Functional Disorder of the Hypothalamus as a Cause of Primary Amenorrhea

Abstract

Functional hypothalamic amenorrhea (FHA) occurs when the hypothalamic-pituitary-ovarian sequence is suppressed due to an energy deficit usually caused by stress, weight loss, excessive exercise and disordered eating, leading to hypogonadism. The diagnosis is of exclusion, and a clinical examination with complementary blood and imaging tests must be performed. Treatment aims to correct the causes, guide adequate nutrition and physical activity. The combined estrogen can be used to restore menstrual cycles and preserve bone mass. We present the case of a 21-year-old patient with primary amenorrhea and hypogonadotropic hypogonadism, with a history of stress linked to low self-esteem, intense ballet activity during puberty and rigidity in eating. Physical examination showed complete pubertal development and low body mass index (16.9 kg/m2). Decreased serum levels of luteinizing hormone (LH) and follicle stimulating hormone (FSH), and normal levels of prolactin (PRL), thyroid stimulating hormone (TSH). Bone densitometry showed osteoporosis of the femur and lumbar spine. After weight restoration, physical activity monitored by a professional, and prescription and combined oral hormone therapy, the patient started menstrual cycles.