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Luteinizing Hormone Deficiency Treatment & Management

  • Author: Nichole M Barker, DO; Chief Editor: Richard Scott Lucidi, MD, FACOG  more...
 
Updated: Oct 30, 2014
 

Medical Care

Hypogonadotropic hypogonadism

Treatment of hypogonadotropic hypogonadism depends on the gender and age of the patient as well as their desire for current fertility.

Females with delayed puberty secondary to hypogonadotropic hypogonadism are treated with estrogen to promote development of secondary sexual characteristics. Adult women with hypogonadotropic hypogonadism who desire fertility undergo ovulation induction with injectable gonadotropins. Clomiphene citrate is typically not effective for inducing ovulation in these patients. Women who do not desire pregnancy are treated with estrogen to prevent osteoporosis. Cyclic progestins are added to decrease the risk of endometrial cancer.[16]

Women with hypogonadotropic hypogonadism secondary to anorexia nervosa or exercise can resume normal menses by gaining and maintaining weight equal at least to 15% of ideal body weight. Mild cases of anorexia nervosa may be treated on an outpatient basis under the care of a primary care physician, psychiatrist, psychologist, and/or nutritionist. Severe cases may require hospital admission for aggressive psychiatric rehabilitation and medical management. Mortality associated with anorexia has been reported to be as high as 15%.[17, 18]

Males with delayed puberty secondary to hypogonadotropic hypogonadism are treated with testosterone to promote the development of secondary sexual characteristics. Likewise, adult men with IHH who do not desire fertility are treated with testosterone to restore libido and secondary sexual characteristics.

Adult men with IHH who desire fertility can be treated with a subcutaneous pump that delivers pulses of GnRH. Alternatively, maintenance treatment clomiphene citrate therapy improves both sexual function and sperm production in men with IHH. Clomiphene citrate does not appear to increase testosterone secretion or sperm production in men with Kallmann syndrome.

Pituitary dysfunction

Men and women with LH deficiency secondary to pituitary dysfunction require treatment depending on the presenting symptoms and associated hormonal disorders. Most commonly, these patients have a pituitary adenoma and hyperprolactinemia. Men and women who desire fertility are best treated medically with a dopamine agonist (eg, bromocriptine, cabergoline), which inhibits prolactin secretion. Most patients with macroadenomas (>1 cm in diameter) are treated with a dopamine agonist to decrease the chance of further growth. Women with hyperprolactinemia who do not desire fertility but have amenorrhea are treated with oral contraceptives or cyclic estrogen and progestin as long as they do not have a macroadenoma.[11] Panhypopituitarism can result in life-threatening adrenal crisis (see Addison Disease). Patients with this condition require lifelong treatment with replacement thyroid and adrenal hormones in addition to the medical treatment discussed above.

Luteal phase deficiency

Women with LPD who are unable to achieve pregnancy are most commonly treated with ovulation induction using clomiphene citrate or injectable human gonadotropins. Women who are able to achieve pregnancy but have recurrent pregnancy losses are more commonly treated with luteal support using progesterone administered orally, vaginally, or by injection.

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Surgical Care

Most conditions that result in LH deficiency are not amenable to surgical therapy. One notable exception is the pituitary adenoma. Surgical therapy is required for large pituitary adenomas, those that continue to enlarge despite dopamine agonist treatment or those that impact the visual field irrespective of size. Most commonly, this type of microsurgery is performed using a transsphenoidal approach. This surgery has a risk of panhypopituitarism or persistent nasal leakage of cerebral spinal fluid.

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Consultations

Kallmann syndrome

These patients are treated by endocrinologists (pediatric, reproductive, or medical) or urologists, depending on their gender and age. Genetic counseling is important, as this condition is often hereditable.

Hypogonadotropic hypogonadism

Women with this condition are most commonly cared for by reproductive endocrinologists (obstetrician-gynecologists with subspecialty training). Some patients with stress-related hypogonadotropic hypogonadic amenorrhea require psychological therapy as well, particularly in the cases of anorexia nervosa or bulimia, which can be fatal.

Men with hypogonadotropic hypogonadism are usually treated by urologists who specialize in infertility and impotence, since these are common presenting symptoms.

Pituitary dysfunction

Women with isolated hyperprolactinemia or anovulation related to pituitary dysfunction are treated by reproductive endocrinologists. Men with infertility related to pituitary dysfunction are often cared for by urologists who specialize in infertility.

Men or women with panhypopituitarism are cared for by medical endocrinologists. Those with pituitary tumors that are symptomatic (headaches, visual disturbances) or enlarging, despite medical therapy, should be referred to neurosurgeons with special expertise in transsphenoidal surgery.

Luteal phase deficiency

Women with LPD are cared for by reproductive endocrinologists or gynecologists with a special interest in infertility.

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Diet

No specific dietary recommendations have been made for the conditions associated with LH deficiency.

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Activity

No specific activity recommendations have been made for the conditions that cause LH deficiency.

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Contributor Information and Disclosures
Author

Nichole M Barker, DO Physician in Reproductive Endocrinology and Infertility, Seattle Reproductive Medicine

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

Disclosure: Nothing to disclose.

Coauthor(s)

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, MD is a member of the following medical societies: American Urological Association

Disclosure: Received consulting fee from lilly for consulting; Received consulting fee from abbott for consulting; Received consulting fee from auxilium for consulting; Received consulting fee from actient for consulting; Received honoraria from journal of urology for board membership; Received consulting fee from endo for consulting.

William W Hurd, MD, MSc, MPH Professor and Director, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke University Medical Center

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

Disclosure: Nothing to disclose.

Rebecca Flyckt, MD Associate Staff, Reproductive Endocrinology and Infertility, Cleveland Clinic

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

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

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

Disclosure: Nothing to disclose.

Acknowledgements

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. 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. 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. 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. Falcone T, Hurd WW, eds. Clinical reproductive medicine and surgery. New York: Elsevier; 2007. 73-84.

  5. Loret de Mola JR. Amenorrhea. 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. 2007 Aug 30. 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. 2004 Dec 16. 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. 1998 Jun 11. 338(24):1729-32. [Medline].

  9. Kalantaridou SN, Makrigiannakis A, Zoumakis E, Chrousos GP. Stress and the female reproductive system. J Reprod Immunol. 2004 Jun. 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. 1995 May. 126(5 Pt 1):683-9. [Medline].

  11. Sehu S, Reddy K, Fleseriu M. Management of pituitary, thyroid and adrenal disorders. 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. 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. 1984 Feb. 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. 1999 Dec 4. 319(7223):1467-8. [Medline].

  16. Solnik JM, Sanfilippo JS. Normal puberty and pubertal disorders. 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. 1991 Apr. 158:495-502. [Medline].

  18. Zipfel S, Lowe B, Reas DL, Deter HC, Herzog W. Long-term prognosis in anorexia nervosa: lessons from a 21-year follow-up study. Lancet. 2000 Feb 26. 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. 1998 Jul. 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. 2006 Mar. 9(1):41-51. [Medline].

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

  22. Pritts SD, Susman J. Diagnosis of eating disorders in primary care. Am Fam Physician. 2003 Jan 15. 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. 2007 Aug 30. 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. 2001 Aug 1. 64(3):445-50. [Medline].

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

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