Causes of Anovulation: Normogonadotropic Normoestrogenic Anovulation Non-PCOS

!DOCTYPE html>

4

Causes of Anovulation: Normogonadotropic Normoestrogenic Anovulation Non-PCOS

Sharon V. Lie Fong and Yvonne V. Louwers

Introduction

The majority of anovulatory women present with normal serum gonadotrophin levels and normal estradiol levels. Of these women, about 10% do not comply with diagnostic criteria for polycystic ovary syndrome (PCOS) according to the Rotterdam consensus (1). Whether or not this should be recognized as a subgroup with a different etiology and prognosis will be discussed further on.

Overview of Existing Evidence

Normogonadotropic anovulation is the most frequent cause of anovulatory infertility and includes women with a heterogeneous phenotype. Because the vast majority of normogonadotropic women has PCOS, WHO 2 anovulation non-PCOS can only be diagnosed after Rotterdam PCOS characteristics have been ruled out (1). This may be challenging in women with hirsutism or acne but normal serum androgen levels, such as in the following conditions:

Idiopathic hirsutism: This is a rather common disorder. Serum androgens are normal, and there is no other identifiable cause for the hirsutism.

Drug use: Oligomenorrhea and hirsutism are known side effects of corticosteroids and valproic acid. Progestins, such as danazol, can cause acne. Minoxidil is an antihypertensive drug that may cause hirsutism. This has also been described in the use of the anti-epileptic drug phenytoin and phenothiazine, a tricyclic antidepressant.

The diagnosis of less common disorders that may cause signs of virilization due to increased serum androgen levels may be even more difficult. These disorders include the following:

Late-onset congenital adrenal hyperplasia (see Chapter 7)

Androgen-secreting tumors in the ovary

Sertoli-Leydig cell tumor: This type of ovarian tumor accounts for less than 0.5% of all ovarian tumors. It has a low grade of malignancy and presents unilaterally. It can occur at all ages but usually during the second and third decade. In 70%–80% of women with this type of tumor, increased testosterone levels may cause progressive virilization.

Tumors in the adrenal gland

Adenoma of the adrenal cortex are common tumors of the adrenal gland. Only 15% of these tumors are functional. Excessive cortisol production typically causes Cushing’s syndrome. Occasionally, androgen production also increases, and in these patients, hirsutism and acne may be present.

Only gold members can continue reading. Log In or Register to continue

Stay updated, free articles. Join our Telegram channel

May 9, 2017 | Posted by in GYNECOLOGY | Comments Off on Causes of Anovulation: Normogonadotropic Normoestrogenic Anovulation Non-PCOS

Full access? Get Clinical Tree

Get Clinical Tree app for offline access