Endocrine Abstracts

A 24-year-old women (wt 63 kg, BMI 23) presented with history of secondary amenorrhea. Menarche occurred at age 16 years and was followed by a regular cycle (7/35). She started the combined oral contraceptive pill (OCP) at 18 years of age for menorrhagia and stopped this 16 months before her presentation, before undergoing elective surgery. Four months after discontinuing the OCP she experienced a single episode of PV bleeding, but otherwise remained amenorrhoeic. Past history included cystic fibrosis and a right sided colectomy. Her current medication included risedronate, nebulisers, antibiotics, pancreatic and vitamin supplements. A pregnancy test was negative. Biochemistry showed Alb 44 g/l, FSH 3.8 IU/l, LH 2.1 IU/l, oestradiol 111 pmol/l, IGF-1 52 (15.2–44.7) nmol/l, GH 7.7 mcg/l, prolactin 95, TSH 1.8, FT4 15.2, random cortisol 262 and ferritin 32 mcg/l. Repeat biochemistry confirmed these values. There was no history or clinical features suggestive of acromegaly. MRI showed normal pituitary gland, but the presence of a Chiari-I malformation with hydrocephalus and syrinx. She underwent elective 3rd ventriculostomy and revision six weeks later. When reviewed four months following surgery she has had a single menstrual bleed. Biochemistry at that time showed FSH 5.7 IU/l, LH 9.2 IU/l, oestradiol 111 pmol/l, IGF-1 41.9 nmol/l, TSH 2.0, FT4 16.3 and OGTT showed normal GH suppression.

We described a rare association between hydrocephalus and secondary amenorrhoea, not previously described in the setting of Chiari-I malformation. Endocrine dysfunction in hydrocephalus has been recognized for many years, and may be characterized by precocious or delayed puberty, primary or secondary amenorrhea Only 22 patients with amenorrhea and hydrocephalus are reported in the medical literature; only three of which presented with secondary amenorrhea. A literature review revealed that all the patients who underwent surgical decompression of hydrocephalus normalised their hypothalamo-pituitary gonadal axis within 1–50 months.