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Hypothalamic-Pituitary Diseases pp 247–287Cite as

Physiopathology, Diagnosis, and Treatment of Secondary Female Hypogonadism

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Part of the book series: Endocrinology ((ENDOCR))

Abstract

Female hypogonadism is a state characterized by absent or decreased ovarian function. It results from a gonadal (primary hypogonadism) or an extragonadal (secondary hypogonadism) princeps defect. In secondary hypogonadism, hypothalamic gonadotropin-releasing hormone or/and pituitary-secreted gonadotropins (follicle-stimulating hormone, luteinizing hormone) are either deficient or inactive leading to decreased secretion of gonadal steroids and subsequent amenorrhea. In certain conditions, both hypothalamic and pituitary dysfunctions are present. The genetic causes of secondary hypogonadism manifest mainly as congenital genetic syndromes (i.e., Kallmann syndrome) while some of them have been attributed to recognized single gene mutations and others have been characterized as idiopathic forms. Acquired causes of secondary hypogonadism include reversible causes such as functional hypothalamic amenorrhea, drugs, chronic illnesses, and irreversible causes such as central nervous system insults (trauma, irradiation, and intracranial tumors). Diagnosis should take in consideration the age at the clinical presentation (prepubertal or postpubertal), the physical findings as well as biochemical and imaging findings. Genetic investigation can be employed for more precise diagnosis. Finally, treatment should focus upon the treatment of the causal factor wherever possible and the hormone replacement therapy. The latter is adapted to the age of diagnosis of secondary female hypogonadism (prepubertal vs. postpubertal).

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Abbreviations

ACTH:

Adrenocorticotropic hormone

ADH:

Antidiuretic hormone

cAMP:

cyclic adenosine monophosphate

AVP:

Antidiuretic hormone

AMH:

Anti-Mullerian hormone

hCG:

Human chorionic gonadotropin

CBT:

Cognitive behavioral therapy

CDGP:

Constitutional delay of growth and puberty

CRH:

Corticotropin-releasing hormone

DHEA:

Dehydroepiandrosterone

FHA:

Functional hypothalamic amenorrhea

FSH:

Follicle-stimulating hormone

GABA:

Gamma-Aminobutyric Acid

GnRH:

Gonadotropin-releasing hormone

GH:

Growth hormone

HPO:

Hypothalamic-pituitary-ovarian

IHH:

Isolated hypogonadotrophic hypogonadism

IGF-1:

Insulin growth factor 1

KDNY:

Kisspeptin-Neurokinin B-Dynorphin

KS:

Kallmann syndrome

LDL:

Low-density lipoprotein

LH:

Luteinizing hormone

α-MSH:

α-Melanocyte-Stimulating hormone

NPY:

Neuropeptide Y

PTH:

Parathyroid hormone

PVN:

paraventricular nucleus

POA:

Preoptic area

PRL:

Prolactin

POMC:

Proopiomelanocortin

SHBG:

Sex hormone binding globulin

TSH:

Thyroid stimulating hormone

TRH:

Thyrotropin-releasing hormone

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  1. Endocrine Unit, ARETAIEION University Hospital, National and Kapodistrian University of Athens, Athens, Greece

    Athanasios Antoniou-Tsigkos & George Mastorakos

  2. Clinic of Endocrinology, Diabetes and Metabolic Diseases, University of Belgrade, Belgrade, Serbia

    Djuro Macut

Authors
  1. Athanasios Antoniou-Tsigkos
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  2. Djuro Macut
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  3. George Mastorakos
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Correspondence to Athanasios Antoniou-Tsigkos .

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Editors and Affiliations

  1. Faculty of Medicine, Biochemistry and Molecular Biology Department, University of Santiago de Compostela, Santiago de Compostela, Spain

    Felipe F. Casanueva

  2. Department of Medical Sciences, University of Torino, Torino, Italy

    Ezio Ghigo

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Antoniou-Tsigkos, A., Macut, D., Mastorakos, G. (2018). Physiopathology, Diagnosis, and Treatment of Secondary Female Hypogonadism. In: Casanueva, F., Ghigo, E. (eds) Hypothalamic-Pituitary Diseases. Endocrinology. Springer, Cham. https://doi.org/10.1007/978-3-319-44444-4_9

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  • DOI: https://doi.org/10.1007/978-3-319-44444-4_9

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-44443-7

  • Online ISBN: 978-3-319-44444-4

  • eBook Packages: MedicineReference Module Medicine

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