Inherited Reproductive Disorders

  • STATUS
    Recruiting
  • participants needed
    600
  • sponsor
    National Institute of Environmental Health Sciences (NIEHS)
Updated on 27 January 2021
gonadotropin
hypogonadism
early puberty
scratch
hormone levels
hormones released
klinefelter syndrome
secondary hypogonadism

Summary

Background
  • During puberty, children begin to develop into adults. Problems with the hormones released during puberty can affect the reproductive system. Some people have low hormone levels that severely delay or prevent puberty. Others start puberty abnormally early. Other people may have a normal puberty but develop reproductive disorders later in life. Researchers want to study people with reproductive disorders to learn more about how these disorders may be inherited.
    Objectives
  • To learn how reproductive system disorders may be inherited.
    Eligibility
  • People with one of the following problems:
  • Abnormally early puberty
  • Abnormally late or no puberty
  • Normal puberty with hormonal problems that develop later in life
  • People who have not yet had puberty but have symptoms that indicate low hormone levels.
    Design
  • Participants will provide a blood sample for testing. They will complete a questionnaire about their symptoms. They will also have a scratch-and-sniff test to study any problems with their ability to smell.
  • Participant medical records will be reviewed. Participants will also provide a family medical history.
  • Family members of those in the study may be invited to participate.
  • Treatment will not be provided as part of this study.

Description

The key initiating factors for reproductive development remain among the great mysteries of pediatric and reproductive endocrinology. The onset of puberty is initiated by pulsatile secretion of gonadotropin-releasing hormone (GnRH) from the hypothalamus. The neuroendocrine events leading to increased GnRH secretion and the resultant onset of puberty remain largely unknown.

Isolated deficiency of GnRH results in the rare clinical syndrome of idiopathic hypogonadotropic hypogonadism (IHH), where decreased secretion of GnRH results in impaired gonadotropin secretion. The resultant hypogonadism presents with delayed, incomplete, or absent sexual maturation. Human and animal models have identified a number of genes responsible for IHH, but more than half of patients with clinical evidence of the disorder do not have a detectable mutation. In addition, there is significant clinical heterogeneity among affected individuals, including members of the same family harboring the same mutations. Careful human phenotyping of such patients and families has expanded our understanding of this spectrum of disorders to include oligo-digenic inheritence, as well as reversibility of the condition, and has provided insight into developmental pathways involved in the ontogeny of GnRH neurons. In particular, hypogonadotropic hypogonadism (HH) exists along a genetic and phenotypic spectrum that includes milder forms of GnRH dysregulation, precocious and delayed puberty, and onset of reproductive dysfunction after puberty.

Genetic analysis of subjects with unknown mutations is likely to yield important insights into additional pathways involved in the regulation of GnRH secretion. Here, we propose a genetic investigation of subjects with IHH to characterize further the phenotypic effect of previously described genetic variants, as well as to identify novel genes involved in congenital GnRH deficiency. We will use both candidate gene and whole exome approaches, as well as linkage analysis.

This protocol will utilize the disease model of IHH to increase our understanding of the physiology of GnRH secretion, including the neuroendocrine regulation of GnRH pulsatility. Examining the genetic characteristics of subjects with isolated GnRH deficiency will reveal insights into the mechanisms underlying the reawakening of the hypothalamic-pituitary-gonadal axis at puberty, providing opportunities for new diagnostic capabilities and therapeutic interventions for disorders of puberty and fertility.

Details
Condition Hypogonadism, Female Genital Diseases, Amenorrhea, Infertility, Hereditary Disease, Hypomenorrhea, Gynecological Infections, Genetic Syndrome, Menstrual Disorders, genetic disorder, genetic syndromes, genetic disorders, genetic disease, hereditary disorders, inherited disease, hereditary diseases, genetic condition, sterility, unable to conceive
Clinical Study IdentifierNCT01500447
SponsorNational Institute of Environmental Health Sciences (NIEHS)
Last Modified on27 January 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

Is your age greater than or equal to 1 yrs?
Gender: Male or Female
Do you have any of these conditions: Menstrual Disorders or Hereditary Disease or Female Genital Diseases or Hypogonadism or Hypomenorrhea or Gynecological Infections or Amenorrhea or Inf...?
Do you have any of these conditions: genetic disorders or Female Genital Diseases or Gynecological Infections or genetic disease or hereditary disorders or Hypomenorrhea or inherited dise...?
Do you have any of these conditions: Female Genital Diseases or genetic disease or Genetic Syndrome or hereditary diseases or Hypomenorrhea or genetic disorder or Amenorrhea or inherited ...?
Do you have any of these conditions: Hypomenorrhea or Infertility or Female Genital Diseases or hereditary diseases or Hereditary Disease or Gynecological Infections or genetic disorders ...?
Do you have any of these conditions: Infertility or Hypogonadism or Amenorrhea or Hereditary Disease or Gynecological Infections or Genetic Syndrome or Menstrual Disorders or genetic diso...?
Do you have any of these conditions: genetic condition or Hypomenorrhea or genetic disorder or genetic disease or sterility or unable to conceive or Hereditary Disease or hereditary disea...?
The essential inclusion criteria include
failure to go through a normal, age-appropriate, spontaneous puberty and low sex steroid levels in the setting of low/normal gonadotropins (due to substantial variability among patient presentations, this will be based on the clinical judgement of the Investigator), or
abnormally early development of puberty, or
normal puberty with subsequent development of low gonadotropin levels, or
pre-pubertal individuals with features suggestive of hypogonadotropic hypogonadism
Family members: both affected and unaffected family members are strongly encouraged to participate

Exclusion Criteria

Since hypogonadotropic hypogonadism is a rare condition, this protocol remains
open to enrollment so that we may study all subjects that are both qualified
and interested in participating
Because HH represents a spectrum, where associated clinical findings may
provide phenotypic clues to the assessment of inheritability and underlying
physiology, exclusion criteria are very limited
Patients who have additional pituitary deficiencies, effectively ruling out isolated GnRH deficiency, whether these deficiencies are congenital or acquired (e.g. secondary to malignancy, infection, or irradiation)
Patients who are taking medications known to affect GnRH secretion, such as corticosteroids or continuous opiate administration (or were taking them at the time of diagnosis)
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