title: Endocrine disorders in adolescent and young female athletes: impact on growth, menstrual cycles, and bone mass acquisition.
abstract: BACKGROUND
  Puberty is a crucial period of dramatic hormonal changes, accelerated growth, attainment of reproductive capacity, and acquisition of peak bone mass. Participation in recreational physical activity is widely acknowledged to provide significant health benefits in this period. Conversely, intense training imposes several constraints, such as training stress and maintenance of very low body fat to maximize performance. Adolescent female athletes are therefore at risk of overtraining and/or poor dietary intake, which may have several consequences for endocrine function. The "adaptive" changes in the hypothalamic-pituitary-gonadal, -adrenal, and somatotropic axes and the secretory role of the adipose tissue are reviewed, as are their effects on growth, menstrual cycles, and bone mass acquisition.
  
  
  METHODS
  A systematic search on Medline between 1990 and 2013 was conducted using the following terms: "intense training," "physical activity," or "exercise" combined with "hormone," "endocrine," and "girls," "women," or "elite female athletes." All articles reporting on the endocrine changes related to intense training and their potential implications for growth, menstrual cycles, and bone mass acquisition were considered.
  
  
  CONCLUSIONS
  Young female athletes present a high prevalence of menstrual disorders, including delayed menarche, oligomenorrhea, and amenorrhea, characterized by a high degree of variability according to the type of sport. Exercise-related reproductive dysfunction may have consequences for growth velocity and peak bone mass acquisition. Recent findings highlight the endocrine role of adipose tissue and energy balance in the regulation of homeostasis and reproductive function. A better understanding of the mechanisms whereby intense training affects the endocrine system may orient research to develop innovative strategies (ie, based on nutritional or pharmacological approaches and individualized modalities of training and competition) to improve the medical care of these adolescents and protect their reproductive function.
authors.affiliation: Service de Médecine Nucléaire (L.M.), Hôpital Lapeyronie, Centre Hospitalier Régional Universitaire (CHRU) de Montpellier and Université Montpellier 1 (UM1), 34295 Montpellier, France; Département d'Hormonologie (L.M., C.S.), Hôpital Lapeyronie, CHRU Montpellier, 34295 Montpellier, France; Physiologie et Médecine Expérimentale du Cœur et des Muscles (L.M.), INSERM Unité 1046, Université Montpellier 1 (UM1) and Université Montpellier 2 (UM2), 34295 Montpellier, France; Division of Reproductive Endocrinology (N.A.G.), Department of Obstetrics and Gynecology, University of Patras Medical School, University Hospital, Patras 265 04, Greece; and Unité d'Endocrinologie et Gynécologie Pédiatrique (C.S.), Département de Pédiatrie, Hôpital Arnaud de Villeneuve, CHRU Montpellier et UM1, 34295 Montpellier, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Maïmoun
authors.forename: Neoklis A
authors.initials: NA
authors.lastname: Georgopoulos
authors.forename: Charles
authors.initials: C
authors.lastname: Sultan
mesh_terms: D000293:Adolescent; D000568:Amenorrhea / Q000503:physiopathology*; D056352:Athletes; D015519:Bone Density / Q000502:physiology*; D004700:Endocrine System Diseases / Q000503:physiopathology*; D015444:Exercise / Q000502:physiology; D005260:Female; D006801:Humans; D008597:Menstrual Cycle / Q000502:physiology*; D008599:Menstruation Disturbances / Q000503:physiopathology*; D012741:Sexual Maturation / Q000502:physiology*; D013177:Sports / Q000502:physiology; D055815:Young Adult