Women with functional hypothalamic amenorrhea but not other forms of anovulation display amplified cortisol concentrations.
OBJECTIVE
To test the hypothesis that increased cortisol secretion is specific to women with decreased GnRH drive and not found in eumenorrheic women or those with other causes of anovulation.


METHODS
Cortisol concentrations in blood were determined at 30-minute intervals for 24 hours in three well-characterized groups: women with functional hypothalamic amenorrhea, those with other causes of anovulation, and eumenorrheic women.


METHODS
Academic medical center.


METHODS
Women aged 20 through 35 years, with well-defined reproductive states.


METHODS
Venous blood samples were obtained from, and psychometric inventories were completed by, the participants.


METHODS
Twenty-four-hour cortisol levels, 24-hour LH pulse patterns, and serial P levels were measured in women with functional hypothalamic amenorrhea, eumenorrheic women, and those with other causes of anovulation.


RESULTS
Cortisol secretion was higher in women with functional hypothalamic amenorrhea (n = 19) than in those with other causes of anovulation (n = 19) or eumenorrheic women (n = 19). Six women who recovered from functional hypothalamic amenorrhea had cortisol levels comparable to those of eumenorrheic women and those with other causes of anovulation.


CONCLUSIONS
These data underscore the association between increased hypothalamic-pituitary-adrenal activity and reduced GnRH drive and support the concept that functional hypothalamic amenorrhea develops in response to stress-induced alterations in central neural function that modify hypothalamic function.
Berga
S L
SL
Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pennsylvania 15213, USA.
Daniels
T L
TL
Giles
D E
DE
D000328:Adult; D000568:Amenorrhea / Q000097:blood*; D000858:Anovulation / Q000097:blood*; D004958:Estradiol / Q000097:blood; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000378:metabolism*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood* / Q000378:metabolism; D007031:Hypothalamus / Q000503:physiopathology*; D011388:Prolactin / Q000097:blood; D012016:Reference Values; D013312:Stress, Physiological; D013972:Thyrotropin / Q000097:blood
D007987:Gonadotropin-Releasing Hormone; D004958:Estradiol; D011388:Prolactin; D013972:Thyrotropin; D006854:Hydrocortisone