[Induction of puberty in Kallmann syndrome by pulsatile gonadotropin-releasing hormone stimulation].

A 23-year-old male, diagnosed as having hypogonadotropic hypogonadism associated with hyposmia (Kallmann syndrome), was given a trial of pulsatile Gn-RH therapy for 100 days. The therapy led to rhythmic secretion of LH and FSH by the anterior pituitary gland. Both the mean and the peak gonadotropin levels rose steadily. Following the 9th day of treatment the previously subnormal gonadotropin levels were found to be within the normal range. After 23 days a pulsatile response of the Leydig cells parallel to the rhythmic LH secretion was noticed. The testosterone level increased significantly and was 2.6 ng/ml 3 months after the initiation of the therapy. At the same time an increasing activity of androgen-dependent glands became apparent and secondary male sex characteristics were noted. The seminal volume rose from 0.1 ml to 2.0 ml, but after 3 months of treatment spermatozoa could still not be detected. In summary, pulsatile Gn-RH stimulation represents a good option in the treatment of hypothalamic hypogonadotropic hypogonadism as the therapy resembles physiological stimulation and is well tolerated by the patient.