hypothalamic amenorrhea
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Etiology
- functional hypothalamic amenorrhea
- failure of LH surge required for ovulation
- emotional stress
- concurrent illness
- sudden weight loss
- increase in exercise
- amenorrhea associated with anorexia
- athlete's amenorrhea - similar to anorexia
- infiltration of hypothalamus
Epidemiology
- 3-5% of women aged 18-40 years
Pathology
History
Clinical manifestations
- amenorrhea lasting > 3 months or time between menses regularly exceeds 45 days
Laboratory
- serum gonadotropins (FSH in serum & LH in serum) low to low normal
- FSH in serum low to low normal
- estradiol in serum low to low normal
- may be in normal range for women in follicular phase of menstrual cycle
- beta-chorionic gonadotropin in serum[3]
- serum GnRH inappropiately low
- progesterone challenge test is negative[1]
- thyroid function similar to euthyroid sick syndrome
- thyroid-stimulating hormone in serum low to low normal[3]
- free thyroxine in serum low to low normal[3]
- prolactin in serum elevated with prolactinoma or antipsychotic[3]
- anti-Mullerian hormone in serum[3]
- serum testosterone & serum DHEA sulfate elevated in patients with signs of hyperandrogenism[3]
- 8 AM 17-hydroxyprogesterone in serum if late-onset congenital adrenal hyperplasia is a possibility[3]
- if chronic illness suspected[3]
- pregnancy test
Radiology
- neuroimaging (MRI) if severe headaches, galactorrhea or laboratory evidence of pituitary disorder[3]
- bone mineral density if amenorrhea exceeds 6 months[3]
Management
- women NOT seeking fertility
- estrogen/progestin containing oral contraceptives
- avoid long-term consequences of estrogen deficiency
- avoid endometrial hyperplasia resulting from lack of progesterone
- do not prescribe hormonal contraceptives unless needed for contraception[3]
- estrogen/progestin containing oral contraceptives
- women seeking fertility
- pulsatile GnRH therapy
- clomiphene citrate
- exogenous gonadotropin therapy
- nutritional supplementation for women below 10th percentile of weight for height
- address psychosocial issues[3]
More general terms
References
- ↑ 1.0 1.1 Medical Knowledge Self Assessment Program (MKSAP) 11, 16. American College of Physicians, Philadelphia 1998, 2012
- ↑ Gordon CM. Clinical practice. Functional hypothalamic amenorrhea. N Engl J Med. 2010 Jul 22;363(4):365-71 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20660404
- ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 Gordon CM et al. Functional hypothalamic amenorrhea: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2017 Mar 22; PMID: https://www.ncbi.nlm.nih.gov/pubmed/28368518