The Journal of Clinical Endocrinology and Metabolism Journal Article

Burden of Rare Variants in Hypothalamic Amenorrhea

March 01, 2021

Angela Delaney, Adam B Burkholder, Christopher A Lavender, Lacey Plummer, Veronica Mericq, Paulina M Merino, Richard Quinton, Katie L Lewis, Brooke N Meader, Alessandro Albano, Natalie D Shaw, Corrine K Welt, Kathryn A Martin, Stephanie B Seminara, Leslie G Biesecker, Joan E Bailey-Wilson, Janet E Hall
The Journal of Clinical Endocrinology & Metabolism, Volume 106, Issue 3, March 2021, Pages e1441–e1452
https://doi.org/10.1210/clinem/dgaa609

Abstract

Context

Functional hypothalamic amenorrhea (HA) is a common, acquired form of hypogonadotropic hypogonadism that occurs in the setting of energy deficits and/or stress. Variability in individual susceptibility to these stressors, HA heritability, and previous identification of several rare sequence variants (RSVs) in genes associated with the rare disorder, isolated hypogonadotropic hypogonadism (IHH), in individuals with HA suggest a possible genetic contribution to HA susceptibility.

Objective

We sought to determine whether the burden of RSVs in IHH-related genes is greater in women with HA than controls.

Design

We compared patients with HA to control women.

Setting

The study was conducted at secondary referral centers.

Patients and Other Participants

Women with HA (n = 106) and control women (ClinSeq study; n = 468).

Interventions

We performed exome sequencing in all patients and controls.

Main Outcome Measure(s)

The frequency of RSVs in 53 IHH-associated genes was determined using rare variant burden and association tests.

Results

RSVs were overrepresented in women with HA compared with controls (P = .007). Seventy-eight heterozygous RSVs in 33 genes were identified in 58 women with HA (36.8% of alleles) compared to 255 RSVs in 41 genes among 200 control women (27.2%).

Conclusions

Women with HA are enriched for RSVs in genes that cause IHH, suggesting that variation in genes associated with gonadotropin-releasing hormone neuronal ontogeny and function may be a major determinant of individual susceptibility to developing HA in the face of diet, exercise, and/or stress.