Follicle-Stimulating Hormone Abnormalities Treatment & Management

  • Author: Serge A Jabbour, MD, FACP, FACE; Chief Editor: George T Griffing, MD   more...
 
Updated: Jan 3, 2012
 

Medical Care

Medical treatment in patients with abnormal levels of follicle-stimulating hormone (FSH) depends on the underlying etiology. Appropriate articles are available that contain detailed discussions. However, the following points deserve mention:

  • In women with primary (ovarian) or secondary (pituitary) hypogonadism, hormone replacement therapy may be administered (estrogen and progesterone). However, a study by the Women's Health Initiative showed health risks from using estrogens plus progesterone in 16,608 postmenopausal women over 5.2 years of follow-up. Excess risks attributable to estrogens plus progesterone included more cardiovascular events, strokes, pulmonary emboli, and invasive breast cancers, but less risk of colorectal cancer. Hormone replacement therapy should take into account all of these factors. Also, other pituitary deficiencies (eg, thyroid, adrenal) must be corrected in the appropriate setting.[11]
  • In men with primary (testes) or secondary (pituitary) hypogonadism, testosterone replacement therapy is administered, either intramuscularly or with patches or gel. Again, other pituitary deficiencies must be corrected.
  • In men and women, treatment targeted at the underlying etiology may suffice.
    • In patients with prolactinomas, medical treatment with a dopamine agonist lowers prolactin levels and may normalize FSH, LH, and testosterone/estradiol levels.[12]
    • In patients with hemochromatosis, repeated phlebotomy to remove iron may reverse the gonadotropin deficiency.
  • A report on the use of recombinant human FSH (rhFSH) in the treatment of male infertility found that the total mobile sperm count (TMSC) rose in men with isolated FSH deficiency who received rhFSH therapy.[13] The investigators studied 61 infertile men, including 13 patients with isolated FSH deficiency, who received 100-150 IU of rhFSH 2-3 times per week. The TMSC rose from 6.64 (±3.27) million to 32.4 (±9.09) million in the isolated FSH deficiency patients.
Next

Surgical Care

Surgery is the treatment of choice for patients with gonadotroph adenomas, adrenal tumors, or gonadal tumors, unless contraindicated for other medical reasons.

Previous
Next

Consultations

Consultation with an endocrinologist or gynecologist is frequently helpful for appropriate diagnostic evaluation and management.

Previous
Proceed to Medication
 
 
Contributor Information and Disclosures
Author

Serge A Jabbour, MD, FACP, FACE  Professor of Medicine, Division of Endocrinology, Diabetes and Metabolic Diseases, Jefferson Medical College of Thomas Jefferson University

Serge A Jabbour, MD, FACP, FACE is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians-American Society of Internal Medicine, American Diabetes Association, American Medical Association, American Thyroid Association, Endocrine Society, and Pennsylvania Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Udaya M Kabadi, MD  Professor, Department of Medicine, University of Iowa College of Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Romesh Khardori, MD, PhD, FACP  Professor of Endocrinology, Director of Training Program, Division of Endocrinology, Diabetes and Metabolism, Strelitz Diabetes and Endocrine Disorders Institute, Department of Internal Medicine, Eastern Virginia Medical School

Romesh Khardori, MD, PhD, FACP is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American Diabetes Association, and Endocrine Society

Disclosure: Nothing to disclose.

Mark Cooper, MBBS, PhD, FRACP  Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD  Professor of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

References

  1. Grover A, Smith CE, Gregory M, et al. Effects of FSH receptor deletion on epididymal tubules and sperm morphology, numbers, and motility. Mol Reprod Dev. Oct 2005;72(2):135-44. [Medline].

  2. Karges B, de Roux N. Molecular genetics of isolated hypogonadotropic hypogonadism and Kallmann syndrome. Endocr Dev. 2005;8:67-80. [Medline].

  3. Nagorny P, Sane N, Fasching B, Aussedat B, Danishefsky SJ. Probing the Frontiers of Glycoprotein Synthesis: The Fully Elaborated ß-Subunit of the Human Follicle-Stimulating Hormone. Angew Chem Int Ed Engl. Dec 9 2011;[Medline].

  4. Dandona P, Dhindsa S, Chaudhuri A, et al. Hypogonadotrophic hypogonadism in type 2 diabetes. Aging Male. Sep 2008;11(3):107-17. [Medline].

  5. Ferhi K, Avakian R, Griveau JF, et al. Age as only predictive factor for successful sperm recovery in patients with Klinefelter's syndrome. Andrologia. Apr 2009;41(2):84-7. [Medline].

  6. Wikstrom AM, Dunkel L. Testicular function in Klinefelter syndrome. Horm Res. 2008;69(6):317-26. [Medline].

  7. Van Saen D, Gies I, De Schepper J, Tournaye H, Goossens E. Can pubertal boys with Klinefelter syndrome benefit from spermatogonial stem cell banking?. Hum Reprod. Dec 12 2011;[Medline].

  8. Cools M, Rooman RP, Wauters J, et al. A nonmosaic 45,X karyotype in a mother with Turner's syndrome and in her daughter. Fertil Steril. Oct 2004;82(4):923-5. [Medline].

  9. Livadas S, Xekouki P, Kafiri G, et al. Spontaneous pregnancy and birth of a normal female from a woman with Turner syndrome and elevated gonadotropins. Fertil Steril. Mar 2005;83(3):769-72. [Medline].

  10. Ardawi MS, Rouzi AA. Plasma adiponectin and insulin resistance in women with polycystic ovary syndrome. Fertil Steril. Jun 2005;83(6):1708-16. [Medline].

  11. Walvoord E. Sex steroid replacement for induction of puberty in multiple pituitary hormone deficiency. Pediatr Endocrinol Rev. Jan 2009;6 Suppl 2:298-305. [Medline].

  12. Trabado S, Maione L, Salenave S, Baron S, Galland F, Bry-Gauillard H, et al. Estradiol levels in men with congenital hypogonadotropic hypogonadism and the effects of different modalities of hormonal treatment. Fertil Steril. Jun 2011;95(7):2324-9, 2329.e1-3. [Medline].

  13. Efesoy O, Cayan S, Akbay E. The efficacy of recombinant human follicle-stimulating hormone in the treatment of various types of male factor infertility at a single university hospital. J Androl. May 28 2009;[Medline]. [Full Text].

  14. Andersson AM, Jorgensen N, Frydelund-Larsen L, et al. Impaired Leydig cell function in infertile men: a study of 357 idiopathic infertile men and 318 proven fertile controls. J Clin Endocrinol Metab. Jul 2004;89(7):3161-7. [Medline]. [Full Text].

  15. Aron DC, Findling JW, Tyrrell JB. Hypothalamus & Pituitary. In: Greenspan FS, Strewler GJ, eds. Basic & Clinical Endocrinology. 5th ed. New York, NY: McGraw-Hill; 1997:112-4.

  16. Bachmann G. Physiologic aspects of natural and surgical menopause. J Reprod Med. Mar 2001;46(3 Suppl):307-15. [Medline].

  17. Cevik R, Gur A, Acar S, et al. Hypothalamic-pituitary-gonadal axis hormones and cortisol in both menstrual phases of women with chronic fatigue syndrome and effect of depressive mood on these hormones. BMC Musculoskelet Disord. Dec 8 2004;5(1):47. [Medline].

  18. Conway GS. Premature ovarian failure. Br Med Bull. 2000;56(3):643-9. [Medline].

  19. Fraser IS, Kovacs G. Current recommendations for the diagnostic evaluation and follow-up of patients presenting with symptomatic polycystic ovary syndrome. Best Pract Res Clin Obstet Gynaecol. Oct 2004;18(5):813-23. [Medline].

  20. Gur A, Cevik R, Nas K, et al. Cortisol and hypothalamic-pituitary-gonadal axis hormones in follicular-phase women with fibromyalgia and chronic fatigue syndrome and effect of depressive symptoms on these hormones. Arthritis Res Ther. 2004;6(3):R232-8. [Medline].

  21. Hayes FJ, Seminara SB, Crowley WF Jr. Hypogonadotropic hypogonadism. Endocrinol Metab Clin North Am. Dec 1998;27(4):739-63, vii. [Medline].

  22. Ishikawa T, Fujioka H, Fujisawa M. Clinical and hormonal findings in testicular maturation arrest. BJU Int. Dec 2004;94(9):1314-6. [Medline].

  23. Klibanski A. Nonsecreting pituitary tumors. Endocrinol Metab Clin North Am. Sep 1987;16(3):793-804. [Medline].

  24. Lamberts SW, de Herder WW, van der Lely AJ. Pituitary insufficiency. Lancet. Jul 11 1998;352(9122):127-34. [Medline].

  25. McDonough PG. Molecular abnormalities of FSH and LH action. Ann N Y Acad Sci. Nov 2003;997:22-34. [Medline].

  26. McIver B, Romanski SA, Nippoldt TB. Evaluation and management of amenorrhea. Mayo Clin Proc. Dec 1997;72(12):1161-9. [Medline].

  27. Plymate S. Hypogonadism. Endocrinol Metab Clin North Am. Dec 1994;23(4):749-72. [Medline].

  28. Practice Committee of the American Society for Reproductive Medicine. Current evaluation of amenorrhea. Fertil Steril. Jul 2004;82(1):266-72. [Medline].

  29. Silber SJ. Evaluation and treatment of male infertility. Clin Obstet Gynecol. Dec 2000;43(4):854-88. [Medline].

  30. Wang C, Swerdloff RS. Androgen replacement therapy. Ann Med. Oct 1997;29(5):365-70. [Medline].

  31. Women's Health Initiative. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA. Jul 17 2002;288(3):321-33. [Medline].

  32. Young J, Chanson P, Salenave S, et al. Testicular anti-mullerian hormone secretion is stimulated by recombinant human FSH in patients with congenital hypogonadotropic hypogonadism. J Clin Endocrinol Metab. Feb 2005;90(2):724-8. [Medline].

 
Previous
Next
 
Human G protein-coupled receptor 54 (GPR54) receptor model. Mutations identified in patients with idiopathic hypogonadotropic hypogonadism are indicated.
This is a frequently sampled serum luteinizing hormone (LH) profile in a male patient with Kallmann syndrome (KS), compared with that in a healthy individual. A lack of LH pulsatility is seen in the former.
Magnetic resonance imaging (MRI) scan of pituitary macroadenoma.
Adolescent male with Klinefelter syndrome who has female-type distribution of pubic hair, as well as testicular dysgenesis.
Hypoplastic right hemiscrotum in a patient with an undescended right testis.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.