Persistent amenorrhoea in weight-recovered anorexics: psychological and biological aspects

Brambilla, Francesca; Monteleone, Palmiero; Bortolotti, Francesca; Grave, Riccardo Dalle; Todisco, Patrizia; Favaro, Angela; Santonastaso, Paolo; Ramacciotti, Carla Emilia; R, Paoli; Maj, Mario

doi:10.1016/s0165-1781(03)00074-x

Cited by 66 publications

(51 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These findings support the hypothesis that a critical fat mass is necessary for the recuperation of menstrual function and that leptin plays a relevant role in gonadal function (27). The persistence of amenorrhea in AN patients who reach a normal BMI could be due to the coexistence of estradiol and leptin deficiencies and the maintenance of specific psychopathological impairments (28). Moreover, it is possible that although the patient's BMI is normalized, they may not have reached their metabolic optimum (29).…”

Section: Discussionsupporting

confidence: 73%

Regional fat distribution in adolescents with anorexia nervosa: effect of duration of malnutrition and weight recovery

Álvaro¹,

Muñoz-Calvo²,

Barrios³

et al. 2007

eur j endocrinol

View full text Add to dashboard Cite

Objective: This study addresses the influence of the duration of malnutrition and the effect of weight recovery on regional fat mass distribution in moderately malnourished adolescents with anorexia nervosa (AN). Study design: We measured total and regional fat mass and leptin levels in 42 restrictive AN female adolescents and 23 controls. AN patients, followed over 2 years, were divided into three groups: prolonged moderate malnutrition (PM; secondary amenorrhea for over 1 year, nZ14); SM, short period of moderate malnutrition (secondary amenorrhea for less than 1 year, nZ13); and R, recovered from AN (BMI, body mass index and menses recovered for over 6 months, nZ15). Results: Total, trunk, and extremity fat mass were reduced in the PM and SM groups (P!0.05), whereas only PM patients showed altered regional fat distribution with a low trunk to extremity fat ratio (P!0.05). BMI increased after 12 months only in the SM group (P!0.05), with menses resumption in 69% of these patients and BMI normalization at 24 months. Their regional fat distribution was similar to controls throughout the study. No difference in any parameter was found between the R group and the controls. Conclusion: Prolonged malnutrition, but not weight recovery, is associated with an abnormal regional fat distribution pattern in moderately malnourished AN adolescents.European Journal of Endocrinology 157 473-479

show abstract

Section: Discussionsupporting

confidence: 73%

Regional fat distribution in adolescents with anorexia nervosa: effect of duration of malnutrition and weight recovery

Álvaro¹,

Muñoz-Calvo²,

Barrios³

et al. 2007

eur j endocrinol

View full text Add to dashboard Cite

show abstract

“…4 Furthermore, while amenorrhea often occurs following a reduction in body weight and body fat, it precedes weight loss in approximately 20% of patients with AN 5,6 and can persist after weight gain. [7][8][9] Amenorrhea can also occur among normal weight women who engage in dietary restraint, who exercise strenuously, or who experience psychological stress. 4 Taken together, these findings suggest that, while reduced weight and/or body fat are associated with amenorrhea for many individuals with AN, other factors also contribute to the development of amenorrhea.…”

Section: Potential Biological Differences Signified By Amenorrheamentioning

confidence: 99%

Should amenorrhea be a diagnostic criterion for anorexia nervosa?

Attia

Roberto

2009

Intl J Eating Disorders

146

102

View full text Add to dashboard Cite

Objective: The removal of the amenorrhea criterion for anorexia nervosa (AN) is being considered for the fifth edition of The Diagnostic and Statistical Manual (DSM-V). This article presents and discusses the arguments for maintaining as well as those for removing the criterion. Method:The psychological and biological literatures on the utility of amenorrhea as a distinguishing diagnostic criterion for AN and as an indicator of illness severity are reviewed.Results: The findings suggest that the majority of differences among patients with AN who do and do not meet the amenorrhea criterion appear largely to reflect nutritional status. Overall, the two groups have few psychological differences. There are mixed findings regarding biological differences between those with AN who do and do not menstruate and the relationship between amenorrhea and bone health among patients with AN.Discussion: Based on these findings, one option is to describe amenorrhea in DSM-V as a frequent occurrence among individuals with AN that may provide important information about clinical severity, but should not be maintained as a core diagnostic feature. The possibilities of retaining the criterion or eliminating it altogether are discussed.

show abstract

“…'Weight restored' persistently amenorrhoeic women with AN have been found to have significantly lower mean weights and weight to height ratios than menstruating women. 38 2 Nutritional status and energy availability. 7,26,36,39 A recent study 39 demonstrated that 31% of teenage girls recovering from an eating disorder needed to achieve a weight actually above the population average in order to restore menses, and the authors hypothesised that nutritional status was more important than IBW to predict menstrual function.…”

Section: Hormone Adaptation In Anmentioning

confidence: 99%

Current concepts in bone and reproductive health in adolescents with anorexia nervosa

Jayasinghe

Grover

Zacharin

2008

BJOG

View full text Add to dashboard Cite

Anorexia nervosa (AN) initiates an adaptive response at the level of the hypothalamus, which results in a complex interplay involving most elements of the neuroendocrine axis. Consequences of onset of disease in adolescence include amenorrhoea, pubertal arrest with potential loss of target height, and osteoporosis with reduced capacity for future attainment of peak bone mass. With recovery, delay in restoration of menses is common. Hormonal therapies for restoration of bone mineral density (BMD) in adolescents have shown limited efficacy. This review will discuss the reproductive endocrine effects of AN in adolescence, and discuss new investigative tools for monitoring restoration of reproductive function and BMD in this population.Keywords Adolescence, amenorrhoea, anorexia nervosa, bone mineral density, eating disorders. IntroductionNinety percent of eating disorders present before the age of 25 years, and in the early stages they may present with menstrual dysfunction. 1 Therefore, it is important that gynaecologists have a good understanding of current concepts of hypothalamic regulation, as those physicians may be the first point of contact in subsyndromal eating disorders. Leptin, a hormone produced by adipocytes, appears to be the critical link between energy homeostasis and neuroendocrine regulation. 2 Since its discovery in 1994, 3 rapid gains in understanding of the hormonal and nutritional regulation of anorexia nervosa (AN) have occurred. 4 These findings are likely to have a significant impact on clinical management of the reproductive-endocrine aspects of AN. Bone loss consequent upon estrogen deficiency may be severe, of long duration with reduced capacity for recovery. Understanding bone loss mechanisms, correct interpretation of bone density measurements and consideration of treatment modalities to ameliorate the problems of eating disorders are an essential part of overall management strategies. EpidemiologyThe Society for Adolescent Medicine together with other medical bodies has recognised that strict Diagnostical and Statistical Manual of Mental Health Disorders-IV (DSM-IV) criteria 5 for AN (particularly requiring weight below 85% of normal and amenorrhoea for 3 months), may not apply to all women. 6,7 This is particularly so in adolescents because of their normal variability in development, and also because adverse health effects occur even in partial syndromes. In adolescence, prevalence of AN is 0.5%, bulimia nervosa is 1% and partial syndromes (eating disorders not otherwise specified) is 2.4-5.0%. 6,[8][9][10] Clinical sequelaeThe clinical sequelae of AN depend on timing of disease in relation to puberty. These may include pubertal delay and primary amenorrhoea, pubertal arrest with potential loss of target height, or secondary amenorrhoea. 11-13 Amenorrhoea has been reported to precede weight loss in 20% of women, which may lead to diagnostic confusion.Low bone mineral density (BMD) is an established risk in AN, with 50% of anorexics demonstrating osteopenia within 20 months of ameno...

show abstract

Persistent amenorrhoea in weight-recovered anorexics: psychological and biological aspects

Cited by 66 publications

References 43 publications

Regional fat distribution in adolescents with anorexia nervosa: effect of duration of malnutrition and weight recovery

Regional fat distribution in adolescents with anorexia nervosa: effect of duration of malnutrition and weight recovery

Should amenorrhea be a diagnostic criterion for anorexia nervosa?

Current concepts in bone and reproductive health in adolescents with anorexia nervosa

Contact Info

Product

Resources

About