NORMOGONADOTROPIC PRIMARY AMENORRHEA IN A GROWTH HORMONE-DEFICIENT WOMAN WITH ECTOPIC POSTERIOR PITUITARY - GONADOTROPIN PULSATILITY AND FOLLICLE-STIMULATING-HORMONE BIOACTIVITY

We studied the gonadotropic function in a 25-year-old woman suffering from congenital GH deficiency, complaining of primary amenorrhea and w ishing to become pregnant. She disclosed a hypoplasic anterior pituita ry within a small sella turcica and an ectopic posterior pituitary lob e located below the median eminence. Immunoreactive LH and FSH plasma levels were normal, basal and in response to a GnRH iv bolus but estra diol was low. LH pulse frequency was elevated and FSH bioactivity was low in a granulosa cell aromatase bioassay. Pulsatile administration o f iv GnRH at a slower, normal pace, failed to induce ovulation or to i ncrease FSH bioactivity, with or without concomitant GH replacement, H owever treatment with exogenous im gonadotropins, when preceeded by GH replacement, succeeded in inducing mature oocytes and pregnancy, We c oncluded that the hypogonadism observed in this patient was due to rap id GnRH pulsatility and poor biological activity of endogenous FSH.