根田鼠下丘脑促性腺激素释放激素的放射免疫学测定

利用大鼠促性腺激素释放激素放射免疫学测定试剂检测了根田鼠下丘脑促性腺激素释放激素水平,测定线性范围为2.5pg至160pg/管,批内和批间差为1.7%(n=10)和7.8%(n=4),样品平均标准回收率为108.2±8.4%.根田鼠下丘脑促性腺激素释放激素测定为0.28±0.04ng/mg湿重组织.从根田鼠下丘脑提取物稀释曲线与大鼠(人工合成)促性腺激素释放激素有较好的平行关系判断,可以推知根田鼠下丘脑促性腺激素释放激素结构活性类似于大鼠(人工合成)的活性.     

不同的下丘脑肽和神经递质对鲤鱼促性腺激素和生物激素分泌活动的影响

以１龄性腺发育中期鲤鱼为材料,采用腹腔注射的方法,研究了不同的下丘脑肽和神经递质对鲤鱼促性腺激素和生长激素分泌的影响。结果表明：促甲状腺激素释放激素,Ｌ－多巴,甲基睾酮,γ－氨基丁酸,促黄体素主激素类似物和三磺甲状腺原氨酸者都能显著刺激ＧｔＨ的分泌,但最大效应时间各不相同。     

17β-雌二醇对不同性腺发育时期鲤鱼生长激素分泌的影响

目的　以不同性腺发育阶段的雌性鲤鱼为材料 ,采用脑垂体碎片离体灌流孵育的方法 ,研究 17β 雌二醇对由神经内分泌因子—促性腺激素释放激素和促甲状腺素释放激素诱导的生长激素分泌的调节作用的季节性变化特点。方法与结果　用 10 - 8mol L和 10 - 1 0 mol L 17β 雌二醇对鲤鱼脑垂体碎片进行 10～ 12h的过夜孵育后 ,性腺处于退化期和发育期的的鲤鱼脑垂体对浓度依次为 10 - 9,10 - 8和 10 - 7mol L的促性腺激素释放激素类似物的脉冲刺激的反应性显著大于对照组 ,但在成熟期 17β 雌二醇作用组的反应性与对照组无显著性差异 ;经过同样浓度的 17β 雌二醇预孵育后 ,鲤鱼脑垂体碎片对浓度依次为 10 - 1 0 ,3× 10 - 8和 10 - 7mol L的促甲状腺素释放激素脉冲刺激的反应性也表现出季节性差异 ,反应性的增强作用表现为 :成熟期 >发育期 >退化期。结论　性类固醇激素具有调节脑垂体对刺激生长激素分泌的神经内分泌因子的反应性的作用 ,这种调节作用与鱼体的性腺发育状态有关 ,具有季节性变化的特点     

LHRH激发试验LH峰值对性早熟女童GnRHa疗效的诊断价值

为了探讨促黄体生成素释放激素(LHRH)激发试验中LH峰值对中枢性性早熟(CPP)女童促性腺激素释放激素类似物(Gn RHa)疗效的评估价值。选取2014年1月~2016年1月我院收治的中枢性性早熟(CPP)女童40例,给予Gn RHa(曲普瑞林)50~100μg/kg肌肉注射,1次/28 d。治疗3个月及以后的每6个月进行LHRH激发试验,分别取LH峰值1 IU/L、2 IU/L、3 IU/L作为LH受抑的界限值,与临床发育受抑情况进行比对,计算3个LH峰值诊断发育受抑的灵敏度、特异度及准确度。40例患儿治疗疗程为6~24个月,共完成了119次LHRH激发试验。治疗后6个月的基础LH值较治疗前明显降低((0.46±0.17)IU/L vs(0.81±0.26)IU/L),差异具有统计学意义(t=1.273,p0.05);Pearson相关性分析:基础LH值与LH峰值之间呈线性正相关(r=0.712,p0.05)。LH峰值2 IU/L诊断临床发育受抑的灵敏度、特异度和准确度分别为88.9%、100.0%、99.2%。LHRH激发试验中LH峰值2 IU/L可以作为判断CPP女童Gn RHa治疗效果的有效指标。     

用于鱼类脑垂体内分泌研究的离体灌流培育系统

本实验建立了研究鲤鱼脑垂体碎片促性腺激素（ＧｔＨ）和生长激素（ＧＨ）分泌反应的离体灌流系统。性腺退化鲤鱼的脑垂体碎片可产生稳定和可测的ＧｔＨ和ＧＨ基础分泌;引入２ｍｉｎ脉冲式鲑鱼促性腺激素释放激素类似物（ｓＧｎＲＨＡ）可产生敏感的、恢复迅速和可再现的ＧｔＨ和ＧＨ分泌峰。该系统为鱼类脑垂体激素（ＧｔＨ和ＧＨ）分泌动力学和分泌调节机理的离体研究提供了可靠的手段。     

鳗鲡繁殖生物学研究Ⅳ．人工催熟过程中下海鳗鲡的GtH分泌活动、性腺发育状况和脑垂体GtH细胞的超显微结构

雌二醇通过正反馈作用能促进脑垂体促性腺激素(GtH)细胞的合成活动,使脑垂体GtH水平显著升高。促黄体素释放激素的类似物(LHRH-A)和利血平(reserpine,RES)能促进脑垂体GtH细胞的分泌活动,使血液中GtH含量显著升高。鲤垂体、人体绒毛膜促性腺激素(HCG)和LHRH—A三种激素混合进行多次注射能诱导雌雄鳗鲡性腺发育成熟,其催熟效果明显优于它们的分别单独多次注射或者鲤鱼脑垂体和HCG的多次注射,表明外源的和内源的促性腺激素对于诱导鳗鲡性腺发育成熟都是重要的。鳗鲡脑垂体GtH细胞超显微结构的观察证实它们在激素诱导性腺发育成熟过程中处于活跃的合成与分泌状态。     

人类精浆中发现免疫活性促黄体生成素释放激素

八十年代以来,已在大鼠卵巢、睾丸和猴曲细精管中分离出促黄体生成素释放激素(LHRH)样物质,在性腺组织中也发现了特异性高亲和力的LHRH受体。但人类精浆中是否存在LHRH样物质则很少报道。日本研究者以放免法检验人精浆中是否存在LHRH样物质,并研究了它与精子质量的关系。103份精浆都取自不育者,LHRH浓度范围从410.5pg/ml直至不能检出(<25.0pg/ml),均值为77.0±7.6pg/ml。将所有样品按精子密度和活动力分成四组,即高密度和活动力佳组(其中包括精子正常者)、高密度和活动力不佳组、低密度和活动力佳组以及低密度和活动力不佳组。高密度为精子密度达40×     

促乳素抑制促性腺激素诱导小鼠卵巢的纤蛋白溶酶原激活因子增加和排卵

为进一步研究纤溶酶原激活因子(PA)在排卵中的作用,我们观察了促乳素(PRL)对hCG诱导小鼠卵巢PA增加和排卵的影响。实验结果表明;(1)PRL抑制促性腺激素诱导小鼠排卵。当bCG注射18 h后,在输卵管中发现卵子平均为31.1±6.7,而hCG加PRL组为19.7±4.9;当hCG注射24 h后,输卵管中发现卵子数为32.3±10.8,hCG加PRL组为20.3±5.4;其抑制率分别为36.5％和37％;(2)PRL对排卵的抑制作用是通过抑制促性腺激素对小鼠颗粒细胞(GC)和膜-间质细胞(TIC)PA分泌的结果;(3)在离体实验中PRL也明显抑制促性腺激素对小鼠GC PA分泌的作用。这些结果进一步证实PA在排卵过程中的重要作用。     

LHRH类似物治疗癌

目前已有一些促黄体生成激素释放激素(LHRH)类似物合成,它们的效力优于天然激素,除了有的半数排除期比另一些长外,其它性质彼此都很相近。 LHRH类似物的药理研究显示:间歇给药可促进性功能。作用与天然激素相差无几;长期给药,抑制促性腺激素的分泌,最终导致男性雄激素、女性雌激素分泌的抑制,该作用可使激素反应性动物肿瘤消退,期望能临床应用于治疗男性的激素依赖性癌。 LHRH类似物在细胞表面与受体结合。然后被占受体聚集或凝集,随之衣被小凹形成,最后被占受体从细胞表面完全内部化或消失。单次脉冲释放LHRH的量不能完全占有细胞     

促性腺激素释放激素类似物对长臀鮠脑垂体促性腺激素分泌的影响

采用离体灌流孵育技术和促性腺激素的放射免疫测定方法,对长臀鮠(Cranoglanis bouderius)脑垂体碎片促性腺激素的分泌进行了研究。结果表明：持续的促性腺激素释放激素类似物(GnRH-A)能显著刺激退化期的长臀鮠离体脑垂体碎片促性腺激素(GTH)的分泌,并且长臀鮠脑垂体碎片对持续的GnRH-A刺激未表现出脱敏性,该结果与胡子鲇和鲇鱼相似,而与金鱼和鲤科鱼类不同;重复脉冲GnRH-A刺激对长臀鮠脑垂体碎片GTH分泌具有促进作用,而且存在剂量依存关系,与鲇鱼和鲤科鱼类相类似。上述结果表明在长臀鮠的人工繁殖中可以用持续高浓度GnRH-A刺激对长臀鮠进行催熟和催产。     

Effect of gonadotropin-releasing hormone agonist treatment in boys with central precocious puberty: final height results

OBJECTIVE: The small number of boys present in most studies on final height (FH) after gonadotropin-releasing hormone agonist (GnRHa) treatment for central precocious puberty (CPP) offers difficulties in the evaluation of the effects of treatment on FH in males. METHOD: We therefore combined FH data from The Netherlands, Italy and France to study the effect of GnRHa treatment in a large group of 26 boys with CPP. RESULTS: The mean chronological age at the start of treatment was 7.6 +/- 2.0 (SD) years, bone age (BA) was 11.0 +/- 2.1 years. All boys were treated with depot formulations of the GnRHa triptorelin with established gonadal suppression for a mean treatment period of 4.7 +/- 2.1 years. FH was 172.9 +/- 6.6 cm. FH standard deviation score (SDS) was -0.66 +/- 1.22, not significantly different from the target height SDS of -0.23 +/- 0.75. FH-SDS was significantly lower in the subgroup of 12 patients with organic CPP compared to patients with idiopathic CPP (-1.34 +/- 1.06 vs. -0.08 +/- 1.06, respectively; p = 0.01), but no difference in height gain was observed. The mean estimated height gain, defined as the difference between predicted and actual adult height was 6.2 +/- 8.7 cm using the average tables of Bayley and Pinneau, and 0.3 +/- 8.6 cm using the BA advance adjusted tables. Regional differences in height gain were observed between the different countries, reflecting different local practices. CONCLUSION: We conclude that GnRHa treatment in boys results in a FH close to target height.     

Spontaneous growth hormone secretion in healthy prepubertal children of normal stature.

To evaluate the dynamics of growth hormone (GH) secretion in healthy prepubertal children of normal stature, we determined spontaneous GH secretion by measuring GH every 30 min in 21 Japanese subjects, age: 5.4 +/- 2.3 (1.6-10.6) years; height: -1.4 +/- 1.1 (-1.98-1.77) SD. The 24-h mean GH concentration was 4.8 +/- 1.5 ng/ml. The 24-h mean GH was similar in boys and girls (mean +/- SD: 4.8 +/- 1.7 vs 4.7 +/- 1.1 ng/ml). No correlation was found between chronological age and the 24-h mean GH. The 24-h mean GH was closely correlated with GH pulse amplitude (r = 0.94; P less than 0.001), but not with the number of GH pulses. The 24-h mean GH was also highly correlated with 3-h mean GH after sleep and 3-h peak GH after sleep (r = 0.86; P less than 0.001 and r = 0.72; P less than 0.001, respectively). Our data suggest that in healthy prepubertal children of normal stature, (1) spontaneous GH secretion is independent of sex and age, (2) the amount of spontaneous GH secretion is controlled by pulse amplitude, not by number of pulses. (3) 3-h mean GH and 3-h peak GH after sleep might represent 24-h total spontaneous GH secretion.     

Bird's-Eye View of GnRH Analog use in a Pediatric Endocrinology Referral Center

Objective: Gonadotropin-releasing hormone analogs (GnRHa) are standard of care for the treatment of central precocious puberty (CPP). GnRHa have also been prescribed in other clinical settings with the hope of increasing adult stature, although evidence to support this practice is lacking. The degree to which GnRHa are being prescribed for indications other than CPP in routine clinical care has not been described. We sought to systematically examine GnRHa prescribing practices among the pediatric endocrinologists at our academic medical center.Methods: We reviewed medical records of children treated with GnRHa during a 6-year interval. Variables analyzed included gender, age at start of treatment, indication for therapy, and use of growth hormone as adjunctive treatment. Nonparametric analyses were utilized to compare treatment characteristics of those with CPP versus those without.Results: A total of 260 patients (82% female) aged 8.06 ± 2.68 years were identified. Of these, 191 (73.5%) were treated for CPP, whereas 69 (26.5%) were treated for normally timed puberty in the context of idiopathic short stature/poor predicted height (n = 37), growth hormone deficiency (n = 17), congenital adrenal hyperplasia (n = 10), primary hypothyroidism (n = 4), and developmental delay (n = 1). Of the 161 girls with CPP, GnRHa therapy was initiated at =8 years of age in 62 (39%).Conclusion: Whereas most patients were treated for CPP, ~27% were treated for other indications. Of girls with CPP, 39% were treated at an age when benefit in terms of height is unlikely. This highlights the need for rigorous studies of GnRHa use for indications beyond CPP.Abbreviations: CPP = central precocious puberty GnRHa = gonadotropin-releasing hormone analogs     

Blunted pubertal growth after leukemia: a new pattern of growth hormone insufficiency

Growth, age at menarche and spontaneous GH secretion were studied in girls after treatment for acute lymphoblastic leukemia (ALL). These girls had normal prepubertal growth but subnormal pubertal growth. Mean final height was 1 SD less than expected before puberty. The average age at menarche was significantly lower than the normal mean for Swedish girls. The mean 24-hour GH secretion was severely blunted and there was no increase during puberty. We suggest that girls treated for ALL, including CNS irradiation, have a relative GH insufficiency which becomes clinically obvious only when the girls cannot respond to the increased demands for GH in puberty.     

Association of pharmacological tests and study of 24-hour growth hormone secretion in the investigation of growth retardation in children: analysis of 257 cases

Growth hormone (GH) secretion can presently be investigated by several methods: pharmacological provocative tests, study of 24-h GH secretion, measurement of somatomedin-C (Sm-C)/insulin-like growth factor (IGF) I, and the growth hormone-releasing hormone (GHRH) test. In order to compare the results obtained, these methods were used in 257 children with growth retardation (169 boys, 88 girls). Their height SD was -2.7 +/- 0.2, chronological age 11 3/12 +/- 1 6/12 years, and bone age 8 4/12 +/- 1 4/12 years. Mean growth velocity was 4.5 +/- 1.5 cm/year. One hundred and thirty-eight boys and 80 girls were prepubertal, and 31 boys and 8 girls were pubertal (B2 G2). All children underwent the study of 24-h GH secretion (n = 257) and pharmacological provocative tests (two tests, n = 213; one test n = 44). Sm-C/IGF I was measured in prepubertal children (n = 131), and a GHRH test was carried out (n = 153). In addition, the mean integrated concentration of growth hormone secretion (IC-GH) was assessed in a control group of 23 children and was found to be 5.4 +/- 1.2 ng/ml/min. The IC-GH in the group as a whole was 2.6 ng/ml/min. The mean maximum peak during pharmacological tests varied considerably according to the test used, ranging from 7.8 ng/ml for the arginine test to 17.1 ng/ml for the glucagon and betaxolol test. The maximum peak and the 24-h IC-GH were not significantly correlated.(ABSTRACT TRUNCATED AT 250 WORDS)     

Comparative Efficacy and Safety of Three Current Clinical Treatments for Girls with Central Precocious Puberty: A Network Meta-Analysis

Objective: The optimal treatment for girls with central precocious puberty (CPP) is unknown. We conducted a network meta-analysis to evaluate the efficacy and safety of existing treatments to provide credible clinical guidelines.Methods: We compared gonadotropin-releasing hormone analogue (GnRHa) therapy, GnRHa plus growth hormone (GH) combination therapy, and no-treatment therapy for girls with CPP by performing an electronic search for studies in PubMed, Embase, Chinese National Knowledge Infrastructure databases, and Wanfang Data from their inception until September 30, 2018. Six outcomes, including bone maturation ratio, final height, final height compared with target height, growth velocity, height gain, and gain in predicted adult height (ΔPAH), were expressed as the mean difference with 95% confidence interval. The surface under the cumulative ranking curve (SUCRA) value illustrated the rank probability of each treatment under different outcomes.Results: Twenty-two studies with 1,268 patients were included. GnRHa plus GH had the best performance on final height, final height compared with target height, growth velocity, height gain, and ΔPAH, with the highest SUCRA values of 0.919, 0.975, 0.909, 0.999, and 0.957, respectively. For bone maturation ratio, GnRHa ranked the highest, with a SUCRA value of 0.663. No severe adverse effects were reported.Conclusion: For girls with CPP, GnRHa plus GH had the highest probability of being the optimal therapy for improving final height, and no severe adverse effects were reported.Abbreviations: BMI = body mass index; CI = confidence interval; CPP = central precocious puberty; GH = growth hormone; GnRHa = gonadotropin-releasing hormone analogue; HPG = hypothalamic-pituitary-gonadal; LH = luteinizing hormone; NMA = network meta-analysis; PAH = predicted adult height; PCOS = polycystic ovary syndrome; RCT = randomized controlled trial; SUCRA = surface under the cumulative ranking curve     

Spontaneous growth hormone secretion and plasma somatomedin-C in children of short stature

We studied 17 short prepubertal children, aged 7.5 to 17.0 years (mean +/- SD: 11.7 +/- 2.4) more than 2.0 SD below the mean height for their age and of delayed bone age (M +/- SD: 8.1 +/- 2.3), to clarify their physiological GH secretory status. The mean concentration of GH (MCGH) was calculated and was compared with the subjects' GH responses to insulin and arginine tolerance tests (IATT) and plasma somatomedin-C (SM-C). The mean 24-h MCGH value was 3.2 +/- 1.3 ng/ml (range 1.6-5.5). The mean peak GH response to the IATT was 13.0 +/- 7.5 ng/ml (range 2.4-33.9). In addition to the two patients with abnormally low GH responses to the IATT, seven with normal responses showed low 24-h MCGH values, a small number of GH pulses and low mean GH amplitude. The mean plasma SM-C in all patients was 0.60 +/- 0.20 U/ml. This was significantly lower than that of age-matched children of normal height (p less than 0.001). The 24-h MCGH was significantly correlated with plasma SM-C levels (r = 0.51, p less than 0.05) and with that of the first three hours of sleep at night (r = 0.84, p less than 0.01). These results indicate that: 1) some short children with normal GH response to pharmacological tests secrete a low amount of GH physiologically and 2) blood sampling during the first three hours of sleep as well as 24-hour sampling is suitable in evaluating the physiological secretion of GH.     

Serum inhibin A and inhibin B in central precocious puberty before and during treatment with GnRH agonists

Serum levels of the gonadal hormones inhibin A and inhibin B are undetectable or low in prepubertal girls, and rise during puberty. In girls with central precocious puberty (CPP) the hypothalamic-pituitary-gonadal axis is prematurely activated, if the girl is thereafter treated with GnRH agonists both gonadotropins and estradiol levels become suppressed. We therefore investigated serum levels of inhibin A and inhibin B in girls with CPP at diagnosis and during treatment in order to test the hypothesis that inhibin secretion would increase and decrease in parallel with the activation and suppression of the hypothalamic-pituitary-gonadal axis. Serum levels of inhibin A and inhibin B were significantly (p < 0.0005) elevated in 42 girls at diagnosis of CPP (inhibin A: 7 pg/ml (<7--139), inhibin B: 80 pg/ml (<20--294) (median, range)) compared to levels in age-matched healthy schoolgirls (inhibin A: all values <7 pg/ml, inhibin B: 21 pg/ml (<20--122) (median, range)), but were appropriate for Tanner stage. During treatment with GnRH agonist (intranasal buserelin and oral cyproterone acetate, treatment group 1, n = 23, or triptorelin depot injections, treatment group 2, n = 19) levels of both hormones fell significantly (p = 0.002). There was a significantly (p = 0.003) greater fall in inhibin B levels during treatment in group 2 compared to group 1, with inhibin B levels now lying below (group 2: <20 pg/ml (<20--68)) rather than within (group 1: 34.5 pg/ml (<20--93)) the age-appropriate range. It is concluded that levels of inhibin A and inhibin B are elevated and suppressed in concert with activation and suppression of the hypothalamo-pituitary-gonadal axis in girls with CPP, supporting the concept that ovarian inhibin secretion is dynamically regulated by gonadotropin stimulation.     

Growth hormone response to growth hormone releasing hormone 1-40 in Turner's syndrome

The response of growth hormone (GH) to acute administration of GH-releasing hormone 1-40 (GHRH) was evaluated in 12 patients with Turner's syndrome and in 12 prepubertal or early pubertal girls. In 7 of 12 patients GHRH induced a definite increase (greater than 10 ng/ml) of plasma GH levels. In 5 patients there was a poor GH rise after GHRH administration (less than 10 ng/ml). Overall, the mean GH response of patients was significantly lower than that of normal girls. Five out of 7 patients with a 45 X,O karyotype had a reduced GH rise after GHRH, while all patients with non X,O karyotype (mosaicism and/or 46 X,iX) had a normal GH response to GHRH. Although the cause of short stature in patients with Turner's syndrome is most likely multifactorial, a reduced pituitary GH reserve, as documented by the reduced GH response to GHRH in some of our patients, may contribute to the growth impairment in this disorder.     

Luteinizing hormone-releasing hormone in prepubertal and pubertal girls.

Estimations of immunoreactive LH-RH and LH in pooled sera of girls, adult women and postmenopausal women have been carried out. The girls were divided into three groups: I--girls aged 2--4 years, II--girls aged 5--8 years and III--girls 9--12 years of age. The estimated concentrations of LH-RH in particular groups were as following: in group I--1.2 +/- 0.2 pg/ml, in group II--2.2 +/- 0.4 pg/ml, in group III 31.0 +/- 4.4 pg/ml, in adult women 6.3 +/- 1.8 pg/ml. and in postmenopausal women 16.6 +/- 2.4 pg/ml. The concentrations of LH in the same groups were 4.3 +/- 0.7; 4.5 +/- 0.8; 11.0 +/- 1.4, 23.3 +/- 2.4; and 120.0 +/- 14.7 mIU/ml, respectively. The authors suggest that the sexual maturation of girls is initiated by the enhanced hypothalamic activity, reflected in higher concentrations of immunoreactive LH-RH in peripheral serum.