Endocrine Abstracts

Introduction: Functional hypothalamic amenorrhea is one of the most common causes of secondary amenorrhea (20–35%) and 3% of primary amenorrhea. FHA can be weight loss-related, stress-related and exercise-related. It results from abnormal GnRH secretion, leading to impairment of gonadotropins and hypoestrogenism.

Case presentation: A 47 year-old female presents for an endocrine evaluation regarding hormone function after 2 years of amenorrhea. She also reported a 40 kg weight loss with dietary management, between 2019-2021, with the cessation of menses after this. Clinical examination revealed a normal BMI, low blood pressure (90/60 mmHg), normal heart rate. Endocrine evaluation revealed a normal palpable thyroid, adipose tissue distribution and senologic exam, no hirsutism or acnee. Biochemistry revealed only a mild anemia with low erythrocyte indices. Hormone evaluation revealed low gonadotropins and estrogen and normal prolactin and total testosterone (panel also tested 18 months ago). Thyroid function was normal. Thyroid ultrasound revealed omogeneous structure, normal vascularisation. Transvaginal ultrasound showed an homogeneous uterus, thin endometrium, micropolycystic right ovary, left ovary unvisualized. A pituitary MRI showed a ~2.1/1.8 mm round-oval image in the right pituitary lobe – possible pituitary microadenoma. We also evaluated other pituitary hormone lines, with no abnormal findings. The patient was started a nutritional, psychological and modified exercise intervention. If these are not suffice, hormone substitution with transdermal estradiol therapy and cyclic oral progestin is considered.

Particularities : The patient’s age suggestive for menopause stage. The presence of the non-functional pituitary microadenoma. The 2 year latency between the onset of symptoms and the correct diagnosis.

Conclusion: Because of the delay in the diagnosis, hypoestrogenism may already have had an impact regarding loss of bone mass density, cardiovascular complications, depression and sexual impairment. Regardless of the patient’s age, diagnosis and proper management is required to prevent both short- and long-term medical complications.