Luteinizing Hormone Deficiency Workup

Author: Nichole M Barker, DO; Chief Editor: Richard Scott Lucidi, MD more...

Updated: Mar 23, 2012

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Laboratory Studies
Imaging Studies
Other Tests
Procedures
Histologic Findings
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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.

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.

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.
Peak luteal phase progesterone (normal ≥12 ng/mL): Peak luteal phase serum progesterone is obtained 1 week after ovulation.

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.

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.

Proceed to Treatment & Management

Contributor Information and Disclosures

Author

Nichole M Barker, DO Fellow in Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University Hospitals/Case Medical Center

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

Disclosure: Nothing to disclose.

Coauthor(s)

Rebecca Flyckt, MD Fellow, Reproductive Endocrinology and Infertility

Disclosure: Nothing to disclose.

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 is a member of the following medical societies: American Urological Association

Disclosure: lilly Consulting fee Consulting; sanofi-aventis Consulting fee Consulting; auxilium Consulting fee Consulting; solvay Consulting fee Consulting; plethora Grant/research funds clinical trial; endo Consulting fee Consulting; nature publishing journal editor

William W Hurd, MD, MSc Professor of Reproductive Biology, Case Western Reserve University School of Medicine; Lilian Hanna Baldwin Chair in Gynecology and Obstetrics, Director, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University Hospitals Case Medical Center

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

Disclosure: Nothing to disclose.

Specialty Editor Board

Karen Loeb Lifford, MD Director of General Gynecology, Associate Program Director, Department of Obstetrics and Gynecology, Instructor, Brigham and Women's Hospital, Harvard Medical School

Karen Loeb Lifford, MD is a member of the following medical societies: Association of Professors of Gynecology and Obstetrics, Massachusetts Medical Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

Frederick B Gaupp, MD Consulting Staff, Department of Family Practice, Hancock Medical Center

Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians

Disclosure: Nothing to disclose.

Chief Editor

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

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

Disclosure: Nothing to disclose.

Additional Contributors

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.