Amenorrhea, hypothalamic

Uses Primary hypothalamic amenorrhea Action Stimulates pituitary release of LH FSH Dose 5 meg IV q90min x 21 d using pump kit Caution [B, M] T Levels w/ androgens, estrogens, progestins, glucocorticoids, spironolactone, levodopa ... 

Currently in development Leptin Obesity. Obesity, hypothalamic amenorrhea... 

Leptin is a peptide hormone secreted by adipocytes. Recombinant human leptin has been investigated for its potential as an antiobesity agent [105,106]. Women with hypothalamic amenorrhea display reduced levels of leptin. Leptin administration to these women improves reproductive and neuroendocrine function [107], Nasal administration of leptin to rats in the presence of either TDM (1) or LPC [108] caused a significant increase in serum leptin levels. Increased serum leptin levels were associated with reduced food consumption [108], The development of an effective nasal formulation of leptin containing an absorption enhancer may allow more frequent dosing with leptin and thereby overcome the limited efficacy observed following subcutaneous injections of large doses of this hormone. 

Welt, C.K., et al. 2004. Recombinant human leptin in women with hypothalamic amenorrhea. N Engl J Med 351 987. 

Over a 7- to 12-day course of daily hMG or urofollitropin administration (intended to mimic the follicular phase of the ovarian cycle in women with hypothalamic amenorrhea), FSH levels gradually rise to twice their baseline level. LH levels increase to 1.5 times their baseline with hMG, but they do not rise with urofollitropin. 

PCOS occurs in about 5% to 10% of premenopausal women and is thought to be caused by a hypothalamic disorder. PCOS is clinically defined by hyperandro-genism with chronic anovulation in women without underlying disease of the adrenal or pituitary glands. This syndrome is characterized by infertility, hirsutism, obesity (in approximately half of those affected), and various menstrual disturbances ranging from amenorrhea to irregular... 

Menstrual complications Amenorrhea secondary to depression of the hypothalamic-pimitary axis. Infertihty wiU result secondary to anovulation. 

Gonadorelin, a GuRH with fertility-inducing properties (5 meg IV q. 90 minutes for 21 days), is used to induce ovulation in women with primary hypothalamic amenorrhea (see Table 15). 

GnRH is nsed in females to treat hypothalamic amenorrhea. A deficit in the synthesis of GnRH has been implicated as the source of menstrual disturbances, hypoprolactinemia, anorexia nervosa, stress- and weight-loss-associated amenorrhea, athletes amenorrhea, some forms of the polycystic ovarian disease syndrome, and infertility associated with hypothalamic tumors (see Table 15). 

Prolactin has no therapeutic uses. Hyperprolactinemia is a relatively common endocrine abnormality that most often is caused by prolactin-secreting pituitary adenomas. Hyperprolactinemia also can result from hypothalamic or pituitary diseases that interfere with the delivery of inhibitory dopaminergic signals primary hypothyroidism associated with increased TRH levels renal failure treatment with dopamine receptor antagonists. Manifestations of prolactin excess in women include galactorrhea, amenorrhea, and infertihty. in men, hyperprolactinemia causes loss of libido, impotence, and infertility. 

Leyendecker, G.L., L. Wildt M. Hansmann. 1980. Pregnancies following intermittent (pulsatile) administration of GnRH by means of a portable pump ( Zyklomat ) A new approach to the treatment of infertility in hypothalamic amenorrhea. J. Clin. Endocr. Metab. 51 1214-16. 

Hyperprolactinemia Hypothalamic amenorrhea Premature ovarian failure... 

Multifollicular ovaries are found in mid to late puberty as a normal finding. Multifollicular ovaries may also result from hyperprolactinemia, hypothalamic anovulation, and weight-related amenorrhea. They may be differentiated from PCO by fewer cysts, the different size of follicles, lack of stromal hypertrophy, and the distribution of the often larger follicles throughout the ovary. In contrast to PCO, the ovaries resume normal appearance after treatment. 

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