Vasquez J M, Greenblatt R B
J Reprod Med. 1985 Aug;30(8):591-600.
As a result of the use of synthetic luteinizing-hormone-releasing hormone (LHRH) (and its analogs), significant advances in modern clinical practice are being realized. We studied the use of LHRH as a test for pituitary reserve for gonadotropin secretion in different reproductive disorders. Synthetic LHRH was used as a diagnostic test for discriminating pituitary from hypothalamic disorders. After appropriate LHRH priming of the pituitary, LHRH was used to document hypothalamic dysfunction in patients with Kallmann's syndrome who had normal gonadotropin responsiveness to LHRH. The gonadotropin responsiveness to 100 micrograms of LHRH was impaired or absent in patients with panhypopituitarism, craniopharyngiomas, hemochromatosis and acromegaly accompanied by abnormal lactation. In women with gonadal dysgenesis, the absence of gonadal steroid feedback exacerbated the pituitary responsiveness to LHRH. Women with hyperprolactinemia are also known to have a blunted gonadotropin response to endogenous and exogenous LHRH. An experimental rat model was developed in our laboratory to study the site of prolactin action on gonadotropin secretion. LHRH challenge tests during perphenazine-induced hyperprolactinemia in rats indicated that prolactin may decrease pituitary sensitivity to LHRH. Additional experiments indicated that the increased progesterone produced in these hyperprolactinemic (pseudopregnant) rats was probably responsible for the decreased pituitary responsiveness to LHRH. Further studies will be necessary to determine whether prolactin, which can alter ovarian steroidogenesis in vitro, interferes with ovulation directly in addition to affecting the hypothalamic-pituitary axis.
由于使用了合成促黄体生成激素释放激素（LHRH）（及其类似物），现代临床实践正在取得重大进展。我们研究了LHRH作为不同生殖疾病中促性腺激素分泌垂体储备测试的应用。合成LHRH被用作区分垂体疾病和下丘脑疾病的诊断测试。在对垂体进行适当的LHRH激发后，LHRH被用于记录卡尔曼综合征患者的下丘脑功能障碍，这些患者对LHRH的促性腺激素反应正常。全垂体功能减退症、颅咽管瘤、血色素沉着症和伴有异常泌乳的肢端肥大症患者对100微克LHRH的促性腺激素反应受损或缺乏。在性腺发育不全的女性中，性腺类固醇反馈的缺乏加剧了垂体对LHRH的反应。高催乳素血症的女性对内源性和外源性LHRH的促性腺激素反应也迟钝。我们实验室建立了一个实验大鼠模型来研究催乳素对促性腺激素分泌作用的部位。大鼠在奋乃静诱导的高催乳素血症期间进行的LHRH激发试验表明，催乳素可能会降低垂体对LHRH的敏感性。额外的实验表明，这些高催乳素血症（假孕）大鼠中产生的孕酮增加可能是垂体对LHRH反应性降低的原因。需要进一步研究以确定在体外可改变卵巢类固醇生成的催乳素除了影响下丘脑-垂体轴外是否还直接干扰排卵。
