Investigation of Hypothalamus-Pituitary-Gonadal Axis in Epileptic Women Treated for Epilepsy

Objectives: Reproductive endocrine disorders, especially polycystic ovary syndrome (PCOS) are common in epileptic women who are less fertile and suffer from more menstrual and reproductive endocrine disorders than non-epileptic women. The etiology of reproductive endocrine dysfunction in epilepsy has not been determined precisely. The aim of the study was to investigate the hypotalamus-pituitary-gonadal axis, insulin resistance and the prevalence of PCOS in patients with generalized idiopathic or cryptogenic epilepsy and receiving treatment with valproate (VPA) and carbamazepine (CBZ). Method: This study included 48 epileptic women with a mean age of 24.2±5.5 years. The patient groups consisted of 34 (70.8%) women with epilepsy on VPA and 14 (29.2%) women with epilepsy on CBZ. The control group consisted of 20 healthy women. Fasting blood samples were obtained for the determination of glucose, insulin, gonadotrophins, estradiol, androgens, 17-OH progesteron (17-OHP), and sex hormone-binding globulin (SHBG) levels. All subjects underwent oral glucose tolerance test (OGTT) and the buserelin stimulation test for glucose tolerance status, insulin resistance parameters and hypothalamus-pituitary-gonadal axis evaluation. Results: PCOS was diagnosed in 17 (35.4%) epileptic patients and glucose intolerance was found in two (4.1%) patients. Basal insulin levels, glucose and insulin responses to OGTT were significantly higher in the patients than in the controls. Peak and area under curve (AUC) 17-OHP responses to the buserelin stimulation test were significantly higher in the patients than in the controls. Discussion: The prevalence of PCOS among women with epilepsy receiving VPA or CBZ treatment was higher than expected. Those patients had increased ovarian stroma and hormonal activity characterized by hyperandrogenemia, as demonstrated by buserelin testing and insulin resistance as demonstrated by OGTT. (Arc-hi-ves of Neu-ropsy-chi-atry 2012;49: 133-138)