Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 0NN, UK.
Department of Endocrinology, National University of Singapore, Singapore 117549.
Endocr Rev. 2024 Mar 4;45(2):171-189. doi: 10.1210/endrev/bnad027.
Obesity-related hypogonadotropic hypogonadism is a well-characterized condition in men (termed male obesity-related secondary hypogonadism; MOSH); however, an equivalent condition has not been as clearly described in women. The prevalence of polycystic ovary syndrome (PCOS) is known to increase with obesity, but PCOS is more typically characterized by increased gonadotropin-releasing hormone (GnRH) (and by proxy luteinizing hormone; LH) pulsatility, rather than by the reduced gonadotropin levels observed in MOSH. Notably, LH levels and LH pulse amplitude are reduced with obesity, both in women with and without PCOS, suggesting that an obesity-related secondary hypogonadism may also exist in women akin to MOSH in men. Herein, we examine the evidence for the existence of a putative non-PCOS "female obesity-related secondary hypogonadism" (FOSH). We précis possible underlying mechanisms for the occurrence of hypogonadism in this context and consider how such mechanisms differ from MOSH in men, and from PCOS in women without obesity. In this review, we consider relevant etiological factors that are altered in obesity and that could impact on GnRH pulsatility to ascertain whether they could contribute to obesity-related secondary hypogonadism including: anti-Müllerian hormone, androgen, insulin, fatty acid, adiponectin, and leptin. More precise phenotyping of hypogonadism in women with obesity could provide further validation for non-PCOS FOSH and preface the ability to define/investigate such a condition.
肥胖相关性低促性腺激素性性腺功能减退症是一种已被充分描述的男性疾病（称为男性肥胖相关性继发性性腺功能减退症；MOSH）；然而，在女性中，尚未明确描述类似的情况。多囊卵巢综合征（PCOS）的患病率随着肥胖而增加，但 PCOS 的典型特征是促性腺激素释放激素（GnRH）（间接的黄体生成素；LH）脉冲性增加，而不是 MOSH 中观察到的促性腺激素水平降低。值得注意的是，LH 水平和 LH 脉冲幅度随着肥胖而降低，无论女性是否患有 PCOS，这表明肥胖相关的继发性性腺功能减退症也可能存在于女性中，类似于男性中的 MOSH。在此，我们研究了是否存在一种假定的非 PCOS“女性肥胖相关性继发性性腺功能减退症”（FOSH）的证据。我们概述了在这种情况下发生性腺功能减退的潜在机制，并考虑了这些机制与男性中的 MOSH 以及肥胖女性中的非 PCOS PCOS 之间的区别。在这篇综述中，我们考虑了肥胖时改变的相关病因因素，这些因素可能会影响 GnRH 脉冲性，以确定它们是否会导致肥胖相关性继发性性腺功能减退症，包括：抗苗勒氏管激素、雄激素、胰岛素、脂肪酸、脂联素和瘦素。对肥胖女性性腺功能减退症进行更精确的表型分析，可以进一步验证非 PCOS FOSH 的存在，并为定义/研究这种情况提供前提。
