Carotenoderma in a young woman of normal body mass index with hypothalamic amenorrhoea: a 2-year follow-up case report

Abstract

Hypothalamic amenorrhoea has been shown to be associated with hypercarotenaemia, but no causal link has been established. Many people are unaware of the health implications of carotenoderma. We report on a 36-year-old woman with normal body mass index and with a history of secondary amenorrhoea for 2 years and carotenoderma for 5 years. She had a history of practising a fixed-menu diet of predominantly leafy greens, exercised intensively and had a stressful job. Blood tests confirmed the presence of hypercarotenaemia and hypogonadotrophic hypogonadism. Carotenoderma subsided after 6 months of lifestyle modification, but she remained amenorrhoeic up to 12 months later. Since then, her condition had relapsed up to the time of 2 years of follow-up. We conclude that hypercarotenaemia/carotenoderma and hypothalamic amenorrhoea are manifestations of a constrained lifestyle rather than causally linked. The presence of carotenoderma should alert public individuals and clinicians, especially in primary care, alike for signs of potential health complications including reproductive dysfunction even without weight problems.

Adrenal hypofunction associated with ashwagandha (Withania somnifera) supplementation: a case report

“…The effects of steroidal compounds from ashwagandha may extend to higher neuroendocrine centres controlled by the hypothalamus and pituitary. The hypothalamic-pituitary axis is known to be vulnerable to stress from restricted dietary practice and excessive exercise [24] and a number of drugs including exogenous steroids and opioids [25]. It is plausible that the steroidal withanolides and alkaloids from ashwagandha could suppress the hypothalamic-pituitary-adrenal (HPA) axis, in a similar way that exogenous corticosteroids (used to treat chronic inflammatory conditions) do to the HPA axis, leading to hypoadrenalism [25,26].…”