Hormone Therapy

Efficacy of GnRH Pulses in Hypogonadism Secondary to Primary Empty Sella: Case Report.

TL;DR

Pulsed gonadotropin delivery using the micropump demonstrates good efficacy and tolerability, and aligns more closely with the physiological rhythm of GnRH secretion in the human body, successfully treating hypogonadotropic hypogonadism caused by primary empty sella.

Key Findings

A 45-year-old male with hypogonadotropic hypogonadism secondary to primary empty sella presented with severely suppressed gonadotropin and testosterone levels.

  • Baseline FSH level was 0.03 mIU/mL
  • Baseline LH level was 0.02 mIU/mL
  • Baseline testosterone level was 0.72 nmol/L
  • Patient presented with fatigue and decreased libido
  • MRI revealed an empty sella

Baseline semen analysis in the patient showed a small number of normal sperm with reduced motility prior to treatment.

  • Semen analysis showed a small number of normal sperm with reduced motility
  • The patient had experienced the loss of his only child, providing clinical motivation for fertility treatment
  • The patient was a middle-aged male aged 45 years

Treatment with micropump pulsed GnRH therapy resulted in normalization of LH, FSH, and testosterone levels.

  • LH, FSH, and T levels returned to normal during treatment
  • No side effects were reported during micropump pulse GnRH treatment
  • Patient showed improvements in fatigue, reduced libido, sexual urge, anxiety, and feelings of inferiority

Sperm activity rate increased substantially following micropump pulsed GnRH treatment, resulting in natural pregnancy.

  • Sperm activity rate increased to 79.9% following treatment
  • The patient's spouse achieved a natural pregnancy as an outcome
  • Treatment was described as demonstrating 'good efficacy and tolerability'

Literature review compared pulsed GnRH treatment to conventional treatment in male patients with hypogonadotropic hypogonadism across multiple outcome measures.

  • Comparisons were made in terms of development of secondary sexual characteristics, sex hormone levels, sperm production rate, and sperm activity rate
  • Pulsed GnRH therapy was described as aligning 'more closely with the physiological rhythm of GnRH secretion in the human body'
  • The comparison involved male patients with hypogonadotropic hypogonadism treated with conventional treatment versus pulse GnRH treatment

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Citation

Ran C, Peng G, Shen R, Liao Q, Liao M, Wang Q, et al.. (2024). Efficacy of GnRH Pulses in Hypogonadism Secondary to Primary Empty Sella: Case Report.. Reproductive sciences (Thousand Oaks, Calif.). https://doi.org/10.1007/s43032-024-01637-1