FUNCTIONAL DISORDER OF THE HYPOTHALAMUS AS A CAUSE OF PRIMARY AMENORRHEA
DOI:
https://doi.org/10.47820/recima21.v3i9.1869Palavras-chave:
Amenorreia, Estresse emocional, Relato de caso, Hipotálamo, AdolescenteResumo
Functional hypothalamic amenorrhea (FHA) occurs when the hypothalamic-pituitary-ovarian sequence is suppressed due to an energy deficit usually caused by stress, weight loss, excessive exercise and disordered eating, leading to hypogonadism. The diagnosis is of exclusion, and a clinical examination with complementary blood and imaging tests must be performed. Treatment aims to correct the causes, guide adequate nutrition and physical activity. The combined estrogen can be used to restore menstrual cycles and preserve bone mass. We present the case of a 21-year-old patient with primary amenorrhea and hypogonadotropic hypogonadism, with a history of stress linked to low self-esteem, intense ballet activity during puberty and rigidity in eating. Physical examination showed complete pubertal development and low body mass index (16.9 kg/m2). Decreased serum levels of luteinizing hormone (LH) and follicle stimulating hormone (FSH), and normal levels of prolactin (PRL), thyroid stimulating hormone (TSH). Bone densitometry showed osteoporosis of the femur and lumbar spine. After weight restoration, physical activity monitored by a professional, and prescription and combined oral hormone therapy, the patient started menstrual cycles.
Downloads
Referências
Adelina De Azevedo M, Orientado A, Júlia M, Gonçalves A, Coorientado F, Doutora Diana M, et al. Papel do cálcio e vitamina D na prevenção e tratamento da osteoporose Role of calcium and vitamin D in the prevention and treatment of osteoporosis [Internet]. Available from: https://repositorio-aberto.up.pt/bitstream/10216/121924/2/346659.pdf
Bomba M, Gambera A, Bonini L, Peroni M, Neri F, Scagliola P, et al. Endocrine profiles and neuropsychologic correlates of functional hypothalamic amenorrhea in adolescents. Fertil Steril. 2007;87(4):876–85.
Chou SH, Mantzoros C. Bone metabolism in anorexia nervosa and hypothalamic amenorrhea. Metabolism [Internet]. 2018;80:91–104. Available from: https://doi.org/10.1016/j.metabol.2017.10.009
Committee Opinion No.702. Obstetrics & Gynecology. 2017 Jun;129(6):e160–7.
Daily JP, Stumbo JR. Female Athlete Triad. Prim Care - Clin Off Pract [Internet]. 2018;45(4):615–24. Available from: https://doi.org/10.1016/j.pop.2018.07.004
Fourman LT, Fazeli PK. Neuroendocrine causes of amenorrhea - An update. J Clin Endocrinol Metab. 2015;100(3):812–24.
Gibson MES, Fleming N, Zuijdwijk C, Dumont T. Where have the periods gone? The evaluation and management of functional hypothalamic amenorrhea. JCRPE J Clin Res Pediatr Endocrinol. 2020;12(Suppl 1):18–27.
Golden NH, Carlson JL. The pathophysiology of amenorrhea in the adolescent. Ann N Y Acad Sci. 2008;1135:163–78.
Gordon CM, Ackerman KE, Berga SL, Kaplan JR, Mastorakos G, Misra M, et al. Functional Hypothalamic Amenorrhea: An Endocrine Society Clinical Practice Guideline. 2017;102(May):1413–39.
Groothuis PG, Dassen HHNM, Romano A, Punyadeera C. Estrogen and the endometrium: Lessons learned from gene expression profiling in rodents and human. Hum Reprod Update. 2007;13(4):405–17.
Hurria A, Cohen HJ, Extermann M. WHO_TRS_854.pdf [Internet]. Vol. 1, Journal of Geriatric Oncology. 2010. p. 40–4. Available from: https://www.analesdepediatria.org/en-tuberculosis-in-paediatric-age-group-articulo-S2341287920302544
Kelly AW, Hecht S. The female athlete triad. Ann Jt. 2022;7(4):3–12.
Klein DA, Paradise SL, Reeder RM. Amenorre Review 2019. 2019;
Klein DA, Poth MA. Amenorrhea: An approach to diagnosis and management. Am Fam Physician. 2013;87(11):781–8.
Liu JH, Bill AH. Stress-associated or functional hypothalamic amenorrhea in the adolescent. Ann N Y Acad Sci. 2008;1135:179–84.
Loveless MB. Female athlete triad. Curr Opin Obstet Gynecol. 2017;29(5):301–5.
Maïmoun L, Paris F, Coste O, Sultan C. Sport intensif et troubles du cycle chez la jeune femme : retentissement sur la masse osseus. Gynécologie Obstétrique & Fertilité. 2016 Nov;44(11):659–63.
Martins CV. Pico de massa óssea : insuficiência da alimentação e da actividade física. 2002; Available from: http://repositorio-aberto.up.pt/handle/10216/54458
Pardini DP. Alterações hormonais da mulher atleta. Arquivos Brasileiros de Endocrinologia & Metabologia [Internet]. 2001 Aug 1 [cited 2020 Mar 2];45(4):343–51. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-27302001000400006
Promoção e Proteção da Saúde da Mulher ATM 2024/1 [Internet]. [cited 2022 May 26]. Available from: https://www.lume.ufrgs.br/bitstream/handle/10183/224054/001128136.pdf?sequence=1
Sena T. Estatísticas e Ciências Humanas: inflexões sobre normalizações e normatizações. Interthesis. 2014;11(2):96–117.
Tensão Pré-Menstrual – Critérios para diagnóstico [Internet]. www.febrasgo.org.br. [cited 2022 Aug 9]. Available from: https://www.febrasgo.org.br/pt/noticias/item/422-tensao-premenstrual-criterios-para-diagnostico
Torbati T, Dutra E, Shufelt C. Hypothalamic Amenorrhea and the Long-Term Health Consequences. Seminars in Reproductive Medicine. 2017 May;35(03):256–62.
Traboulsi S, Itani L, Tannir H, Kreidieh D, El Masri D, El Ghoch M. IS BODY FAT PERCENTAGE A GOOD PREDICTOR OF MENSTRUAL RECOVERY IN FEMALES WITH ANOREXIA NERVOSA AFTER WEIGHT RESTORATION? A SYSTEMATIC REVIEW AND EXPLORATORY AND SELECTIVE META-ANALYSIS. Journal of Population Therapeutics & Clinical Pharmacology. 2019 Jul 31;26(2):e25–37.
Travassos LHR, Lima SMRR, Simony ACSD, Pacheco GT, Simone MC, Ferro RSP. Amenorreia em atletas: revisão da literatura Amenorrhea in athletes: literature review. Arq Med Hosp Fac Cienc Med. 2017;62(1):27–34.
Valdes-Socin H, Almanza MR, Fernández-Ladreda MT, Debray FG, Bours V, Beckers A. Reproduction, smell, and neurodevelopmental disorders: Genetic defects in different hypogonadotropic hypogonadal syndromes. Front Endocrinol (Lausanne). 2014;5(JUL):1–8.
Williams NI, Helmreich DL, Parfitt DB, Caston-Balderrama A, Cameron JL. Evidence for a causal role of low energy availability in the induction of menstrual cycle disturbances during strenuous exercise training. J Clin Endocrinol Metab. 2001;86(11):5184–93.
Downloads
Publicado
Como Citar
Edição
Seção
Categorias
Licença
Copyright (c) 2022 RECIMA21 - Revista Científica Multidisciplinar - ISSN 2675-6218
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
Os direitos autorais dos artigos/resenhas/TCCs publicados pertecem à revista RECIMA21, e seguem o padrão Creative Commons (CC BY 4.0), permitindo a cópia ou reprodução, desde que cite a fonte e respeite os direitos dos autores e contenham menção aos mesmos nos créditos. Toda e qualquer obra publicada na revista, seu conteúdo é de responsabilidade dos autores, cabendo a RECIMA21 apenas ser o veículo de divulgação, seguindo os padrões nacionais e internacionais de publicação.
