Hypothalamic Hypogonadism

Hypothalamic dysfunction leading to hypogonadism is a frequent etiology for secondary amenorrhea. A variety of behavioral and organic etiologies exist that can lead to the disorder. Diagnosis is via history, serologic work-up, and imaging, and treatment includes lifestyle modification for functional causes (in setting of nutritional deficiency, over-exercise, and/or stress) or targeted surgical/pharmacologic therapy for organic causes. Fertility can be restored by either reversing the underlying pathology or by directly stimulating the ovaries with gonadotropins. Careful attention must be paid to bone density considerations in patients with longstanding estrogen deficiency related to hypothalamic dysfunction.