LHRH

Показания

GnRH (gonadorelin, luteinizing hormone–releasing hormone) is a decapeptide that stimulates production of LH and FSH. It is released in bursts from the hypothalamus at regular intervals, about every 2 hours, although in women the interval may lengthen in the luteal end of the menstrual cycle.The pituitary gland responds to these regular pulses by producing LH and FSH. The pattern of LH and FSH in cycling women, including the large burst of LH release before ovulation, can be stimulated by regular administration of GnRH pulses. The large burst of LH from the pituitary gland appears to be induced by feedback through estradiol and other products of the gonads that change the response of the pituitary gland to the GnRH pulses rather than by large changes in the amounts of GnRH secreted. The stimulatory response to GnRH depends on pulsatile administration and the timing of the pulses. Continual administration of GnRH does not have the same effects as pulsatile administration; although production of LH and FSH is stimulated initially, it is suppressed within a few days. Part of this desensitization to GnRH is caused by a decrease in the number of pituitary receptors for GnRH; additional postreceptor mechanisms are also important in this complete suppression.

Биологические функции

Gonadotropin-releasing hormone (GnRH) is a decapeptide that causes the release of the gonadotropins, luteinizing hormone (LH) and follicle-stimulating hormone (FSH), from the anterior pituitary gland, but not in equal amounts (FSH release is partially inhibited by the gonadal protein inhibin). Therefore, GnRH is intimately involved in the control of both male and female reproduction. Medicinal chemists have capitalized on the relatively simple decapeptide structure of GnRH by preparing many analogues as potential fertility and antifertility agents, several of which are commercially available, especially those that are referred to as superagonists. It is known that GnRH can be degraded by enzymatic cleavage between Tyr5- Gly6 and Pro9-Gly10. Structure–activity relationship studies of GnRH analogues have shown that when Gly6 is replaced with certain D-amino acids, as well as with changes in the peptide C terminus, they generally are less susceptible to proteolytic enzymes, resulting in a longer lasting action. For that reason, they are referred to as superagonists. Furthermore, when these D-amino acids at position 6 are hydrophobic, the half-life is enhanced.

Механизм действия

In physiological doses, GnRH agonists are able to induce ovulation and spermatogenesis by increasing LH and FSH levels and the resulting sex steroid levels, as does the normal hormone. In larger pharmacological (therapeutic) doses, however, GnRH agonists, especially the superagonists, block implantation of the fertilized egg, cause luteolysis of the corpus luteum, and can act as postcoital contraceptive agents (although not approved for this latter use). This paradoxical antifertility effect seen with the superagonists has been attributed to the fact that GnRH must be administered in a low-dose, pulsatile manner for it to be therapeutically effective as a fertility agent. Natural GnRH release from the hypothalamus occurs in a pulsatile manner. When GnRH or, especially, a superagonist is administered in pharmacological doses each day, LH and FSH levels will initially rise but then begin to fall after a few days because of target tissue desensitization/downregulation of pituitary GnRH receptors. The continued use of these agents in a nonpulsatile manner will result in a drastic drop of the gonadal steroid levels to near castrate levels in both males and females, thereby giving rise to their use in such conditions as precocious puberty, endometriosis, and advanced metastatic breast and prostate carcinoma.Typically, however, the GnRH superagonists take approximately 2 weeks to finally desensitize the GnRH receptors, and during this time, there is a transient rise in LH and FSH levels, which often results in an initial “flare-up” of the original symptoms.

Клиническое использование

Oxytocin is generally considered to be the drug of choice for inducing labor at term. In combination with amniotomy, oxytocin is highly successful in inducing and augmenting labor. When given oxytocin, approximately 80% of patients with documented labor disorders progress into labor and deliver vaginally. It has also been used following incomplete abortion after 20 weeks of gestation (although use of prostaglandins may be preferred in this instance), and it may be used after fullterm delivery to prevent or control uterine hemorrhage. Oxytocin in high doses is used to induce abortion. An oxytocin challenge test (an assessment of the fetal heart rate in response to oxytocin-induced contractions) can be performed in certain high-risk (e.g., those with hypertension, diabetes, preeclampsia) obstetrical patients as a measure of fetal well-being.

Побочные эффекты

Inappropriate use of oxytocin can lead to uterine rupture, anaphylactoid and other allergic reactions, and possibly maternal death. Prolonged stimulation of uterine contractions can result in the following fetal adverse reactions: persistent uteroplacental insufficiency, sinus bradycardia, premature ventricular contractions, other arrhythmias, and fetal death. Prolonged use of oxytocin can lead to water intoxication secondary to the antidiuretic hormone–like effects of oxytocin. Maternal and fetal cardiovascular parameters should be monitored during oxytocin administration.

Профиль безопасности

An experimental teratogen. Human reproductive effects in women by subcutaneous route: menstrual cycle changes and other unspecified effects. Experimental reproductive effects. Used in the treatment of oligospermia and male inferthty. See also LUTEINIZING HORMONE and other luteinizing hormone-releasing hormone entries.