[
    {
        "page": 1,
        "title": "HIPOGONADISMO HIPOGONADOTROFICO",
        "body": "<p><strong style=\"background-color: transparent; color: rgb(0, 0, 0);\">HIPOGONADISMO EN MUJERES<\/strong><\/p><p><strong style=\"background-color: transparent; color: rgb(0, 0, 0);\">DEFINICI\u00d3N<\/strong><\/p><ul><li><span style=\"background-color: transparent;\">Estado caracterizado por <\/span><strong style=\"background-color: transparent;\">baja producci\u00f3n de estr\u00f3genos<\/strong><span style=\"background-color: transparent;\"> por alteraci\u00f3n del eje hipot\u00e1lamo-hip\u00f3fiso-ov\u00e1rico.<\/span><\/li><li><span style=\"background-color: transparent;\">Se manifiesta como <\/span><strong style=\"background-color: transparent;\">hipoestrogenismo<\/strong><span style=\"background-color: transparent;\">, alteraciones menstruales (amenorrea, oligomenorrea) e infertilidad.<\/span><\/li><\/ul><p><strong style=\"background-color: transparent; color: rgb(0, 0, 0);\">CLASIFICACI\u00d3N<\/strong><\/p><p><strong style=\"background-color: transparent; color: rgb(0, 0, 0);\">1. Hipogonadismo hipogonadotr\u00f3fico (HH):<\/strong><\/p><ul><li><span style=\"background-color: transparent;\">Falla en el est\u00edmulo hipotal\u00e1mico o hipofisario.<\/span><\/li><li><span style=\"background-color: transparent;\">\u2193 FSH, \u2193 LH \u2192 \u2193 estr\u00f3genos.<\/span><\/li><\/ul><p><strong style=\"background-color: transparent; color: rgb(0, 0, 0);\">2. Hipogonadismo hipergonadotr\u00f3fico (HG):<\/strong><\/p><ul><li><span style=\"background-color: transparent;\">Falla ov\u00e1rica primaria.<\/span><\/li><li><span style=\"background-color: transparent;\">\u2191 FSH, \u2191 LH \u2192 \u2193 estr\u00f3genos.<\/span><\/li><\/ul><p><strong style=\"background-color: transparent; color: rgb(0, 0, 0);\">HIPOGONADISMO HIPOGONADOTR\u00d3FICO<\/strong><\/p><p><strong style=\"background-color: transparent; color: rgb(0, 0, 0);\">Etiolog\u00edas<\/strong><\/p><ul><li><strong style=\"background-color: transparent;\">Funcionales (transitorias o reversibles):<\/strong><\/li><li class=\"ql-indent-1\"><span style=\"background-color: transparent;\">Ejercicio excesivo.<\/span><\/li><li class=\"ql-indent-1\"><span style=\"background-color: transparent;\">P\u00e9rdida ponderal o trastornos alimentarios.<\/span><\/li><li class=\"ql-indent-1\"><span style=\"background-color: transparent;\">Estr\u00e9s psicol\u00f3gico.<\/span><\/li><li class=\"ql-indent-1\"><span style=\"background-color: transparent;\">Enfermedad sist\u00e9mica.<\/span><\/li><li><strong style=\"background-color: transparent;\">Cong\u00e9nitas:<\/strong><\/li><li class=\"ql-indent-1\"><span style=\"background-color: transparent;\">S\u00edndrome de Kallmann (anosmia + HH).<\/span><\/li><li class=\"ql-indent-1\"><span style=\"background-color: transparent;\">Malformaciones hipotal\u00e1micas\/hipofisarias.<\/span><\/li><li><strong style=\"background-color: transparent;\">Adquiridas:<\/strong><\/li><li class=\"ql-indent-1\"><span style=\"background-color: transparent;\">Tumores hipotal\u00e1micos o hipofisarios.<\/span><\/li><li class=\"ql-indent-1\"><span style=\"background-color: transparent;\">Radiaci\u00f3n craneal.<\/span><\/li><li class=\"ql-indent-1\"><span style=\"background-color: transparent;\">Traumatismos.<\/span><\/li><li class=\"ql-indent-1\"><span style=\"background-color: transparent;\">Hiperprolactinemia (inhibe GnRH).<\/span><\/li><li class=\"ql-indent-1\"><span style=\"background-color: transparent;\">Hipotiroidismo (TRH \u2191 prolactina).<\/span><\/li><\/ul><p><strong style=\"background-color: transparent; color: rgb(0, 0, 0);\">Manifestaciones<\/strong><\/p><ul><li><span style=\"background-color: transparent;\">Amenorrea primaria o secundaria.<\/span><\/li><li><span style=\"background-color: transparent;\">Retraso puberal (si cong\u00e9nito).<\/span><\/li><li><span style=\"background-color: transparent;\">Hipoestrogenismo: sequedad vaginal, sofocos, osteoporosis.<\/span><\/li><\/ul><p><strong style=\"background-color: transparent; color: rgb(0, 0, 0);\">Diagn\u00f3stico<\/strong><\/p><ul><li><span style=\"background-color: transparent;\">FSH y LH bajas o normales.<\/span><\/li><li><span style=\"background-color: transparent;\">Estradiol disminuido.<\/span><\/li><li><span style=\"background-color: transparent;\">MRI de hip\u00f3fisis si sospecha de lesi\u00f3n estructural.<\/span><\/li><li><span style=\"background-color: transparent;\">Prolactina, TSH, test de progesterona.<\/span><\/li><\/ul><p><strong style=\"background-color: transparent; color: rgb(0, 0, 0);\">HIPOGONADISMO HIPERGONADOTR\u00d3FICO<\/strong><\/p><p><strong style=\"background-color: transparent; color: rgb(0, 0, 0);\">Etiolog\u00edas<\/strong><\/p><ul><li><strong style=\"background-color: transparent;\">Disgenesia gonadal:<\/strong><\/li><li class=\"ql-indent-1\"><span style=\"background-color: transparent;\">S\u00edndrome de Turner (45,X): infantilismo sexual, talla baja, cuello alado.<\/span><\/li><li class=\"ql-indent-1\"><span style=\"background-color: transparent;\">Disgenesias con cariotipo 46,XX o 46,XY.<\/span><\/li><li><strong style=\"background-color: transparent;\">Insuficiencia ov\u00e1rica prematura (IOP):<\/strong><\/li><li class=\"ql-indent-1\"><span style=\"background-color: transparent;\">Falla ov\u00e1rica antes de los 40 a\u00f1os.<\/span><\/li><li class=\"ql-indent-1\"><span style=\"background-color: transparent;\">Causas: autoinmunes, gen\u00e9ticas (s\u00edndrome X fr\u00e1gil), iatrog\u00e9nicas (quimio, cirug\u00eda ov\u00e1rica).<\/span><\/li><li class=\"ql-indent-1\"><span style=\"background-color: transparent;\">FSH &gt;40 mUI\/mL.<\/span><\/li><li><strong style=\"background-color: transparent;\">Iatrogenia:<\/strong><\/li><li class=\"ql-indent-1\"><span style=\"background-color: transparent;\">Quimioterapia, radioterapia, ooforectom\u00eda bilateral.<\/span><\/li><\/ul><p><strong style=\"background-color: transparent; color: rgb(0, 0, 0);\">Manifestaciones<\/strong><\/p><ul><li><span style=\"background-color: transparent;\">Ausencia de caracteres sexuales secundarios (primaria).<\/span><\/li><li><span style=\"background-color: transparent;\">Amenorrea secundaria.<\/span><\/li><li><span style=\"background-color: transparent;\">S\u00edntomas hipoestrog\u00e9nicos.<\/span><\/li><\/ul><p><strong style=\"background-color: transparent; color: rgb(0, 0, 0);\">Diagn\u00f3stico<\/strong><\/p><ul><li><span style=\"background-color: transparent;\">FSH y LH elevadas.<\/span><\/li><li><span style=\"background-color: transparent;\">Estradiol bajo.<\/span><\/li><li><span style=\"background-color: transparent;\">Cariotipo si &lt;30 a\u00f1os o sospecha de anomal\u00eda gen\u00e9tica.<\/span><\/li><li><span style=\"background-color: transparent;\">Anticuerpos antiovario (si se sospecha etiolog\u00eda autoinmune).<\/span><\/li><\/ul><p><strong style=\"background-color: transparent; color: rgb(0, 0, 0);\">MANEJO GENERAL DEL HIPOGONADISMO<\/strong><\/p><p><strong style=\"background-color: transparent; color: rgb(0, 0, 0);\">Terapia hormonal<\/strong><\/p><ul><li><strong style=\"background-color: transparent;\">Estrogenoterapia secuencial<\/strong><span style=\"background-color: transparent;\"> si se desea desarrollar caracteres sexuales o evitar osteoporosis.<\/span><\/li><li><span style=\"background-color: transparent;\">A\u00f1adir <\/span><strong style=\"background-color: transparent;\">progesterona<\/strong><span style=\"background-color: transparent;\"> si \u00fatero presente para protecci\u00f3n endometrial.<\/span><\/li><li><span style=\"background-color: transparent;\">Objetivos: inducci\u00f3n puberal, restaurar menstruaci\u00f3n, prevenir osteoporosis.<\/span><\/li><\/ul><p><strong style=\"background-color: transparent; color: rgb(0, 0, 0);\">Fertilidad<\/strong><\/p><ul><li><strong style=\"background-color: transparent;\">HH:<\/strong><span style=\"background-color: transparent;\"> Gonadotropinas ex\u00f3genas o pulsos de GnRH.<\/span><\/li><li><strong style=\"background-color: transparent;\">HG:<\/strong><span style=\"background-color: transparent;\"> Ovodonaci\u00f3n es el \u00fanico m\u00e9todo efectivo.<\/span><\/li><\/ul><p><br><\/p>",
        "footer": "P\u00e1gina 1"
    }
]