MEASUREMENT OF GONADOTROPHINS, TESTOSTERONE, Δ4 ANDROSTENEDIONE AND DIHYDROTESTERONE IN IDIOPATHIC OLIGOSPERMIA

Basal concentrations of FSH, LH, testosterone, delta4 androstenedione and dihydrotestosterone, together with FSH and LH responses to single injections of LHRH were determined in eighty-four patients with oligospermia and in twenty-seven normal men. LHRH responses were heterogeneous and indicate that various disorders might cause this syndrome. In six cases there appeared to be an isolated deficiency in spermatogenesis, as indicated by an increased FSH response, whilst the LH response was normal as were the concentrations of the testicular hormones. In twenty cases a concomitant disorder of Leydig cell function and spermatogenesis is suggested as indicated by increased FSH and LH responses and decreased concentrations of testosterone and delta4 androstenedione (six) or concentrations at the lower limit of normal (fourteen). Furthermore, in five cases a hypothalamic and/or pituitary disturbance may be accepted on the basis of normal or decreased basal concentrations decreased and responses to LHRH with decreased concentrations of testosterone and delta4 androstenedione. Finally, in thirty-seven cases, oligospermia was not associated with any modification basal gonadotrophin concentrations or response to LHRH when compared with normal subjects.     

SPECIFIC CONTROL OF FOLLICLE STMULATING HORMONE IN THE MALE: POSTULATED SITE OF ACTION OF INHIBIN

Serum luteinizing and follicle stimulating hormone concentrations were related to gonadal function, as reflected by sperm count and serum testosterone concentrations, in a group of men studied over 10 years after surgical correction of bilateral cryptorchidism in childhood. The results indicated that while all degrees of gonadal function occurred in these patients, the main adverse effect of cryptorchidism was on spermatogenesis. In some of the patients with oligospermia and normal Leydig cell function there was an isolated increase of basal serum FSH concentrations, suggesting a specific impairment of the testicular production of 'inhibin'. Gonadotrophin releasing hormone (LHRH) tests in these patients were compared to those in patients with normal basal gonadotrophins and to those with elevated basal LH and FSH concentrations. A selective exaggeration of the FSH response to exogenous LHRH in the group of patients with a monotropic elevation of FSH concentrations suggests that 'inhibin' modulates the secretion of FSH by an action on the pituitary rather than by modifying endogenous LHRH production by the hypothalamus.     

Evaluation of the hypothalamic-pituitary-gonadal function in the Bardet-Biedl syndrome

The hypothalamic-pituitary-gonadal system was evaluated in three siblings with the Bardet-Biedl syndrome. All patients had mental retardation, pigmentary retinopathy, obesity, polydactyly, and hypogonadism. Serum levels of luteinizing hormone (LH) were above the upper limit of normality in the elder brothers (101.6 and 62.6 ng/ml, respectively) but were within normal limits in the younger patient. Serum follicle-stimulating hormone (FSH) was within the normal range for all three patients. After 100 μg of intravenous gonadotropin-releasing hormone (LH-RH), the LH and FSH serum levels showed a response that correlated well with the respective pubertal stages of the patients. Chronic stimulation with synthetic LH-RH (500 μg for 3 days) was also followed by a marked rise in both LH and FSH. Clomiphene administration induced a marked rise in serum LH, while FSH values did not show a clear elevation. Although plasma testosterone was found to be normal for each individual patient, repeated stimulation with human chorionic gonadotrophin failed to further increase plasma testosterone in the two elder brothers. Basal levels of serum prolactin and growth hormone were within the normal range and stimulatory and supressive tests for these pituitary hormones were also normal in these patients. An oral glucose tolerance test revealed high basal levels and an exaggerated rise in plasma insulin values. Testicular biopsy performed in the three patients showed a nonuniform degenerative lesion of the seminiferous tubules with marked reduction of spermatogenic activity. Only scant groups of Leydig cells were seen in the interstitium with a clear decrease of the total number of these cells. These findings indicated a trend to an evolutive gonadal disorder possibly beginning near the onset of puberty and progressing throughout the adult life.     

BIOACTIVE LUTEINIZING HORMONE IN PLASMA OF URAEMIC MEN AND MEN WITH PRIMARY TESTICULAR DAMAGE

Elevation of immunoreactive LH and reduced testosterone production are consistent features of Leydig cell dysfunction in uraemic hypogonadism. To investigate further Leydig cell regulation in uraemia, we measured plasma bioactive LH (B-LH) and immunoreactive LH (I-LH), as well as FSH, testosterone, creatinine, urea and albumin in seven uraemic men before and after haemodialysis and compared them to levels both in eugonadal controls (n = 10) and in men with primary testicular damage (n = 10). Plasma B-LH was increased in uraemic men compared with both nonuraemic control groups. Plasma I-LH and FSH were increased and testosterone decreased in uraemic men compared to eugonadal controls. In comparison with nonuraemic men with primary testicular damage, plasma I-LH levels were similar but FSH and testosterone lower in uraemic men. As a consequence, the ratio of B-LH to I-LH (LH:B/I ratio) was decreased in men with primary testicular damage but normal in uraemic men. A single session of haemodialysis decreased creatinine (50.5%) and urea (58.5%) and increased B-LH (47.7%), I-LH (32.9%), FSH (24.4%), testosterone (15.8%) and albumin (17.8%) levels, but the LH:B/I ratio was unchanged. Increases in gonadotrophin levels were greater than could be accounted for by haemoconcentration suggesting that dialysis may also ameliorate uraemic suppression of the hypothalamus and pituitary. Ultrafiltrates of human uraemic plasma (mol wt less than 25 000) had no inhibitory effect on in-vitro steroidogenesis by isolated rat Leydig cells making circulating uraemic 'middle-molecule'-type toxins unlikely to be involved in causing lowered testosterone levels in uraemic men.(ABSTRACT TRUNCATED AT 250 WORDS)     

HORMONAL CHANGES ASSOCIATED WITH TESTICULAR ATROPHY AND GYNAECOMASTIA IN PATIENTS WITH LEPROSY

Basal LH, FSH, 17 beta-oestradiol and testosterone and the gonadotrophin responses to luteinizing hormone releasing hormone (LHRH) were studied in male patients with leprosy (twenty-four with lepromatous and six with tuberculoid leprosy). The mean basal LH and FSH was significantly elevated in the lepromatous group and was associated with an excessive response of both gonadotrophins following LHRH administration. The mean basal testosterone and 17 beta-oestradiol values in the lepromatous group were significantly lower than those of the tuberculoid and control groups. The abnormal gonadotrophin and sex steroid values in the lepromatous group are in keeping with the testicular atrophy and gynaecomastia accompanying this form of leprosy. However, the lack of a significant correlation between basal FSH and testicular atrophy should be noted. In addition, no correlation between any of these hormonal values and gynaecomastia could be demonstrated. The patients with tuberculoid leprosy had essentially normal hormonal profiles (except for two who had raised 17 beta-oestradiol values). This is compatible with the lack of gonadal involvement in these patients.     

Alterations in spermatogenic activity and hormonal status in a seasonally breeding rat,Rattus fuscipes

The changes in the levels of serum FSH, LH, and testosterone have been studied during the seasonal reproductive cycle in males of the species Rattus fuscipes. In males captured in winter the seminiferous tubules were small, spermatogenesis was arrested at the primary spermatocyte stage, and the Sertoli cells contained increased numbers of lipid inclusions. The Leydig cells were atrophic and contained large crystalloids. The aspermatic state was accompanied by low levels of serum FSH, LH, and androgen. Reactivation of spermatogenesis occurred in spring and was accompanied by a rise in the levels of FSH, LH, and androgen. These hormonal changes were associated with a depletion of lipid inclusions from the Sertoli cells which paralleled the activation of spermatogenesis. The rising androgen levels were accompanied by the enlargement of Leydig cells and the disappearance of the crystalloids. In summer the fully active testes were associated with further increments of serum FSH and androgen levels above those seen during spring. It is concluded that the environmental cues controlling the seasonal reproductive cycle exert their influence on the testis through changes in gonadotrophin secretion by the pituitary gland.     

Pituitary and gonadal function in prepubertal and pubertal cryptorchidism

LRH and hCG tests were performed in 35 prepubertal and 35 pubertal boys with unilateral or bilateral cryptorchidism to examine the pituitary and gonadal function. Twenty-one normal boys were also examined as controls. In the prepubertal group, distinct increases in serum LH, FSH and testosterone levels by LRH and hCG tests were found in all of the normal and unilateral cryptorchid boys. However, no or very little response was observed in 4 out of 17 boys with bilateral cryptorchidism. In the pubertal group, serum levels of LH, FSH and testosterone in normal boys, in unilateral and in bilateral cryptorchid boys were evidently higher than those in the prepubertal group, and distinct or moderate responses by the LRH and hCG tests were found in all boys examined. Although serum testosterone levels were similar in all groups, serum basal and peak gonadotrophin levels by the LRH test were significantly higher in bilateral cryptorchid boys than in normal and unilateral cryptorchid boys. The difference was more marked in FSH than in LH level. An elevated level of serum LH is suggestive of the hypofunction of not only the seminiferous tubules but also of the Leydig cells in cryptorchid testes.     

Hypogonadotropic hypogonadism in idiopathic hemochromatosis: evidence for combined hypothalamic and pituitary involvement

Hypogonadism is a common finding in idiopathic hemochromatosis. Most studies have localized the defect to either the pituitary gland or the testes. We describe a case with evidence that favors the likely concomitant involvement of the hypothalamus as a factor in the observed hypogonadism. A clinically hypogonadal male with hemochromatosis had a low testosterone concentration with inappropriately normal serum LH levels. Leydig cell function was intact, as demonstrated by a normal increase in serum testosterone following HCG administration. However, although the pituitary secretion of LH was normal in response to GnRH stimulation, clomiphene administration did not produce an increase in LH and FSH, suggesting that there was a defect in the hypothalamic GnRH response. Since the FSH and prolactin responses to stimulatory testing were inadequate, coexisting pituitary dysfunction was likely also present. We conclude that this man had hypogonadism with laboratory evidence for a combined defect in hypothalamic and pituitary function.     

Luteinizing hormone regulation by sex steroids in men with germinal and Leydig cell tumours

OBJECTIVE We examined the gonadotrophin secretion in patients with increased plasma concentrations of testosterone and oestradiol due to hCG-producing tumours. DESIGN Comparison of plasma gonadotrophin concentrations before and after stimulation by GnRH, in eight men with hCG-producing tumours resulting in Increased testosterone and oestradiol plasma levels, and In 29 men with Leydig cell tumours resulting in increased oestradiol and normal to low testosterone plasma levels. PATIENTS Eight men with hCG-producing tumours (six with testicular tumours, two with extratesticular tumours), 29 men with Leydig cell tumours and 15 normal men. The six men with germinal cell tumours of the testis were studied before and after unilateral orchidectomy. MEASUREMENTS Plasma concentrations of hCG, testosterone and oestradiol were measured before and after intramuscular injection of hCG. LH and FSH were measured before and after intravenous Injection of 100 μg GnRH. RESULTS Plasma LH and FSH concentrations were low In patients with germ cell tumours, who exhibited increased plasma testosterone and oestradiol concentrations, and were normal in patients with Leydig cell tumours, in whom oestradiol only was increased. Plasma LH and FSH were normalized in the five patients with successful (e.g. normal hCG, testosterone and oestradiol) unilateral orchldectomy. Basal plasma testosterone concentrations correlated positively (P <001) with plasma oestradiol concentrations in patients with germ cell tumours and negatively (P <0 01) in patients with Leydig cell tumours. CONCLUSIONS In patients with hCG-secreting germ cell tumours complete suppression of plasma LH and FSH with increased plasma concentrations of both testosterone and oestradiol are often discovered. No such gonadotrophin suppression is found In patients with Leydig cell tumours, but the negative correlation observed between plasma testosterone and oestradiol in these patients suggests a weak negative feedback effect of oestradiol on LH secretion, which cannot be demonstrated by basal LH measurements in plasma.     

MALE GONADAL FUNCTION IN COELIAC DISEASE: III. PITUITARY REGULATION

Pituitary regulation of gonadal function was investigated in 39 consecutive men with treated and untreated coeliac disease and in an intestinal disease control group of 19 men with Crohn's disease of similar age and general nutritional status. Basal serum FSH concentration was increased in 10 of the coeliacs (26%) compared to only two of 19 men with Crohn's disease (11%). This abnormality was observed with equal frequency in both treated and untreated coeliacs, and was not associated with oligospermia. Serum LH concentration was increased in eight of 15 untreated coeliacs (53%) with sub-total villous atrophy, an abnormality which unlike the elevation of serum FSH, appears to return towards normal after gluten withdrawal. Serum LH was high in coeliacs despite marked elevation of the free testosterone index. Exaggerated responses of FSH and LH to LHRH were found in 89% and 45% respectively, of coeliacs with sub-total villous atrophy. However, exaggerated responses of LH alone were found more frequently in coeliacs than in men with Crohn's disease (P less than 0.02) and unlike the exaggerated FSH responses, LH responses were closely related to jejunal morphology. Exaggerated responses of FSH and LH in coeliacs were commonly found when basal gonadotrophin concentrations were normal. The occurrence of exaggerated gonadotrophin responses could not be related to plasma concentration of testosterone, dihydrotestosterone, oestradiol or the free testosterone index. Serum prolactin was modestly raised in 25% of untreated and partially treated coeliacs and in the same proportion of men with Crohn's disease. Elevated serum prolactin concentrations never exceeded 809 mU/l and were not associated with impotence or infertility. This study provides further evidence that in men with coeliac disease there is a derangement of pituitary regulation of gonadal function. This would seem to be part of a wider disturbance of central regulatory mechanisms of endocrine function in coeliac disease.     

Endocrinological and histological changes induced by flutamide treatment on the hypothalamo-hypophyseal testicular axis of the adult male rat and their incidences on fertility

Adult male Wistar rats were treated with flutamide from 90 to 105 days of age. In a first experiment, testis and accessory sex organs were weighed. In the same animals, hypothalamic LRH content, pituitary gonadotrophin concentrations, plasma LH, FSH, prolactin and testosterone levels, and testicular gonadotrophin receptors were evaluated. In a second experiment, fertility was tested at the end of the treatment, and histology of the testis was performed. All the results were compared to those obtained in control animals of the same age. Accessory glands of genital tract were significantly lower in flutamide-treated animals (P less than 0.01). Hypothalamic LRH, pituitary and plasma FSH, and prolactin concentrations were unchanged, while pituitary and plasma LH level and especially plasma testosterone concentration were increased (P less than 0.001). Flutamide therefore exerted a strong inhibition on testosterone-dependent organs, and blocked the negative feedback of testosterone on the hypothalamo-pituitary axis, increasing the LH levels. Testis weight, intertubular tissue volume, total number and total volume of Leydig cells/testis, as well as total length and diameter of seminiferous tubules were unchanged in flutamide treated rats. However number of LH receptors/Leydig cell, nuclear area of Sertoli cells, number of FSH receptors/Sertoli cell, number of leptotene spermatocytes and of round spermatids per cross section, and yield of spermatogonial divisions were decreased after treatment. Flutamide treatment also decreased fertility by 48% (P less than 0.05). This lowered fertility is likely the result of impaired spermatogenesis and/or a dysfunction of accessory sex organs.     

Endocrine investigations in two cases of feminizing Leydig cell tumour

Two patients, aged 32 and 35 years, presented with gynaecomastia and a unilateral testicular tumour which proved to be a Leydig cell tumour. Pre-operative samples taken at 08.00 h on different days showed marked elevation of plasma oestradiol in the first patient, and very slight irregular oestradiol elevation in the second, plasma oestrone within the normal range in both patients, reduced plasma testosterone in the first patient and reduced or normal testosterone in the second, and low or low-normal serum LH and FSH in both patients. One of the patients received an oral dose of 100 mg of clomiphene citrate for 3 consecutive days which induced a rise in LH and FSH and a decrease in the 17-hydroxyprogesterone/androstenedione ratio. These data suggest the inhibiting effect of endogenous hyperoestrogenism on testicular steroidogenesis owing to both the reduction of gonadotropin secretion and a direct local negative effect on C 17,20-lyase. After human chorionic gonadotropin stimulation, oestradiol response was increased and abnormally prolonged, a finding which may be helpful when diagnosing a feminizing Leydig cell tumour; testosterone reached normal values. After removal of the tumoural testis, gynaecomastia regressed within a few days, gonadotropins increased, oestrogens dropped, testosterone and 5 alpha-dihydrotestosterone normalized in one patient but remained low in the other at day 30. The Leydig cells outside the tumour appeared morphologically normal, but the count gave evidence of juxtatumoural Leydig cell hyperplasia in areas where the tumour was well encapsulated while showing a significant reduction at a distance from the tumour and in the contralateral testis by comparison with control testes.(ABSTRACT TRUNCATED AT 250 WORDS)     

Gynecomastia as a familial incomplete male pseudohermaphroditism type 1: a limited androgen resistance syndrome.

Four postpubertal 46 XY male patients with an inherited form of bilateral gynecomastia were studied to delineate the nature of the disease. Normal serum FSH and moderately elevated serum LH with concomitantly increased circulating levels of testosterone (T) and estradiol (E2) were found persistently in all cases in blood samples drawn at frequent intervals. LRH pituitary stimulation resulted in an exaggerated LH response and a normal FSH response. Chronic administration of T-cyclopentylate failed to decrease serum LH levels. The peripheral conversion rate of androstenedione to estrone was within normal limits. All patients had low ejaculate volumes with relatively normal spermatozoa counts. Testicular biopsies revealed normal Leydig cells and complete spermatogenesis. Urological examination disclosed that the prostate gland was extremely small. The breast tissue demonstrated the presence of tubular structures as well as the specific binding of [3H]T and [3H]dihydrotestosterone (DHT), which was inhibited by nonlabeled T, DHT, E2, and progesterone, but not by cortisol. The pedigree suggested a recessive X-linked inherited trait. A patient with a nonfamilial form of gynecomastia served as a control in all studies. These data were interpreted as demonstrating that this inherited type of gynecomastia represents the mildest expression of the androgen resistance syndromes and, therefore, belongs to the type 1 form of familial incomplete male pseudohermaphroditism.     

TESTICULAR ENLARGEMENT AND ELEVATED SERUM INHIBIN CONCENTRATIONS OCCUR IN PATIENTS WITH PITUITARY MACROADENOMAS SECRETING FOLLICLE STIMULATING HORMONE

We studied four male patients with pituitary macroadenomas. Before treatment all had high serum FSH concentrations, but LH and testosterone were normal or subnormal; all patients were found to have large testes. All had had normal sexual function, and three patients had fathered children. After pituitary surgery there were decreases in serum gonadotrophins and testosterone, which were accompanied by decreases in testicular volumes. hCG stimulation tests in two patients showed normal responses of testosterone and oestradiol, confirming normal Leydig cell function. Inhibin levels were increased in two patients studied when FSH levels were high, suggesting a defect in gonadal-pituitary feedback control. Later, as FSH concentrations decreased to normal, so did inhibin levels. Histology showed that increased testicular size was due to increased lengths of seminiferous tubules. The association of pituitary macroadenomas, large testes and increased serum inhibin has not been reported previously. Assessment of testicular size in patients with raised serum FSH is important, since enlarged testes suggest the likely pathogenesis is that of a pituitary gonadotrophinoma, rather than primary gonadal failure. Increased inhibin levels may then confirm this, and be a biochemical marker for these tumours.     

Effects of castration or testosterone implants upon pituitary function in hypogonadal mice bearing normal foetal preoptic area grafts

Grafts of normal mouse preoptic area (POA) tissue into the third ventricle of gonadotrophin-releasing hormone (GnRH)-deficient hypogonadal (hpg) mice resulted in an elevation of pituitary GnRH receptors, an increased synthesis of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) by the pituitary gland, an elevation of gonadal LH receptors and in the stimulation of steroidogenesis and spermatogenesis in the testis. In normal mice both castration or the subcutaneous implantation of testosterone capsules for 10 days reduced GnRH receptors, pituitary LH and FSH content, and the latter treatment also caused a 50% reduction in testicular LH receptors. In hpg mice bearing POA grafts testosterone implants failed to affect any of the above parameters, and castration failed to affect pituitary gonadotrophin hormone content, although there was a slight reduction in pituitary GnRH receptors after castration. These experiments suggest that neither the pituitary gonadotroph, nor the GnRH neurone represent major sites for the direct negative feedback of testosterone upon gonadotrophic hormone secretion in male mice.     

Androgens and spermatogenesis

Male infertility contributes to 50% of all cases of infertility. The main cause is low quality and quantity of sperm. In humans, spermatogenesis starts at the beginning of puberty and lasts lifelong. It is under the control of FSH and testicular androgens, and mainly testosterone (T), and therefore requires a normal gonadotroph axis, intratesticular T production by Leydig cells and functional androgen receptors (ARs) within testicular Sertoli cells. Various clinical cases illustrate the roles of T in human spermatogenesis. Men with complete congenital hypogonadotropic hypogonadism (HH) are usually azoospermic. Treatment by exogenous testosterone injection and FSH is not able to produce sperm. However, combined treatment with FSH and hCG is effective. This example shows that intratesticular T plays a major role in spermatogenesis. Furthermore, testicular histology of men with LH receptor mutations shows Leydig cell hypoplasia/agenesis/dysplasia with conserved Sertoli cell count. The sperm count is reduced, as in males with partial inactivating mutation of the androgen receptor. Some protocols of hormonal male contraception or exogenous androgen abuse induce negative feedback in the hypothalamic pituitary axis, decreasing FSH, LH and T levels and inducing sperm defects and testicular atrophy. The time to recovery after cessation of drug abuse is around 14 months for sperm output and 38 months for sperm motility. In summary, abnormal androgen production and/or AR signaling impairs spermatogenesis in humans. The minimal level of intratesticular T for normal sperm production is a matter of debate. Interestingly, some animal models showed that completely T-independent spermatogenesis is possible, potentially through strong FSH activation. Finally, recent data suggest important roles of prenatal life and minipuberty in adult spermatogenesis.     

Spermatogenesis, seminal characteristics and reproductive hormone levels in mature rams with induced hypothyroidism and hyperthyroidism

Mature Merino rams were made hypothyroid by daily oral drenching with methylthiouracil or hyperthyroid by daily subcutaneous injections of thyroxine for 8 weeks. Neither hypothyroidism nor hyperthyroidism had any apparent effect on either spermatogenesis or daily sperm production, but motility of ejaculated spermatozoa and circulating testosterone concentrations were reduced in both conditions. The ratio of testosterone concentrations in plasma from the internal spermatic vein to those in peripheral blood plasma was higher in hyperthyroid (21.2 +/- 3.5) than in control (11.1 +/- 4.4) and hypothyroid (7.6 +/- 1.4) rams. The basal secretion rate for testosterone was slightly lower in hypothyroid rams and testosterone responses to human chorionic gonadotrophin and after LH-releasing hormone (LHRH) were very much reduced. Basal serum LH levels were low in both hypothyroid and hyperthyroid rams compared with controls whereas there were no differences in FSH levels. The LH response to exogenous LHRH was reduced in hypothyroid rams but not in hyperthyroid rams. Serum prolactin levels on the other hand were higher than control in both hypothyroid and hyperthyroid rams. Reduced testosterone secretion in hypothyroid rams indicates that the normal function of Leydig cells depends on an adequate level of thyroid hormones. The decrease in circulating testosterone concentrations in hyperthyroid rams with normal secretion rates suggests an increased testosterone clearance rate in these animals. The decreased spermatozoal motility in hypo- and hyperthyroid rams suggests that the lowered testosterone level in these animals has altered the androgen-dependent maturation of spermatozoa in the epididymis.(ABSTRACT TRUNCATED AT 250 WORDS)     

GONADAL-PITUITARY HORMONE LEVELS IN GYNAECOMASTIA

Plasma levels of LH, FSH, oestradiol 17 beta and testosterone were measured in twenty-two men with gynaecomastia. The group was divided by age into those under and those over 50-years-old and the mean hormone levels of the two groups were compared with two groups of age-matched normal men. In the young men with gynaecomastia LH and consequently the LH:FSH ratio was lower than in controls. Older patients with gynaecomastia had higher values of both LH and FSH than normal controls but the LH:FSH ratio was similar in the two groups. A pulsatile pattern of LH was present only in the young controls. Older controls had higher FSH levels than younger controls. In older men with gynaecomastia oestradiol levels and the oestradiol:testosterone ratio were higher than in those without.     

ENDOCRINE FUNCTION IN THE PRADER-WILLI SYNDROME

Hypothalamic, pituitary and gonadal function was studied in five male and three female patients with the Prader-Willi syndrome. All were clinically hypogonadal: all males had low circulating testosterone levels, although in two females basal plasma oestradiol was within the normal range for the early follicular phase of the menstrual cycle. Basal gonadotrophin levels were low and the response to the intravenous administration of LHRH was subnormal in seven. Repeat administration of LHRH after 10 days and 6 weeks treatment with oral clomiphene (200 mg daily) was followed by a normal rise in luteinizing hormone (LH) and follicle stimulating hormone (FSH) in four out of five patients tested. All five males were tested with human chorionic gonadotrophin (hCG) and the rise in plasma testosterone was subnormal in four. Treatment with hCG was continued for 6 weeks in these four patients, but in only one did testosterone levels rise (transiently) to the normal adult male range. In one female patient studied no rise in plasma oestradiol was detected in response to human menopausal gonadotrophin (hMG). These results suggest that the hypogonadism in the Prader-Willi syndrome is due to combined hypothalamic and primary gonadal abnormalities.     

Effects of active and passive immunization with LH-RH on gonadotrophin secretion and reproductive function in female rats.

In order to get information about the physiological role played by LH-RH in the regulation of tonic and phasic secretion of gonadotrophins, and about the existence of FSH-RH distinct from LH-RH, we attempted to neutralize endogenous LH-RH by passive and active immunization with LH-RH in female rats. Anti-LH-RH serum prevented pre-ovulatory gonadotrophin surges at proestrus and ovulation, and it suppressed gonadotrophin increase induced by oestradiol benzoate or progesterone in ovariectomized rats. Elevated serum gonadotrophin concentrations in long-term ovariectomized rats were lowered by anti-LH-RH serum injection. The decrease in FSH levels was less than that in LH levels. Serum FSH rose without significant changes in serum LH level for 6 h after ovariectomy on pro-oestrus or dioestrus. The post-ovariectomy rise of FSH was not suppressed by the anti-LH-RH serum which was enought to inhibit serum LH to undetectable levels. Active immunization with LH-RH resulted in decreasing LH levels but failed to alter FSH levels in both serum and pituitary. Seven out of 10 rats immunized with LH-RH became constantly di-oestrous. The weights of anterior pituitary, ovary and uterus of the LH-RH immunized rats were significantly smaller than those of BSA immunized controls. Ovaries of LH-RH immunized rats contained few fresh corpora lutea. These results indicate that LH-RH plays a significant role in the control of both plastic and tonic secretion of LH and FSH. The existence of FSH-RH distinct from LH-RH or mechanism which specially controls the basal FSH secretion is indicated.