Luteinizing Hormone Deficiency Workup
- Author: Nichole M Barker, DO; Chief Editor: Richard Scott Lucidi, MD, FACOG more...
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.
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.
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.
Screening for eating disorders
Patients suspected of have an eating disorders can be screened for by asking the British SCOFF questions:
- 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.
- Peak luteal phase progesterone (normal ≥12 ng/mL): Peak luteal phase serum progesterone is obtained 1 week after ovulation.
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.
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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