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Prevalence and treatment of central hypogonadism and hypoandrogenism in women with hypopituitarism

Artikel i vetenskaplig tidskrift
Författare C. Olivius
Kerstin Landin-Wilhelmsen
Daniel S Olsson
Gudmundur Johannsson
Åsa Tivesten
Publicerad i Pituitary
Volym 21
Nummer/häfte 5
Sidor 445-453
ISSN 1386-341X
Publiceringsår 2018
Publicerad vid Institutionen för medicin, avdelningen för invärtesmedicin och klinisk nutrition
Sidor 445-453
Språk en
Länkar dx.doi.org/10.1007/s11102-018-0895-...
https://gup.ub.gu.se/file/207574
Ämnesord Hypopituitarism, Women, Hypogonadism, Estrogens, Androgens, Estrogen replacement therapy
Ämneskategorier Endokrinologi

Sammanfattning

Purpose Women with hypopituitarism have increased morbidity and mortality, and hypogonadism has been suggested to be a contributing mechanism. The purpose of this study was to investigate the prevalence of central hypogonadism and hypoandrogenism in women with hypopituitarism at a single Swedish center. Methods All consecutive women (n = 184) who commenced growth hormone (GH) replacement therapy at Sahlgrenska University Hospital in Gothenburg between 1995 and 2015 were included. In accordance with the Endocrine Society Clinical Practice Guidelines, strict criteria, based on menstrual history combined with laboratory measurements, were used to define central hypogonadism. Hypoandrogenism was defined as subnormal levels of dehydroepiandrosterone sulfate and/or androstenedione. Results Central hypogonadism was present in 78% of the women, in 75% of those ≤ 52 years and in 82% of those > 52 years of age. Hypoandrogenism was found in 61% of all the women and in 92% of those with adrenocorticotropic hormone (ACTH) deficiency. The estrogen substitution rate in hypogonadal women ≤ 52 years was lower than the hormonal substitution rate in the other pituitary hormone axes (74% versus 100%, P < 0.001). The use of estrogen substitution tended to decrease between 2000 and 2016. Few women received androgen treatment. Conclusions In this first study of hypogonadism in women with hypopituitarism, using stringent diagnostic criteria for hypogonadism, the prevalence of central hypogonadism and low androgen levels was high and estrogen substitution was insufficient. Further studies are needed to elucidate the importance of hypogonadism and insufficient sex steroid replacement for the increased morbidity in hypopituitary women.

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