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Algorithm for evaluation of amenorrhea. β-hCG, human chorionic gonadotropin; PRL, prolactin; FSH, follicle-stimulating hormone; TSH, thyroidstimulating hormone. Hypogonadotropic Hypogonadism Low estrogen levels in combination with normal or low levels of LH and FSH are seen with anatomic, genetic, or functional abnormalities that interfere with hypothalamic GnRH secretion or normal pituitary responsiveness to GnRH. Although relatively uncommon, tumors and infiltrative diseases should be considered in the differential diagnosis of hypogonadotropic hypogonadism (Chap. 333). These disorders may present with primary or secondary amenorrhea. They may occur in association with other features suggestive of hypothalamic or pituitary dysfunction such as short stature, diabetes insipidus,. | Chapter 051. Menstrual Disorders and Pelvic Pain Part 3 Algorithm for evaluation of amenorrhea. P-hCG human chorionic gonadotropin PRL prolactin FSH follicle-stimulating hormone TSH thyroidstimulating hormone. Hypogonadotropic Hypogonadism Low estrogen levels in combination with normal or low levels of LH and FSH are seen with anatomic genetic or functional abnormalities that interfere with hypothalamic GnRH secretion or normal pituitary responsiveness to GnRH. Although relatively uncommon tumors and infiltrative diseases should be considered in the differential diagnosis of hypogonadotropic hypogonadism Chap. 333 . These disorders may present with primary or secondary amenorrhea. They may occur in association with other features suggestive of hypothalamic or pituitary dysfunction such as short stature diabetes insipidus galactorrhea or headache. Hypogonadotropic hypogonadism may also be seen following cranial irradiation. In the postpartum period it may be due to pituitary necrosis Sheehan syndrome or lymphocytic hypophysitis. Because reproductive dysfunction is commonly associated with hyperprolactinemia either from neuroanatomic lesions or medications prolactin should be measured in all patients with hypogonadotropic hypogonadism Chap. 333 . Isolated hypogonadotropic hypogonadism IHH is more common in men than women and is often associated with anosmia. IHH generally presents with primary amenorrhea. A number of genetic causes of IHH have been identified Chaps. 340 and 341 . Functional hypothalamic amenorrhea HA is caused by a mismatch between energy expenditure and energy intake. Leptin secretion may play a key role in transducing the signals from the periphery to the hypothalamus in HA. The hypothalamic-pituitary-adrenal axis may also play a role. The diagnosis of HA can generally be made on the basis of a careful history physical examination and the demonstration of low levels of gonadotropins and normal prolactin levels. Eating disorders and chronic disease
