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Luteinizing Hormone Deficiency Workup

  • Author: Nichole M Barker, DO; Chief Editor: Richard Scott Lucidi, MD, FACOG  more...
 
Updated: Oct 30, 2014
 

Laboratory Studies

The basic laboratory evaluation for females or males suspected of having luteinizing hormone (LH) deficiency includes serum levels of thyroid-stimulating hormone (TSH), prolactin (PRL), LH, follicle-stimulating hormone (FSH), and estradiol. Low or normal LH and FSH levels in the presence of low estradiol suggest a hypothalamic problem. A pituitary problem is most commonly associated with elevated PRL levels.

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Imaging Studies

When hypothalamic or pituitary dysfunction is suspected, the most important imaging study is magnetic resonance imaging (MRI) of the head to determine the presence of a tumor or other abnormality.

MRI of pituitary macroadenoma. MRI of pituitary macroadenoma.
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Other Tests

Olfactory testing

When Kallmann syndrome is suspected, olfactory testing can be performed. Screening tests can be performed using vanilla or aromatic oils (eg, wintergreen, cinnamon). Quantitative tests have been developed using either scratch-and-sniff panels or serial dilutions of odorants such as dimethyl sulfide or acetic acid. Perhaps the most widely used clinical olfactory test is the University of Pennsylvania Smell Identification Test (UPSIT) that uses scratch-and-sniff panels.[14]

Screening for eating disorders

Patients suspected of have an eating disorders can be screened for by asking the British SCOFF questions:[15]

  • Do you ever make yourself SICK when you feel uncomfortably full?
  • Do you worry you have lost CONTROL over how much you eat?
  • Have you lost more than 14 pounds (ONE stone's worth of weight) within the last 3 months?
  • Do you believe you are FAT when others say you are too thin?
  • Would you say that FOOD dominates your life?

Luteal phase deficiency

When infertile women are suspected of having luteal phase deficiency (LPD), the luteal phase should be evaluated.

  • Duration (normal ≥12 d): Luteal phase duration is measured as the time from the onset of the LH surge detected in the urine to the onset of menses or as the number of days of basal body temperature rise (see following image).
    Basal body temperature (BBT) chart. Basal body temperature (BBT) chart.
  • Peak luteal phase progesterone (normal ≥12 ng/mL): Peak luteal phase serum progesterone is obtained 1 week after ovulation.
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Procedures

Transsphenoidal resection is used to remove pituitary macroadenomas (>1 cm in diameter) that remain symptomatic or increase in size despite medical treatment.

Luteal phase endometrial biopsies were used in the past to diagnose LPD. However, because of the day-to-day variation in the histologic findings within the luteal phase, biopsies are now rarely performed for this purpose.

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Histologic Findings

Pituitary adenomas are rarely malignant. The most common benign adenomas are prolactinomas (70%). Approximately 25% of adenomas do not secrete any hormone (null cell tumors). The remainder secrete TSH, GH, ACTH, and in rare cases, LH and FSH.

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Contributor Information and Disclosures
Author

Nichole M Barker, DO Physician in Reproductive Endocrinology and Infertility, Seattle Reproductive Medicine

Nichole M Barker, DO is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Society for Reproductive Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Allen Donald Seftel, MD Professor of Urology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School; Head, Division of Urology, Director, Urology Residency Training Program, Cooper University Hospital

Allen Donald Seftel, MD is a member of the following medical societies: American Urological Association

Disclosure: Received consulting fee from lilly for consulting; Received consulting fee from abbott for consulting; Received consulting fee from auxilium for consulting; Received consulting fee from actient for consulting; Received honoraria from journal of urology for board membership; Received consulting fee from endo for consulting.

William W Hurd, MD, MSc, MPH Professor and Director, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke University Medical Center

William W Hurd, MD, MSc, MPH is a member of the following medical societies: American College of Surgeons, American Gynecological and Obstetrical Society, AAGL, Society of Reproductive Surgeons, Alpha Omega Alpha, American College of Obstetricians and Gynecologists, American Medical Association, American Society for Reproductive Medicine, Society for Reproductive Investigation

Disclosure: Nothing to disclose.

Rebecca Flyckt, MD Associate Staff, Reproductive Endocrinology and Infertility, Cleveland Clinic

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Richard Scott Lucidi, MD, FACOG Associate Professor of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine

Richard Scott Lucidi, MD, FACOG is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Society for Reproductive Medicine

Disclosure: Nothing to disclose.

Acknowledgements

MRI of pituitary adenoma courtesy of Kristine Blackham, MD, University Hospitals Case Medical Center, Department of Radiology

References
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Basal body temperature (BBT) chart.
MRI of pituitary macroadenoma.
 
 
 
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