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

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      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.
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