Expert consensus document: European Consensus Statement on congenital hypogonadotropic hypogonadism--pathogenesis, diagnosis and treatment

Nat Rev Endocrinol. 2015 Sep;11(9):547-64. doi: 10.1038/nrendo.2015.112.

Ulrich Boehm ¹, Pierre-Marc Bouloux ², Mehul T Dattani ², Nicolas de Roux ³, Catherine Dodé ⁴, Leo Dunkel ⁵, Andrew A Dwyer ⁶, Paolo Giacobini ⁷, Jean-Pierre Hardelin ⁸, Anders Juul ⁹, Mohamad Maghnie ¹⁰, Nelly Pitteloud ⁶, Vincent Prevot ⁷, Taneli Raivio ¹¹, Manuel Tena-Sempere ¹², Richard Quinton ¹³, Jacques Young ¹⁴

Affiliations

1 University of Saarland School of Medicine, Germany.
2 University College London, UK.
3 Université Paris Diderot, France.
4 Université Paris Descartes, France.
5 William Harvey Research Institute, UK.
6 Endocrinology, Diabetes and Metabolism Sevice of the Centre Hospitalier Universitaire Vaudois (CHUV), du Bugnon 46, Lausanne 1011, Switzerland.
7 University of Lille, France.
8 Institut Pasteur, France.
9 University of Copenhagen, Denmark.
10 University of Genova, Italy.
11 University of Helsinki, Finland.
12 University of Cordoba, Spain.
13 Newcastle University, UK.
14 Bicêtre Hospital, France.

PMID: 26194704 DOI: 10.1038/nrendo.2015.112

Abstract

Congenital hypogonadotropic hypogonadism (CHH) is a rare disorder caused by the deficient production, secretion or action of gonadotropin-releasing hormone (GnRH), which is the master hormone regulating the reproductive axis. CHH is clinically and genetically heterogeneous, with >25 different causal genes identified to date. Clinically, the disorder is characterized by an absence of puberty and infertility. The association of CHH with a defective sense of smell (anosmia or hyposmia), which is found in ∼50% of patients with CHH is termed Kallmann syndrome and results from incomplete embryonic migration of GnRH-synthesizing neurons. CHH can be challenging to diagnose, particularly when attempting to differentiate it from constitutional delay of puberty. A timely diagnosis and treatment to induce puberty can be beneficial for sexual, bone and metabolic health, and might help minimize some of the psychological effects of CHH. In most cases, fertility can be induced using specialized treatment regimens and several predictors of outcome have been identified. Patients typically require lifelong treatment, yet ∼10-20% of patients exhibit a spontaneous recovery of reproductive function. This Consensus Statement summarizes approaches for the diagnosis and treatment of CHH and discusses important unanswered questions in the field.

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