GnRH & Hypogonadism

[Michael Scally MD]

van Breda E, Keizer HA, Kuipers H, Wolffenbuttel BH. Androgenic anabolic steroid use and severe hypothalamic-pituitary dysfunction: a case study. Int J Sports Med 2003;24(3):195-6. https://www.thieme-connect.com/DOI/DOI?10.1055/s-2003-39089

The data of the present case demonstrate that the abuse of androgenic anabolic steroids (AAS) may lead to serious health effects. Although most clinical attention is usually directed towards peripheral side effects, the most serious central side effect, hypothalamic-pituitary-dysfunction, is often overlooked in severe cases. Although this latter central side-effect usually recovers spontaneously when AAS intake is discontinued, the present case shows that spontaneous recovery does not always take place.

We suggest that hypothalamic-pituitary dysfunction should always be considered in the differential diagnosis in athletes seen with typical presentation of anabolic steroid use.

In order to regain normal hypothalamic-pituitary function, supraphysiological doses of 200 microg LH-RH should be considered when the physiological challenge test with LH-RH (50 microg) fails to show an acceptable response.

 

[Michael Scally MD]

Iwamoto H, Yoshida A, Suzuki H, Tanaka M, Watanabe N, Nakamura T. A man with hypogonadotropic hypogonadism successfully treated with nasal administration of the low-dose gonadotropin-releasing hormone analog buserelin. Fertil Steril 2009;92(3):1169 e1-3. http://www.fertstert.org/article/S0015-0282(09)01228-X/abstract (Elsevier)

OBJECTIVE: To report a patient with hypogonadotropic hypogonadism of hypothalamic origin successfully treated with nasal administration of a low-dose gonadotropin-releasing hormone (GnRH) analogue.

DESIGN: Case report.

SETTING: A reproductive medical center.

PATIENT(S): A 37-year-old man with anejaculation and infertility.

INTERVENTION(S): Nasal administration of a low-dose GnRH analogue, buserelin.

MAIN OUTCOME MEASURE(S): Semen analysis and serum levels of gonadotropins and testosterone after nasal buserelin use.

RESULT(S): The patient's laboratory examination showed low serum levels of gonadotropins and testosterone. After being diagnosed with hypogonadotropic hypogonadism, 15 mug of buserelin acetate spray was administrated in each nostril three times a day (total: 90 mug/day). This therapy improved semen parameters and serum gonadotropin and testosterone levels. After approximately 1 year of this treatment, the patient's serum gonadotropin and testosterone levels remained in the normal range and semen analysis showed normozoospermia. The patient and his wife were treated with intracytoplasmic sperm injection, resulting in pregnancy.

CONCLUSION(S): A low-dose buserelin nasal spray appears to be an effective and well-tolerated therapeutic option for patients with hypogonadotropic hypogonadism of hypothalamic origin.

 

[Michael Scally MD]

Pirola I, Cappelli C, Delbarba A, et al. Anabolic steroids purchased on the Internet as a cause of prolonged hypogonadotropic hypogonadism. Fertil Steril 2010;94(6):2331 e1-3. http://www.fertstert.org/article/S0015-0282(10)00503-0/abstract (Elsevier)

OBJECTIVE: To report a case of hypogonadotropic hypogonadism due to the chronic abuse of anabolic steroids purchased over the Internet.

DESIGN: Case report.

SETTING: Endocrinology unit of the University of Brescia.

PATIENT(S): A 34-year-old man.

INTERVENTION(S): A single dose (100 mug) of triptorelin (triptorelin test).

MAIN OUTCOME MEASURE(S): Clinical symptoms, androgen normalization, levels of serum testosterone, follicle-stimulating hormone, and luteinizing hormone.

RESULT(S): Within 1 month, the patient's serum testosterone was in the normal range, and he reported a return to normal energy and libido.

CONCLUSION(S): The World Anti-Doping Code has proved to be a very powerful and effective tool in the harmonization of antidoping efforts worldwide, but it is insufficient to combat this illegal phenomenon. To tackle the serious side effects caused by doping we believe that it is necessary to increase monitoring and adopt severe sanctions, particularly with regard to Internet sites.

 

[Michael Scally MD]

In the past months, I have been contacted for "disasters" from the use of GnRH agonists. In each case, they now have castrate hypogonadism. Their use should be left for use under strict conditions.