Section of Endocrinology and Investigative Medicine, Hammersmith Hospital, Imperial College London, London, UK.
Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK.
Clin Endocrinol (Oxf). 2021 Aug;95(2):239-252. doi: 10.1111/cen.14402. Epub 2021 Jan 19.
Secondary oligo/amenorrhoea occurs in 3%-5% of women of reproductive age. The two most common causes are polycystic ovary syndrome (PCOS) (2%-13%) and functional hypothalamic amenorrhoea (FHA) (1%-2%). Whilst both conditions have distinct pathophysiology and their diagnosis is supported by guidelines, in practice, differentiating these two common causes of menstrual disturbance is challenging. Moreover, both diagnoses are qualified by the need to first exclude other causes of menstrual disturbance.
To review clinical, biochemical and radiological parameters that could aid the clinician in distinguishing PCOS and FHA as a cause of menstrual disturbance.
FHA is uncommon in women with BMI > 24 kg/m , whereas both PCOS and FHA can occur in women with lower BMIs. AMH levels are markedly elevated in PCOS; however, milder increases may also be observed in FHA. Likewise, polycystic ovarian morphology (PCOM) is more frequently observed in FHA than in healthy women. Features that are differentially altered between PCOS and FHA include LH, androgen, insulin, AMH and SHBG levels, endometrial thickness and cortisol response to CRH. Other promising diagnostic tests with the potential to distinguish these two conditions pending further study include assessment of 5-alpha-reductase activity, leptin, INSL3, kisspeptin and inhibin B levels.
Further data directly comparing the discriminatory potential of these markers to differentiate PCOS and FHA in women with secondary amenorrhoea would be of value in defining an objective probability for PCOS or FHA diagnosis.
继发性闭经在育龄妇女中的发生率为 3%-5%。最常见的两个原因是多囊卵巢综合征（PCOS）（2%-13%）和功能性下丘脑性闭经（FHA）（1%-2%）。虽然这两种情况的病理生理学有明显的不同，其诊断也有指南支持，但实际上，区分这两种常见的月经失调原因具有挑战性。此外，这两种诊断都需要首先排除其他原因引起的月经失调。
综述有助于临床医生区分 PCOS 和 FHA 作为月经失调原因的临床、生化和影像学参数。
BMI>24kg/m2的女性中 FHA 不常见，而 PCOS 和 FHA 均可发生在 BMI 较低的女性中。AMH 水平在 PCOS 中显著升高；然而，在 FHA 中也可能观察到较轻的升高。同样，多囊卵巢形态（PCOM）在 FHA 中比在健康女性中更常见。PCOS 和 FHA 之间存在差异的特征包括 LH、雄激素、胰岛素、AMH 和 SHBG 水平、子宫内膜厚度和 CRH 对皮质醇的反应。其他有希望的诊断测试，具有潜在区分这两种情况的能力，包括评估 5-α-还原酶活性、瘦素、INSL3、kisspeptin 和抑制素 B 水平。
进一步比较这些标志物在区分继发性闭经的 PCOS 和 FHA 方面的鉴别潜力的直接数据，将有助于确定 PCOS 或 FHA 诊断的客观可能性。
