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Advisor(s)
Abstract(s)
Introdução: O Hipogonadismo Hipogonadotrófico ainda que raro, é uma das várias
etiologias quer de amenorreia primária, quer de amenorreia secundária e carateriza-se por
apresentar diversos fenótipos nas mulheres por ele afetadas. É consequência de doenças
congénitas ou adquiridas/funcionais que afetam o hipotálamo e/ou a hipófise. Esta
patologia caracteriza-se pela diminuição da concentração sérica de estradiol, associada a
baixos níveis séricos das gonadotrofinas: hormona folículo-estimulante e hormona
luteinizante. A diminuição das concentrações destas hormonas resulta da falência ou da
secreção pulsátil inadequada da hormona libertadora de gonadotrofinas, ou da
incapacidade da hipófise anterior responder a este pulso.
Objetivos: A presente dissertação tem como objetivo reunir a informação necessária para
um bom conhecimento desta doença na mulher, através de uma revisão de literatura e
comparação com um caso clínico.
Métodos: Análise de artigos publicados entre 1997 e 2020, na PubMed, Medscape e
Google Scholar, na língua inglesa ou portuguesa.
Resultados: É apresentado um caso clínico de uma mulher de 36 anos, com história de
gravidez prévia bem-sucedida, que recorreu à consulta de Infertilidade no Centro
Hospitalar e Universitário da Cova da Beira, por quadro de infertilidade e amenorreia
secundárias, que após investigação dirigida se diagnosticou com hipogonadismo
hipogonadotrófico, no entanto a sua etiologia permanece incerta. À luz da literatura
analisada, existe apenas um outro caso sobreponível, existindo escassa informação sobre
esta patologia com início na idade adulta em mulheres. Apesar de, uma das principais
morbilidades ser a infertilidade existem outras repercussões do hipoestrogenismo que
determinam grande impacto na saúde da mulher, sendo a maioria destas revertida se for
possível o tratamento da condição de base.
Conclusão: Em geral, esta entidade clínica acarreta mais consequências na saúde do que as
anteriormente consideradas e em determinados casos, como o descrito, é difícil identificar
a etiologia por trás desta. É, por esta razão, crucial que sejam desenvolvidas mais
investigações nesta área, de forma a ampliar o conhecimento clínico e assim permitir um
diagnóstico quer clínico, quer etiológico e um tratamento, com maior precocidade.
Introduction: Hypogonadotropic Hypogonadism, although rare, is one of several etiologies, either of primary amenorrhea and secondary amenorrhea, and it is characterized by exhibiting several phenotypes in the women affected by it. It is a consequence of congenital or acquired/functional diseases that affect the hypothalamus and/or the pituitary gland. This pathology is characterized by a decrease in the serum concentration of estradiol, associated with low serum levels of gonadotropins: follicle stimulating hormone and luteinizing hormone. The decrease in the concentrations of these hormones results from the failure or inadequate pulsatile secretion of the gonadotropin-releasing hormone, or the inability of the anterior pituitary to respond to this pulse. Objectives: This dissertation aims to gather the necessary information for a good understanding of this disease in women, through a literature review and comparison with a clinical case. Methods: Analysis of articles published between 1997 and 2020, in PubMed, Medscape and Google Scholar, in English or Portuguese. Results: It is reported a clinical case of a 36-year-old woman with a history of a successful previous pregnancy, who was referred to the Infertility Department at Centro Hospitalar Universitário da Cova da Beira, due to secondary infertility and amenorrhea, and after a directed investigation, she was diagnosed with hypogonadotropic hypogonadism. However, its etiology remains uncertain. In the light of the literature analyzed, there is only one other similar case, and it was verified that there is scarce information about this pathology, with its beginning during the adulthood in women. Although one of the main morbidities is infertility, there are other repercussions of hypoestrogenism that have a major impact on the women’s health, most of which can be reversed when the underlying condition is treated. Conclusion: In general, this clinical entity entails more health consequences than those previously considered, and in certain cases, as described, it is difficult to identify the etiology behind it. It is therefore, crucial, that further research is developed in this area, in order to broaden the clinical knowledge, and thus allow an early diagnosis and treatment.
Introduction: Hypogonadotropic Hypogonadism, although rare, is one of several etiologies, either of primary amenorrhea and secondary amenorrhea, and it is characterized by exhibiting several phenotypes in the women affected by it. It is a consequence of congenital or acquired/functional diseases that affect the hypothalamus and/or the pituitary gland. This pathology is characterized by a decrease in the serum concentration of estradiol, associated with low serum levels of gonadotropins: follicle stimulating hormone and luteinizing hormone. The decrease in the concentrations of these hormones results from the failure or inadequate pulsatile secretion of the gonadotropin-releasing hormone, or the inability of the anterior pituitary to respond to this pulse. Objectives: This dissertation aims to gather the necessary information for a good understanding of this disease in women, through a literature review and comparison with a clinical case. Methods: Analysis of articles published between 1997 and 2020, in PubMed, Medscape and Google Scholar, in English or Portuguese. Results: It is reported a clinical case of a 36-year-old woman with a history of a successful previous pregnancy, who was referred to the Infertility Department at Centro Hospitalar Universitário da Cova da Beira, due to secondary infertility and amenorrhea, and after a directed investigation, she was diagnosed with hypogonadotropic hypogonadism. However, its etiology remains uncertain. In the light of the literature analyzed, there is only one other similar case, and it was verified that there is scarce information about this pathology, with its beginning during the adulthood in women. Although one of the main morbidities is infertility, there are other repercussions of hypoestrogenism that have a major impact on the women’s health, most of which can be reversed when the underlying condition is treated. Conclusion: In general, this clinical entity entails more health consequences than those previously considered, and in certain cases, as described, it is difficult to identify the etiology behind it. It is therefore, crucial, that further research is developed in this area, in order to broaden the clinical knowledge, and thus allow an early diagnosis and treatment.
Description
Keywords
Amenorreia Secundária Défice de Gnrh Hipogonadismo Hipogonadotrófico Hipogonadismo Secundário