- p/c: fatigue, amenorrhoea, infertility, male pattern baldness, acne, hirsuitism, anosmia (in Kallman’s syndrome), signs of oestrogen withdrawel (menopausal symptoms), obesity (PCOS), galactorrhoea (increased PRL), Hx of excessive exercise/stress, any drugs that may increase PRL, CTs?
- In primary hypogonadism, oestrogen withdrawel symptoms occur – hot flushes, sweats, mood changes, vaginal dryness, pain on intercourse.
- Signs of established hypogonadism include facial wrinkling, breast involution, general reduction in body hair.
- Primary hypogonadism = ovarian failure: relate to genetic or acquired disease, occurs in 1% of women <40yo and accounts for 10% of secondary amenorrhoea.
- Genetic causes include:
- o Turners syndrome (45X0), 1/2000, causes gonadal dysgenesis, will have delayed puberty leading to premature gonadal failure, short stature, characteristic phenotype (=arched palate, webbed neck, widely spaced nipples, short 4th metatarsal, wide carrying angle, few secondary sexual characteristics). May also have associated cardiac (aortic coarctation), endocrine (hypothyroidism, DM), skeletal, and renal abnormalities (=horseshoe kidney)
- o Acquired premature ovarian failure: results from autoimmune disease = most common cause of premature menopause, maybe idiopathic or relate to cytotoxic CT.
- Secondary hypogonadism = hypothalamic-pituitary failure: hypogonadotrophic hypogonadism results from hypothalamic or pituitary disease, including tumours, hyperprolactinaemia, or extreme physical or psychological stress – including anorexia nervosa.
- Mx of female hypogonadism:
- o In ovarian failure = oestrogens (alleviate deficiency syndromes and prevent long-term complications), such as osteoporosis
- o Progesterones are added for women with an intact uterus to avoid endometrial hyperplasia and subsequent endometrial carcinoma
- o Oocyte donation is needed for fertility.
- o In secondary hypogonadism – vital to have a full assessment of hypothalamic-pituitary axis functionally and structurally to diagnose and treat underlying disease
- o Gonadotrophins (FSH/hMG + hCG) or pulsatile GnRH therapy are used to induce fertility in hypogonadotrophic hypogonadism