor intermediate pulses of 2.3 micrograms every 22.2 min) by means of portable pumps were evaluated in a patient with primary hypothalamic amenorrhea. Observations of the amplitude and duration of the induced serum gonadotropin concentrations, of follicular growth (via ultrasound), and of ovarian steroids were made. Iv delivery of GnRH, 15 micrograms every 90 min, induced a normal menstrual cycle. Dividing this dose, as described above, giving it iv and sc, resulted in inappropriate gonadotropin secretion (overstimulation and desensitization, respectively) and arrest of follicular development. Sc delivery of 15 micrograms GnRH every 90 min resulted in an insufficient LH stimulation.