Nutritional and Endocrine-Metabolic Aberrations in Women with Functional Hypothalamic Amenorrhea1

G. A. Laughlin, C. E. Dominguez, S. S. C. Yen
1998 Journal of Clinical Endocrinology and Metabolism  
The development of functional hypothalamic amenorrhea (FHA) in weight-stable, nonathletic women has long been thought to be psychogenic in origin. This study was designed to gain insight into the possibility that nutritional deficits and compensatory endocrine-metabolic adaptations contribute to the development and maintenance of FHA of the psychogenic type. Nutritional intake, insulin sensitivity, and 24-h dynamics of insulin/glucose, cortisol, leptin, somatotropic, and LH axes were
more » ... sly assessed in eight women with FHA not associated with exercise or weight loss and in eight age-and body mass index-matched regular cycling controls (NC). The percent fat body mass was lower and lean body mass was higher in FHA than in NC (P Ͻ 0.05). The FHA subjects scored higher (P Ͻ 0.05) on two Eating Disorder Inventory subscales and had a higher (P Ͻ 0.05) Beck depression rating than NC, although all were in the subclinical range. Although daily caloric intake did not differ, FHA consumed 50% less (P Ͻ 0.001) fat, twice (P Ͻ 0.05) as much fiber, and more carbohydrate (P Ͻ 0.05) compared to NC. During the feeding phase of the day, FHA exhibited lower glucose (P Ͻ 0.05) and insulin (P Ͻ 0.01) levels than NC, and the degree of hypoinsulinemia was directly related to relative dietary fat (r ϭ 0.73). Although 24-h mean GH levels did not differ, the pattern of GH release in FHA was distinctly altered from that in NC. GH pulse amplitude was blunted, pulse frequency was accelerated 40% (P Ͻ 0.01), and interpulse GH concentrations were elevated 2-fold (P Ͻ 0.01) throughout the day for FHA compared to NC. This distorted pattern of GH pulses was associated with a 40% decrease (P Ͻ 0.01) in GH-binding protein levels. Levels of the insulin-dependent insulinlike growth factor (IGF)-binding protein-1 (IGFBP-1) were elevated (P Ͻ 0.001) during the feeding portion of the day in FHA and were
doi:10.1210/jcem.83.1.4502 pmid:9435412 fatcat:oenlmxwrbnfqle22rber32lcki