Abstract
Hypothalamic amenorrhea is a treatable cause of infertility. Our patient was presented with secondary amenorrhea and diabetes insipidus. Cortisol and prolactin responded normally to a combined insulin tolerancetest (ITT) and thyrotropin-releasing hormone (TRH) challenge ,while thyroid-stimulating hormone (TSH) response to TRH was diminished ,and no response of growth hormone to ITT was detected. Both luteinizinghormone (LH) and follicle-stimulating hormone (FSH) levels increased following gonadotropin-releasing hormone (GnRH) challenge. No response of LH to clomiphene citrate challenge was detected. Magnetic resonanceimaging findings demonstrated a midline mass occupying the inferior hypothalamus ,with posterior lobe not visible and thickened pituitary stalk. Ovulation induction was carried out first with combined humanmenopausal gonadotropins (hMG/LH/FSH) (150 IU/day) and afterwards with pulsatile GnRH (150 ng/kg/pulse).Ovulation was achieved with both pulsatile GnRH and combine gonadotropin therapy. Slightly betterresults were achieved with the pulsatile GnRH treatment.
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