STUDIES ON THE ENDOCRINE FUNCTION OF THE PITUITARY-TESTICULAR AXIS, WITH SPECIAL REFERENCE TO THE DIAGNOSIS OF PITUITARY-TESTICULAR DYSFUNCTION AND THERAPEUTIC EFFECT OF A LH-RH ANALOG

• Published in: Nippon Hinyokika Gakkai zasshi Vol. 73; no. 7; pp. 917 - 928
• Main Author: Tatara, Kiyoshi
• Format: Journal Article
• Language: Japanese
• Published: Japan THE JAPANESE UROLOGICAL ASSOCIATION 01.07.1982
• Subjects: Adult; Aged; Child; Child, Preschool; Cryptorchidism - diagnosis; Cryptorchidism - drug therapy; Follicle Stimulating Hormone - blood; Gonadotropin-Releasing Hormone - analogs & derivatives; Humans; Hypogonadism - diagnosis; Hypogonadism - drug therapy; Leuprolide; Luteinizing Hormone - blood; Male; Middle Aged; Testosterone - blood
• ISSN: 0021-5287; 1884-7110
• DOI: 10.5980/jpnjurol1928.73.7_917

Plasma LH, FSH and testosterone levels and responses of these hormones to various tests were examined in patients with prepubertal hypogonadism, unilateral cryptorchidism, bilateral cryptorchidism, hypospadia, hypogonadotropic hypogonadism, oligozoospermia or azoospermia to evaluate the endocrine function of the pituitary-testicular axis. The effects of intranasal administration of [D-Leu6, des Gly-NH210]-LH-RH ethylamide, one of the LH-RH analog, on plasma gonadotropin and testosterone levels were examined in five normal male adults and three patients with hypogonadotropic hypogonadism. Therapeutic effect of this analog was also studied in patients with hypogonadotropic hypogonadism, cryptorchidism and oligozoospermia. In children, no significant difference was observed in basal levels of plasma LH, FSH and testosterone and increment in plasma LH level during the LH-RH test between normal and patients with prepubertal hypogonadism (4 cases), unilateral cryptorchidism (15 cases), bilateral cryptorchidism (11 cases) and hypospadia (7 cases). The patients with hypospadia showed a significant increase in the levels of plasma FSH from the basal value of 2.8±2.7 (mean±SD) mIU/ml to 17.5±5.6 mIU/ml (p<0.05) after the LH-RH administration, but no significant difference was observed in plasma FSH response to LH-RH among normal children and patients with hypogonadism, unilateral cryptorchidism and bilateral cryptorchidism. The response of plasma testosterone to human chorionic gonadotropin (hCG) administration (100IU/kg/day for 3 days) was very low in all patients with hypogonadism (peak value, 66±23ng/dl) as compared with normal children (peak value, 270±34ng/dl). Some of the patients with unilateral cryptorchidism (peak value, 230±124ng/dl) and bilateral cryptorchidism (peak value, 261±150ng/dl) showed a relatively low response of plasma testerone to hCG, but all patients with hypospadia had a normal response. In 48 normal adults, plasma levels of LH and FSH in basal states were 10.9±3.8mIU/ml and 8.6±3.9mIU/ml, respectively, Lower plasma gonadotropin levels were observed in hypogonadotropic hypogonadism (LH; 2.4±1.7mIU/ml, FSH; 3.4±2.7mIU/ml, n=5). In patients with oligozoospermia (13 cases), plasma levels of LH and FSH were within normal range, but 11 cases of azoospermia showed slightly higher levels of plasma LH and FSH (LH; 24.2±15.1mIU/ml, FSH; 35.2±22.7mIU/ml). Response of plasma LH-RH were low in hypogonadotropic hypogonadism (peak value, 14.0±10.5mIU/ml), but patients with oligozoospermia (174.2±100.5mIU/ml) and azoospermia (194.0±175.0mIU/ml) showed relatively high response. Plasma level of FSH to LH-RH significantly high in patients with azoospermia (peak value, 80.5±32.0mIU/ml) as compared to the normal value (peak value, 14.2±7.1mIU/ml). The basal level of plasma testosterone in hypogonadotropic hypogonadism (80±38ng/dl) and azoospermia (435±153ng/dl) was significantly lower than in normal subjects(708±161ng/dl, n=50). On the other hand, response of testosterone to hCG(5000IU/day for 3 days) was lower in patients with hypogonadotropic hypogonadism (peak value, 172±54ng/dl) than in normal subjects (peak value, 1453±169ng/dl), but patients with oligozoospermia and azoospermia had values within normal range. Three patients with hypogonadotropic hypogonadism were treated with intranasal administration of the LH-RH analog (100μg/day) for 6 months. Their pituitary. testicular axis was stimulated to some extent by the treatment but complete development of the external genitalia and testes were not achieved at the end of the treatment. One of seven cases with cryptorchidism treated with the LH-RH analog(50μg/day) for 14 days showed full descent of the unilateral undescended testis into the scrotum. Patient