Investigating the potential of clinical and biochemical markers to
diagnose functional hypothalamic amenorrhoea in females with
amenorrhoea: a retrospective observational study.
Abstract
Objective: Functional hypothalamic amenorrhoea (FHA) is a common cause
of amenorrhoea, but few non-specialist clinicians are able to diagnose
affected women. The aim of this study was to investigate the clinical
and biochemical features of FHA, compared to that of polycystic ovarian
syndrome (PCOS) and assess the diagnostic performance of the different
parameters for differentiating between the two conditions. Design: A
retrospective observational study Setting: Specialist reproductive
endocrine gynaecology clinic, St Mary’s Hospital, London, UK Population:
Women diagnosed with FHA and PCOS following specialist assessment.
Methods: Clinical and biochemical data were collected from electronic
hospital data base. Results: Compared with PCOS, women with FHA had
significantly lower body mass index (BMI) (20.1±2.9 vs 31.1±7.8 kg/m2,
P<0.0001) and a thinner endometrium (3.75±2.23 vs 6.82±3.32
mm, P<0.0001). Women with FHA had significantly lower
luteinising hormone (LH) (3.46±7.31 vs 8.79±4.98 IU/L, P<
0.0001), as well as lower LH: follicle stimulating hormone (FSH) ratio,
estradiol, thyroid-stimulating, free thyroxine and prolactin levels;
there was no significant difference in FSH levels. Low BMI had the
greatest predictive performance for FHA (area under the curve [AUC];
0.93, P<0.001), followed by low estradiol (AUC 0.89,
P<0.001), low LH (AUC 0.88, P<0.001) and LH:FSH
ratio (AUC 0.86, P<0.001). Conclusions: Our data provides
quantification for diagnostic accuracy of clinical parameters to
differentiate FHA from PCOS, namely low BMI, estradiol, LH and LH:FSH
ratio. These data could help clinicians more reliably diagnose FHA in
women with secondary amenorrhoea. Key words: Amenorrhoea, Hypogonadism,
Polycystic Ovarian Syndrome, Luteinising Hormone