Potential hormonal mediators of amenorrhea

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Presentation transcript:

Potential hormonal mediators of amenorrhea Potential hormonal mediators of amenorrhea. There are several conditions that influence the production of hormones which modulate GnRH release. Conditions (ie, stress, Cushings disease) which increase CRH and/or cortisol levels suppress gonadotropin-releasing hormone (GnRH) release and/or decrease LH responsiveness to GnRH. Low leptin levels and likely increased FGF-21 levels (ie, starvation) possibly suppress GnRH release by decreasing kisspeptin expression. Increased thyrotropin releasing hormone (TRH) levels (ie, primary hypothyroidism) stimulate prolactin release. Hyperprolactinemia suppresses GnRH release by decreasing kisspeptin expression, and possibly through a CRH-mediated pathway. High androgen and progesterone levels may be seen in congenital adrenal hyperplasia (CAH), and these hormones likely suppress GnRH release. (Reproduced with permission from Fourman LT, Fazeli PK. Neuroendocrine causes of amenorrhea—an update. J Clin Endocrinol Metab. 2015 Mar;100(3):812-824.) Source: Female Reproductive Endocrinology and Infertility, Greenspan's Basic & Clinical Endocrinology, 10e Citation: Gardner DG, Shoback D. Greenspan's Basic & Clinical Endocrinology, 10e; 2017 Available at: http://accessmedicine.mhmedical.com/DownloadImage.aspx?image=/data/books/2178/gardgreen10_ch13_f011-1.png&sec=166250811&BookID=2178&ChapterSecID=166250715&imagename= Accessed: November 11, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved