The Long-term Curative Effect Of Pulsatile GnRH Pump For The Treatment Of Adult Male IHH And The Screening Of Its Genetic Factors

Objective: To explore the best strategy for the treatment of adult male IHH by evaluating the therapeutic effect of pulsatile Gn RH pump and discussing the correlation between the genetic factors and efficacy of Gn RH pulsatile pump therapy.Methods: 30 adult male patients during Augest 1,2013 to Decem.31,2016 who were diagnosed as IHH in our hospital were included in this study.All the patients were treated with pulsatile GnRH pump.Their clinical characteristic including secondary sex characters,morphology and size of external genitalia,sex hormones level,fertility and sexual function were detected and recorded before and during 3,6,12 months of the treatment,and the adverse event during treatment were also followed.14 patients were were screened for the disease causing genes.The correlation between the genetic factors and efficacy of pulsatile Gn RH pump for the treatment of adult male IHH were discussed.Results: The mean follow-up time was 15.9(2-40)months.20 patients with the treatment of pulsive Gn RH infusion were followed-up for over 1 year,3 cases were followed-up for half a year,4 cases were followed-up for 3 months to half a year and 3 cases were followed-up under 3 months.Before treatment,the mean testicular volume of male IHH patients is(3.43±1.94)ml,LH is(0.66±0.60)U/L,FSH is(1.25±0.85)U/L,T is(0.50±0.51)ng/ml,the pull length of penis is(5.77±1.47)cm,the resting length of penis is(3.68±1.06)cm,The circumference of penis is(5.16±1.31)cm;After half a year consistent treatment,the mean testicular volume of 23 cases of male IHH patients is(6.50±2.04)ml,LH is(6.60±5.10)U/L,FSH is(5.36±3.10)U/L,T is(2.32±1.31)ng/ml,the pull length of penis is(7.93±1.22)cm,the resting length of penis is(4.91±0.81)cm,The circumference of penis is(7.21±1.29)cm,which were dramatically increased than those before treatment(P < 0.01);After 1 year treatment,the mean testicular volume of 20 cases of male IHH patients is(8.93±2.40)ml,LH is(6.20±3.86)U/L,FSH is(4.93±2.38)U/L,T is(3.59±1.03)ng/ml,the resting length of penis is(5.82±0.77)cm,pull length of penis is(9.29±1.45)cm,The circumference of penis is(8.13±0.97)cm,which were dramatically increased than those before treatment(P < 0.01).External genitals and T were also further dramatically improved compared with half a year ago(P < 0.05).All the 23 patients who have over 6 months treatment present ejaculations.16 of the 20 patients who have over half a year treatment present sperms in their ejaculations.Fortunately,2 married patients who had been accepted 1 year treatment made their wife pregnant.Among the 14 patients who were screened for causative genes,the pathogenic gene was found in 2 cases.missense mutation was found in 2 cases and samesense mutation was found in 1 case(the clinical significance is unknown).Only a few minor adverse events were found.All of the patients showed good adherence during the treatment.Conclusion: The Gn RH pulsatile pump for the treatment of adult male IHH is safe and effective strategy with ideal long-term curative effect.It is sugested to be the preferred treatment for the IHH patients.