Genazzani A D, Petraglia F, Volpogni C, Gastaldi M, Pianazzi F, Montanini V, Genazzani A R
Department of Obstetrics and Gynecology, University of Modena, Italy.
Fertil Steril. 1993 Sep;60(3):465-70. doi: 10.1016/s0015-0282(16)56162-7.
To define the characteristics of spontaneous GH episodic secretion and the modulatory role of gonadal steroids in patients with hypothalamic amenorrhea associated with weight loss.
Women were studied for 8 hours, sampling every 10 minutes, and plasma GH levels were measured by RIA.
Fifteen patients with weight-loss-related amenorrhea were studied in baseline conditions. Five out of 15 patients underwent two cycles of hormonal replacement therapy with E2 patches (100 micrograms every 3 days for 24 days) and medroxyprogesterone acetate (MPA) (10 mg/d, from day 12 to day 24). On the second cycle of therapy, the pulsatility study was repeated twice: after only estrogen (day 11) and after E2 plus progestin (day 22). Four normally cycling women were studied as a reference group during midfollicular and midluteal phases.
Amenorrheic patients showed mean plasma GH levels similar to healthy women during the follicular phase but significantly lower than those observed during the luteal phase. GH pulse frequency was higher in patients than in controls, whereas pulse amplitude was comparable with the follicular phase but lower during the luteal phase. During the hormonal replacement therapy, when only E2 was administered, GH pulse frequency decreased, whereas GH integrated plasma concentrations and GH pulse amplitude increased significantly. After MPA and E2 administration, GH pulse amplitude and GH plasma levels decreased, which was similar to pretreatment condition.
The present study demonstrated that in amenorrhea associated with weight loss the frequency of GH episodic release is significantly higher than in normally cycling women. Moreover, a different modulatory role of estrogen (increased amplitude) and P (decreased amplitude) on the episodic release of GH in amenorrheic women undergoing a replacement treatment was shown by the present data.
明确体重减轻所致下丘脑性闭经患者生长激素（GH）自发性脉冲式分泌的特征以及性腺类固醇激素的调节作用。
对女性进行8小时研究，每10分钟采样一次，采用放射免疫分析法（RIA）测定血浆GH水平。
15例体重减轻相关闭经患者接受基线状态研究。15例患者中有5例接受了两个周期的激素替代治疗，使用雌二醇（E2）贴片（每3天100微克，共24天）和醋酸甲羟孕酮（MPA）（10毫克/天，从第12天至第24天）。在治疗的第二个周期，脉冲式分泌研究重复两次：仅使用雌激素后（第11天）和使用E2加孕激素后（第22天）。选取4例月经周期正常的女性在卵泡中期和黄体中期作为参照组进行研究。
闭经患者在卵泡期的血浆GH平均水平与健康女性相似，但显著低于黄体期观察到的水平。患者的GH脉冲频率高于对照组，而脉冲幅度与卵泡期相当，但在黄体期较低。在激素替代治疗期间，仅给予E2时，GH脉冲频率降低，而GH血浆综合浓度和GH脉冲幅度显著增加。给予MPA和E2后，GH脉冲幅度和GH血浆水平降低，与治疗前情况相似。
本研究表明，体重减轻相关闭经患者GH脉冲式释放频率显著高于月经周期正常的女性。此外，本研究数据显示，雌激素（幅度增加）和孕激素（幅度降低）对接受替代治疗的闭经女性GH脉冲式释放具有不同的调节作用。
