[Diagnosis and treatment of polycystic ovary syndrome].

Obesity, ultrasonic ovarian morphology, serum LH levels and LH/FSH ratio are inconstant symptoms of the polycystic ovary syndrome (PCOS) and are thus no longer essential for diagnosis. PCOS is diagnosed today by the finding of chronic anovulation and hyperandrogenism characterized by a high serum level of "free" testoterone. The other causes of hyperandrogenism, as well as anovulations due to hyperprolactinemia, high levels of FSH and abnormal thyroid function have to be ruled out.

[Pre-ovulatory peaks of gonadotropins. Recent data].

From recent data we know that: The duration of the LH peak seems to be more important than its amplitude for the induction of ovulation. Ovulation induction by hCG is not physiological; the absence of an FSH surge, and the long duration of LH activity would contribute to some of the luteal phase abnormalities. Recombinant hLH, on the other hand could give better results provided its action last about 48 hours.

[The biological activity of luteinizing hormone (LH)].

In vitro bioassay (BIO) is a very specific and sensitive method for determining levels of luteinizing hormone (LH). It provides a means of evaluating the values obtained with routine radioimmunoassays (RIA). Serum levels with bioassay are higher than those obtained with radioimmunoassay.

[Functional hypothalamic amenorrheas. II. Clinical aspects].

The most important causes of the functional hypothalamic amenorrhea (FHA), that are psychological stress, physical stress and weight loss, are associated with a decrease of the frequency of the LH secretory pulses and with a state of hypercortisolism. The slowing down of the LH pulse frequency is difficult to demonstrate in clinical practice. The classical symptoms of FHA which are low gonadotropin levels, and hypogonadism are not very specific.

[Functional hypothalamic amenorrheas. I. Physiopathology].

Functional hypothalamic amenorrhea are very probably due to a decrease of the frequency of the secretory pulses of LH, ie of GnRH. This decrease could be the consequence of a chronic hypersecretion of the corticotropin releasing hormone (CRH). CRH seems to act on the hypotalamic pulse generator of GnRH through the effect of the endogenous opioid peptides of the central nervous system.