Wentz A C, Jones G S, Sapp K C
Obstet Gynecol. 1976 Jun;47(6):677-83.
Clomiphene citrate was administered to 17 patients with either secondary amenorrhea or oligomenorrhea to study its effect on hypothalamic-pituitary response. Measurement of pulsatile gonadotropin output was accomplished utilizing samples collected every 20 minutes for 6 to 8 hours before and after clomiphene administration. Response to 100 mug synthetic luteinizing hormone releasing hormone (LRH) was measured at the end of the sampling period. Patients with polycystic ovarian disease who ovulated showed increased baseline FSH and LH, decreased peak LH, and a decrease in the percentage increase over baseline for both LH and FSH. On patient wil clinical anorexia nervosa responded to clomiphene as an estrogen, with lowered baseline LH and FSH values. Patients with resolving anorexia responded to clomiphene as an antiestrogen, with increased baseline gonadotropins, and decreased gonadotropin peak values. A patient with a surgically treated chromophobe adenoma showed no change in parameters measured before and after clomiphene administration. Baseline and pulsatile LH output appear to reflect the tonic output of gonadotropin as affected by estrogen acting in a negative feedback system, and the peak response to LRH administration, the response to the positive feedback of estrogen. Thus, LRH stimulation in clomipheneresistent patients may be of value in diagnosing the site and degree of the defect and aid in improving therapy.
对17例继发性闭经或月经过少的患者给予枸橼酸氯米芬，以研究其对下丘脑 - 垂体反应的影响。在给予氯米芬之前和之后6至8小时，每隔20分钟采集样本，以此来测定促性腺激素的脉冲式分泌量。在采样期结束时，测量对100微克合成促黄体生成激素释放激素（LRH）的反应。排卵的多囊卵巢疾病患者表现为基础促卵泡激素（FSH）和促黄体生成素（LH）升高，LH峰值降低，LH和FSH相对于基础值的升高百分比下降。1例神经性厌食症患者对氯米芬呈现雌激素样反应，基础LH和FSH值降低。厌食症状缓解的患者对氯米芬呈现抗雌激素样反应，基础促性腺激素升高，促性腺激素峰值降低。1例接受手术治疗的嫌色细胞瘤患者在给予氯米芬前后测量的参数无变化。基础和脉冲式LH分泌量似乎反映了在负反馈系统中受雌激素影响的促性腺激素的持续性分泌量，以及对LRH给药的峰值反应，即对雌激素正反馈的反应。因此，对氯米芬抵抗的患者进行LRH刺激可能有助于诊断缺陷的部位和程度，并有助于改善治疗。
