Primary amenorrhea secondary to noncommunicating hydrocephalus. Case report

Effects of congenital hydrocephalus on the hypothalamic gonadotrophin-releasing hormone system

Object

Despite the investigations that have linked hydrocephalus to reproductive system abnormalities, no researchers have attempted to identify the pathophysiological mechanism of this relationship. Because the role of the hypothalamic gonadotrophin-releasing hormone (GnRH) system in the regulation of reproductive functions is well established, the authors used immunohistochemical and radioimmunoassay (RIA) techniques to determine the morphological and biochemical effects of hydrocephalus on the hypothalamic GnRH system.

Methods

Hypothalamic GnRH levels, fiber density, and cell types were studied in 21- and 50-day-old control and congenitally hydrocephalic Texas rats. Results of RIA indicated a significant (8.4%) increase in GnRH in 21-day-old hydrocephalic rats (9.17 ± 0.64 pg/ng total protein) compared with that in controls (0.97 ± 0.74 pg/ng total protein). In addition, the 50-day-old hydrocephalic animals had a significantly higher level of GnRH compared with age-matched controls (20.4 pg/ng compared with 1.88 ± 2.1 pg/ng total protein). This increase was accompanied by changes in the fiber appearance and a shift from low GnRH producing cells to high GnRH producing cells in the hydrocephalic animals; however, there was no significant difference in the fiber density between the control and hydrocephalic animals at 21 days. In addition, poor neurological scores correlated with the severity of hydrocephalus.

Conclusions

These results demonstrated that hypothalamic GnRH levels are significantly affected by fetal-onset hydrocephalus and that the mechanisms responsible for these effects may take place at the cellular rather than the gross structural level. Furthermore, they suggest that impairments in the GnRH system may be protracted in neonates and infants with hydrocephalus, and thus may be overcome by relatively early treatment with ventricular diversion. However, the clinical implications of GnRH perturbations in shunt-dependent patients must await a forthcoming study in shunted animals.

Secondary amenorrhea due to hydrocephalus treated with endoscopic ventriculocisternostomy. Case report

The authors present a case of secondary amenorrhea in a 32-year-old woman found to have noncommunicating hydrocephalus due to aqueductal stenosis. Although the presentation of hydrocephalus with amenorrhea has been previously reported, this association remains rare. After treatment via endoscopic third ventriculocisternostomy, the patient resumed normal menstruation and all hormonal abnormalities have resolved except hypothyroidism. A review of the literature on the etiology of endocrinological disturbances in patients with hydrocephalus is presented.

Symptoms and signs of progressive hydrocephalus

The clinical features of 107 cases of children with hydrocephalus and measured raised intraventricular pressure were analysed retrospectively. Fifty one children had recently been diagnosed as having hydrocephalus, and the remainder had had shunts injected to direct the cerebrospinal fluid. The most common symptoms in the group were vomiting, behavioural changes, drowsiness, and headaches. The most common clinical signs were inappropriately increasing occipitofrontal head circumferences, tense anterior fontanelles, splayed sutures, and distension of the scalp veins. Half the infantile cases of hydrocephalus were without symptoms, and a quarter of the cases with cerebrospinal fluid shunts and measured raised intraventricular pressure were without signs. There were no fewer than 33 different clinical signs including several unusual ones, such as macular rash and sweating. We believe that the presentation of hydrocephalus with raised intraventricular pressure is sufficiently variable, unusual, or even absent to justify the direct measurement of intracranial pressure.

Double-stimulation with LH-RH in primary amenorrhea caused by chronic internal hydrocephylus: a case study

A 19-year-old female patient with primary amenorrhea and pubertas tarda due to chronic internal hydrocephalus presented with normal hormonal findings except for low estradiol and a prepubertal type of reaction in the double-stimulation test with LH-RH. After successful operative treatment with a Spitz-Holter high-pressure valve, the intracranial decompression was promptly followed by pubertal development, she began to menstruate, and the LH-RH double-stimulation test showed an adult pattern of response. The results of the test support the view that a partial deficiency in the secretion of LH-RH is the cause of hypogonadism in such a case.

Slow tremor and macrocephaly: expanded version of the bobble-head doll syndrome

The clinical features of three children in whom a slow tremor involving the head, trunk, or limbs was associated with macrocephaly are presented. The findings were similar but not identical to those previously reported in four children with the bobble-head doll syndrome. These seven children have many of the signs and symptoms found in patients with surgically or spontaneously arrested hydrocephalus, including motor incoordination, behavior and psychologic deviations, and endocrine dysfunction. The tremor which can be voluntarily inhibited and which disappears following shunt surgery, is unique. The theoretical basis for the tremor is briefly discussed.

Alteration of circadian temperature rhythm with third ventricular obstruction

✓ Body temperature and endocrine function were studied in three hydrocephalic patients with tumors in the region of the hypothalamus. A circadian temperature rhythm was present under normal intraventricular pressure but was upset during elevated pressure. The results suggest that the absence of a circadian temperature rhythm in patients with third ventricular neoplasms indicates ventricular obstruction with consequent intracranial pressure and/or hydrocephalus. Conversely, the presence of a circadian temperature rhythm indicates that ventricular obstruction has not occurred or that a shunt system placed to bypass such an obstruction is functioning.