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Prevalence and treatment of central hypogonadism and hypoandrogenism in women with hypopituitarism

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgements

This study was supported by the Swedish Research Council, the Swedish Heart–Lung Foundation, the ALF (Avtal om Läkarutbildning och Forskning) research grant, Gothenburg, the Marianne and Marcus Wallenberg Foundation, AFA Insurance, the Novo Nordisk Foundation, the Inga-Britt and Arne Lundberg Foundation and the Scientific Council in the Region of Halland.

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Authors and Affiliations

  1. Department of Medicine, Hospital of Halland, Tölövägen 3, 434 80, Kungsbacka, Sweden

    Catharina Olivius

  2. Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden

    Kerstin Landin-Wilhelmsen, Daniel S. Olsson, Gudmundur Johannsson & Åsa Tivesten

  3. Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Kerstin Landin-Wilhelmsen, Daniel S. Olsson, Gudmundur Johannsson & Åsa Tivesten

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  1. Catharina Olivius
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  2. Kerstin Landin-Wilhelmsen
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Correspondence to Catharina Olivius.

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Olivius, C., Landin-Wilhelmsen, K., Olsson, D.S. et al. Prevalence and treatment of central hypogonadism and hypoandrogenism in women with hypopituitarism. Pituitary 21, 445–453 (2018). https://doi.org/10.1007/s11102-018-0895-1

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