Luteinizing Hormone Deficiency Clinical Presentation

  • Author: Nichole M Barker, DO; Chief Editor: Richard Scott Lucidi, MD   more...
 
Updated: Mar 23, 2012
 

History

  • Kallmann syndrome presents in males and females with delayed puberty and anosmia. These patients lack secondary sexual characteristics. Female patients also give a history of primary amenorrhea.
  • In children, idiopathic hypogonadotropic hypogonadism (IHH) can present identical to Kallmann syndrome, but without anosmia. Adult-onset IHH presents in men as sexual dysfunction and infertility and in women as amenorrhea.
  • Stress-related hypogonadotropic hypogonadism presents in women as amenorrhea. Women who lose 10-15% of normal weight for any reason, including excessive exercise, malnutrition, anorexia nervosa, or bulimia, often experience menstrual irregularities or amenorrhea.[5, 13] Anorexia nervosa presents with weight loss greater than 15% of ideal body weight, behavioral changes (ie, altered self-image), and amenorrhea. Bulimia nervosa typically presents with menstrual irregularities and oligomenorrhea. Patients with anorexia and bulimia may also present with depressive episodes, social withdrawal, and other psychosocial disturbances. Men with hypogonadotropic hypogonadism usually present with a chief complaint of decreased libido and erectile dysfunction.
  • Pituitary dysfunction in women can result in irregular menses or amenorrhea.[5] In the presence of hyperprolactinemia, approximately one third of women have galactorrhea as well. Men with hyperprolactinemia can present with hypogonadism, impotence, infertility, and/or galactorrhea. Occasionally, patients with pituitary tumors complain of visual changes or headaches. Patients with panhypopituitarism often present with fatigue, hypotension, cold intolerance, or inadequate growth.
  • Luteal phase deficiency can manifest in women as infertility or recurrent pregnancy loss.
Next

Physical

  • Patients with Kallmann syndrome and IHH fail to develop secondary sex characteristics, eg, facial, body, and pubic hair; musculature; and deeper voice in men and underarm and pubic hair, breasts, and body shape in women. Patients with Kallmann syndrome are also affected by either anosmia or severe hyposmia.
  • Female athletes in training with amenorrhea caused by hypogonadotropic hypogonadism are noted to have minimal body fat. Patients with anorexic nervosa usually have < 15% ideal body fat. Physical findings in patients suffering from anorexia or bulimia can include lanugo (fine, soft, lightly pigmented hair), dry skin, and/or poor dental enamel from excessive vomiting. Severe cases may result in potential life-threatening gastrointestinal or cardiopulmonary conditions.
  • Women with prolactinomas present with hyperprolactinemia and, in approximately one third of cases, galactorrhea. Less common symptoms include those related to increased TSH (hyperthyroidism) or GH (acromegaly) levels. Visual field defects resulting from pressure of a pituitary tumor on the optic chiasm are rare. Men or women with panhypopituitarism often have physical findings related to hypothyroidism or adrenal insufficiency.
  • Luteal phase deficiency does not manifest with physical findings.
Previous
Next

Causes

  • Kallmann syndrome
    • Genetic
  • Hypogonadotropic hypogonadism
    • Genetic
    • Idiopathic
    • Prolonged Strenuous Exercise
    • Anorexia Nervosa/Bulimia
    • Starvation
  • Pituitary dysfunction
    • Pituitary tumors
    • Pituitary Infarction
  • Luteal phase deficiency
    • Idiopathic
Previous
Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Nichole M Barker, DO  Fellow in Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University Hospitals/Case Medical Center

Nichole M Barker, DO is a member of the following medical societies: American College of Obstetricians and Gynecologists and American Society for Reproductive Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Rebecca Flyckt, MD  Fellow, Reproductive Endocrinology and Infertility

Disclosure: Nothing to disclose.

Allen Donald Seftel  MD, Professor of Urology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School; Head, Division of Urology, Director, Urology Residency Training Program, Cooper University Hospital

Allen Donald Seftel is a member of the following medical societies: American Urological Association

Disclosure: lilly Consulting fee Consulting; sanofi-aventis Consulting fee Consulting; auxilium Consulting fee Consulting; solvay Consulting fee Consulting; plethora Grant/research funds clinical trial; endo Consulting fee Consulting; nature publishing journal editor

William W Hurd, MD, MSc  Professor of Reproductive Biology, Case Western Reserve University School of Medicine; Lilian Hanna Baldwin Chair in Gynecology and Obstetrics, Director, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University Hospitals Case Medical Center

William W Hurd, MD, MSc is a member of the following medical societies: Alpha Omega Alpha, American Association of Gynecologic Laparoscopists, American College of Obstetricians and Gynecologists, American College of Physician Executives, American College of Surgeons, American Gynecological and Obstetrical Society, American Medical Association, American Society for Reproductive Medicine, Society for Gynecologic Investigation, and Society of Reproductive Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Karen Loeb Lifford, MD  Director of General Gynecology, Associate Program Director, Department of Obstetrics and Gynecology, Instructor, Brigham and Women's Hospital, Harvard Medical School

Karen Loeb Lifford, MD is a member of the following medical societies: Association of Professors of Gynecology and Obstetrics, Massachusetts Medical Society, and Phi Beta Kappa

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

Frederick B Gaupp, MD  Consulting Staff, Department of Family Practice, Hancock Medical Center

Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians

Disclosure: Nothing to disclose.

Chief Editor

Richard Scott Lucidi, MD  Associate Professor of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine

Richard Scott Lucidi, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists and American Society for Reproductive Medicine

Disclosure: Nothing to disclose.

Additional Contributors

MRI of pituitary adenoma courtesy of Kristine Blackham, MD, University Hospitals Case Medical Center, Department of Radiology

References

  1. Speroff L, Fritz MA. Hormone Biosynthesis, Metabolism, and Mechanism of Action. In: Weinberg RW, Murphy J, Pancotti R. Clinical Gynecologic Endocrinology and Infertility. 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005:77-81.

  2. Speroff L, Fritz MA. Neuroendocrinology. In: Weinberg RW, Murphy J, Pancotti R. Clinical Gynecologic Endocrinology and Infertility. 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005:145-173.

  3. Mahutte NG, Ouhilal S. Hypothalamic-pituitary-ovarian axis & control of the menstrual cycle. In: Falcone T, Hurd WW, eds. Clinical reproductive medicine and surgery. First ed. New York: Elsevier; 2007:1-16.

  4. Sharma RK. Physiology of Male Gametogenesis. In: Falcone T, Hurd WW, eds. Clinical reproductive medicine and surgery. New York: Elsevier; 2007:73-84.

  5. Loret de Mola JR. Amenorrhea. In: Falcone T, Hurd WW, eds. Clinical reproductive medicine and surgery. New York: Elsevier; 2007:233-52.

  6. Lofrano-Porto A, Barra GB, Giacomini LA, Nascimento PP, Latronico AC, Casulari LA. Luteinizing hormone beta mutation and hypogonadism in men and women. N Engl J Med. Aug 30 2007;357(9):897-904. [Medline].

  7. Valdes-Socin H, Salvi R, Daly AF, Gaillard RC, Quatresooz P, Tebeu PM. Hypogonadism in a patient with a mutation in the luteinizing hormone beta-subunit gene. N Engl J Med. Dec 16 2004;351(25):2619-25. [Medline].

  8. Phillip M, Arbelle JE, Segev Y, Parvari R. Male hypogonadism due to a mutation in the gene for the beta-subunit of follicle-stimulating hormone. N Engl J Med. Jun 11 1998;338(24):1729-32. [Medline].

  9. Kalantaridou SN, Makrigiannakis A, Zoumakis E, Chrousos GP. Stress and the female reproductive system. J Reprod Immunol. Jun 2004;62(1-2):61-8. [Medline].

  10. Hergenroeder AC. Bone mineralization, hypothalamic amenorrhea, and sex steroid therapy in female adolescents and young adults. J Pediatr. May 1995;126(5 Pt 1):683-9. [Medline].

  11. Sehu S, Reddy K, Fleseriu M. Management of pituitary, thyroid and adrenal disorders. In: Falcone T, Hurd WW, eds. Clinical reproductive medicine and surgery. New York: Elsevier; 2007:311-34.

  12. Fluker M, Fisher S. Anovulation and ovulatory dysfunction. In: Falcone T, Hurd WW. Clinical reproductive medicine and surgery. New York: Elsevier; 2007:277-86.

  13. Walsh BT, Roose SP, Katz JL, Dyrenfurth I, Wright L, Vande Wiele R. Hypothalamic-pituitary-adrenal-cortical activity in anorexia nervosa and bulimia. Psychoneuroendocrinology. 1987;12(2):131-40. [Medline].

  14. Doty RL, Shaman P, Kimmelman CP, Dann MS. University of Pennsylvania Smell Identification Test: a rapid quantitative olfactory function test for the clinic. Laryngoscope. Feb 1984;94(2 Pt 1):176-8. [Medline].

  15. Morgan JF, Reid F, Lacey JH. The SCOFF questionnaire: assessment of a new screening tool for eating disorders. BMJ. Dec 4 1999;319(7223):1467-8. [Medline].

  16. Solnik JM, Sanfilippo JS. Normal puberty and pubertal disorders. In: Falcone T, Hurd WW, eds. Clinical reproductive medicine and surgery. New York: Elsevier; 2007:157-70.

  17. Ratnasuriya RH, Eisler I, Szmukler GI, Russell GF. Anorexia nervosa: outcome and prognostic factors after 20 years. Br J Psychiatry. Apr 1991;158:495-502. [Medline].

  18. Zipfel S, Löwe B, Reas DL, Deter HC, Herzog W. Long-term prognosis in anorexia nervosa: lessons from a 21-year follow-up study. Lancet. Feb 26 2000;355(9205):721-2. [Medline].

  19. Cahill DJ, Wardle PG, Harlow CR, Hull MG. Onset of the preovulatory luteinizing hormone surge: diurnal timing and critical follicular prerequisites. Fertil Steril. Jul 1998;70(1):56-9. [Medline].

  20. McComb JJ, Qian XP, Veldhuis JD, J McGlone J, Norman RL. Neuroendocrine responses to psychological stress in eumenorrheic and oligomenorrheic women. Stress. Mar 2006;9(1):41-51. [Medline].

  21. Patel SS, Bamigboye V. Hyperprolactinaemia. J Obstet Gynaecol. Jul 2007;27(5):455-9. [Medline].

  22. Pritts SD, Susman J. Diagnosis of eating disorders in primary care. Am Fam Physician. Jan 15 2003;67(2):297-304. [Medline].

  23. Raivio T, Falardeau J, Dwyer A, Quinton R, Hayes FJ, Hughes VA. Reversal of idiopathic hypogonadotropic hypogonadism. N Engl J Med. Aug 30 2007;357(9):863-73. [Medline].

  24. Seidenfeld ME, Rickert VI. Impact of anorexia, bulimia and obesity on the gynecologic health of adolescents. Am Fam Physician. Aug 1 2001;64(3):445-50. [Medline].

  25. Yao MWM, Batchu K. Oogenesis. In: Falcone T, Hurd WW, eds. Clinical reproductive medicine and surgery. New York: Elsevier; 2007:51-72.

 
Previous
Next
 
Basal body temperature (BBT) chart.
MRI of pituitary macroadenoma.
 
 
 
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.