Amenorrhea Induced by Hydrocephalus Due to Tuberculous Meningitis: A Rare Case Report and Literature

Abstract: Secondary amenorrhea is commonly associated with endocrine or gynecological disorders; however, central nervous system diseases may also disrupt the hypothalamic–pituitary–ovarian (HPO) axis and lead to hypogonadotropic hypogonadism. Hydrocephalus caused by tuberculous meningitis represents a rare but important neurological cause of menstrual disturbance. We report the case of a 24-year-old Indonesian woman of Southeast Asian ethnicity presenting with secondary amenorrhea for 2.5 years following a history of tuberculous meningitis complicated by communicating hydrocephalus and ventriculoperitoneal shunt placement. Hormonal evaluation revealed low gonadotropin and estradiol levels consistent with hypogonadotropic hypogonadism. Neuroimaging demonstrated ischemic lesions involving the thalamic and basal ganglia regions with radiological features of hydrocephalus and tuberculoma-related meningeal enhancement. Transrectal ultrasonography showed preserved ovarian morphology with antral follicles, supporting a central rather than ovarian etiology. Bone mineral density assessment revealed reduced bone mass associated with prolonged hypoestrogenism. A review of the literature highlights several proposed mechanisms linking hydrocephalus and hypothalamic dysfunction, including increased intracranial pressure and structural compression of hypothalamic pathways. This case emphasizes that neurological conditions such as tuberculous meningitis with hydrocephalus may cause secondary amenorrhea through disruption of hypothalamic–pituitary regulation. Early recognition of neuroendocrine complications is essential to prevent delayed diagnosis and long-term reproductive or metabolic consequences. Keywords: secondary amenorrhea, hypogonadotropic hypogonadism, hydrocephalus, tuberculous meningitis, ventriculoperitoneal shunt