South S A, Asplin C M, Carlsen E C, Booth R A, Weltman J Y, Johnson M L, Veldhuis J D, Evans W S
Department of Internal Medicine, University of Virginia, Charlottesville 22908.
J Clin Endocrinol Metab. 1993 Apr;76(4):1048-53. doi: 10.1210/jcem.76.4.8473380.
To investigate hypothalamic and/or pituitary abnormalities in women with poorly controlled insulin-dependent diabetes mellitus (IDDM) and secondary amenorrhea, we measured serum LH every 10 min for 24 h and for 2 additional h after the administration of exogenous GnRH in 8 women with IDDM and amenorrhea and compared these to data from 15 eumenorrheic nondiabetic women. LH pulses were characterized by the pulse detection algorithm Cluster, and secretory episodes were evaluated using the multiple parameter deconvolution procedure Deconv. Cluster analysis revealed fewer LH pulses per 24 h (14.3 +/- 1.2 vs. 19.9 +/- 0.6; P < 0.001; mean +/- SEM), a greater peak width (63 +/- 4.9 vs. 44 +/- 2.2 min; P < 0.01), and greater peak area (136 +/- 17 vs. 89 +/- 13 IU/L.min; P < 0.01) in the diabetic women. Analysis with Deconv revealed fewer LH secretory episodes per 24 h in the diabetic women (14.4 +/- 0.9 vs. 20.4 +/- 0.5; P < 0.001) and no statistical difference in LH half-lives. The IDDM women responded to a 10-micrograms GnRH bolus with LH pulses of larger total (51 +/- 15.9 vs. 15 +/- 1.4 IU/L; P < 0.01) and incremental (29 +/- 7.6 vs. 9 +/- 1.2; P < 0.001) amplitude. In summary, we observed that amenorrheic diabetic women have fewer LH pulses/secretory episodes than normal women. However, they respond well to exogenous GnRH, suggesting that compromise of the GnRH pulse generator, rather than pituitary dysfunction, is responsible for their menstrual dysfunction.
为研究胰岛素依赖型糖尿病（IDDM）控制不佳且继发闭经的女性下丘脑和/或垂体异常情况，我们对8例IDDM闭经女性每10分钟测定一次血清促黄体生成素（LH），共24小时，并在给予外源性促性腺激素释放激素（GnRH）后再持续测定2小时，同时将这些数据与15例月经正常的非糖尿病女性的数据进行比较。采用聚类脉冲检测算法（Cluster）对LH脉冲进行特征分析，并用多参数去卷积程序（Deconv）评估分泌峰。聚类分析显示，糖尿病女性每24小时的LH脉冲数较少（分别为14.3±1.2次与19.9±0.6次；P<0.001；均值±标准误），峰宽更大（分别为63±4.9分钟与44±2.2分钟；P<0.01），峰面积也更大（分别为136±17与89±13IU/L·分钟；P<0.01）。Deconv分析显示，糖尿病女性每24小时的LH分泌峰次数较少（分别为14.4±0.9次与20.4±0.5次；P<0.001），而LH半衰期无统计学差异。IDDM女性对10微克GnRH推注的反应是，LH脉冲的总幅度（分别为51±15.9与15±1.4IU/L；P<0.01）和增量幅度（分别为29±7.6与9±1.2；P<0.001）更大。总之，我们观察到闭经的糖尿病女性LH脉冲/分泌峰次数少于正常女性。然而，她们对外源性GnRH反应良好，这表明GnRH脉冲发生器功能受损而非垂体功能障碍是导致其月经功能紊乱的原因。
