American Journal of
Obstetrics and Gynecology volume 121
number 8
APRIL
15, 1975
CLINICAL OPINION
This section reports opinion on the handling of clinical situations, i.e., the clinical diagnosis and management of certain disease entities. Papers should range from eight to twenty typed pages, including illustrations, tables, and figures which clarify the author's management. References are limited to six citations. Mail to Frederick P. Zuspan, M.D., Editor.
Use of serum luteinizing hormone in the clinical management of short-term amenorrhea SAUL K. BLOCH, M.D., F.A.C.O.G. Los
Angeles~
California
Serum luteinizing hormone ( LH) values determined by radioimmunoassay can be of aid in evaluating patients with short-term amenorrhea. These values have proved useful in ruling out pregnancy in cases of hypothalamic amenorrhea and amenorrhea occurring during treatment with contraceptive pills and also in diagnosing early pregnancy after clomiphene therapy.
H u M A N c H o R 1 o N 1 c gonadotropin (HCG) and luteinizing hormone (LH) are complex proteins sharing an antigenically common alpha subunit such that each cross reacts with the other in available urine or serum HCG or LH detenninations. 1 Use of the cross-reaction in detection of very early pregnancy has been reported in the past. 2 • 3 Recent development of assay systems specific for the beta subunit of HCG 4 • 5 may soon make a test for this hormone alone available to the clinician and will be
of great use in early diagnosis of pregnancy, evaluating problem pregnancies, and following the response to treatment of HCG-producing tumors. However, investigators thus far have utilized techniques not available to the average clinician. The physiologic range of LH is rather narrow, varying from 10 to 20 ml.U. per milliliter with the lower values at about the time of the expected menstrual period/• 4 • 5 except under rather specific circumstances. It is increased (over 25 mi.U. per milliliter) during the preovulatory surge, in pregnancy and certain related tumors, in menopause, in the polycystic ovarian syndrome, and in HCGtreated patients. Pituitary gonadotropin-producing tumors have not been reported. LH may be decreased (under 6 ml.U. per milliliter) in pituitary
From the Department of Obstetrics and Gynecology, Southern California Permanente Medical Group and Kaiser Foundation Hospitals. Reprint requests: Dr. Saul K. Bloch, Department of Obstetrics and Gynecology, 4900 Sunset Blvd., Los Angeles, California 90027.
1021
1022 Bloch
April15,
!~7;,
Am.]. Obstet. Gynccol.
failure, in hypothalamic "failure," in the presence of sex-steroid producing tumors, and subsequent to treatment with pharmacologic agents, most commonly oral contraceptives or phenothiazine tranquilizers. Use of this information mav aid in thl' di!!PT~osis and management of short-t~~ a~~~o~-he~-~';;
Obstetrics and Gynecology volume 121
number 8
APRIL
15, 1975
CLINICAL OPINION
This section reports opinion on the handling of clinical situations, i.e., the clinical diagnosis and management of certain disease entities. Papers should range from eight to twenty typed pages, including illustrations, tables, and figures which clarify the author's management. References are limited to six citations. Mail to Frederick P. Zuspan, M.D., Editor.
Use of serum luteinizing hormone in the clinical management of short-term amenorrhea SAUL K. BLOCH, M.D., F.A.C.O.G. Los
Angeles~
California
Serum luteinizing hormone ( LH) values determined by radioimmunoassay can be of aid in evaluating patients with short-term amenorrhea. These values have proved useful in ruling out pregnancy in cases of hypothalamic amenorrhea and amenorrhea occurring during treatment with contraceptive pills and also in diagnosing early pregnancy after clomiphene therapy.
H u M A N c H o R 1 o N 1 c gonadotropin (HCG) and luteinizing hormone (LH) are complex proteins sharing an antigenically common alpha subunit such that each cross reacts with the other in available urine or serum HCG or LH detenninations. 1 Use of the cross-reaction in detection of very early pregnancy has been reported in the past. 2 • 3 Recent development of assay systems specific for the beta subunit of HCG 4 • 5 may soon make a test for this hormone alone available to the clinician and will be
of great use in early diagnosis of pregnancy, evaluating problem pregnancies, and following the response to treatment of HCG-producing tumors. However, investigators thus far have utilized techniques not available to the average clinician. The physiologic range of LH is rather narrow, varying from 10 to 20 ml.U. per milliliter with the lower values at about the time of the expected menstrual period/• 4 • 5 except under rather specific circumstances. It is increased (over 25 mi.U. per milliliter) during the preovulatory surge, in pregnancy and certain related tumors, in menopause, in the polycystic ovarian syndrome, and in HCGtreated patients. Pituitary gonadotropin-producing tumors have not been reported. LH may be decreased (under 6 ml.U. per milliliter) in pituitary
From the Department of Obstetrics and Gynecology, Southern California Permanente Medical Group and Kaiser Foundation Hospitals. Reprint requests: Dr. Saul K. Bloch, Department of Obstetrics and Gynecology, 4900 Sunset Blvd., Los Angeles, California 90027.
1021
1022 Bloch
April15,
!~7;,
Am.]. Obstet. Gynccol.
failure, in hypothalamic "failure," in the presence of sex-steroid producing tumors, and subsequent to treatment with pharmacologic agents, most commonly oral contraceptives or phenothiazine tranquilizers. Use of this information mav aid in thl' di!!PT~osis and management of short-t~~ a~~~o~-he~-~';;
