Kimura K, Minakami H, Tamada T
Department of Obstetrics and Gynecology, Jichi Medical School, Tochigi-ken, Japan.
Nihon Naibunpi Gakkai Zasshi. 1988 Oct 20;64(10):1088-101. doi: 10.1507/endocrine1927.64.10_1088.
To study the prognosis of adolescent ovulatory disturbance in patients with persistently elevated LH levels (greater than or equal to 25 mIU/ml), normal FSH levels and high LH/FSH (greater than 2.0), 17 patients aged 12-19 years were studied longitudinally for 4-9 years. These 17 patients consisted of 7 patients suffering from amenorrhea with estrogenic effect, 5 patients with functional bleeding, 3 patients with delayed menarche and 2 patients with oligomenorrhea. All of the patients showed exaggerated LH responses to 100 micrograms of LHRH administration while the FSH responses were not different from those obtained from normal women. Out of the 17 patients, 10 (58.8%) patients showed the values of testosterone and 7 (41.2%) androstenedione which were above the mean + 2SD of normal women. Consequently, the mean serum testosterone and androstenedione levels were significantly higher than those in normal women. The mean LH (36.6 +/- 8.3 mIU/ml), FSH (11.2 +/- 1.5 mIU/ml) and LH/FSH (3.3 +/- 0.8) at the age of 21.4 +/- 2.5 years were not different from the mean LH (39.9 +/- 13.3 mIU/ml), FSH (10.8 +/- 1.8 mIU/ml) and LH/FSH (3.8 +/- 1.5) at the age of 16.1 +/- 1.8 years, respectively. None of the 17 patients showed amelioration or deterioration of ovulatory disturbance during long-term observation. To further investigate the central dopamine activity, 10 mg of metoclopramide (MCP) was administered intravenously in these 17 patients. The LH and PRL responses to MCP were evaluated, and the results were compared to those obtained from 17 patients aged over 20 with PCO and from 17 normal women. The LH responses to MCP were positive in this juvenile patient group and the patients aged over 20 PCO group. However, the LH responses to MCP were negative in normal women in both the follicular and luteal phases. In contrast, the PRL responses to MCP were significantly attenuated in juvenile patients and in patients aged over 20 with PCO compared to those in normal women. Since the hormonal profiles in these 17 patients with anovulation or oligo-ovulation were very similar to those in the group aged over 20 with established PCO, it may be suggested that 1) at least part of the adult patients with PCO may have had PCO from late adolescence; 2) the majority of the patients with high LH and normal FSH levels in adolescence will suffer from ovulatory disturbance continuously; 3) in these patients, an aberration of central dopamine in control of LH and PRL may exist.
为研究促黄体生成素（LH）水平持续升高（大于或等于25 mIU/ml）、促卵泡生成素（FSH）水平正常且LH/FSH升高（大于2.0）的青春期排卵障碍患者的预后，对17例年龄在12至19岁的患者进行了4至9年的纵向研究。这17例患者包括7例有雌激素效应的闭经患者、5例功能性出血患者、3例月经初潮延迟患者和2例月经过少患者。所有患者对100微克促性腺激素释放激素（LHRH）给药的LH反应均增强，而FSH反应与正常女性无异。17例患者中，10例（58.8%）的睾酮值和7例（41.2%）的雄烯二酮值高于正常女性的均值加2个标准差。因此，血清睾酮和雄烯二酮的平均水平显著高于正常女性。在21.4±2.5岁时，平均LH（36.6±8.3 mIU/ml）、FSH（11.2±1.5 mIU/ml）和LH/FSH（3.3±0.8）与16.1±1.8岁时的平均LH（39.9±13.3 mIU/ml）、FSH（!0.8±1.8 mIU/ml）和LH/FSH（3.8±1.5）相比，无差异。在长期观察中，17例患者均未出现排卵障碍的改善或恶化。为进一步研究中枢多巴胺活性，对这17例患者静脉注射10毫克甲氧氯普胺（MCP）。评估了对MCP的LH和催乳素（PRL）反应，并将结果与17例年龄超过20岁的多囊卵巢（PCO）患者和17例正常女性的结果进行了比较。该青少年患者组和年龄超过20岁的PCO患者组对MCP的LH反应为阳性。然而，正常女性在卵泡期和黄体期对MCP的LH反应均为阴性。相比之下，与正常女性相比，青少年患者和年龄超过20岁的PCO患者对MCP的PRL反应明显减弱。由于这17例无排卵或排卵过少患者的激素谱与年龄超过20岁的已确诊PCO患者组非常相似，因此可能提示：1）至少部分成年PCO患者可能从青春期晚期就患有PCO；2）青春期LH水平高且FSH水平正常的大多数患者将持续存在排卵障碍；3）在这些患者中，可能存在中枢多巴胺对LH和PRL控制的异常。
