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Clinical Science (London, England :... Jun 2023Reproductive conditions secondary to disorders of the hypothalamic-pituitary-gonadal (HPG) axis are common and are associated with important health implications and... (Review)
Review
Reproductive conditions secondary to disorders of the hypothalamic-pituitary-gonadal (HPG) axis are common and are associated with important health implications and considerable psychosocial impact. Basal and dynamic tests enable interrogation of individual components of the HPG axis, facilitating diagnosis and understanding of the pathophysiology of reproductive disorders. Onset of puberty is controlled by hypothalamic gonadotrophin-releasing hormone (GnRH) neuronal function. To date, a dynamic test of hypothalamic function is not yet available. Therefore, accurate differentiation of pubertal disorders such as constitutional delay of growth and puberty (CDGP) and congenital hypogonadotrophic hypogonadism (CHH) as causes of delayed puberty is challenging due to similar clinical presentations and hormonal profiles. Likewise, although the two commonest reproductive disorders in women, polycystic ovary syndrome (PCOS) and functional hypothalamic amenorrhoea (FHA) have disparate hypothalamic function, oligo/amenorrhoea frequently poses a diagnostic conundrum owing to the overlap in the criteria used to define both conditions. This review aims to describe pubertal and reproductive disorders secondary to pathologies affecting the HPG axis. Challenges encountered in clinical practice in differentiating pubertal and reproductive conditions are reviewed in conjunction with the utility of baseline and dynamic endocrine tests to interrogate specific components of the HPG axis. We also highlight putative hypothalamic, pituitary, and gonadal markers in development that could improve the diagnosis of patients presenting with disorders of puberty or reproduction.
Topics: Humans; Female; Amenorrhea; Reproduction; Gonadotropin-Releasing Hormone; Gonads; Hypogonadism
PubMed: 37272254
DOI: 10.1042/CS20220146 -
British Medical Journal Mar 1971
Topics: Adolescent; Amenorrhea; Anorexia Nervosa; Disorders of Sex Development; Female; Gonadotropins, Pituitary; Humans; Hymen; Ovarian Diseases; Pituitary Diseases; Turner Syndrome; Vagina
PubMed: 5551248
DOI: 10.1136/bmj.1.5751.711 -
Handbook of Clinical Neurology 2014Athletic activity may be associated with alterations in various neuroendocrine axes depending on the state of energy availability. In addition, genetic factors and an... (Review)
Review
Athletic activity may be associated with alterations in various neuroendocrine axes depending on the state of energy availability. In addition, genetic factors and an underlying predilection for polycystic ovarian syndrome (PCOS) may predispose some athletes to develop functional hypothalamic amenorrhea earlier than other athletes. In conditions of low energy availability associated with athletic activity, changes that occur in various neuroendocrine axes are primarily adaptive, and aim to either conserve energy for the most essential functions, or allow the body to draw on its reserves to meet energy needs. These hormonal changes, however, then lead to changes in body composition and bone metabolism. Impaired bone accrual in younger athletes and low bone density in older athletes constitutes the major pathologic consequence of neuroendocrine changes associated with low energy availability. The female athlete triad of low energy availability, menstrual dysfunction, and low bone density is prevalent in certain kinds of sports and activities, particularly endurance sports, gymnastics, and ballet. It is essential to screen for this condition in athletes at every preparticipation physical and during office visits, and to put in place an effective treatment team to manage the triad early, in order to optimize outcomes.
Topics: Amenorrhea; Animals; Athletes; Bone Density; Female; Humans; Hypothalamo-Hypophyseal System; Neurosecretory Systems; Physical Examination; Pituitary Hormones; Pituitary-Adrenal System
PubMed: 25248600
DOI: 10.1016/B978-0-444-59602-4.00025-3 -
Journal of Endocrinological... Nov 2014Functional hypothalamic amenorrhea (FHA) is one of the most common causes of secondary amenorrhea. There are three types of FHA: weight loss-related, stress-related, and... (Review)
Review
INTRODUCTION
Functional hypothalamic amenorrhea (FHA) is one of the most common causes of secondary amenorrhea. There are three types of FHA: weight loss-related, stress-related, and exercise-related amenorrhea. FHA results from the aberrations in pulsatile gonadotropin-releasing hormone (GnRH) secretion, which in turn causes impairment of the gonadotropins (follicle-stimulating hormone and luteinizing hormone). The final consequences are complex hormonal changes manifested by profound hypoestrogenism. Additionally, these patients present mild hypercortisolemia, low serum insulin levels, low insulin-like growth factor 1 (IGF-1) and low total triiodothyronine.
AIM
The aim of this work is to review the available data concerning the effects of FHA on different aspects of women's health.
RESULTS
Functional hypothalamic amenorrhea is related to profound impairment of reproductive functions including anovulation and infertility. Women's health in this disorder is disturbed in several aspects including the skeletal system, cardiovascular system, and mental problems. Patients manifest a decrease in bone mass density, which is related to an increase in fracture risk. Therefore, osteopenia and osteoporosis are the main long-term complications of FHA. Cardiovascular complications include endothelial dysfunction and abnormal changes in the lipid profile. FHA patients present significantly higher depression and anxiety and also sexual problems compared to healthy subjects.
CONCLUSIONS
FHA patients should be carefully diagnosed and properly managed to prevent both short- and long-term medical consequences.
Topics: Amenorrhea; Animals; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Hypothalamic Diseases; Luteinizing Hormone; Osteoporosis; Reproduction; Women's Health
PubMed: 25201001
DOI: 10.1007/s40618-014-0169-3 -
BMJ Case Reports May 2015
Topics: 46, XX Disorders of Sex Development; Amenorrhea; Congenital Abnormalities; Female; Humans; Magnetic Resonance Imaging; Mullerian Ducts; Young Adult
PubMed: 25979964
DOI: 10.1136/bcr-2015-210187 -
Optimizing bone health in anorexia nervosa and hypothalamic amenorrhea: new trials and tribulations.Metabolism: Clinical and Experimental Jul 2012
Topics: Amenorrhea; Anorexia Nervosa; Bone Density; Bone Diseases, Metabolic; Female; Humans; Hypothalamic Diseases; Male; Sex Factors
PubMed: 22300837
DOI: 10.1016/j.metabol.2012.01.003 -
Medycyna Pracy 2016Substance use and misuse (SUM), eating disorders (ED) and consequent amenorrhea (AM) occur frequently in professional ballet dancing. The objective of this study has...
BACKGROUND
Substance use and misuse (SUM), eating disorders (ED) and consequent amenorrhea (AM) occur frequently in professional ballet dancing. The objective of this study has been to explore the prevalence and association between ED, AM and SUM in ballet.
MATERIAL AND METHODS
The sample comprised 21 ballet dancers, 23.1±4.5 years old, members of the professional National Ballet Ensemble from Croatia. Variables were collected by questionnaires examining SUM, occurrence of amenorrhea, and corresponding ballet-specific and socio-demographic factors (Questionnaire on Substance Use - QSU) and the level of ED (Brief Eating Disorder in Athletes Questionnaire - BEDA-Q).
RESULTS
Smoking is prevalent in 40% of dancers (25% smoke on a daily basis), 36% often use analgesics, and 25% engage in binge drinking at least once a month. Smoking and binge drinking are less frequent in ballerinas with a higher academic level (r = 0.60 and r = 0.54 for binge drinking and smoking, respectively; p < 0.05). Alcohol drinking is higher among dancers who consume analgesics more often and those with a higher BEDA-Q score (r = 0.53 and r = 0.54 for analgesics and BEDA-Q, respectively; p < 0.05). Amenorrhea is more prevalent among those dancers with a higher BEDA-Q score. Women who consume nutritional supplements are less likely to use analgesics (Mann Whitney U test = 2.11; p < 0.05).
CONCLUSIONS
Efforts seeking to prevent ED in ballet should target dancers who consume alcohol to a greater extent. Future studies should specifically explore the less frequent consumption of analgesics among dancers who consume nutritional supplements.
Topics: Adolescent; Adult; Amenorrhea; Croatia; Dancing; Feeding and Eating Disorders; Female; Humans; Prevalence; Substance-Related Disorders; Surveys and Questionnaires; Young Adult
PubMed: 27044716
DOI: 10.13075/mp.5893.00294 -
Journal of Pediatric and Adolescent... Apr 2021Hypothalamic amenorrhea is common in adolescents and young adults (AYAs) with anorexia nervosa (AN), and ovarian reserve is not routinely assessed. AN increases rates of...
STUDY OBJECTIVES
Hypothalamic amenorrhea is common in adolescents and young adults (AYAs) with anorexia nervosa (AN), and ovarian reserve is not routinely assessed. AN increases rates of fertility problems, but how or when AN negatively influences future fertility is unclear. We sought to determine whether biomarkers of ovarian reserve were impacted in AYA with AN.
DESIGN
Cross-sectional study.
SETTING
Tertiary care center.
PARTICIPANTS
Females with AN and amenorrhea (n = 97) at the pre-intervention visit of a clinical trial, n = 19 females without an eating disorder or menstrual dysfunction.
MAIN OUTCOME MEASURES
Serum anti-Müllerian hormone (AMH) concentrations.
RESULTS
AMH levels were higher in AYA with AN than unaffected adolescents (4.7 vs. 3.2 ng/mL; P = .03). Neither FSH nor inhibin B differed between groups. In 19.6% of participants with AN, AMH levels were elevated above the normal range (>6.78 ng/mL). These subjects had a longer disease duration than those with normal AMH levels (9 vs. 3 mos; P = .03); age or degree of malnutrition did not differ between AN subjects with normal or elevated AMH.
CONCLUSIONS
AMH levels appear to be normal or elevated in AYA with AN. Low AMH in a patient with AN should raise clinical concern regarding ovarian reserve, and should not be attributed to degree of malnutrition alone. Currently, AMH is not regularly assessed during routine AN clinical care. However, our findings suggest some clinical utility in identifying those patients with reduced ovarian reserve. Potential links between the hypothalamic amenorrhea suffered by patients with AN and PCOS should be explored.
Topics: Adolescent; Amenorrhea; Anorexia Nervosa; Anti-Mullerian Hormone; Clinical Trials as Topic; Cross-Sectional Studies; Female; Humans; Ovarian Diseases; Ovarian Reserve; Research Subjects; Young Adult
PubMed: 33278562
DOI: 10.1016/j.jpag.2020.11.021 -
Nutrients Jan 2023As the diet, hormones, amenorrhea, and bone mineral density (BMD) of physique athletes (PA) and gym enthusiasts (GE) are little-explored, we studied those in 69 females...
As the diet, hormones, amenorrhea, and bone mineral density (BMD) of physique athletes (PA) and gym enthusiasts (GE) are little-explored, we studied those in 69 females (50 PA, 19 GE) and 20 males (11 PA, 9 GE). Energy availability (EA, kcal·kgFFM−1·d−1 in DXA) in female and male PA was ~41.3 and ~37.2, and in GE ~39.4 and ~35.3, respectively. Low EA (LEA) was found in 10% and 26% of female PA and GE, respectively, and in 11% of male GE. In PA, daily protein intake (g/kg body mass) was ~2.9−3.0, whereas carbohydrate and fat intakes were ~3.6−4.3 and ~0.8−1.0, respectively. PA had higher protein and carbohydrate and lower fat intakes than GE (p < 0.05). Estradiol, testosterone, IGF-1, insulin, leptin, TSH, T4, T3, cortisol, or BMD did not differ between PA and GE. Serum IGF-1 and leptin were explained 6% and 7%, respectively, by EA. In non-users of hormonal contraceptives, amenorrhea was found only in PA (27%) and was associated with lower fat percentage, but not EA, BMD, or hormones. In conclusion, off-season dietary intakes, hormone levels, and BMD meet the recommendations in most of the PA and GE. Maintaining too-low body fat during the off-season may predispose to menstrual disturbances.
Topics: Humans; Male; Female; Amenorrhea; Bone Density; Leptin; Insulin-Like Growth Factor I; Athletes; Running; Eating; Carbohydrates
PubMed: 36678253
DOI: 10.3390/nu15020382 -
British Medical Journal (Clinical... Sep 1985
Topics: Adult; Amenorrhea; Animals; Female; Humans; Pseudopregnancy; Rats
PubMed: 3929900
DOI: 10.1136/bmj.291.6497.687