Pulsatile gonadotropin-releasing hormone therapy in persistent amenorrheic weight-recovered anorexia nervosa patients
Retrospective evaluation of pulsatile gonadotropinreleasing hormone therapy in amenorrheic persistent weight-recovered anorexia nervosa patients showed a high rate of pregnancy with higher hormonal response compared with the other hypothalamic amenorrhea forms.
Volume 107, Issue 2, Pages 502–509
Natacha Germain, M.D., Ph.D., Anaïs Fauconnier, M.D., Jean-Philippe Klein, M.D., Ph.D., Amélie Wargny, M.Sc., Yadh Khalfallah, M.D., Ph.D., Chrysoula Papastathi-Boureau, M.D., Bruno Estour, M.D., Ph.D., Bogdan Galusca, M.D., Ph.D.
To compare hormonal and clinical responses to GnRH pulsatile treatment in weight-recovered anorexia nervosa patients (Rec-AN) with persistent functional hypothalamic amenorrhea (HA) vs. in patients with secondary and primary HA.
Retrospective, observational, ambulatory study.
Forty-one women: 19 Rec-AN (body mass index >18.5 kg/m2 without menses recovery), 15 secondary HA without any eating disorders patients (SHA), and 7 primary HA patients (PHA).
Gonadotropin-releasing hormone pulsatile therapy.
Main Outcome Measure(s)
Baseline E2, LH, and P plasma levels and their changes during induction cycles; ovulation, follicular recruitment, and pregnancies.
The Rec-AN group displayed higher basal E2 and LH plasma levels after GnRH injection compared with SHA and PHA. Higher E2 and LH levels were observed during induction cycles in Rec-AN compared with SHA and PHA. Follicular recruitment was higher in Rec-AN. The ovulation rate was higher in Rec-AN compared with PHA but similar to SHA.
This study showed increased gonadal status and higher E2 response to pulsatile GnRH therapy in persistent amenorrheic weight-recovered AN compared with HA from other causes. It suggests that their individual set-point of body weight allowing a fully functional gonadal axis is not reached yet. Specific factors of gonadal inertia in Rec-AN still remain unclear.