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KMID : 0350519920450031077
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Journal of Catholic Medical College
1992 Volume.45 No. 3 p.1077 ~ p.1014
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The Relationship of Serum Testosterone on Secretory Mechanism of Gonadotropins in the Patients with Polycystic Ovarian Disease
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Abstract
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LHRH and Premarin stimulation tests were performed on 2 groups of PCOD with normal and high concentrations of serum testosterone in order to evaluate whether serum testosterone can interfere with secretion of gonadotropins and then can suppress
the
ovulatory mechanism at the level of hypothalamopituitary unit in the patients with polycystic ovarian disease(PCOD).
Well known general criteria for diagnosis of PCOD including (1) clinical manifestations, (2) pelvic vaginal sonography performed to see the presence or absence of enlarged, cystic and multifollicular patterns of ovarie(s) and(3) various important
PCOD
-related hormone levels evaluation were employed for recuruitment of the disease. The case with elevated gonadotropin secretion higher than the Mean+1.5 SD of normal control group or higher LH/FSH ratio than 3 were basically considered to be
PCOD.
Among them, 22 cases of the patients with normal baseline levels of serum prolactin(hPRL) and dehydroepiandrosterone sulphate(DHEA-S) were elected to remove the well known frequent suppressive effect of these 2 hormones from pituitary and adrenal
glands, and divided into 2 groups focusing on their serum levels of testosterone, the 13 cases of group PCOD-I and 9 cases of PCOD-II with normal and high level of testosterone, below and above the Mean+1.5 SD, respectively.
For normal control, 15 selected cases with normal regular cycles women were employed.
To each case, LHRH 100 microgram was injected and blood samplings were done before and 30, 60, 90 and 120 minutes after injeceion for the evaluation of gonadotropin secretion function of pituitary gland. At least 1 day later Premarin 20mg was
injected
to induce negative and positive feedback mechanisms of hypothalamus which are essential for occurrence of nomal ovulation, and blood samplings were performed before and every 12 hours until 96 hours after injection. To make the interpretation
simpler,
only the values of maximum increases of LH and FSH for LHRH test, LH only for Premarin test were compared with corresponding values of normal control.
@ES The results were as follows:
@EN 1) The values of maximum increase of LH after injection of LHRH of both groups of PCOD-I and PCOD-II were significantly higher than that of normal control group(P<0.005) but without difference between these 2 group of PCOD.
2) Although the maximum increase of FSH of PCOD-I, that of PCOD-II was significantly lower than that of normal control(P<0.05).
3) Although all 3 groups of normal control, PCOD-I and PCOD-II revealed negative feedback effects showing minimum values of LH after injection of premarin comparing their own baseline values; the values of PCOD-I and PCOD-II remained higher
levels(P<0.005) than that of normal controls, which may be due to higher baseline levels.
4) All 3 groups of normal control, PCOD-I and PCOD-II revealed positive feedback effect showing incresed values of maximum LH than their own baseline levels. Important finding was that the value of PCOD-II was significantly lower than that of
PCOD-I
(P<0.05).
Considering above results , it is postulated that elevated serum testosterone seems to suppress the estrogen positive feedback mechanism of hypothalamus, the main event of normal ovulation in the patients with PCOD in spite of augmented
gonadotropin
secretion pattern of pituitary gland.
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KEYWORD
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