Chorioretinal biomarkers in hypothalamic amenorrhea

Area of Science:

• Ophthalmology
• Endocrinology
• Vascular Biology

Background:

• Hypothalamic amenorrhea (HA) is a condition characterized by the absence of menstruation due to hypothalamic dysfunction.
• Ocular microvascular changes associated with HA are not well understood.
• Optical coherence tomography angiography (OCTA) allows non-invasive assessment of retinal and choroidal vasculature.

Purpose of the Study:

• To evaluate changes in retinal and choriocapillaris circulations in patients with HA.
• To investigate the relationship between ocular microvascular alterations and systemic parameters in HA.

Main Methods:

• Prospective, cross-sectional observational study involving 25 HA patients and 25 age-matched healthy controls.
• OCTA was utilized to measure vessel density (VD) in the superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillaris.
• Systemic parameters including BMI, hormone levels (FSH, LH, prolactin), insulin, and cortisol were collected in the HA group.

Main Results:

• No significant differences in SCP and DCP vessel density were observed between HA patients and controls.
• A trend towards higher choriocapillaris VD was noted in HA patients in the whole image region (p=0.038 RE, p=0.044 LE).
• Foveal choriocapillaris VD was significantly higher in HA women compared to controls (p=0.005 LE).
• Correlations were found between foveal SCP/DCP VD and endometrial thickness, and between foveal DCP/whole area SCP VD and cortisol/FSH levels, respectively.

Conclusions:

• OCTA detected alterations in the choriocapillaris layer in HA patients, characterized by increased VD.
• This finding suggests that microvascular "compaction" in the choriocapillaris may represent an early adaptive response to hypoestrogenism in HA.
• The study highlights potential early vascular changes in the retina associated with HA.