Evaluation and Treatment of Patients With Hypothalamic Hypogonadism

The prevalence of eating disorders has more than doubled in the past 20 years, now affecting more than 28 million people in the United States. With eating disorders on the rise, a review of the ways in which disordered eating can present, as well as the impact on patients' gynecological health and fertility, is relevant as these causes often have reversible origins with early intervention and treatment.

The aim of this review is to address for the practicing clinician the pathophysiology, evaluation, and treatment of hypothalamic hypogonadism (HH) with a specific focus on functional hypothalamic hypogonadism (FHH).

PubMed was used as a search engine. Key words searched were "hypothalamic hypogonadism," "hypothalamic amenorrhea," "functional hypothalamic amenorrhea," "athletes' triad," "kisspeptin and hypothalamic hypogonadism," "neuroendocrinology of hypothalamic hypogonadism," and "fertility and functional hypothalamic hypogonadism." Articles that pertained to the pathophysiology, evaluation, and treatment of HH with a specific focus on FHH were reviewed and cited as references.

The most prevalent causes of FHH are disordered eating, intensive exercise, and stress or a combination thereof. Treatment should be based on cause. When disordered eating is the cause, treatment must involve psychiatric input. Pregnancy is not recommended in patients whose FHH persists, but for the majority of women who have achieved a modicum of control, pregnancy can be achieved via ovulation induction with excellent obstetrical outcomes.

With eating disorders on the rise, it is important for the practicing clinician to understand the etiologies, workup, and treatment of FHH for patients in general and for patients who desire pregnancy. It is important to review these causes and their treatments as they often have reversible origins. Prognosis is excellent with treatment, especially in cases where there is early recognition.