HYPOGONADOTROPIC HYPOGONADISM IN WOMEN: CAUSES, APPROACHES TO DIAGNOSIS AND TREATMENT


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Abstract

Hypogonadotropic hypogonadism caused by the impaired synthesis and/or secretion of gonadotropins may be organic (i.e. developing from anatomic and functional disorders in the hypothalamic-pituitary area in case of different chiasmal-cellar tumors) or may be functional, acquired, or congenital (mutations in the gonadotropin-releasing hormone receptor gene, the follicle-stimulating hormone (FSH) β-subunit gene, SF-1 and DAX-1 genes, impairments in the luteinizing hormone and FSH receptor genes, etc.). Neuropeptide Y (NPY), corticotropin-releasing hormone, leptin, ghrelin, and β-endorphin are involved in the development of functional impairments. The diagnosis of the disease comprises determination of gonadotropins and exclusion of hyperprolactinemia and other endocrine disorders, uterine and ovarian ultrasonography, and brain magnetic resonance imaging. Bone densitometry is indicated if amenorrhea lasts more than a year. When the causes of hypogonadotropic hypogonadism are revealed, they must be primarily eliminated (for example, to abolish stress, to avoid physical exercises, to restore normal body weight, or to treat pituitary tumors, etc.), which can recover menstrual function and fertility. In most cases, cyclic estrogen/gestagen therapy whose efficiency and safety requires long-term use of a combination of 17β-estradiol 2 mg and dydrogesterone 10 mg is, however, indicated for sustained hypoestrogenism in patients with hypogonadotropic hypogonadism.

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About the authors

I. I DEDOV

Endocrinology Research Center, Ministry of Health and Social Development of Russia

Email: dedov@endocrincentr.ru

G. A MELNICHENKO

Endocrinology Research Center, Ministry of Health and Social Development of Russia

Email: melnich@endocrincentr.ru

I. A ILOVAISKAYA

M.F. Vladimirsky Moscow Regional Research Clinical Institute

Email: info@endocrin-help.ru irena.ilov@yandex.ru

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