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Management of hypogonadotrophic-hypogonadism ( Hypo-Hypog)

Hypogonadotrophic-hypogonadism or Hypo-Hypog (hypothalamic-pituitary failure), is a situation in which gonadotrophin concentrations are so low as to be completely unable to stimulate follicle development and oestrogen production from the ovaries. Anovulation, absence of menstruation (amenorrhea) and very low oestrogen levels are the consequences. There are several possible causes for this condition which may be hypothalamic or pituitary.

Hypothalamic causes include: Weight-related amenorrhea, stress, strenuous exercise, Kallmann’s syndrome, craniopharyngioma, debilitating systemic diseases, idiopathic.
Pituitary causes: Surgical removal of the pituitary (hypophysectomy), radiotherapy, Sheehan’s syndrome.
If infertility is not a concern, every patient with hypogonadotrophic-hypogonadism over the age of puberty should be treated with hormone replacement therapy with cyclical oestrogen and progestins.

For those desiring a pregnancy, if the pituitary is intact and the hypothalamus is failing to function, ‘replacement therapy’ with gonadotrophin-releasing hormone (GnRH) administered in pulses every 90 minutes using a pump similar to that used for giving insulin to diabetics, is highly effective, if a little cumbersome.
Direct stimulation of the ovaries with gonadotrophins serves the purpose for ovulation induction whether the cause is of hypothalamic or pituitary origin. If the cause of the amenorrhea is an extreme low body weight, every attempt should be made to increase weight before starting treatment.

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