A longitudinal study of disturbances of the hypothalamic-pituitary-adrenal axis in women with progestin-negative functional hypothalamic amenorrhea.
OBJECTIVE
To longitudinally evaluate disturbances of the hypothalamic-pituitary-adrenal (HPA) axis in women with secondary progestin-negative hypothalamic amenorrhea.


METHODS
Retrospective cohort study.


METHODS
Yokohama City University, Yokohama, Japan.


METHODS
Twenty-four women with progestin-negative hypothalamic amenorrhea.


METHODS
Administration of human corticotropin-releasing hormone (hCRH) and treatment with a combination of estrogen and progesterone.


METHODS
Plasma cortisol and ACTH concentrations and period required for recovery from amenorrhea.


RESULTS
Plasma ACTH concentrations 30 and 60 minutes after injection of hCRH and the percent maximum increment (%Cmax) of ACTH were significantly lower in the amenorrheic patients compared with the control group patients. The basal cortisol was significantly higher, and the %Cmax of cortisol was significantly lower. In the 16 patients who recovered from amenorrhea, there was a significant positive correlation (Y = 1.93X-10.8, r = 0.629) between the basal cortisol concentrations (X) and the period for recovery (Y). The serum E2 gradually increased before recovery, and this E2 increase was preceded by changes in the plasma cortisol concentration and the %Cmax values of cortisol and ACTH.


CONCLUSIONS
The CRH test might be useful for evaluating the roles of stress and for estimating the period required for recovery in hypothalamic amenorrhea.
Kondoh
Y
Y
Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan. ym-kondo@pk9.so-net.ne.jp
Uemura
T
T
Murase
M
M
Yokoi
N
N
Ishikawa
M
M
Hirahara
F
F
D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000568:Amenorrhea / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology*; D003346:Corticotropin-Releasing Hormone / Q000494:pharmacology; D045166:Estradiol Congeners / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007027:Hypothalamic Diseases / Q000150:complications*; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology*; D008137:Longitudinal Studies; D008656:Mestranol / Q000627:therapeutic use; D009640:Norethindrone / Q000627:therapeutic use; D010913:Pituitary-Adrenal System / Q000503:physiopathology*; D045167:Progesterone Congeners / Q000627:therapeutic use; D011372:Progestins / Q000097:blood*; D012016:Reference Values; D013997:Time Factors
D045166:Estradiol Congeners; D045167:Progesterone Congeners; D011372:Progestins; D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone; D008656:Mestranol; D009640:Norethindrone; D006854:Hydrocortisone