We have studied nine children with a variety of hypothalamic pituitary disorders and delayed puberty, before and during nocturnal pulsatile GnRH therapy given subcutaneously in a dose of 2 - 4 ug every 90-120 minutes. Initial age ranged from 13.5 - 18 years. The duration of therapy was >0.5 years. Overnight serum profiles of prolactin, growth hormone and gonadotrophins were obtained by blood sampling at 15 minute intervals.In the three severely growth hormone deficient patients there were very low levels of prolactin (0-150 mIU/L), without appreciable pulsatility or sleep-related rise. In the remainder there was no clear relationship between prolactin levels and GnRH or gonadotrophin pulses. In those patients with normal growth hormone secretion, including two with isolated gonadotrophin deficiency, there was a temporal relationship between growth hormone and prolactin pulses.These results therefore seem to contrast with data from adult studies, in that pulsatile prolactin secretion was more related to growth hormone status and release than to GnRH or gonadotrophins. This may have important implications for our understanding and management of hypothalamic-pituitary disorders.
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