title: Persistent amenorrhea and decreased DHEAS to cortisol ratio after recovery from anorexia nervosa.
abstract: Persistent amenorrhea is a frequent condition affecting anorexic patients after stable weight recovery. It has been proposed that it could be due to alterations of the hypothalamic-pituitary-gonadal axis linked with persistent hormonal impairments, such as relative hypercortisolemia and hypoleptinemia, and psychological symptoms related to anorexia nervosa (AN). The aim of our study was to evaluate the metabolic and hormonal pattern involved in the persistence of amenorrhea after recovery from AN. Eight weight-recovered anorexic patients with amenorrhea were investigated and matched with 10 healthy eumenorrhoic women, comparable for age and BMI. Data showed basal FSH and LH values similar in both groups and a normal pituitaric response to LHRH administration. Morning serum cortisol was normal but significantly higher in patients, while dehydroepiandrosterone sulfate (DHEAS) to cortisol ratio, leptin and vitamin D were significantly lower in patients than controls. Women with previous AN presented insulin resistance and two patients showed an overall picture consistent with polycystic ovary syndrome (PCOS). In conclusion, long-lasting amenorrhea after recovery from AN is linked with a persistent hypothalamic dysfunction, although other concomitant causes like PCOS and insulin resistance should be considered. Decreased DHEAS to cortisol ratio is a new finding which could be correlated to the persistent hypogonadism.
authors.affiliation: a Department of Women's and Children's Health , University of Padua , Padua , Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Andrisani
authors.affiliation: b Department of Medicine-Endocrinology , University of Padua , Padua , Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Sabbadin
authors.affiliation: b Department of Medicine-Endocrinology , University of Padua , Padua , Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Minardi
authors.affiliation: c Department of Neurosciences , University of Padua , Padua , Italy , and.
authors.forename: Angela
authors.initials: A
authors.lastname: Favaro
authors.affiliation: d Department of Molecular Medicine-Biological Chemistry , University of Padua , Padua , Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Donà
authors.affiliation: d Department of Molecular Medicine-Biological Chemistry , University of Padua , Padua , Italy.
authors.forename: Luciana
authors.initials: L
authors.lastname: Bordin
authors.affiliation: a Department of Women's and Children's Health , University of Padua , Padua , Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Ambrosini
authors.affiliation: b Department of Medicine-Endocrinology , University of Padua , Padua , Italy.
authors.forename: Decio
authors.initials: D
authors.lastname: Armanini
mesh_terms: D000293:Adolescent; D000328:Adult; D000568:Amenorrhea / Q000097:blood* / Q000209:etiology; D000856:Anorexia Nervosa / Q000150:complications*; D001835:Body Weight; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood*; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007333:Insulin Resistance / Q000502:physiology*; D007986:Luteinizing Hormone / Q000097:blood; D011085:Polycystic Ovary Syndrome / Q000097:blood; D055815:Young Adult
chemical_list: D019314:Dehydroepiandrosterone Sulfate; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone; D006854:Hydrocortisone
keywords: Anorexia nervosa; DHEAS to cortisol ratio; hypothalamic amenorrhea; insulin resistance; polycystic ovary syndrome