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功能性下丘脑性闭经(functional hypothalamic amenorrhoea, FHA)属于低促性腺激素性闭经,是继发性闭经的常见病因,也可见于原发性闭经患者。FHA诊断前需先除外器质性病变或药源性因素,并与多囊卵巢综合征、非典型性先天性肾上腺皮质增生等疾病相鉴别,针对性药物选择上有差别。FHA最常见于过度减重、神经性厌食、精神打击等情况,其病理过程通常是可逆的,经增加体重、减少运动量、行为心理干预等治疗后可恢复排卵。下丘脑性闭经可通过达必佳刺激试验与垂体性闭经相鉴别,在需要诱导排卵时,可选择GnRH脉冲治疗。本文从两例有一定代表性的闭经病例出发,对FHA的诊断和治疗进行复习和讨论。
Abstract：[1] 田秦杰葛秦生主编.实用女性生殖内分泌学(第2版)[M].北京：人民卫生出版社，2018.
[2] Gordon CM.Clinical practice.Functional hypothalamic amenorrhea[J].N Engl J Med,2010,363:365-371.
[3] Giles DE,Berga SL.Cognitive and psychiatric correlates of functional hypothalamic amenorrhea:a controlled comparison[J].Fertil Steril,1993,60:486-492.
[4] Marcus MD,Loucks TL,Berga SL.Psychological correlates of functional hypothalamic amenorrhea[J].Fertil Steril,2001,76:310-316.
[5] Meczekalski B,Podfigurna-Stopa A,Warenik-Szymankiewicz A,et al.Functional hypothalamic amenorrhea:current view on neuroendocrine aberrations[J].Gynecol Endocrinol,2008,24:4-11.
[6] Loucks AB,Kiens B,Wright HH.Energy availability in athletes[J].J Sports Sci,2011,29(Suppl 1):S7-S15.
[7] Williams NI,Leidy HJ,Hill BR,et al.Magnitude of daily energy deficit predicts frequency but not severity of menstrual disturbances associated with exercise and caloric restriction[J].Am J Physiol Endocrinol Metab,2015,308:E29-E39.
[8] Pauli SA,Berga SL.Athletic amenorrhea:energy deficit or psychogenic challenge?[J].Ann N Y Acad Sci,2010,1205:33-38.
[9] Bomba M,Gambera A,Bonini L,et al.Endocrine profiles and neuropsychologic correlates of functional hypothalamic amenorrhea in adolescents[J].Fertil Steril,2007,87:876-885.
[10] Gordon CM,Ackerman KE,Berga SL,et al.Functional hypothalamic amenorrhea:an Endocrine Society Clinical Practice Guideline[J].J Clin Endocrinol Metab,2017,102:1413-1439.
[11] Golden NH,Jacobson MS,Schebendach J,et al.Resumption of menses in anorexia nervosa[J].Arch Pediatr Adolesc Med,1997,151:16-21.
[12] Berga SL,Marcus MD,Loucks TL,et al.Recovery of ovarian activity in women with functional hypothalamic amenorrhea who were treated with cognitive behavior therapy[J].Fertil Steril,2003,80:976-981.
[13] Reindollar RH,Novak M,Tho SP,et al.Adult-onset amenorrhea:a study of 262 patients[J].Am J Obstet Gynecol,1986,155:531-543.
[14] Reindollar RH,Byrd JR,McDonough PG.Delayed sexual development:a study of 252 patients[J].Am J Obstet Gynecol,1981,140:371-380.
[15] Robin G,Gallo C,Catteau-Jonard S,et al.Polycystic ovary-like abnor-malities(PCO-L) in women with functional hypothalamic amenorrhea[J].J Clin Endocrinol Metab,2012,97:4236-4243.
[16] Carmina E,Fruzzett F,Lobo RA.Increased antiMullerian hormone levels and ovarian size in a subgroup of women with functional hypothalamic amenorrhea:further identification of the link between polycystic ovary syndrome and functional hypothalamic amenorrhea[J].Am J Obstet Gynecol,2016,214:714-716.
[17] 陈怡，张兰梅.下丘脑性闭经误诊为多囊卵巢综合征一例及文献复习[J/OL].实用妇科内分泌电子杂志，2019,6:197-198.
[18] 中国医师协会内分泌代谢科医师分会.促性腺激素释放素(GnRH)脉冲治疗专家共识(草案)[J].中华内分泌代谢杂志，2016,32:628-633.
基本信息:
中图分类号:R711.51
引用信息:
[1]袁志英,邓姗.从闭经中识别功能性下丘脑性闭经[J].生殖医学杂志,2022,31(01):98-101.
2022-01-15
2022-01-15