Predictors of Outcome of Long-Term GnRH Therapy in Men with Idiopathic Hypogonadotropic Hypogonadism

• DOI: 10.1210/jc.2002-020518
• Publication Date: 2002-09-05T17:22:39Z
• Authors: Nelly Pitteloud; Frances J. Hayes; Andrew Dwyer; Paul A. Boepple; Hang Lee; William F. Crowley
• Keywords: Virilization; Anosmia

GnRH treatment is successful in inducing virilization and spermatogenesis men with idiopathic hypogonadotropic hypogonadism (IHH). However, a small subset of IHH men, poorly characterized to date, fail reach normal testicular volume (TV) produce sperm on this therapy. To determine predictors outcome terms TV count, we studied 76 (38% anosmia) undergoing therapy for 12–24 months. The population was stratified according the baseline degree prior pubertal development: absent (group 1, n = 52), partial 2, 18), or complete (adult onset HH; group 3, 6). Cryptorchidism recorded 40% 5% none 3. Pulsatile initiated at 5–25 ng/kg per pulse sc titrated attain adult male testosterone (T) levels. LH, FSH, T, inhibin B (IB) levels were measured serially, maximum count recorded. A longitudinal mixed effects model used final TV. LH (97%) T (93%) normalized majority men. Groups 2 3 achieved size (92%), FSH (96%), IB (93%), their ejaculate (100%). given puberty thus primed gonadotropes testes, responded faster, normalizing androgen production by months completing 6 In contrast, 1 failed normalize (11 ± 0.4 ml) (92 pg/ml) 24 months, despite normalization IU/liter). Similarly, counts plateaued well below range (median × 106/ml) 18% remaining azoospermic. independent long-term were: 1) presence some development (positive predictor; effect (β) 4.3; P 0.003); 2) less than 60 pg/ml (negative β −3.7; 0.009); 3) cryptorchidism −1.8; 0.05). Notably, anosmia not an predictor when adjusted other variables. Our conclusions are: pulsatile very spermatogenesis; LH-Leydig cell-T axis more uniformly FSH-Sertoli cell-IB during therapy; favorable achieving consequently optimizing are history sexual maturation, greater pg/ml, absence cryptorchidism.