Postpubertal hypothalamic hypogonadism: causes, symptoms, diagnosis, treatment

Postpubertal hypothalamic hypogonadism is a medical condition in which the function of the gonads (ovaries in women and testes in men) is suppressed or impaired after the completion of puberty, which usually occurs during adolescence (puberty). Hypothalamic hypogonadism means that the hypothalamus (part of the brain) and pituitary gland (a gland in the brain) do not produce enough gonadotropic hormones, such as gonadotropin-releasing hormone (GnRH), follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which regulate sexual function.

This condition can cause different symptoms and consequences depending on the person’s gender and age. Some possible symptoms and consequences of postpubertal hypothalamic hypogonadism include:

For men:

• Low testosterone levels.
• Decreased libido (sexual desire).
• Erectile dysfunction.
• Enlargement of the mammary glands (gynecomastia).
• Decreased muscle mass.
• Decreased mood and energy levels.

For women:

• Menstrual irregularities, including amenorrhea (absence of menstruation) or oligomenorrhea (infrequent menstruation).
• Infertility.
• Decreased libido.
• Osteoporosis (decreased bone density).
• Hot flashes and night sweats.
• Decreased mood and decreased energy.

Postpubertal hypothalamic hypogonadism can be caused by a variety of factors, including chronic stress, eating disorders, excessive exercise, certain medical conditions, and other factors. For accurate diagnosis and treatment, a consultation with an endocrinologist or gynecologist (for women) or urologist (for men) is necessary. Treatment may include correction of the underlying cause, hormonal therapy, or other medical interventions depending on the specific situation.

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Causes postpubertal hypothalamic hypogonadism.

Etiological factors of postpubertal hypothalamic hypogonadism may be malnutrition with reduced body weight along with significantly increased physical activity associated with the requirements of the profession. Such is the amenorrhea of ballerinas and athletes. The role of stress factors is great. Both acute emotional stress and long-term chronic stressful situation are important. It often accompanies neuroses, various types of depressive states, is observed after electroshock therapy, within the framework of hysteria (Alvarez syndrome - false pregnancy - abdominal enlargement, amenorrhea). In such cases, the term "psychogenic" or "functional amenorrhea" is often used. Some psychotropic drugs of the phenothiazine series, reserpine can also act as an etiological factor. It can occur after long-term use of oral contraceptives.

Pathogenesis

Neurodynamic hypothalamic dysfunction associated with impaired catecholamine control leads to a deficiency of gonadotropin-releasing factors that regulate the level of LH and FSH in the blood.

Symptoms postpubertal hypothalamic hypogonadism.

Postpubertal hypothalamic hypogonadism occurs predominantly in women. It is mainly manifested by secondary amenorrhea (amenorrhea preceded by a normal menstrual cycle). Infertility associated with an anovulatory cycle, sexual dysfunction due to decreased secretion of the vaginal glands and libido are possible. It is often combined with asthenic and anxiety-depressive manifestations. It can acquire features of the so-called early menopause. In this case, early wrinkles and gray hair, atrophied mammary glands, thinning hair on the pubis and in the armpits, amenorrhea, hot flashes, asthenic and depressive manifestations are characteristic. The levels of LH, FSH and estrogens in the blood are usually reduced. Pulse fluctuations of LH are absent. In response to stimulation of LH-RF, an excess of normal increase in the levels of LH and FSH in the blood is observed. In men, hypogonadism is manifested by decreased libido and potency.

Diagnostics postpubertal hypothalamic hypogonadism.

Diagnosis of postpubertal hypothalamic hypogonadism usually involves a number of medical tests and examinations to determine the presence of the condition and its causes. Some of the main diagnostic methods include:

1. Clinical history and physical examination: The doctor will interview the patient, collecting information about his medical history, including changes in the menstrual cycle (for women), symptoms of decreased libido, erectile dysfunction (for men), and other symptoms. A physical examination can help identify signs associated with a lack of sex hormones.
2. Hormonal measurements: Blood tests may be performed to measure levels of gonadotropin-releasing hormones (gonadotropin-releasing hormone, FSH, LH) and sex hormones (estrogens in women and testosterone in men). Low levels of these hormones may indicate hypothalamic hypogonadism.
3. Exclusion of other causes: The doctor must exclude other medical conditions that can cause similar symptoms, such as hyperprolactinemia, polycystic ovary syndrome, hypothyroidism, etc.
4. MRI (magnetic resonance imaging) of the brain: This test may be done to rule out tumors or abnormalities in the hypothalamus or pituitary gland.
5. Thyroid function tests and other tests: Additional tests may be done to evaluate the function of other endocrine glands and medical conditions that may affect sexual function.
6. Pelvic ultrasound (for women): This can help detect changes in the ovaries associated with polycystic ovary syndrome.

Differential diagnosis

It should be differentiated from amenorrhea within the framework of persistent galactorrhea-amenorrhea syndrome, from primary and secondary hypopituitarism, cerebral types of obesity, from nervous anorexia. Increased release of LH and FSH in response to stimulation of LH-RF is of great importance for diagnosis.

Treatment postpubertal hypothalamic hypogonadism.

Often the disease goes away spontaneously and does not require therapeutic intervention. Restoration of the menstrual cycle is noted with normalization of the diet, reduction of physical activity, vitamin therapy (vitamins A, E, C), general tonics, withdrawal of phenothiazine drugs, reserpine. In the presence of neurotic manifestations, the menstrual cycle is normalized with an improvement in the course of neurosis.

In exceptional cases (desire for rapid pregnancy, sexual dysfunction associated with symptoms of hypoestrogenism), hormone replacement therapy can be used under the supervision of gynecologists-endocrinologists.

It should be emphasized that it is not recommended to start treatment with hormonal therapy.