Alterations in luteinizing hormone secretory activity in women with insulin-dependent diabetes mellitus and secondary amenorrhea

To investigate hypothalamic and/or pituitary abnormalities in women with poorly controlled insulin-dependent diabetes mellitus (IDDM) and secondary amenorrhea, we measured serum LH every 10 min for 24 h and for 2 additional h after the administration of exogenous GnRH in 8 women with IDDM and amenorrhea and compared these to data from 15 eumenorrheic nondiabetic women. LH pulses were characterized by the pulse detection algorithm Cluster, and secretory episodes were evaluated using the multiple parameter deconvolution procedure Deconv. Cluster analysis revealed fewer LH pulses per 24 h (14.3 ± 1.2 vs. 19.9 ± 0.6; P < 0.001; mean ± SEM), a greater peak width (63 ± 4.9 vs. 44 ± 2.2 min; P < 0.01), and greater peak area (136 ± 17 vs. 89 ± 13 IU/L-min; P < 0.01) in the diabetic women. Analysis with Deconv revealed fewer LH secretory episodes per 24 h in the diabetic women (14.4 ± 0.9 vs. 20.4 ± 0.5; P < 0.001) and no statistical difference in LH half-lives. The IDDM women responded to a 10-μg GnRH bolus with LH pulses of larger total (51 ± 15.9 us. 15 ± 1.4 IU/ L; P<0.01) and incremental (29 ± 7.6 vs. 9 ± 1.2; P< 0.001) amplitude. In summary, we observed that amenorrheic diabetic women have fewer LH pulses/secretory episodes than normal women. However, they respond well to exogenous GnRH, suggesting that compromise of the GnRH pulse generator, rather than pituitary dysfunction, is responsible for their menstrual dysfunction.