1984년 3월부터 1991년 2월까지 연세의료원에 내원하여 GnRH-TRH 복합자극시험을 받았던 83명의 무월경환자를 대상으로 GnRH-TRH 복합자극시험의 임상적 의의를 알아보기 위해 시행한 본 조사의 결과 GnRH-TRH 복합자극시험은 시상하부-뇌하수체축의 병소를 구별하여 질병의 병인을 이해하는데 참고적인 역할을 하였으나, 결과의 판정에 객관성이 적고, 환자의 내분비적 환경이 변화에 따라 그 결과가 일관성을 유지할 수 없어, 실제 임상에서 무월경환자의 진단이나 치료 또 그 예후를 결정하는데에 크게 의의있는 필수적인 검사방법은 될 수 없을 것으로 사료되는 바이다.

The early detection of the etiologic factors is important for the management of amenorrheic patients to relief their anxiety and finally to achieve the goal of fertility. Usually, we can get many informations by measuring basal serum gonadotropin levels with complete history taking and physical examination. However, with these conventional tools, we cannot differentiate the defected lesions causing amenorrhea in hypothalmo-pituitary axis in some cases. recently dynamic tests are applied to evaluate the functional capacity of the pituitary gland and combined anterior pituitary stimulation test is most widely used for the purpose of direct assessment of anterior pituitary functions and indirectly to prove the integrity of hypothalamus. To evaluate the clinical efficacy of this test, we reviewed the 307 amenorrheic patients treated at the Yonsei University Medical Center in period of March 1986 through February 1991. 1. Among these 307 patients, 83 cases were undertaken GnRH-TRH stimulation test.(including 2 outflow tract anomilies, 13 ovarian failures, 20 devective pituitary functions and 48 CNS hypothalamic defects.) 2. In the 2 cases of outflow tract obstructions, the serum level of LH, TSH and PRL showed normal responses to GnRH-TRH administration but serum FSH showed slightly decreased response. 3. Thirteen ovarian failure including 4 Turner syndromes, 1 gonadal dysgenesis 1 mosaicism, 5 spontaneous premature ovarian failures and 2 postsurgical states showed marked increased basal serum gonadotropin level. After GnRH-TRH administration, FSH showed decreased responses in 10 cases and no responses in 3 cases, and LH showed normal responses in 4 cases while 9 cases showed decreased responses. 4. Devective pituitary function including 10 hyperprolactinemias, 4 gonadotropin deficiencies, 5 Sheehan`s syndromes and 1 empty sella syndrome with lovered basal serum FSH and LH levels showed decreased FH and LH responses to GnRH stimulation. Seven hyperprolactinemic patients with pituitary tumor showed decreased to none PRL responses to TRH stimulation. 5. CNS-hypothlamic defect including 14 PCOS, 8 hypothalamic injuries, 8 stress induced, 7 weight losses, 5 hypothalamic GnRH deficiencies, 5 Kallman`s syndromes and 1 obesity showed various pituitary hormone responses to GnRH-TRH stimulation test. We can concluded that GnRH-TRH stimulation test may give some helpful informations about the understnading the pathophysiology of the amenorrhea and is able to differentiate hypothalamus and/or pituitary lesions. However, due to the great variation of the test result definite informations about the diagnosis or the managements and the prognosis of the amenorrhea can hardly be obtained.