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Endocrine axes (prolactin, thyroid and adrenal axes) directly and indirectly modulate and drive human female central functions, mainly behavior and reproduction. Though having distinct abilities, they greatly act both at peripheral as well as at neuroendocrine levels, so as to participate in the control of reproduction. Any event that changes these balanced activities produces specific peripheral signals that induce abnormal functions centrally, thus triggering menstrual disorders such as oligomenorrhea or amenorrhea. It is clear that the knowledge of the relationships that exist between the different endocrine axes becomes essential for the choice of therapeutical approach. This review aims to focus on the main aspects of the physiopathology of the endocrine diseases that might be at the basis of that interference with female reproductive capacity.

Background: Functional Hypothalamic Amenorrhea (FHA) is a stress-induced blockade of the reproductive axis. Such impairment is mainly due to altered control of GnRH-induced gonadotropin secretion as well as alterations of other endocrine functions. Methods: Seventeen patients with FHA participated in the study. Basal hormonal profiles and GnRH and Naloxone tests for LH (Luteinizing Hormone) and for LH and cortisol responses, respectively, were performed before and after two weeks of administration of a very low dose of estradiol (2.5 ng two times a day). Results: The treatment improved both gonadotropins, mainly LH. The LH response to the GnRH test improved in terms of the peak amplitude, as evaluated using Instantaneous Secretory Rates (ISR) computation. Moreover, when performing the Naloxone test after the treatment interval, FHA patients showed a quicker LH response and recovery of the cortisol response. Conclusions: Our study supports the relevance of very low dose estradiol priming to promote and restore impaired neuroendocrine function in patients with FHA.

Polymyalgia rheumatica (PMR) is an inflammatory disorder, more common in the elderly, characterised by girdle pain and stiffness, constitutional symptoms and raised serological markers of inflammation. Studies on the seasonality of onset of PMR have shown conflicting results, possibly due to the different diagnostic criteria and onset recognition. In this study, the month of onset of PMR was evaluated in patients originating from one geographical area, visited by the same clinician.In 383 PMR patients (245 women, median age 73 years, range 47-92 years) examined between 1990 and 2014, PMR was diagnosed according to Bird's criteria. The month of onset was recorded systematically during the patient's interview. Clinical features initially recorded included the location of joint involvement, the coexistence of temporal arteritis (TA) or peripheral arthritis, and the type of onset (acute if reported of 72h or less). Patient follow-up, PMR severity and outcome were also recorded throughout the study.We failed to identify any peak month (p=0.93) or season (p=0.45) for the onset of PMR. Timing of onset did not correlate with the clinical features, severity or outcome of PMR. Only when patients were also affected by concomitant TA, the onset of PMR was more often seen in autumn (p=0.02). Patients with PMR onset in autumn also has a greater risk of developing TA during their follow-up (p=0.03). By multiple regression, the only outcome predicted by autumn onset was the use of methotrexate (p=0.039).PMR showed no seasonality of onset, except for the subset associated with TA. A risk factor with seasonal variation is suggested for the pathogenesis of this form of PMR.

Systemic sclerosis (SSc) is characterised by microvascular inflammatory damage, loss of capillaries and progressive systemic fibrosis. Capillary rarefaction may precede sarcopenia, we therefore evaluated the body composition and occurrence of sarcopenia in SSc patients, in relation to the peripheral microcirculatory status, assessed and scored by nailfold videocapillaroscopy (NVC) patterns, including capillary number count and microangiopathy evolution score (MES).Body composition and bone mineral density were assessed by Dual X-ray absorptiometry and a dedicated software (GE Lunar, USA) in 43 SSc patients (age 64.1 ± 11.2 yrs, 83.7% women) affected by limited or diffuse cutaneous (74.4%) according to the 2013 EULAR/ACR criteria and 43 age-matched healthy subjects (HS). Sarcopenia was checked as relative skeletal muscle index (RSMI). Clinical, laboratory, body composition and bone parameters were analysed according to the different NVC patterns and MES. Means were compared by the Student's t test or by one way analysis of variance; medians were compared by the Kruskall Wallis test; and frequencies by the chi square test.Sarcopenia was found in 23.26% of SSc patients with a prevalence significantly higher than age matched HS (4.65%; p = 0.03). Interestingly, SSc patients with "late" NVC pattern showed a significantly higher prevalence of sarcopenia (43.75%) compared to "early" (9.1%) and "active" (12.5%) NVC patterns (p0.0002). In addition, capillary density was found significantly lower in sarcopenic versus non sarcopenic patients (4.4±1.8 vs. 5.8±2.2, p0.05). Finally, MES showed significantly most severe score in sarcopenic SSc patients (p0.001): peripheral blood flow analised in a sample of sarcopenic SSc patients by Laser speckle contrast analysis (LASCA) showed lowest values (p0.05). Total mass (TM), lean mass (LM), fat mass (FM) and bone mineral content (BMC) values were found significantly lower in sarcopenic SSc patients (p0.0001, p0.001, p=0.004, p=0.04, respectively).SSc patients with sarcopenia and altered body composition were found affected by the most severe NVC pattern ("late"), a significantly reduced/altered number of capillaries and microvascular array (MES), suggesting a strong link between severity of local microvascular failure and associated muscle sufferance.

Objectives Defects in female pelvic organ support are highly prevalent. Uterosacral ligament suspension at the time of primary prolapse repair (McCall culdoplasty) is a well-established surgical option to prevent prolapse recurrences. Recently Shull's high uterosacral ligament suspension technique has gained increasing popularity among Uro-Gynaecologists. A study carried out in 2017 by Spelzini et al. compared these two techniques, showing proper safety and efficacy in the treatment of prolapse, with no statistically significant differences as to operative time, complication rate, anatomical, functional and subjective outcomes [ 1 ]. Our study aims at comparing the effectiveness, complication rate, recurrence rate, quality of life and functional result of the two techniques. Study design This is a retrospective study carried out on 224 patients who underwent vaginal cuff suspension for pelvic organ prolapse. Cases were extracted from hospital medical records of all women managed with surgical prolapse repair at our Gynaecology and Obstetrics department between January 2013 and February 2017. Shull suspension (group A) or McCall culdoplasty (group B) were performed according to surgeon's familiarity with the two suspension techniques. Results A total of 224 patients (69 in group A and 155 in group B) underwent surgical cuff suspension. Median operating time was 88 min for both techniques and ureteral injuries were very rare in both group A and B (1 and 0 respectively). In the evaluation of postoperative questionnaires, no statistically significant differences were found, except for "Urinary Impact Questionnaire" (UIQ), which showed significantly less urinary subjective symptoms in group A. Median follow up was 13 months in group A and 15 months in group B. Post-operative Pop-Q items analysis revealed only a higher Aa point in group A at 12 months follow up visit. Objective vaginal cuff recurrence was observed in 1 patient (1,4%) in group A and 4 patients in group B (2,6%) with no statistically significant difference between the two groups. Conclusions Both uterosacral ligament suspension procedures are safe and highly effective. There were no statistically significant differences concerning surgical data, complication rates, and the majority of anatomical, functional and subjective outcomes between Shull suspension and McCall culdoplasty.