Glycoprotein Hormones

Abstract

Three gonadotropins, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and human chorionic gonadotropin (hCG) and a fourth non-gonadotropin member, thyroid-stimulating hormone (TSH), make up the glycoprotein hormone family. FSH is used for ovulation induction and development of multiple follicles in the ovulatory patient participating in assisted reproduction and is also used in men for the induction of spermatogenesis. Ovarian enlargement and/or ovarian hyperstimulation syndrome (OHSS) following FSH is the subject of a warning by regulatory agencies. Thromboembolism with complications may occur in association with, or separate from, OHSS. Lutropin alfa together with follitropin alfa is indicated for stimulation of follicle development in infertile hypogonadotropic hypogonadol women with profound LH deficiency. Careful observation should be undertaken for ovarian enlargement, ovarian torsion, multiple pregnancy, pregnancy loss and ectopic pregnancy, congenital malformations, thromboembolic events, and reproductive system neoplasms. Warnings for the main serious adverse events following hCG therapy are for OHSS; enlargement of preexisting ovarian cysts and rupture of cysts with resultant hemoperitoneum; multiple births; arterial thromboembolism; and the possibility of anaphylaxis. Thyrotropin alfa can cause a transient elevation of the serum concentration of thyroid hormones in patients with thyroid cancer metastases or some remaining thyroid tissue. Consequences may range from hyperthyroidism to death. Symptoms of acute hemiplegia, hemiparesis, loss of vision, laryngeal edema, pain at a distant site, and respiratory distress may result from a sudden and rapid enlargement of residual thyroid tissue or distant metastases following treatment with thyrotropin alfa. Stroke and stroke-like symptoms within 3 days of thyrotropin alfa administration have been reported.