枸橼酸氯米芬对促性腺激素释放激素类似物治疗期间催乳素和促性腺激素释放的影响。

Effect of clomiphene citrate on prolactin and gonadotropin release during GnRH-analog treatment.

作者信息

Martikainen H, Rönnberg L, Ruokonen A, Kauppila A

机构信息

Department of Obstetrics and Gynecology, University of Oulu, Finland.

出版信息

Gynecol Endocrinol. 1988 Mar;2(1):53-8. doi: 10.3109/09513598809029339.

DOI:10.3109/09513598809029339

PMID:3140590

Abstract

The capacity of the anterior pituitary to secrete prolactin (PRL) and gonadotropins was evaluated by TRH and GnRH stimulation, followed by metoclopramide (MC) administration 1 hour later, before and after clomiphene citrate (CC) priming in 8 endometriosis patients receiving GnRH agonist analog (Buserelin) therapy for 6 months. GnRH-analog treatment lowered the maximal PRL responses to TRH and MC stimulation in the luteal phase, compared to those of 8 normally menstruating control patients. The LH response to GnRH stimulation was also diminished, indicating pituitary desensitization, while the FSH response remained unchanged. Antiestrogen administration during GnRH-analog treatment further reduced the capacity of pituitary lactotropes to secrete PRL in TRH and MC tests, and it increased the LH response but not the FSH response to GnRH stimulation. These data suggest that CC affects the mechanisms controlling PRL and gonadotropin secretions in hypoestrogenic women after prolonged GnRH agonist analog treatment by different modes of action, the action on gonadotropes being stimulatory and that on lactotropes inhibitory.

摘要

在8例接受促性腺激素释放激素（GnRH）激动剂类似物（布舍瑞林）治疗6个月的子宫内膜异位症患者中，于枸橼酸氯米芬（CC）预处理前后，通过促甲状腺激素释放激素（TRH）和促性腺激素释放激素（GnRH）刺激，随后1小时后给予甲氧氯普胺（MC），评估垂体前叶分泌催乳素（PRL）和促性腺激素的能力。与8例正常月经周期的对照患者相比，GnRH类似物治疗降低了黄体期PRL对TRH和MC刺激的最大反应。LH对GnRH刺激的反应也减弱，表明垂体脱敏，而FSH反应保持不变。在GnRH类似物治疗期间给予抗雌激素进一步降低了垂体催乳细胞在TRH和MC试验中分泌PRL的能力，并增加了LH对GnRH刺激的反应，但未增加FSH反应。这些数据表明，CC通过不同的作用方式影响长期GnRH激动剂类似物治疗后低雌激素女性中控制PRL和促性腺激素分泌的机制，对促性腺细胞的作用是刺激性的，对催乳细胞的作用是抑制性的。