[Nutritional hypogonadism].
Functional hypothalamic amenorrhea are frequently observed. Body weight, body composition, eating attitudes, exercise are potent modulators of gonadotrop axis. Animal studies and clinical observations stress the fact of a major impact on ovary function of starvation or caloric restriction, weight loss and fat mass deficiency, eating disorders, stress or high intensive exercise training. From a pathophysiological point of view, insulin, IGF's system, leptine and central neuromediators are a link between nutrition and the gonadotropic axis. Initial clinical evaluation may strongly suggest the environmental origin of the amenorrhea. Basal hormonal evaluation (gonadotropins, prolactin, androgens ...) excludes other diseases and specialised evaluations [basal metabolic rate (BMR), Free T3 ...] could confirm the diagnosis. A low BMR, and a low Free T3, a normal FSH level with a low LH level suggest the nutritional origin of the amenorrhea. Improvement of nutritional intake and body composition with a psychological follow up may reverse the gonadotropin deficiency. If this deficiency persists hormonal replacement therapy is added in order to prevent the short or long term consequences (osteoporosis) of hypoestrogenism.
Bringer
J
J
Service des maladies endocriniennes, CHU hôpital Lapeyronie, Montpellier.
Lefebvre
P
P
Renard
E
E
D000568:Amenorrhea / Q000209:etiology*; D001823:Body Composition; D004032:Diet; D015914:Estrogen Replacement Therapy; D004967:Estrogens / Q000172:deficiency; D005260:Female; D006062:Gonadotropins / Q000172:deficiency* / Q000494:pharmacology; D006801:Humans; D007006:Hypogonadism / Q000209:etiology* / Q000628:therapy; D009748:Nutrition Disorders / Q000150:complications*; D009752:Nutritional Status; D010024:Osteoporosis / Q000209:etiology / Q000517:prevention & control
D004967:Estrogens; D006062:Gonadotropins