R. M. Boyar

Human Puberty SIMULTANEOUS AUGMENTED SECRETION OF LUTEINIZING HORMONE AND TESTOSTERONE DURING SLEEP

Plasma luteinizing hormone (LH) and testosterone (T) were measured by radioimmunoassay in nine pubertal boys and three sexually mature young men at 20-min intervals for 24 h. Plasma LH and T were also measured in one boy during a delayed sleep onset study. Polygraphic monitoring was carried out to identify precisely sleep onset. Wakefulness, and specific sleep stages. In all nine pubertal boys the plasma T concentration fluctuated and was significantly higher during normal nocturnal sleep as compared to daytime waking. This increased T secretion during sleep was temporally linked to the characteristic pubertal sleep augmentation of LH secretion. To define further the relationship of this increased T secretion to sleep, plasma LH and T were also measured in three of the pubertal boys after acute (1-day) reversal of the sleep-wake cycle. One of these boys was also studied after 3 days of sleep-wake cycle reversal. The results of these studies showed that plasma T was now augmented during the reversed daytime sleep period; the mean T concentrations during this period were significantly higher (P < 0.001) than during nocturnal waking in all four studies. Measurement of plasma LH and T in the three sexually mature young men showed episodic secretion of LH and T during both waking and sleep periods; there was no consistent significant augmentation of LH or T secretion during sleep. This study demonstrates that (a) in normal pubertal boys and sexually mature young men plasma T fluctuates episodically; (b) there is marked augmentation of T secretion during sleep in pubertal boys, which is dependent on increased LH secretion; (c) this pubertal LH-T secretory program is dependent on sleep, since it shifts with delayed sleep onset and reversal of the sleep-wake cycle; and (d) this demonstrable tropic effect of LH on T is evident only during puberty, since sexually mature young men fail to show any consistent relationship between LH and T secretion either awake or asleep.

Hypothalamic-Pituitary Function in Diverse Hyperprolactinemic States

Prolactin secretion in normal adults is characterized by periods of episodic secretion which increase in magnitude during sleep. In this study, we report the 24-h mean prolactin concentrations, prolactin secretory patterns, and associated pituitary hormone function in nine patients (seven women and two men) with hyperprolactinemia of diverse etiologies. Four of the women and one of the men had clinically demonstrable pituitary tumors, one boy had a hypothalamic tumor, and the three other women had functional hyperprolactinemia. The 24-h mean prolactin concentrations derived from averaging the 20-min interval samples for 24 h ranged from 28.6 to 1,220 ng/ml. The plasma prolactin patterns in these patients showed persistence of episodic secretion in all and loss of the normal sleep-wake difference in plasma prolactin in seven of nine. Three of the patients with galactorrhea and comparable 24-h mean prolactin concentrations (58.3, 59.7, and 64.3 ng/ml) showed similar prolactin secretory patterns despite different etiologic mechanisms. Evaluation of the secretory patterns of luteinizing hormone (LH) in these patients showed loss of normal pulsatile LH release and a low 24-h mean LH concentration in the patient with the pituitary tumor, while the two patients without clinically demonstrable pituitary tumors (post-pill galactorrhea and idiopathic galactorrhea) showed normal LH secretory patterns and 24-h mean LH concentrations. The 24-h mean cortisol concentrations and secretory patterns were normal in five of the seven patients who had these parameters measured. The patient with the hypothalamic tumor had a low 24-h mean cortisol concentration and production rate and absent response to metyrapone. The patient with idiopathic galactorrhea had an elevated 24-h mean cortisol concentration but normal cortisol production rate and urinary 17-hydroxycorticoid excretion. Growth hormone secretion was abnormal in four of the patients (one with the hypothalamic tumor and three with pituitary tumors). Thyrotropin-releasing hormone (TRH) administration in four patients resulted in normal TSH release in two patients (one of whom developed galactorrhea after the test), an absent response in the patient with the hypothalamic tumor, and a blunted response in one of the women with a pituitary tumor. The two men had low 24-h mean plasma testosterone concentrations (69 and 30 ng/100 ml) and symptoms of impotence and loss of libido. Five of the women (four with pituitary tumors and one with Chiari-Frommel syndrome) had either low 24-h mean LH concentrations, abnormal LH secretory patterns, or both. These data indicate that patients with hyperprolactinemia encompassing a varied etiological range frequently show loss of the normal sleep-associated increase in prolactin secretion as well as abnormalities in the regulation of the other hypothalamic pituitary-regulated hormones. The finding that the abnormalities in LH, growth hormone, thyrotropin, and cortisol (adrenocorticotrophic) secretion were almost uniformly confined to the patients with the clinically demonstrable hypothalamic or pituitary tumors suggests that the size of the lesion is the critical factor.

Syndrome of Benign Nodular Adrenal Hyperplasia Associated with Feminization and Hyperprolactinemia

Abstract A 38-year-old man with severe gynecomastia, hypogonadism, and impotence had a pituitary tumor associated with markedly elevated plasma prolactin concentrations. Testicular biopsy showed a ...

Ontogeny of luteinizing hormone and testosterone secretion

Abstract Plasma luteinizing hormone (LH) and testosterone (T) were measured by radioimmunoassay in 9 pubertal boys and 9 sexually mature adult men at 20 min intervals for 24 h. Polygraphic monitoring of sleep was also carried out to precisely identify sleep onset, wakefulness and specific sleep stages. In all 9 pubertal boys, plasma LH showed the characteristic augmentation of secretion synchronous with sleep. This increased LH secretory activity was effective in stimulating increased T secretion during sleep that resulted in uniformly higher mean T concentrations during sleep compared with waking. Plasma LH and T were also measured in 3 of these pubertal boys during acute inversion of the sleep wake cycle. The results showed that plasma LH and T were now augmented during the reversed daytime sleep period; the mean LH and T concentrations were significantly higher than during nocturnal waking. Measurement of LH and T in the 9 adult men showed episodic secretion of both hormones during waking and sleep periods with no consistent augmentation of either hormone during sleep.

ONTOGENY OF LUTEINIZING HORMONE AND TESTOSTERONE SECRETION

Plasma luteinizing hormone (LH) and testosterone (T) were measured by radioimmunoassay in 9 pubertal boys and 9 sexually mature adult men at 20 min intervals for 24 h. Polygraphic monitoring of sleep was also carried out to precisely identify sleep onset, wakefulness and specific sleep stages. In all 9 pubertal boys, plasma LH showed the characteristic augmentation of secretion synchronous with sleep. This increased LH secretory activity was effective in stimulating increased T secretion during sleep that resulted in uniformly higher mean T concentrations during sleep compared with waking. Plasma LH and T were also measured in 3 of these pubertal boys during acute inversion of the sleep wake cycle. The results showed that plasma LH and T were now augmented during the reversed daytime sleep period; the mean LH and T concentrations were significantly higher than during nocturnal waking. Measurement of LH and T in the 9 adult men showed episodic secretion of both hormones during waking and sleep periods with no consistent augmentation of either hormone during sleep.