Amenorrhea in cushing , Please help.

[eduro25]

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Hi guys,
I was wondering if anyone know what is the pathophysiological process behind amenorrhea and corticoid excess . It is mentioned in BRS and FA , but not explanation there or on the web.

Thanks in advance for your help,
Regards,
Eduro

 

[Mortal_Lessons]

Hi guys,
I was wondering if anyone know what is the pathophysiological process behind amenorrhea and corticoid excess . It is mentioned in BRS and FA , but not explanation there or on the web.

Thanks in advance for your help,
Regards,
Eduro

In Cushing's disease, where there's a pituitary adenoma secreting ACTH, I think the excess ACTH causes hyperplasia of the zonas fasiculata and reticularis. The zona reticularis will now secrete more androgens, thus causing hirsutism and amenhorrea. I think the amenorrhea is a result of the increased androgen: estrogen ratio, though I'm not entirely sure about this. Perhaps there's suppression of LH release secondary to increased androgen feedback...?

 

[Doctor4Life1769]

In Cushing's disease, where there's a pituitary adenoma secreting ACTH, I think the excess ACTH causes hyperplasia of the zonas fasiculata and reticularis. The zona reticularis will now secrete more androgens, thus causing hirsutism and amenhorrea. I think the amenorrhea is a result of the increased androgen: estrogen ratio, though I'm not entirely sure about this. Perhaps there's suppression of LH release secondary to increased androgen feedback...?

Pretty sure it is the excess androgens, leading to hirsutism, that also cause amenorrhea. Excess androgens will cause a negative feedback to the ant pit and hence lower LH.

 

[eduro25]

Thank you very much both , I get the picture now , hehe , just to summarize the ideas then:
Too much adrenal androgens (which will eventually be testosterone)
®Negative Feedback on GnRH (and also LH) ® No FSH /LH ®No or poor endometrial proliferation®no endometrial sloughing at end of cycle.
Thank you very much for your help.

 

[Burnt Almonds]

In other words, amenorrhea is strictly related to Cushing disease or ectopic ACTH?

And not exogenous steroid use or primary adrenal tumor? Just checking.

 

[tarsuc]

In other words, amenorrhea is strictly related to Cushing disease or ectopic ACTH?

And not exogenous steroid use or primary adrenal tumor? Just checking.

bump

 

[ZKenpachi]

@tarsuc
@Burnt Almonds

UpToDate says that the menstrual abnormalities are due to GnRH suppression by hypercortisolemia, and that they are correlated with high serum cortisol and low estradiol, but not with serum androgen concentrations. This means that all causes of Cushing syndrome will cause menstrual abnormalities, including exogenous glucocorticoids, which is mentioned in FA16 p 336.

Sorry if I'm bumping an old thread, just was searching and found it and wanted to post in case you guys hadn't found out the answer.

Cheers

 

[cellsaver]

Cheers

Good save. Two textbooks I used in preclinical years covered this topic in detail
Robbins & Cotran, "Pathologic Basis of Disease", 9th edition (p. 1125) and
Felner's "Endocrine Pathophysiology" (p. 221).

They state that adrenal gland excess (e.g. Cushing Syndrome) often reflect menstrual irregularities (not amenorrhea - see below). Robbins & Cotran have a table (24-9) listing clinical features of Cushing Syndrome with "menstrual irregularity" as being 80%. "Hypercortisolism (Cushing Syndrome) is most often caused by exogenous administration of steroids"

Kudos to you for due diligence.

Menstrual Cycle Abnormalities include Amenorrhea, Dysmenorrhea, and abnormal uterine bleeding include menorrhagia, hypomenorrhea, oligomenorrhea, polymenorrhea, metrorrhagia (Felner, p. 263-6).

Once again First Aid for the USMLE Step 1 failed to teach important concepts.