We present a 27 year-old female patient suffering from multiple sclerosis (MS) since 3 years ago. She currently consults for menstrual disturbances. She has not any neurological secuelae of MS now and she is not on medical treatment. She is with amenorrhea since 10 months ago, but she had been oligomenorrhea just before for 24 months. She doesnt have any symptoms suspicious for other hormonal impairment. Physical examination is normal.
The laboratory test reveals a hypogonadotropic hypogonadism with a normal thyrotropin, prolactin, cortisol, corticotrophin hormone, androgens and 17 OH progesterone levels. The Magnetic Resonance of the brain shows multiple signal alterations of white matter, hyperintense in T2 and without enhancing.
She has a demyelinization plaque in the right side of the hypothalamus.
There are some clinical cases in the literature about MS and hypogonadism. One of them describes also growth hormone deficit. Another one shows subclinical pituitary deficits in these patients. But the authors doesnt find any etiologic lesion on imaging tests.
In our case we can show the hypothalamic lesion causing hypogonadotropic hypogonadism. This should make us remember about the possibility of pituitary deficits in patients with multiple sclerosis.
25 - 29 Apr 2009
European Society of Endocrinology