| Disorders of steroid secretion in the female
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| Just as in the male, endocrine disorders of subnormal sex steroid secretion in the female may result from a wide range of disorders in the hypothalamus, pituitary, or ovary
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| POLYCYSTIC OVARY SYNDROME - A COMMON CAUSE OF INFERTILITY |
A 24-year-old woman presented with a 2-year history of oligomenorrhea (infrequent menstruation) and infertility. She was obese with facial acne and mild hirsutism. Basal hormone studies showed normal FSH, LH prolactin and estradiol , but she has a serum testosterone of 4.5 nmol/L (0.9-3.2 nmol/L). |
| Comment. This woman's polycystic ovary syndrome (PCOS) was confirmed by ultrasound of the ovaries showing enlargement with the characteristic cysts that secrete testosterone (and other androgens). The androgen is the cause of the hirsutism and its interference with the normal estrogen feedback at the pituitary causes the oligomenorrhea and infertility. The cause of the syndrome is unclear but hyperinsulinaemia secondary to peripheral insulin resistance has been implicated. Insulin and insulin growth factor stimulate the ovaries to secrete androgens. |
| Kallmann's syndrome is seen in females as well as males, but the most common genetic disorder affecting the ovary is
Turner's syndrome (karyotype 45X), which has characteristic somatic features and an elevated plasma FSH and prepubertal estradiol pattern. In the mature female there are various endocrine causes of infertility, which is beyond the scope of this text. Although reduced estradiol secretion is a natural consequence of menopause, hormone replacement therapy (HRT) can no longer be routinely recommended because of the numerous undesirable side-effects (box).
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| Syndromes of excess ovarian steroid secretion lead to precocious puberty in children and infertility and/or hirsutism in the adult
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| Precocious puberty may arise from early maturation of the normal axis, an estradiol- or androgen-secreting cyst or tumor of the ovary or the adrenal gland, or congenital adrenal hyperplasia. In the mature female, hypersecretion of androgen in the polycystic ovary syndrome (PCOS) may result both in infertility and/or hirsutism (growth of male type and distribution of hair in women).
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