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The Same Molecular Defects of the Gonadotropin-Releasing Hormone Receptor Determine a Variable Degree of Hypogonadism in Affected Kindred¹

INSERM U-135 et Laboratoire d’Hormonologie et Biologie Moléculaire (N.d.R., S.B.T., M.M., E.M.), and Service d’Endocrinologie et des Maladies de la Reproduction (J.Y., G.S.), Hôpital de Bicêtre, 94275 Le Kremlin Bicetre, France

Address all correspondence and requests for reprints to: Dr. E. Milgrom, Hôpital de Bicêtre, 78 rue du Général Leclerc, 94275 Le Kremlin Bicetre, France. E-mail: u135{at}infobiogen.fr

Detailed endocrinological studies were performed in the three affected kindred of a family carrying mutations of the GnRH receptor gene. All three were compound heterozygotes carrying on one allele the Arg²⁶²Gln mutation and on the other allele two mutations (Gln¹⁰⁶Arg and Ser²¹⁷Arg). When expressed in heterologous cells, both Gln¹⁰⁶Arg and Ser²¹⁷Arg mutations altered hormone binding, whereas the Arg²⁶²Gln mutation altered activation of phospholipase C.

The propositus, a 30-yr-old man, displayed complete idiopathic hypogonadotropic hypogonadism with extremely low plasma levels of gonadotropins, absence of pulsatility of endogenous LH and -subunit, absence of response to GnRH and GnRH agonist (triptorelin), and absence of effect of pulsatile administration of GnRH.

The two sisters, 24 and 18 yr old, of the propositus displayed, on the contrary, only partial idiopathic hypogonadotropic hypogonadism. They both had primary amenorrhea, and the younger sister displayed retarded bone maturation and uterus development, but both sisters had normal breast development. Gonadotropin concentrations were normal or low, but in both cases were restored to normal levels by a single injection of GnRH. In the two sisters, there were no spontaneous pulses of LH, but pulsatile administration of GnRH provoked a pulsatile secretion of LH in the younger sister.

The same mutations of the GnRH receptor gene may thus determine different degrees of alteration of gonadotropin function in affected kindred of the same family.

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