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Stress-related hypogonadotrophic hypogonadism and alopecia universalis in a young woman

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Introduction: Alopecia universalis is a severe form of alopecia areata, of unknown exact pathogenesis, frequently considered autoimmune. Hypogonadotrophic hypogonadism can occur in a number of conditions, including autoimmune syndromes. Case report: We present the case of a young woman who presented with secondary amenorrhea and alopecia universalis, both developed in the first year after a significant stressful event. The personal and family history were clear, there was no abnormality at the clinical examination apart from complete alopecia. The laboratory examination diagnosed hypo-gonadotrophic hypogonadism and excluded hyperprolactinemia, hyperandrogenism, adrenal failure, hypothyroidism. During a 8 year follow-up the alopecia showed no sign of recovery but after 6-7 years the hypogonadism completely recover and the patient resumed normal menses. The final diagnosis was stress-induced hypothalamic amenorrhea associated with alopecia universalis of unknown origin. Conclusion: hypogonadotrophic hypogonadism can occur in association with alopecia universalis and both can be triggered by severe stress. Affected cases should be strictly monitored for associated autoimmune conditions and longterm follow-up is usually needed. During long follow-up the hypogonadism can spontaneously recover.

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