Amenorrhea: Observations based on the analysis of luteninizing hormone–releasing hormone testing

      This paper is only available as a PDF. To read, Please Download here.
      From 1973 to 1976, 130 patients with symptomatic amenorrhea were evaluated by pituitary gonadotropin response to a subcutaneous injection of luteinizing hormone–releasing hormone (LHRH). These patients were placed in 13 specific disease categories by extensive endocrine evaluation. The LHRH test itself was not used for diagnostic categorization. Test results from these groups of patients were compared with those from 18 early follicular control subjects using logarithms of four baseline and 13 response measurements. Results were as follows: Gonadotropin measurements demonstrated a logarithmic distribution. Each diagnostic category demonstrated multiple significant differences when compared to the control group. Statistical comparisons using logarithms yielded additional significant differences (when n<10) which were not apparent using the untransformed (original) values. Multiple variables were examined in order to determine how best to characterize the response of gonadotropins to LHRH. The gonadotropin peak, peak minus baseline, area under the curve, and mean change were highly correlated and could be used relatively interchangeably to quantitate the gonadotropin response. The peak/base ratio conveyed quantitative information that was different from the other parameters. Each disease category demonstrated a pattern that was distinguishable from the control group; however, the variability in gonadotropin response limited the usefulness of the LHRH test as a diagnostic tool to categorize individual patients.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Matsuo H.
        • Baba Y.
        • Nair R.M.G.
        • Arimura A.
        • Schally A.V.
        Structure of the porcine LH and FSH releasing hormone.
        Biochem. Biophys. Res. Commun. 1971; 43: 1334
        • Amoss M.
        • Burgus R.
        • Blackwell R.
        • Vale W.
        • Fellows R.
        • Guillemin R.
        Purification, amino acid composition and N-terminus of the hypothalamic luteinizing hormone releasing factor of ovine origin.
        Biochem. Biophys. Res. Commun. 1971; 44: 205
        • Wentz A.C.
        • Jones G.S.
        • Rocco L.
        • Matthews R.R.
        Gonadotropin response to LHRH administration in secondary amenorrhea and galactorrhea syndromes.
        Obstet. Gynecol. 1975; 45: 256
        • Campenhout J.V.
        • Papas S.
        • Blanchet P.
        • Wyman H.
        • Somma M.
        Pituitary responses to synthetic LHRH in thirty-four cases of amenorrhea or oligomenorrhea associated with galactorrhea.
        Am. J. Obstet. Gynecol. 1977; 127: 723
        • Cantor B.
        • Kalra P.S.
        • Buhi W.C.
        • Birk S.A.
        • Spellacy W.N.
        Factors influencing the dynamics of gonadotropin response following bolus infusion of luteinizing hormone releasing factor in women with menstrual abnormalities.
        Fertil. Steril. 1977; 28: 526
        • Mortimer R.H.
        • Fleischer N.
        • Lev-Gur M.
        • Freeman R.G.
        Correlation between integrated LH and FSH levels and response to LRF.
        J. Clin. Endocrinol. Metab. 1976; 43: 1230
        • Odell W.D.
        • Rayford P.L.
        • Ross G.T.
        Radioimmunoassay of human thyroid stimulating, growth, luteinizing, and follicle stimulating hormone.
        J. Lab. Clin. Med. 1967; 70: 973
        • Aksel S.
        • Schomberg D.W.
        • Tyrey L.
        • Hammond C.B.
        Vasomotor symptoms, serum estrogens, and gonadotropin levels in surgical menopause.
        Am. J. Obstet. Gynecol. 1976; 126: 165
        • Kletzky O.A.
        • Nakamura R.M.
        • Thorneycroft I.H.
        • Mishell D.R.
        Log normal distribution of gonadotropins and ovarian steroid values in the normal menstrual cycle.
        Am. J. Obstet. Gynecol. 1975; 121: 688
        • Yen S.S.C.
        • Rebar R.
        • Vandenberg G.
        • Judd H.
        Hypothalamic amenorrhea and hypogonadotropinism: Response to synthetic LRF.
        J. Clin. Endocrinol. Metab. 1973; 36: 811
        • Sherman B.M.
        • Halmi K.A.
        • Zamudio R.
        LH and FSH response to gonadotropin releasing hormone in anorexia nervosa: Effect of nutritional rehabilitation.
        J. Clin. Endocrinol. Metab. 1975; 41: 135
        • Aono T.
        • Miyake A.
        • Shioji T.
        • Kinugasa T.
        • Onishi T.
        • Kurachi K.
        Impaired LH release following exogenous estrogen administration in patients with amenorrhea galactorrhea syndrome.
        J. Clin. Endocrinol. Metab. 1976; 42: 696
        • Bohnet H.
        • Dahlen G.
        • Wuttke W.
        • Schneider H.P.G.
        Hyperprolactinemic anovulatory syndrome.
        J. Clin. Endocrinol. Metab. 1976; 42: 132
        • Thorner M.O.
        • McNeilly A.S.
        • Hagen C.
        • Beser G.M.
        Long term treatment of galactorrhea and hypogonadism with bromocryptine.
        Br. Med. J. 1974; 2: 419
        • Chang R.J.
        • Keye W.R.
        • Young J.R.
        • Wilson C.B.
        • Jaffe R.B.
        Detection, evaluation, and treatment of pituitary microadenomas in patients with galactorrhea and amenorrhea.
        Am. J. Obstet. Gynecol. 1977; 128: 356
        • Zarate A.
        • Jacobs L.S.
        • Canales E.S.
        • Schally A.V.
        • Cruz A.D.L.
        • Soria J.
        • Daughaday W.H.
        Functional evaluation of pituitary reserve in patients with the amenorrhea-galactorrhea syndrome utilizing LHRH, l-dopa, and chlorpromazine.
        J. Clin. Endocrinol. Metab. 1973; 37: 855
        • Lachelin G.C.L.
        • Abu-Fadil S.
        • Yen S.S.C.
        Functional delineation of hyperprolactinemic amenorrhea.
        J. Clin. Endocrinol. Metab. 1977; 44: 1163
        • Jewelewicz R.
        • Dyrenfurth I.
        • Warren M.
        • Frantz A.G.
        • VandeWiele R.L.
        Effect of thyrotropin releasing hormone upon the menstrual cycle in women.
        J. Clin. Endocrinol. Metab. 1974; 39: 387
        • Del Pozo E.
        • Varga L.
        • Schulz K.D.
        • Kunzig H.J.
        • Marbach P.
        • Campo G.L.
        • Eppenberger U.
        Pituitary and ovarian response patterns to stimulation in the postpartum and in galactorrhea-amenorrhea.
        Obstet. Gynecol. 1975; 46: 539
        • Glass M.R.
        • Shaw R.W.
        • Butt W.R.
        • Edwards R.L.
        • London D.R.
        An abnormality of estrogen feedback in amenorrhea-galactorrhea.
        Br. Med. J. 1975; 3: 274
        • Wiebe R.H.
        • Hammond C.B.
        • Handwerger S.
        Treatment of functional amenorrhea-galactorrhea with 2-bromoergocryptine.
        Fertil. Steril. 1977; 28: 426
        • Yen S.S.C.
        • VandenBerg G.
        • Rebar R.
        • Ehara Y.
        Variation of pituitary responsiveness to synthetic LRF during different phases of the menstrual cycle.
        J. Clin. Endocrinol. Metab. 1972; 35: 931
        • Yen S.S.C.
        • Vandenberg G.
        • Siler T.M.
        Modulation of pituitary responsiveness to LRF by estrogen.
        J. Clin. Endocrinol. Metab. 1974; 39: 170
        • Thompson I.E.
        • Arfania J.
        • Taymor M.L.
        Effects of estrogen and progesterone on pituitary response to stimulation by LHRH.
        J. Clin. Endocrinol. Metab. 1973; 37: 152
        • Keye W.R.
        • Jaffe R.B.
        Modulation of pituitary gonadotropin response to gonadotropin-releasing hormone by estradiol.
        J. Clin. Endocrinol. Metab. 1974; 38: 805
        • Nillius S.S.
        • Wide L.
        Variation in LH and FSH response to LHRH during the menstrual cycle.
        Br. J. Obstet. Gynaecol. 1972; 79: 865
        • Bremner W.J.
        • Paulsen C.A.
        Two pools of luteinizing hormone in the human pituitary: Evidence from constant administration of LHRH.
        J. Clin. Endocrinol. Metab. 1974; 39: 811
        • Yen S.S.C.
        • Lein A.
        The apparent paradox of the negative and positive feedback control system on gonadotropin secretion.
        Am. J. Obstet. Gynecol. 1976; 126: 942
        • Nillius S.J.
        • Wide L.
        The LHRH test in 31 women with secondary amenorrhea.
        Br. J. Obstet. Gynaecol. 1972; 79: 874