A new approach in the evaluation of gonadotropins for the diagnosis of polycystic ovary syndrome.

The new immunometric methods using monoclonal antibodies to detect gonadotropins revealed a reduction in the absolute values of these hormones, especially LH, due to a decrease in cross-reaction between gonadotropin subunits. Therefore, reference values of the LH/FSH ratio and their diagnostic significance in the polycystic ovary syndrome (PCOS) need to be defined again. We evaluated the LH/-FSH ratio in basal conditions and after administration of GnRH (100 micrograms as i.v. bolus) in seventy patients with PCOS employing an immunoenzymatic method. In PCOS patients the LH/FSH ratio was greater than 1 in 70% when evaluated on a single sample and in 88% when evaluated on a pooled serum from four samples every 30 minutes; in the control group the ratio was always lower than 1. The LH/-FSH ratio evaluated on the peak values in response to GnRH was greater than 2 in all patients and lower than 2 in the control group. Our results indicate that the LH/FSH ratio is still an important diagnostic tool in PCOS, especially when evaluated on the peak values in response to GnRH, even if its reference values are lower using these new monoclonal methods.

Naltrexone must not be considered a real therapy in functional hypothalamic amenorrhea. The results of a double blind controlled study.

Endogenous opioids exert a tonic inhibitory control on GnRH pulsatility at the hypothalamic level and it must be responsible for some hypogonadotropic hypogonadic syndromes such as functional hypothalamic amenorrhea (FHA). We treated 22 patients suffering from FHA with an oral anti-opioid drug, Naltrexone Hydrochloridrate (NH), 50 mg once a day or placebo, in a double blind controlled study. Six patients exhibited a regular resumption of their menstrual cycles (4 on placebo and only 2 on NH). There was an increase of 17BE2 in 3 of these 6 patients; progesterone levels did not change at all. Gynaecological echography demonstrated folliculogenesis in 4 of these 6 patients (only 1 on NH). The results show that NH is not a real therapy in patients suffering from FHA. Furthermore placebo, useful to the resumption of menstrual bleeding in 4 patients, underlines the importance of psychosomatic effects in the therapeutic management of FHA.

The GnRH 10 micrograms test promotes a maximal gonadotropic response in normal women.

The authors have compared the results of gonadotropin stimulation with a gonadotropin releasing hormone (GnRH) intravenous bolus of 100 micrograms and of 10 micrograms in a group of eumenorrheic women. They conclude that there are no differences between the responses of the two dosages in normal women. Therefore the authors clarify that the dosage of 10 micrograms of GnRH as a bolus test may be used currently in clinical practice in order to assess gonadotropic function.

Gonadotropin evaluation in the diagnosis of polycystic ovary syndrome using either a monoclonal or a polyclonal antibody radioimmunoassay.

The LH/FSH ratio values between gonadotropins dosed with a monoclonal antibody assay (IRMA) in the micropolycystic ovary syndrome (PCOS), are discussed and compared to those obtained with the classic assays using polyclonal antibodies. Because of the higher selectivity of this IRMA assay it is noteworthy that the cut-off value between normal and PCOS patients is now equal to or above one. The evaluation of the LH/FSH ratio between the peak values of the two gonadotropins after a GnRH 100 micrograms iv bolus, may be useful in the diagnosis of PCOS in those patients who present an LH/FSH less than 1 in basal conditions even in the presence of clinical and ecographic aspects of PCOS.