Functional Hypothalamic Amenorrhea: An Endocrine Society Clinical Practice Guideline

COSPONSORING ASSOCIATIONS: The American Society for Reproductive Medicine, the European Society of Endocrinology, and the Pediatric Endocrine Society. This guideline was funded by the Endocrine Society. OBJECTIVE: To formulate clinical practice guidelines for the diagnosis and treatment of functional hypothalamic amenorrhea (FHA). PARTICIPANTS: The participants include an Endocrine Society-appointed task force of eight experts, a methodologist, and a medical writer. EVIDENCE: This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation approach to describe the strength of recommendations and the quality of evidence. The task force commissioned two systematic reviews and used the best available evidence from other published systematic reviews and individual studies. CONSENSUS PROCESS: One group meeting, several conference calls, and e-mail communications enabled consensus. Endocrine Society committees and members and cosponsoring organizations reviewed and commented on preliminary drafts of this guideline. CONCLUSIONS: FHA is a form of chronic anovulation, not due to identifiable organic causes, but often associated with stress, weight loss, excessive exercise, or a combination thereof. Investigations should include assessment of systemic and endocrinologic etiologies, as FHA is a diagnosis of exclusion. A multidisciplinary treatment approach is necessary, including medical, dietary, and mental health support. Medical complications include, among others, bone loss and infertility, and appropriate therapies are under debate and investigation

Another Positive Pregnancy Test.

A 16-year-old female presented to an emergency department with complaints of nausea and vomiting, dehydration, increasing weakness, and resting tremor. The past history included mild exercise-induced asthma. She denied sexual activity, but a urine test for beta-human chorionic gonadotropin was positive and she was transferred to a gynecology service for management of pregnancy. She also had primary amenorrhea and delayed growth for age. Further complaints included headaches accompanied with worsening of visual activity. Pelvic ultrasound revealed no intrauterine or ectopic pregnancy. Head CT scan showed a suprasellar tumor, better defined on an MRI as a hypothalamic tumor. Pathology following partial tumor resection revealed a mixed germ cell tumor with negative metastatic work-up.