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Endocrine

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Many endocrine disorders can cause amenorrhoea. The most common causes are functional disorders of the hypothalamus and hyperprolactinaemia.

Hypothalamic disorders:

  • hypogonadotrophic hypogonadism - e.g. Kallmann's syndrome
  • psychogenic - associated with emotional stress, shift work especially, night / day shifts
  • exercise
  • excessive weight gain / weight loss
  • eating disorders - anorexia nervosa, bulimia
  • infections - e.g. tuberculosis, syphilis
  • chronic diseases - e.g. diabetes, AIDS (1)
  • tumours - e.g. craniopharyngioma
  • post-oral contraceptive use - "post-pill amenorrhoea"

Pituitary lesions:

  • tumours - with or without hyperprolactinaemia; includes prolactin secreting pituitary adenomas, non-functional pituitary adenomas with suprasellar extension impairing blood flow down the pituitary stalk; growth hormone secreting tumours - 30% secrete prolactin
  • infarction necrosis - Sheehan's syndrome
  • granulomatous infiltration - e.g. sarcoidosis

Ovarian lesions:

  • ovarian dysgenesis - Turner's syndrome / mosaic
  • polycystic ovarian syndrome
  • resistant ovary syndrome
  • premature ovarian failure
  • androgen secreting ovarian tumours
  • surgery - oophorectomy; ovarian suppression by pelvic irradiation

Other endocrine lesions:

  • thyroid - primary hypothyroidism; hyperthyroidism
  • pancreas - poorly controlled diabetes
  • adrenal - Cushing's syndrome; advanced Addison's disease

Notes:

  • head injury and gonadotropin deficiency (2)
    • marked changes of the hypothalamo-pituitary axis have been documented in the acute phase of traumatic brain injury (TBI)
      • following TBI as many as 80% of patients showing evidence of gonadotropin deficiency, 18% of growth hormone deficiency, 16% of corticotrophin deficiency and 40% of patients demonstrating vasopressin abnormalities leading to diabetes insipidus or the syndrome of inappropriate anti-diuresis
      • longitudinal prospective studies have shown that some of the early abnormalities are transient, whereas new endocrine dysfunctions become apparent in the post-acute phase. There remains a high frequency of hypothalamic-pituitary hormone deficiencies among long-term survivors of TBI, with approximately 25% patients showing one or more pituitary hormone deficiencies

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