Neuroendocrine Aberrations in Women With Functional Hypothalamic Amenorrhea*

Abstract

To further elucidate the neuroendocrine regulation of anterior pituitary function in women with functional hypothalamic amenorrhea (FHA), we measured serum LH, FSH, cortisol, GH, PRL, TSH concentrations simultaneously at frequent intervals for 24 h in 10 women with FHA and in 10 normal women in the early follicular phase (NC). Using the same data, we separately analyzed the cortisol-PRL responses to meals in these women. In addition, the pituitary responses to the simultaneous administration of GnRH, CRH, GHRH, and TRH were assessed in 6 FHA and 6 normal women. The 24-h secretory pattern of each hormone except TSH was altered in the women with FHA. Compared to normal women, the women with FHA had a 53% reduction in LH pulse frequency (P less than 0.0001) and an increase in the mean LH interpulse interval (P less than 0.01); LH pulse amplitude was similar. The 24-h integrated LH and FSH concentrations were reduced 30% (P = 0.01) and 19% (P less than 0.05), respectively. The mean cortisol pulse frequency, amplitude, interpulse interval, and duration were similar in the two groups, but integrated 24-h cortisol secretion was 17% higher in the women with FHA (P less than 0.05). This increase was greatest from 0800-1600 h, but also was present from 2400-0800 h. Cortisol levels were similar in the two groups from 1600-2400 h, resulting in an amplified circadian excursion. In contrast, the 24-h serum PRL levels were markedly lower at all times (P less than 0.0001), the sleep-associated nocturnal elevation of PRL was proportionately greater (P less than 0.05), and serum GH levels were increased at night in the women with FHA (P less than 0.05). Although 24-h serum TSH levels were similar at all times, T3 (P less than 0.05) and T4 (P less than 0.01) levels were lower in the FHA women. The responses of serum cortisol to lunch (P less than 0.01) and dinner (P less than 0.05) and those of serum PRL to lunch (P less than 0.05) and dinner (P = 0.08) were blunted in the women with FHA. Pituitary hormone increments in response to the simultaneous iv administration of GnRH, CRH, GHRH, and TRH were similar in the two groups, except for a blunted PRL response to TRH in the women with FHA (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

The neuroscience and endocrinology of fibromyalgia

“…Interactions between the HPA and HPG axes in FMS patients have yet to be thoroughly investigated. However, stress has been shown to compromise fertility (35,36). In women, stressrelated increases in cortisol secretion suppress hypothalamic gonadotropin-releasing hormone (GnRH) input to the pituitary-ovarian axis.…”

Luteinizing hormone pulse characteristics in depressed women

“…The 8-hour sampling period was chosen since Berga et al (8) demonstrated significant differences in LH area under the curve between normal women and women with hypothalamic amenorrhea during an 8-hour period in the afternoon and evening.…”

“…The LH pulse characteristics for each subject were analyzed by means of the computerized algorithm cluster analysis of Veldhuis and Johnson (7). Pulse characteristics such as amplitude, interpeak interval, mean peak duration, area under the curve, and peak and valley frequencies were determined (8). Rhythm was defined as the standard deviation of the interpeak intervals.…”

Irregularidades menstruais: inter-relações com o psiquismo

“…Grande parte dos estudos que abordam o assunto enfoca particularmente as amenorréias hipotalâmicas. Sabe-se que essa situação caracteriza-se por disfunção global, reflexo da ativação do eixo hipotálamo-hipófise-adrenal e associada a aumento no tônus opióide, depressão da função tireoideana, concentrações reduzidas de leptina e de alopregnanolona (metabólito da progesterona), além de alteração na atividade inibitória do sistema receptor de GABA (Suh et al, 1988;Berga et al, 1989;Laatikainen, 1991;Berga, 1996;Dominguez et al, 1997).…”