Pulsatile gonadotropin-releasing hormone therapy in persistent amenorrheic weight-recovered anorexia nervosa patients

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• 作者：Natacha Germain ; M.D. ; Ph.D.^a ; ^b ; ^{natacha.germain@chu-st-etienne.fr} ; Anaï ; s Fauconnier ; M.D.^a ; Jean-Philippe Klein ; M.D. ; Ph.D.^c ; ^d ; Amé ; lie Wargny ; M.Sc.^b ; Yadh Khalfallah ; M.D. ; Ph.D.^a ; Chrysoula Papastathi-Boureau ; M.D.^a ; Bruno Estour ; M.D. ; Ph.D.^a ; ^b ; Bogdan Galusca ; M.D. ; Ph.D.^a ; ^b
• 关键词：Anorexia nervosa ; hypothalamic amenorrhea ; pulsatile GnRH therapy
• 刊名：Fertility and Sterility
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：107
• 期：2
• 页码：502-509
• 全文大小：701 K
• 卷排序：107

文摘

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.DesignRetrospective, observational, ambulatory study.SettingUniversity hospital.Patient(s)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).Intervention(s)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.ResultsThe 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.Conclusion(s)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.