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Pituitary-testis axis function may improve with GnRH in congenital combined pituitary hormone deficiency
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Men with hypogonadotropic hypogonadism caused by congenital combined pituitary hormone deficiency may see an increase in serum testosterone levels with the use of gonadotropin-releasing hormone therapy, according to findings from researchers in China.
Xueyan Wu, MD, of the department of endocrinology, Peking Union Medical College Hospital, Key Laboratory of Endocrinology, Ministry of Health in Beijing, and colleagues evaluated 40 men (mean age, 25.5 years) with hypogonadotropic hypogonadism caused by congenital combined pituitary hormone deficiency assigned to subcutaneous pulsatile gonadotropin-releasing hormone (GnRH) therapy for 3 months to determine the pituitary response to the therapy.
Overall, 60% of participants responded to GnRH with a significant increase in testosterone levels compared with baseline levels; the remaining 40% of participants showed poor response to GnRH therapy with no increase in testosterone levels.
In the good response group, serum luteinizing hormone and follicle-stimulating hormone levels increased to the normal range, total serum testosterone increased from 0.29 nmol/L to 8.67 nmol/L (P = .00002), and testicular volume increased from 3.3 mL to 6 mL (P = .00005). Eight participants in this group achieved spermatogenesis with mean sperm concentration of 5.51 million/mL at 3 months.
The poor response group showed an increased in luteinizing hormone and follicle-stimulating hormone levels, but no change was observed in serum testosterone levels. However, testicular volume increased from 1.9 mL to 2.9 mL.
“This study focused on male [congenital combined pituitary hormone deficiency] patients and found that 60% of them responded to GnRH therapy,” the researchers wrote. “This surprising finding suggests the existence of a gonadotropic cell reservoir in the pituitary gland of these patients, despite their hypogonadotropic hypogonadism. To our knowledge, this is the first large study that has revealed the effectiveness of pulsatile GnRH therapy in restoring pituitary-gonadal axis function in [congenital combined pituitary hormone deficiency] patients.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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