Department of Medicine, Hospital of Halland, Tölövägen 3, 434 80, Kungsbacka, Sweden.
Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Pituitary. 2018 Oct;21(5):445-453. doi: 10.1007/s11102-018-0895-1.
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.
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.
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.
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.
患有垂体功能减退症的女性发病率和死亡率增加，而性腺功能减退症被认为是一个促成因素。本研究的目的是在瑞典的一家中心研究垂体功能减退症女性的中枢性性腺功能减退症和低雄激素血症的患病率。
所有连续的（n=184）在哥德堡的萨尔格伦斯卡大学医院于 1995 年至 2015 年间开始生长激素（GH）替代治疗的女性都被纳入本研究。根据内分泌学会的临床实践指南，基于月经史结合实验室测量，使用严格的标准来定义中枢性性腺功能减退症。低雄激素血症定义为脱氢表雄酮硫酸盐和/或雄烯二酮的水平低于正常值。
78%的女性存在中枢性性腺功能减退症，其中≤52 岁的女性占 75%，>52 岁的女性占 82%。所有女性中 61%存在低雄激素血症，其中促肾上腺皮质激素（ACTH）缺乏的女性占 92%。≤52 岁的低性腺激素血症女性的雌激素替代率低于其他垂体激素轴（74%比 100%，P<0.001）。2000 年至 2016 年期间，雌激素替代的应用呈下降趋势。很少有女性接受雄激素治疗。
在这项对垂体功能减退症女性性腺功能减退症的首次研究中，使用严格的性腺功能减退症诊断标准，中枢性性腺功能减退症和低雄激素水平的患病率较高，雌激素替代治疗不足。需要进一步研究来阐明性腺功能减退症和性激素替代不足对垂体功能减退女性发病率增加的重要性。
