Natacha Germain1, Anaïs Fauconnier2, Jean-Philippe Klein3, Amélie Wargny4, Yadh Khalfallah2, Chrysoula Papastathi-Boureau2, Bruno Estour5, Bogdan Galusca5. 1. Department of Endocrinology, Diabetes, Metabolism and Eating Disorders, University hospital of Saint-Etienne, Saint-Etienne, France; Eating Disorders, Addictions & Extreme Bodyweight Research Group EA 7423, Jean Monnet University, Saint-Etienne, France. Electronic address: natacha.germain@chu-st-etienne.fr. 2. Department of Endocrinology, Diabetes, Metabolism and Eating Disorders, University hospital of Saint-Etienne, Saint-Etienne, France. 3. Department of Histology and Embryology, University Hospital of Saint-Etienne, Saint-Etienne, France; Unité de Mixte de Recherche Institut National de la Santé et de la Recherche Médicale 1059, Jean Monnet University, Saint Etienne, France. 4. Eating Disorders, Addictions & Extreme Bodyweight Research Group EA 7423, Jean Monnet University, Saint-Etienne, France. 5. Department of Endocrinology, Diabetes, Metabolism and Eating Disorders, University hospital of Saint-Etienne, Saint-Etienne, France; Eating Disorders, Addictions & Extreme Bodyweight Research Group EA 7423, Jean Monnet University, Saint-Etienne, France.
Abstract
OBJECTIVE: To compare hormonal and clinical responses to GnRH pulsatile treatment in weight-recovered anorexia nervosa patients (Rec-AN) with persistent functional hypothalamic amenorrhea (HA) vs. in patients with secondary and primary HA. DESIGN: Retrospective, observational, ambulatory study. SETTING: University hospital. PATIENT(S): Forty-one women: 19 Rec-AN (body mass index >18.5 kg/m2 without menses recovery), 15 secondary HA without any eating disorders patients (SHA), and 7 primary HA patients (PHA). INTERVENTION(S): Gonadotropin-releasing hormone pulsatile therapy. MAIN OUTCOME MEASURE(S): Baseline E2, LH, and P plasma levels and their changes during induction cycles; ovulation, follicular recruitment, and pregnancies. RESULTS: The Rec-AN group displayed higher basal E2 and LH plasma levels after GnRH injection compared with SHA and PHA. Higher E2 and LH levels were observed during induction cycles in Rec-AN compared with SHA and PHA. Follicular recruitment was higher in Rec-AN. The ovulation rate was higher in Rec-AN compared with PHA but similar to SHA. CONCLUSION(S): This study showed increased gonadal status and higher E2 response to pulsatile GnRH therapy in persistent amenorrheic weight-recovered AN compared with HA from other causes. It suggests that their individual set-point of body weight allowing a fully functional gonadal axis is not reached yet. Specific factors of gonadal inertia in Rec-AN still remain unclear.
OBJECTIVE: To compare hormonal and clinical responses to GnRH pulsatile treatment in weight-recovered anorexia nervosapatients (Rec-AN) with persistent functional hypothalamic amenorrhea (HA) vs. in patients with secondary and primary HA. DESIGN: Retrospective, observational, ambulatory study. SETTING: University hospital. PATIENT(S): Forty-one women: 19 Rec-AN (body mass index >18.5 kg/m2 without menses recovery), 15 secondary HA without any eating disorderspatients (SHA), and 7 primary HA patients (PHA). INTERVENTION(S): Gonadotropin-releasing hormone pulsatile therapy. MAIN OUTCOME MEASURE(S): Baseline E2, LH, and P plasma levels and their changes during induction cycles; ovulation, follicular recruitment, and pregnancies. RESULTS: The Rec-AN group displayed higher basal E2 and LH plasma levels after GnRH injection compared with SHA and PHA. Higher E2 and LH levels were observed during induction cycles in Rec-AN compared with SHA and PHA. Follicular recruitment was higher in Rec-AN. The ovulation rate was higher in Rec-AN compared with PHA but similar to SHA. CONCLUSION(S): This study showed increased gonadal status and higher E2 response to pulsatile GnRH therapy in persistent amenorrheic weight-recovered AN compared with HA from other causes. It suggests that their individual set-point of body weight allowing a fully functional gonadal axis is not reached yet. Specific factors of gonadal inertia in Rec-AN still remain unclear.