Amenorrhea in anorexia nervosa neuroendocrine control of hypothalamic dysfunction

Abstract

Amenorrhea is one of the cardinal features of anorexia nervosa and is associated with hypothalamic dysfunction. Earlier theories of weight loss, decreased body fat, or exercise do not fully explain the etiology of amenorrhea in anorexia nervosa. Disturbances in central dopaminergic and opioid activity have been described in anorexia nervosa and both these substances are known to modulate gonadotropin‐releasing hormone (GnRH)‐mediated luteinizing hormone (LH) release. Serum LH, folliclestimulating hormone (FSH), estradiol, and prolactin levels were measured at baseline and after administration of metoclopramide (a central D‐2 dopamine receptor blocker) in 10 newly diagnosed women with anorexia nervosa and in 10 healthy age‐matched controls. Basal prolactin levels and the prolactin response to metoclopramide were significantly impaired in the group with anorexia nervosa. Metoclopramide did not induce a significant rise in LH levels in either the anorexic or the control groups. Neurotransmitter abnormalities may influence hypothalamic dysfunction in anorexia nervosa but the exact mechanism remains to be determined. © 1994 by John Wiley & Sons, Inc.

Should amenorrhea be a diagnostic criterion for anorexia nervosa?

“…21 It has also been hypothesized that amenorrhea is related to neurotransmitter abnormalities such as increased dopamine activity. 22,23 Therefore, it is possible that important biological differences exist between individuals with AN who are menstruating compared with those who are not. If the presence of amenorrhea reflects biological differences central to understanding the etiology of the illness and/or developing treatments, then it may be a useful diagnostic criterion.…”

Anorexia Nervosa and the Use of Total Parenteral Nutrition Refeeding

“…First and foremost is amenorrhea which is now one of the diagnostic criteria for anorexia nervosa. It is due in part to low levels of plasma luteinizing hormone (LH) and folliclestimulating hormone (FSH), despite low estrogen levels [23]. Further, there is a lack of the normal variation in LH secretion.…”

Menstrual dysfunction in anorexia nervosa

“…19 Repeated administration of exogenous GnRH results in normalization of LH secretion patterns in anorectics, but demonstrates an exaggerated response in non eating-disordered athletes suggesting a different mechanism for athletic amenorrhea. 20 The female athlete triad marks a subset of athletes with three co-existent medical concerns: disordered eating, amenorrhea, and osteoporosis. Athletes do not need to meet full criteria from Diagnostic and Statistical Manual of Mental Disorders, 4th ed, (DSM-IV) for an eating disorder, but may demonstrate any combination of restrictive eating, binge eating, or purging behaviors.…”