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Clinical and biochemical discriminants between functional hypothalamic amenorrhoea (FHA) and polycystic ovary syndrome (PCOS)

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Title: Clinical and biochemical discriminants between functional hypothalamic amenorrhoea (FHA) and polycystic ovary syndrome (PCOS)
Authors: Phylactou, M
Clarke, S
Patel, B
Baggaley, C
Jayasena, C
Kelsey, T
Comninos, A
Dhillo, W
Abbara, A
Item Type: Journal Article
Abstract: Background 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. Aim To review clinical, biochemical and radiological parameters that could aid the clinician in distinguishing PCOS and FHA as a cause of menstrual disturbance. Results FHA is uncommon in women with BMI > 24 kg/m2, 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. Conclusion 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.
Issue Date: Aug-2021
Date of Acceptance: 16-Dec-2020
URI: http://hdl.handle.net/10044/1/86305
DOI: 10.1111/cen.14402
ISSN: 0300-0664
Publisher: Society for Endocrinology
Start Page: 239
End Page: 252
Journal / Book Title: Clinical Endocrinology
Volume: 95
Issue: 2
Copyright Statement: © 2020 The Authors. Clinical Endocrinology published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Sponsor/Funder: National Institute for Health Research
National Institute for Health Research
Funder's Grant Number: CS-2018-18-ST2-002
Keywords: Science & Technology
Life Sciences & Biomedicine
Endocrinology & Metabolism
functional hypothalamic amenorrhoea
polycystic ovary syndrome (PCOS)
functional hypothalamic amenorrhoea
polycystic ovary syndrome (PCOS)
1103 Clinical Sciences
1114 Paediatrics and Reproductive Medicine
Endocrinology & Metabolism
Publication Status: Published
Online Publication Date: 2020-12-23
Appears in Collections:Department of Metabolism, Digestion and Reproduction
Faculty of Medicine

This item is licensed under a Creative Commons License Creative Commons