Hypogonadism in adolescent females: new insights and rationale supporting the use of physiologic regimens to induce puberty.
Puberty in girls begins with nocturnal pulsatile gonadotropin releasing hormone (GnRH) secretion which increases gradually over a 4 year period and occurs throughout the day. Pulsatile GnRH secretion stimulates pituitary luteinizing hormone (LH) and follicle stimulating hormone (FSH) which induces gonadal steroid secretion, ovulation and oogenesis. Over the past decade, naturally occurring genetic mutations have been identified in a number of genes that impact the onset and progression of puberty and continued progress in this area will lead to earlier diagnosis of hypogonadotropic hypogonadism (HypoH) and potentially improved therapeutic options. Data are accumulating to support the use of more physiological hormone regimens to induce puberty. In addition, our better understanding of how estrogen interacts with the growth hormone - insulin-like growth factor-1 (GH-IGF-1) axis and of differential effects of oral versus non-oral estrogen on various biological parameters have important therapeutic implications for the management of hypogonadal adolescent girls. These implications will be addressed.
Rubin
Karen
K
University of Connecticut, School of Medicine, Division of Pediatric Endocrinology, Connecticut Children's Medical Center, Hartford, CT, 06106, USA. krubin@ccmkids.org
D000293:Adolescent; D004704:Endocrinology; D005260:Female; D006801:Humans; D007006:Hypogonadism / Q000503:physiopathology* / Q000628:therapy*; D011627:Puberty