Acetyl-L-carnitine (ALC) administration positively affects reproductive axis in hypogonadotropic women with functional hypothalamic amenorrhea.
BACKGROUND
Hypothalamic amenorrhea (HA) is characterized by neuroendocrine impairment that, in turn, negatively modulates endocrine function, mainly within the reproductive axis. HA presents with hypo-LH, hypoestrogenism and, until now, a definite therapeutic strategy has not yet been found. The aim of the following study was to test the efficacy of acetyl-L-carnitine (ALC) administration in HA-affected subjects.


METHODS
Twenty-four patients affected by stress-induced HA were divided into two groups according to LH plasma levels: group A, hypo-LH (LH≤3 mIU/ml; no.=16), and group B, normo-LH (LH>3 mIU/ml; no.=8), were treated with ALC (1 g/day, per os) for 16 weeks.


METHODS
Patients underwent baseline hormonal assessment, pulsatility test (for LH and FSH), naloxone test (for LH, FSH and cortisol) both before and after 16 weeks of treatment.


RESULTS
Under ALC administration hypo-LH patients showed a significant increase in LH plasma levels (from 1.4±0.3 to 3.1±0.5 mIU/ml, p<0.01) and in LH pulse amplitude (p<0.001). No changes were observed in the normo-LH group. LH response to naloxone was restored under ALC therapy. Maximal LH response and area under the curve under naloxone were significantly increased (p<0.05 and p<0.01, respectively). No changes were observed in the normo-LH patients.


CONCLUSIONS
Our data support the hypothesis of a specific role of ALC on counteracting the stress-induced abnormalities in hypo-LH patients affected by hypothalamic amenorrhea.
Genazzani
A D
AD
Department of Obstetrics and Gynecology, University of Modena and Reggio Emilia, Via del Pozzo 71, 41100 Modena, Italy. algen@unimo.it
Lanzoni
C
C
Ricchieri
F
F
Santagni
S
S
Rattighieri
E
E
Chierchia
E
E
Monteleone
P
P
Jasonni
V M
VM
D000108:Acetylcarnitine / Q000627:therapeutic use*; D000328:Adult; D000568:Amenorrhea / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007006:Hypogonadism / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D007027:Hypothalamic Diseases / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D007328:Insulin / Q000097:blood; D007986:Luteinizing Hormone / Q000097:blood; D012098:Reproduction / Q000187:drug effects* / Q000502:physiology; D013312:Stress, Physiological; D055815:Young Adult
D007328:Insulin; D000108:Acetylcarnitine; D007986:Luteinizing Hormone