PULSATILE LUTEINIZING-HORMONE SECRETION PATTERN IN HYPERANDROGENEMIC WOMEN

Objective: To elucidate changes in gonadotropin secretion pattern in patients with hyperandrogenemic chronic anovulation of various origins. Design and Participants: Hyperandrogenemic patients (n = 32), divided into subgroups according to certain clinical and biochemical criteria, and a control group (n = 9) of regularly cycling women with normal androgen and PRL levels were prospectively investigated. Setting: Infertility and Biochemical Endocrinology Unit, Department of Obstetrics and Gynecology, University of Dusseldorf, Dusseldorf, Germany. Main Outcome Measures: Blood samples for radioimmunological analyses of gonadotropins and steroids were taken at 10-minute intervals for 12-hour sampling periods. In nonamenorrheic patients, investigations were performed on the 5th day of a cycle. Pulsatile LH and FSH data were analyzed by computerized peak identification programs. Results: In hyperandrogenemic women, mean LH levels were higher than controls, the most elevated concentrations being observed in women with secondary amenorrhea (subgroup 5), in those selected for elevated mean LH levels (subgroup 3), and in those with elevated T and/or androstenedione (A) but normal DHEAS levels (subgroup 1). With the exception of patients with DHEAS elevations but normal T and A levels (subgroup 2), LH pulse frequency and amplitude were increased with most distinct effects occurring in subgroups 3 and 5. Highly elevated T and free T levels were observed in subgroup 5 and in overweight patients (subgroup 6). Estrone (E1) serum concentrations were highest in those subgroups (3 and 5) in which acceleration of LH pulse frequency and increments in LH pulse amplitude were most pronounced; these parameters correlated significantly with E1 levels. Conclusions: Changes in pulsatile LH release in patients with hyperandrogenemic chronic anovulation correlate primarily with elevated E1 levels, rather than with T or A serum concentrations.