Dexamethason normalisiert nicht die gestörte LH-Pulsatilität bei der hyperandrogenämischen Ovarialinsuffizienz*

Abstract

Application of dexamethasone (DEX) is well accepted for treatment of hyperandrogenemic ovarian failure (HOI). In some cases of clomiphene resistance, additional DEX can induce ovulatory cycles. In this study, we evaluated the influence of adrenal androgen reduction on the gonadotroph during longterm therapy with 0.5 mg DEX daily in a larger group of patients (n = 25) in order to investigate subgroups of HOI. Women with elevated DHEA-sulfate levels only (DS-group); with elevated testosterone and/or androstenedione levels only (TA); with polycystic ovaries in ultrasound (PCO), with highest LH levels (LH); with secondary amenorrhea (SA); with oligomenorrhea (OL) and with elevated body mass index (BMI) were included. Blood samples were taken at 10 min intervals for 12 h sampling periods (8am-8pm) and analyzed by RIA. In amenorrhoeic patients, investigations took place at monthly intervals; in cycling women preferentially on day 5 of the cycle. LH and FSH profiles were evaluated by 3 different computerized peak identification programs ("pulsar", "ultra" and "modified Santen and Bardin"). DEX resulted in significant decreases in T, A, DS and progesterone serum levels in all subgroups. No significant alterations were found in estradiol levels and only small variations in few subgroups with estrone. Mean LH concentrations exhibited small decreases (p less than 0.05) in DS-, LH- and OL subgroups and no changes in the others. With the exception of a decrease in "pulsar" pulse frequency in the OL subgroup, no changes in pulse frequency or amplitude were found in any other group during DEX therapy. Mean FSH concentrations and pulsatility did not vary either.(ABSTRACT TRUNCATED AT 250 WORDS)