What is the pathogenesis of pituitary amenorrhea?

Updated: Oct 14, 2019
  • Author: Kristi A Tough DeSapri, MD; Chief Editor: Richard Scott Lucidi, MD, FACOG  more...
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A deficiency in FSH and LH may result from GnRH receptor gene mutations, although such mutations are rare. Mutations in the FSH beta gene have also been associated with amenorrhea; women with these mutations have low FSH and estradiol levels and high LH levels.

Primary amenorrhea caused by hyperprolactinemia is a rare condition characterized by the onset of thelarche and pubarche at appropriate ages but arrest of pubertal development before menarche. [11] Hyperprolactinemia is associated with suppression of the GnRH from the hypothalamus and subsequent inhibition of LH and FSH, suppressed gonadal function and galactorrhea. Prolactinomas are the most common cause of persistent hyperprolactinemia, accounting for 40-50% of pituitary tumors. [12] Prolactinomas are more commonly noted in secondary amenorrhea.

Pituitary tumors may suppress gonadotropin secretion, such as in Cushing disease or hypothalamic tumors, craniopharyngioma, or germinoma. Brain injury or cranial irradiation may also result in amenorrhea. Other pituitary causes include empty sella syndrome, pituitary infarct, hemochromatoses, and sarcoidosis.

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