Howell R, Dowsett M, King N, Edmonds D K
Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, London, UK.
Clin Endocrinol (Oxf). 1995 Nov;43(5):609-15. doi: 10.1111/j.1365-2265.1995.tb02926.x.
GnRH analogues are being used increasingly for a number of oestrogen dependent conditions in women. The resultant profound hypo-oestrogenism is a disadvantage, however, but the preservation of pituitary sensitivity to negative feedback by oestradiol is not well defined. We have determined the effect on gonadotrophins and inhibin of GnRH analogue plus low-dose continuous combined hormone replacement therapy in comparison with GnRH analogue therapy alone.
Randomized controlled trial.
Fifty premenopausal women with endometriosis randomized to treatment with goserelin alone (Group 1) or goserelin plus 17 beta-oestradiol and medroxyprogesterone acetate (Group 2).
FSH, LH, oestradiol, oestrone, inhibin before and during treatment.
Oestradiol and oestrone were suppressed in both groups, but Group 2 had significantly higher oestradiol during the hormone replacement therapy period. LH was suppressed in both groups. In Group 1, FSH levels recovered during treatment but, in contrast, in Group 2, FSH levels remained suppressed throughout treatment. Inhibin was significantly lower in Group 2, but not in Group 1, during treatment compared to pretreatment.
Pituitary secretion of FSH appears to remain responsive to feedback control by oestradiol during GnRH analogue therapy and is incompletely suppressed, unlike LH which remains completely suppressed. The possible mechanisms for this are discussed.
促性腺激素释放激素（GnRH）类似物越来越多地用于治疗女性多种雌激素依赖型疾病。然而，由此导致的严重低雌激素状态是一个不利因素，而且垂体对雌二醇负反馈的敏感性保留情况尚不明确。我们已确定GnRH类似物联合低剂量连续联合激素替代疗法与单独使用GnRH类似物疗法相比，对促性腺激素和抑制素的影响。
随机对照试验。
50名患有子宫内膜异位症的绝经前女性，随机分为单独使用戈舍瑞林治疗组（第1组）或戈舍瑞林联合17β - 雌二醇和醋酸甲羟孕酮治疗组（第2组）。
治疗前及治疗期间的促卵泡生成素（FSH）、促黄体生成素（LH）、雌二醇、雌酮、抑制素。
两组的雌二醇和雌酮均受到抑制，但在激素替代治疗期间，第2组的雌二醇水平显著更高。两组的LH均受到抑制。在第1组中，FSH水平在治疗期间有所恢复，而相比之下，在第2组中，FSH水平在整个治疗过程中一直受到抑制。与治疗前相比，治疗期间第2组的抑制素显著降低，但第1组未降低。
在GnRH类似物治疗期间，垂体FSH的分泌似乎仍对雌二醇的反馈控制有反应，且未被完全抑制，这与完全被抑制的LH不同。文中讨论了其可能的机制。
