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Observational Study
. 2024 Oct;310(4):2247-2252.
doi: 10.1007/s00404-024-07603-1. Epub 2024 Jul 4.

Chorio-retinal vessel density in women affected by functional hypothalamic amenorrhea: a monocentric observational cross-sectional study to evaluate the impact of hypoestrogenism on chorio-retinal vascularization

Alice Diterlizzi  1 , Anna Tropea  2 , Emanuela Angelini  3 , Valentina Cestrone  3   4 , Romina Fasciani  3   4 , Annamaria Merola  2 , Giovanna Notaristefano  3 , Martina Asia Policriti  3 , Teresa Polimeno  3 , Monia Ranalli  5 , Maria Cristina Savastano  3   4 , Ghazal Tannous  3 , Valeria Versace  2 , Stanislao Rizzo  3   4   6 , Giovanni Scambia  2   3 , Antonio Lanzone  2   3 , Rosanna Apa  2   3
Affiliations
Observational Study

Chorio-retinal vessel density in women affected by functional hypothalamic amenorrhea: a monocentric observational cross-sectional study to evaluate the impact of hypoestrogenism on chorio-retinal vascularization

Alice Diterlizzi et al. Arch Gynecol Obstet. 2024 Oct.

Abstract

Purpose: Functional hypothalamic amenorrhea (FHA) is characterized by an estrogen deficiency which in turn can cause vascular dysfunction. The aim of this study is to evaluate any changes in the chorio-retinal circulation in patients affected by FHA. 24 patients with FHA and 24 age-matched controls underwent a gynecological evaluation and an OCT angiography (OCTA) to study chorio-retinal vascularization.

Results: OCTA in FHA patients showed an increase in vessel density in the choriocapillaris (CC) layer (both in the fovea area, at 5% p value = 0.037 and in the whole area, at 5% p value = 0.028) and an increase in vascular density in the deep fovea (DVP) (at 10% p value = 0.096) in the whole district compared to controls. Simple linear regressions show a significant negative association between CC vessel density and insulin (p = 0.0002) and glucose values (p = 0.0335) for the fovea district and a negative association between DVP vessel density and endometrial thickness (at 10%, p value: 0.095) in the whole district.

Conclusion: Our study shows that CC vessel density is increased in women affected by FHA. This could represent a compensation effort to supply the vascular dysfunction caused by estrogen deficiency. We also found an increasing trend in vascular density in DVP associated with the decrease of endometrial thickness, an indirect sign of estrogenization. Considering that these changes occur in absence of visual defects, they could be used as a biomarker to estimate hypoestrogenism-induced microcirculation changes before clinical appearance.

Keywords: Chorio-retinal circulation; Estrogens; Functional hypothalamic amenorrhea; Vascular dysfunction; Vessel density.

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Conflict of interest statement

The authors have not disclosed any competing interests.

Figures

Fig. 1
Fig. 1
Box plots of the distributions of vessel density for superficial fovea, deep fovea, and choriocapillaris fovea in the cases and controls
See this image and copyright information in PMC

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