Hypothalamic pituitary failure

Question 1

what is it?

Answer 1

• Hypogonadotrophic hypogonadism
• 10% of ovulatory disorders
• Normal prolactin
• Low levels of FSH and LH
• There is oestrogen deficiency (resulting in negative progesterone challenge test)
• Amenorrhoea

Question 2

what causes it?

Answer 2

stress, 
excessive exercise, 
anorexia/low BMI, brain/pituitary tumours, 
head trauma, 
Kallman’s syndrome, 
drugs (steroids, opiates), 
isolated gonadotrophin deficiency

Question 3

how is it managed?

Answer 3

stabilise weight (BMI >18.5), 
lifestyle modification (smoking, alcohol), 
folic acid (400 mcg daily), 
check prescribed drugs, 
check rubella immunity (vaccine), 
normal semen analysis, 
patent fallopian tube

Question 4

how is hypothalamic anovulation managed?

Answer 4

Pulsatile GnRH if hypogonadotrophic hypogonadism [SC or IV]

Gonadotrophin (FSH and LH) daily injections [risk of multiple pregnancies] Both need ultrasound monitoring of response (follicle tracking)