The GnRH test in the assessment of patients with pituitary and parapituitary lesions: results of a 5-year retrospective study

• Published in: Pituitary 2008-09, Vol.11 (3), p.271-278
• Main Authors: Chammas, N. K., Chambers, S. M., Harris, P. E.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Brain Neoplasms - complications; Brain Neoplasms - diagnosis; Brain Neoplasms - metabolism; Brain Neoplasms - pathology; Brain Neoplasms - therapy; Child; Child, Preschool; Endocrinology; Female; Follicle Stimulating Hormone - blood; Gonadotropin-Releasing Hormone - administration & dosage; Human Physiology; Humans; Hypogonadism - etiology; Hypogonadism - metabolism; Hypogonadism - pathology; Hypogonadism - therapy; Injections, Intravenous; Luteinizing Hormone - blood; Male; Medicine; Medicine & Public Health; Middle Aged; Pituitary Function Tests; Pituitary Neoplasms - complications; Pituitary Neoplasms - diagnosis; Pituitary Neoplasms - metabolism; Pituitary Neoplasms - pathology; Pituitary Neoplasms - therapy; Predictive Value of Tests; Retrospective Studies; Time Factors
• ISSN: 1386-341X; 1573-7403
• DOI: 10.1007/s11102-008-0124-4

Objective To examine the utility of the GnRH (gonadotrophin-releasing hormone) test in the management of patients with pituitary and parapituitary lesions. Patients and Methods A 5-year retrospective study of LH (luteinizing hormone) and FSH (follicle stimulating hormone) responses to GnRH test in patients with HP (hypothalamic-pituitary) disease in a regional endocrine centre. Serum LH and FSH concentrations were measured at baseline and at 20 and 60 min after an intravenous bolus of 100 mcg (micrograms) of GnRH. The GnRH responses were categorised by tumour size, tumour type, and gonadal status. Results Of the 104 patients studied, 46 were male and 58 were female. There were 50 normal, 38 subnormal and 16 exaggerated LH responses compared with 34 normal 67 subnormal and three exaggerated responses for FSH. Seventy-four patients (71.2%) were hypogonadal. Normal LH responses were achieved in half of the hypogonadal subjects and normal FSH responses in more than a third. Furthermore, the LH responses were exaggerated in nine hypogonadal patients compared with three for FSH. The GnRH test could not differentiate between pituitary or parapituitary lesions either by size or type of lesion. An exception was the male non-functioning adenoma (NFA) sub-group (10 patients, all were hypopituitary, seven were hypogonadal), which demonstrated significant subnormal LH and FSH responses compared with other male and female tumour type sub-groups. Conclusions The data from this study indicate that the GnRH test is unhelpful in the clinical assessment of the HP axis in patients with HP disease.