Studies of the pituitary-Leydig cell axis in young men with hypogonadotropic hypogonadism and hyposmia: comparison with normal men, prepuberal boys, and hypopituitary patients

Abstract

A B S T R A C T Pituitary and gonadal function was studied in seven chromatin-negative men, ages 15-27 yr, with retarded sexual and somatic development, skeletal anomalies, and hyposnmia. These hyposmic patients were compared with normal men, prepuberal boys and hypogonadal patients with hypopituitarism. The urinary follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels of hyposmic subjects were the same as those of normal boys and hypopituitary patients but significantly lower than those of normal men. Clomiphene citrate did not cause an increase in plasma FSH and LH levels in either hypogonadal group as it does in normal men. In contrast to hypopituitary patients, thyroid and adrenocortical function and release of growth hormone in the hyposmic subjects were normal. The plasma testosterone levels were equally low in prepuberal, hypopituitary, and hyposmic patients but were increased to a greater extent by human chorionic gonadotropin (HCG) treatment in prepuberal and hypopituitary subjects than in the hyposmic patients. Prolonged treatment with HCG has failed to return plasma testosterone levels to normal in two hyposmic patients. These observations suggest that there are defects of both pituitary and Leydig cell function in men with the syndrome of hypogonadism, skeletal anomalies, and hyposmia. They have impaired secretion of FSH and LH and a Leydig cell insensitivity to gonadotropin.

Pituitary-testicular responsiveness in male hypogonadotropic hypogonadism.

“…A previous study separated gonadotropinrepresented isolated, sporadic occurrences. In addition deficient from normal adult males by measuring immunoto the findings of hypogonadism in all subjects, only reactive FSH and LH in urine extracts (17). In the L. E. displayed other anomalies, specifically anosmia and present study, radioimmunoassay of a single blood sample unilateral renal agenesis, an association previously re-for both FSH and LH permitted us to clearly separate viewed by Nowakowski and Lenz (7).…”

“…Plasma testosterone was in the normal adult male range in all subjects during HCG administration. 6 ness in affected individuals becomes paramount since separate normal from low levels (17,(27)(28)(29)(30). This may the success of newer modes of therapy in this disorder be related to methodology, since both precision and sensiwill depend on such responsiveness.…”

“…Despite this knowledge, few studies are available which have examined blood levels of androgens and gonadotropins before and after treatment with clomiphene citrate and human Received for publication 14 July 1973 and in revised form 8 October 1973. chorionic gonadotropin (HCG)1 (17). We have studied six males with hypogonadism due to an isolated deficiency of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) and have quantitated levels of pituitary gonadotropins, testosterone,2 androstenedione, and dehydroepiandrosterone before and during treatment with clomiphene citrate and HCG.…”

Episodic Luteinizing Hormone Secretion in Man PULSE ANALYSIS, CLINICAL INTERPRETATION, PHYSIOLOGIC MECHANISMS

“…The precision of the assay was determined by assaying 20 (20). Plasma U-1 and FSH were measured during clomiphene citrate administration (200 mg/day for 6 days) (15,21). ACTH reserve was tested by the administration of Metopirone, 2.0 or 3.0 g in a single dose followed by the measurement of 11-deoxycortisol in serum 8 h later (16).…”

“…Received for publication 21 (FSH) were secreted continuously in man with resultant constant serum levels. However, several investigators have recently demonstrated that LH is secreted in a pulsatile fashion in man as well as in other species (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14).…”