OVARIAN 17-ALPHA-HYDROXYPROGESTERONE RESPONSES TO GNRH ANALOG TESTINGIN OLIGOMENORRHEIC INSULIN-DEPENDENT DIABETIC ADOLESCENTS

Objective: To investigate the pituitary-ovarian function in adolescent girls with insulin-dependent diabetes mellitus (IDDM). Design: Clinic al case-control study. Methods: The GnRH analog leuprolide acetate was administered subcutaneously to 16 adolescents with IDDM (seven eumeno rrheic and nine oligomenorrheic) and 13 controls between 0800 and 9900 h. Blood samples were collected at baseline and 0.5, 3, 6 and 24 h af ter leuprolide to measure levels of gonadotropins, 17 alpha-hydroxypro gesterone (17-OHP), androgens and estradiol. Results: Mean baseline se rum LH levels were significantly higher in eumenorrheic compared with oligomenorrheic IDDM patients, while peak LPI responses to GnRH analog testing were similar in all subjects. Oligomenorrheic IDDM girls show ed, as a group, a distinct 17-OHP response to GnRH analog stimulation, which in five out of nine girls was in the range of functional ovaria n hyperandrogenism (greater than or equal to 8.6 nmol/l). Androgen and estradiol levels were not significantly altered in any group, No corr elation was found between steroid levels and HbA(1c) levels, although the latter were significantly higher in oligomenorrheic than in eumeno rrheic patients. Conclusion: About 50% of the oligomenorrheic IDDM ado lescents had an increased ovarian 17-OHP response to GnRH analog stimu lation in the range of functional ovarian hyperandrogenism Factors oth er than metabolic control, such as stress, may play an etiologic role in IDDM ovarian dysfunction.