Methods of pituitary function examination in patients with pituitary amenorrhea

Patients with amenorrhea should first check the cause, determine the location of the lesion, and then take symptomatic treatment. There are two ways to check their pituitary function:

Gonadotropin measurement

1. Method: Radioimmunoassay to determine the levels of follicle-stimulating hormone and luteinizing hormone in the blood. If estrogen and progesterone tests have been done, the test should be delayed for two weeks. Blood samples were drawn every 15 minutes from 9 am for a total of 3 times, and the average value of the measured values ​​was taken or mixed before measurement to avoid excessive errors.

2. Result determination

High gonadotropin levels indicate that the disease is in the ovaries, and a laparoscopy is required to directly observe the appearance of the uterus, fallopian tubes, and ovaries. An ovarian biopsy can also be performed to confirm whether it is gonadal dysgenesis, hermaphroditism, ovarian impedance syndrome, or premature ovarian failure.

If gonadotropin is low, further pituitary stimulation tests should be performed to distinguish whether the primary cause is in the pituitary gland itself or in the nervous system above the hypothalamus.

Pituitary stimulation test

1. Method: 100 μg of luteinizing hormone-releasing hormone was dripped intravenously for 4 hours. 2 ml of blood was collected before and 0.5, 0.75, 1, 1.5, 2, and 4 hours after the drip to measure the changes in the luteinizing hormone content in the blood. Under normal circumstances, the luteinizing hormone content will rise 30 to 45 minutes after the drip, and then decrease after 60 to 90 minutes. It will rise for the second time within 2 to 4 hours and can be maintained for 4 hours.

2. Result determination: There is a first rising reaction but no second rising phenomenon, indicating pituitary failure; a delayed reaction occurs 2 to 4 hours after infusion, suggesting that the hypothalamus is damaged and the pituitary is inert; repeated stimulation reaction of luteinizing hormone-releasing hormone: When luteinizing hormone-releasing hormone is deficient for a long time and the pituitary is in an inert state, 100 μg of luteinizing hormone-releasing hormone is given by intramuscular injection once a day for 5 consecutive days. After treatment, the luteinizing hormone reaction is restored, indicating that the lesion is in the hypothalamus.