♦ Hypothalamic pulsatile secretion of GnRH controls pituitary gonadotrophins.
♦ Blood level of steroids controls hypothalamic production of GnRH.
♦ Also higher centers control GnRH production through neurotransmitters.
♦ Hypothalamic disorders affect GnRH release cause amenorrhea.
♦ Other symptoms may be associated with amenorrhea e.g.
– Galactorrhea & errors in physical growth.
– Over-eating, under-eating,
– Obesity or wasting, &
– Faults in fluid balance.
Aetiology of Hypothalamic amenorrhea:
1- Kallmann’s Syndrome:
– 1ry amenorrhea (GnRH neurons disorder),
– Anosmia, cleft palate, color blindness, & tall stature.
2- Frohlich’s syndrome:
– 1ry amenorrhea, genital hypoplasia,
– Obesity of shoulder girdle with breast,
and pelvic girdle with thighs.
3- Chiarri-Frommel syndrome:
– Amenorrhea, galactorrhea, small uterus.
– Positive history of pregnancy.
4- Del-Castillo syndrome:
– Amenorrhea, galactorrhea and small sized uterus.
– Negative history of pregnancy.
5- Psychic Shock:
– Depressive mental disorders.
– Emotional upsets and stresses.
6- Anorexia nervosa:
– Young females with weight controlling mania,
– Hypothalamic disorder leading to marked
weight loss and wasting.
– The main treatment is psychotherapy.
– Sever fear of/or desire for pregnancy.
– A woman imagines that she is pregnant with amenorrhea.
– More over other pregnancy manifestations such as nausea and vomiting persist.
– U/S → normal sized non pregnant uterus.
– Main treatment is general anaesthesia.
8- Traumatic injuries in the region of midbrain:
* Tumors and fractures of the base of the skull.
9- Inflammatory causes & Iatrogenic conditions:
* Meningitis, encephalitis,
* Phenothiazine derivatives: Reserpin and ganglion-blocking agents’ →
prolactin inhibiting factors → ↑↑ prolactin level.
* Post-pill amenorrhea: Amenorrhea for 3 months or more after last pill.
10- Exercise: (Jogger’s syndrome):
* Excessive production of B-endorphin (neurotransmitter),
affect the pulsatile pattern of GnRH release.
Treatment of Hypothalamic amenorrhea :
* GnRH given by infusion pump (pulsatile manner).
* Post pill amenorrhea treated by antiestrogen e.g. clomiphene citrate.
Hypothalamic amenorrhea videos:
Primary & Secondary Amenorrhea – Pediatrics | Lecturio
Hypothalamic amenorrhea PPT power point presentations
AMENORRHEA By Assoc Professor Dr MNM AZHAR Faculty of Medicine & Health Sciences UNIMAS
AMENORRHEA Is the absence or abnormal cessation of the menses.