Central causes of hypogonadism--functional and organic

Hyperprolactinemia is not associated with hyperestrogenism in noncycling African elephants (Loxodonta africana)

African elephants in US zoos are not reproducing at replacement levels. This is in part due to physiological problems, one of which is abnormal ovarian cyclicity that has been linked to increased prolactin secretion (hyperprolactinemia). A relationship between increased estrogen production (hyperestrogenism) and hyperprolactinemia has been found in other species. Therefore, the objective of this study was to determine if elevated prolactin was associated with increased estrogen concentrations in non-cycling African elephants. In cycling elephants (n=12), prolactin secretion followed a normal cyclic pattern, with higher concentrations observed during the follicular phase; overall mean concentration was ∼18ng/ml and baseline prolactin was ∼6ng/ml. Non-cycling females (n=18) were categorized into three groups: (1) low prolactin (<15ng/ml; n=3); (2) moderate hyperprolactinemia (16-30ng/ml; n=7); and marked hyperprolactinemia (>31ng/ml; n=8). Mean urinary estrogen conjugate concentrations ranged from 5.4 to 41.4ng/mg Crt, and were similar between normal cycling (15.4±1.5ng/mg Crt) and non-cycling, low prolactin elephants (18.4±7.3ng/mg Crt), but were lower in moderate (9.4±1.3ng/mg Crt) and marked hyperprolactinemic (9.8±1.1ng/mg Crt) groups (P<0.05). In conclusion, African elephants appear to be sensitive to alterations in prolactin production, with both low (e.g., a non-cycling pattern) and high prolactin secretion being associated with abnormal ovarian activity. However, hyperestrogenism was not related to hyperprolactinemia in the non-cycling females.

Systemic illness

Systemic illnesses are associated with alterations in the hypothalamic-pituitary-peripheral hormone axes, which represent part of the adaptive response to stressful events and may be influenced by type and severity of illness and/or pharmacological therapy. The pituitary gland responds to an acute stressful event with two secretory patterns: adrenocorticotropin (ACTH), prolactin (PRL) and growth hormone (GH) levels increase, while luteinizing hormone (LH), follicle-stimulating hormone (FSH) and thyrotropin (TSH) levels may either decrease or remain unchanged, associated with a decreased activity of their target organ. In protracted critical illness, there is a uniformly reduced pulsatile secretion of ACTH, TSH, LH, PRL and GH, causing a reduction in serum levels of the respective target-hormones. These adaptations are initially protective; however, if inadequate or excessive they may be dangerous and may contribute to the high morbidity and mortality risk of these patients. There is no consensus regarding the type of approach, as well as the criteria to use to define pituitary axis function in critically ill patients. We here provide a critical approach to pituitary axis evaluation during systemic illness.

Puberty-timing is everything!

Puberty is a dynamic period of physical growth, sexual maturation, and psychosocial achievement that generally begins between age 8 and 14 years. The age of onset varies as a function of sex, ethnicity, health status, genetics, nutrition, and activity level. Puberty is initiated by hormonal changes triggered by the hypothalamus. Children with variants of normal pubertal development--both early and late puberty--are common in pediatric practice. Recognizing when variations are normal and when referral for further evaluation is indicated is an important skill.