Altered pulsatile pattern of luteinizing hormone in men with idiopathic normogonadotropic oligospermia.

Gonadotropin serum levels and pulsatile secretion of gonadotropin-releasing hormone (GnRH) and luteinizing hormone (LH) are regulated by sexual steroids and perhaps inhibin, but the relative rates of LH and follicle-stimulating hormone (FSH) secretion are modulated by the frequency of GnRH pulses. This study evaluated LH pulsatility in patients with idiopathic normogonadotropic oligospermia (INO) and normal men before and after clomiphene citrate (CC) administration. INO patients evidenced a lower mean LH levels (P less than 0.001), a higher mean pulse frequency (P less than 0.05) and similar pulse amplitude than normal men. CC induced in normal men a higher LH and testosterone (T) increments and increased pulse amplitude only in normal men. Estradiol (E2) showed no difference in either group. Patients with INO might evidence a hypothalamic disorder that may alter pulsatile GnRH secretion. A different response to CC in patients with INO seems to lend support to a primary hypothalamic lesion. A probable gonadotropin imbalance might alter intratesticular concentrations of T and E2 and be the cause of spermatogenic failure.

Hiper e hipotiroidismo inducidos por amiodarona / Hyper and hypothyroidism induced by amiodarone

Se evaluaron 8 hipertiroidismos y 4 hipotiroidismos inducidos por amiodarona desde el punto de vista clínico y bioquímico a través de dosajes hormonales de tiroxina (T4), triiodotironina (T3), tiroxina libre (T4L) y tirotrofina (TSH), medición de anticuerpos antitiroideos y prueba de TRH en los hipertiroideos luego de la remisión del cuadro. El hipertiroidismo se presentó en una relación mujer: varón 1:1, en mujeres con tiroideopatía previa y en varones sin ella; bajo la ingesta del fármaco o luego de su supensión, con clínica leve o florida. Aunque la elevación de T4 resultó más constante, la de T3 adquiró mayor jerarquía por cuanto la primera situación podría deberse a un mero bloqueo de T4 a T3. En los cuadros leves sólo se suspendió la amiodarona, en los francos se agregó, además, ß bloqueantes y antitiroides, observándose tendencia a requerimientos mayores en tiempo y dosis para alcanzar el eutiroidismo. La prueba de TRH permitió inferir integridad previa del eje en 6 casos. El hipotiroidismo se presentó en mujeres, 3 de ellas con tiroideopatía previa y clínica franca. En los casos factibles se suspendió la amiodarona, agregándose hormona tiroidea cuando el cuadro clínico resultó relevante

Restoration and maintenance of spermatogenesis by HCG therapy in patients with hypothalamo-hypophyseal damage.

Both gonadotropins are necessary to induce spermatogenesis in man and to recover hypophysectomized males. The patients who suffer from tumoral or traumatic hypothalamo-hypophyseal lesion use to have low endogenous gonadotropins (opposite to hypophysectomized patients), which can produce a minor involution of spermatogenesis. Three patients with postpubertal hypogonadotropic hypogonadism and oligozoospermia were studied. Two of them were operated on for chromophobous adenoma of pituitary, and the other patient had traumatic hypothalamo-hypophyseal lesion. The three patients were treated with 5000 IU HCG/week, associated with testosterone enanthate, in two cases and with bromocryptine in the remaining one. All the patients had normalized spermiogram, but when HCG was interrupted, the sperm count regressed to pretreatment levels in spite of the maintenance of treatment with testosterone or bromocryptine. Minimal amounts of FSH together the testosterone supplied by Leydig cell under the HCG stimulus, are able to recover and maintain the spermatogenesis in these patients.

Bromocriptine in the management of infertile men after surgery of prolactin secreting adenomas.

This study evaluated bromocriptine treatment in nine patients with prolactin secreting adenomas who continued to have elevated circulating levels of prolactin after surgery, and who were interested in improving their sperm counts. These patients were brought into the study 3.2 +/- 1.8 years (mean +/- SD) after surgery. All of them presented with high circulating levels of prolactin, and eight of the patients had oligozoospermia (range 0-10 X 10(6) spermatozoa/ml). LH and testosterone levels were low in seven patients, and eight patients had low FSH values. All patients were treated for 90 days with 7.5 mg/day of bromocriptine. After treatment, prolactin levels decreased significantly in all patients, while sperm counts increased significantly in five of them. Testosterone levels increased in four subjects. Bromocriptine therefore seems useful in the management of this type of patient because of the observed decline in prolactin levels and the increase in sperm counts. Possible mechanisms involved in this action are discussed.