Article: article from journal or magazin.
Case report (case report): feedback on an observation with a short commentary.
Ovulation induction with pulsatile gonadotropin-releasing hormone (GnRH) or gonadotropins in a case of hypothalamic amenorrhea and diabetes insipidus.
Publication types: Case Reports ; Journal Article Publication Status: ppublish
Hypothalamic amenorrhea is a treatable cause of infertility. Our patient was presented with secondary amenorrhea and diabetes insipidus. Cortisol and prolactin responded normally to a combined insulin tolerance test (ITT) and thyrotropin-releasing hormone (TRH) challenge, while thyroid-stimulating hormone (TSH) response to TRH was diminished, and no response of growth hormone to ITT was detected. Both luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels increased following gonadotropin-releasing hormone (GnRH) challenge. No response of LH to clomiphene citrate challenge was detected. Magnetic resonance imaging findings demonstrated a midline mass occupying the inferior hypothalamus, with posterior lobe not visible and thickened pituitary stalk. Ovulation induction was carried out first with combined human menopausal gonadotropins (hMG/LH/FSH) (150 IU/day) and afterwards with pulsatile GnRH (150 ng/kg/pulse). Ovulation was achieved with both pulsatile GnRH and combine gonadotropin therapy. Slightly better results were achieved with the pulsatile GnRH treatment.
Adult, Amenorrhea/etiology, Amenorrhea/therapy, Clomiphene/diagnostic use, Diabetes Insipidus/complications, Diabetes Insipidus/physiopathology, Female, Follicle Stimulating Hormone/blood, Gonadotropin-Releasing Hormone/administration & dosage, Gonadotropin-Releasing Hormone/diagnostic use, Gonadotropins/administration & dosage, Human Growth Hormone/blood, Humans, Hydrocortisone/blood, Hypogonadism/etiology, Hypogonadism/therapy, Hypothalamus/physiopathology, Infertility, Female/therapy, Insulin/diagnostic use, Luteinizing Hormone/blood, Magnetic Resonance Imaging, Ovulation Induction/methods, Periodicity, Prolactin/blood, Thyrotropin/blood, Thyrotropin-Releasing Hormone/diagnostic use
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