Postpubertal hypothalamic hypogonadism: causes, symptoms, diagnosis, treatment

Causes of post-pubertal hypothalamic hypogonadism

Etiological factors of post-pubertal hypothalamic hypogonadism may be malnutrition with a reduced body weight, along with significantly increased physical loads associated with the requirements of the profession. Such is the amenorrhea of ballerinas and athletes. The role of stress factors is great. Important as acute emotional stress, and a long chronic stressing situation. Often accompanies neuroses, various types of depressive conditions, observed after electroconvulsive 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. In the role of the etiological factor, some psychotropic preparations of the phenothiazine series, reserpine, may also act. May occur after prolonged use of oral contraceptives.

Pathogenesis of post-pubertal hypothalamic hypogonadism

Neurodynamic hypothalamic dysfunction associated with a violation of catecholamine control leads to deficiency of gonadotropin releasing factors regulating the level of LH and FSH in the blood.

Symptoms of post-pubertal hypothalamic hypogonadism

Postpubertal hypothalamic hypogonadism occurs mainly in women. It is mainly manifested by secondary amenorrhea (amenorrhea, which was preceded by a normal menstrual cycle). Possible infertility associated with the anovulatory cycle, the violation of sexual life as a result of decreased secretion of the vaginal glands and libido. Often combined with asthenic and anxious-depressive manifestations. Can acquire the features of the so-called early menopause. At the same time, early appearance of wrinkles and gray hair, atrophied mammary glands, thinning of the pubic hair and in the armpits, amenorrhea, hot flashes, asthenic and depressive manifestations are characteristic. Levels of LH, FSH and estrogens in the blood are usually reduced. Pulse oscillations of LH are absent. In response to stimulation of LH-RF, there is an increase in the levels of LH and FSH in the blood that is higher than normal. In men hypogonadism is manifested by a decrease in libido and potency.

Differential diagnosis

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

Treatment of post-pubertal hypothalamic hypogonadism

Often the disease passes spontaneously and does not require therapeutic intervention. The restoration of the menstrual cycle was noted during the normalization of diet, reduced physical exertion, vitamin therapy (vitamins A, E, C), restorative drugs, withdrawal of phenothiazine series, reserpine. In the presence of neurotic manifestations, the menstrual cycle is normalized with an improvement in the course of the neurosis.

In exceptional cases (the desire for rapid onset of pregnancy, sexual dysfunction associated with hypoestrogenic symptoms) hormonal replacement therapy may be used under the supervision of gynecologists-endocrinologists.

It should be emphasized that starting treatment with hormone therapy is not recommended.

[1], [2], [3], [4], [5], [6]