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Query: UMLS:C0002453 (amenorrhea)
 6,245 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The significance of amenorrhea as a criterion for anorexia nervosa was examined. Twelve nonamenorrheic women treated for anorexia were compared with 40 women meeting full DSM-IV criteria. The nonamenorrheic group displayed the same high levels of eating disorder, body-image disturbance, and psychopathology as the amenorrheic group, as measured by the following variables: body-size overestimation on the Image Marking Procedure; body distortion on the Body Distortion Questionnaire; eating disorder on the Eating Disorder Inventory; depression on the Beck Depression Inventory; psychopathology on the MMPI; and external locus of control on the Rotter Locus of Control Scale. Amenorrhea does not appear to be a useful criterion for distinguishing full-syndrome anorexia nervosa from partial-syndrome cases.
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PMID:Is amenorrhea a critical criterion for anorexia nervosa? 958 85

Sleeping sickness (SS; African trypanosomiasis) is an anthropozoonosis transmitted by the tsetse fly. Infection with Trypanosoma brucei in humans is associated with adynamia, lethargy, anorexia, and more specifically amenorrhea/infertility in women and loss of libido/impotence in men. Recent evidence suggests that experimental infection in animals with Trypanosoma brucei species causes polyglandular endocrine failure by local inflammation of the pituitary, thyroid, adrenal, and gonadal glands. In a cross-sectional study we investigated the prevalence and significance of neuroendocrine abnormalities in 137 Ugandan patients with SS. In the untreated stage of the disease, there was a high prevalence of adrenal insufficiency (27%), hypothyroidism (50%) and hypogonadism (85%). Pituitary function tests suggested an unusual combined central (hypothalamic/pituitary) and peripheral defect in hormone secretion. Specific therapy resulted in a rapid recovery of adrenal/thyroid function, whereas hypogonadism persisted for years in a substantial portion of patients. We did not detect pituitary, thyroid, adrenal, and gonadal autoantibodies in patients with endocrine dysfunction, ruling out an autoimmune origin of the endocrine abnormalities. However, the presence of hypopituitarism correlated with high cytokine concentrations (TNF-alpha, IL-6) which--together with direct parasitic infiltration of the endocrine glands--are involved in the pathogenesis of SS-associated endocrine dysfunction.
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PMID:Neuroendocrine dysfunction in African trypanosomiasis. The role of cytokines. 962 7

Because the exact etiology of functional, or idiopathic, hypothalamic amenorrhea (FHA) is still unknown, FHA remains a diagnosis of exclusion. The disorder may be stress induced. However, mounting evidence points to a metabolic/nutritional insult that may be the primary causal factor. We explored the thyroid, hormonal, dietary, behavior, and leptin changes that occur in FHA, as they provide a clue to the etiology of this disorder. Fourteen cycling control and amenorrheic nonathletic subjects were matched for age, weight, and height. The amenorrheic subjects denied eating disorders; only after further, detailed questioning did we uncover a higher incidence of anorexia and bulimia in this group. The amenorrheic subjects demonstrated scores of abnormal eating twice those found in normal subjects (P < 0.05), particularly bulimic type behavior (P < 0.01). They also expended more calories in aerobic activity per day and had higher fiber intakes (P < 0.05); lower body fat percentage (P < 0.05); and reduced levels of free T4 (P < 0.05), free T3 (P < 0.05), and total T4 (P < 0.05), without a significant change in rT3 or TSH. Cortisol averaged higher in the amenorrheics, but not significantly, whereas leptin values were significantly lower (P < 0.05). Bone mineral density was significantly lower in the wrist (P < 0.05), with a trend to lower BMD in the spine (P < 0.08). Scores of emotional distress and depression did not differ between groups. The alterations in eating patterns, leptin levels, and thyroid function present in subjects with FHA suggest altered nutritional status and the suppression of the hypothalamic-pituitary-thyroid axis or the alteration of feedback set-points in women with FHA. Both lower leptin and thyroid levels parallel changes seen with caloric restriction. Nutritional issues, particularly dysfunctional eating patterns and changes in thyroid metabolism, and/or leptin effects may also have a role in the metabolic signals suppressing GnRH secretion and the pathogenesis of osteopenia despite normal body weight. These findings suggest that the mechanism of amenorrhea and low leptin in these women results mainly from a metabolic/nutritional insult.
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PMID:Functional hypothalamic amenorrhea: hypoleptinemia and disordered eating. 1008 64

Anorexia nervosa is a syndrome of unknown etiology. It is associated with multiple endocrine abnormalities. Hypothalamic monoamines (especially serotonin), neuropeptides (especially neuropeptide Y and cholecystokinin) and leptin are involved in the regulation of human appetite, and in several ways they are changed in anorexia nervosa. However, it remains to be clarified whether the altered appetite regulation is secondary or etiologic. Increased secretion of corticotropin-releasing hormone and proopiomelanocortin seems to be secondary to starvation, however, there is evidence that it may maintain and intensify anorexia, excessive physical activity and amenorrhea. Hypothalamic amenorrhea, which is a diagnostic criterion in anorexia nervosa, is not solely related to the low body weight and exercise. Growth hormone resistance with low production of insulin-like growth factor I and high growth hormone secretion reflect the nutritional deprivation. The nutritional therapy of patients with anorexia nervosa might be improved by administering an anabolic agent such as growth hormone or insulin-like growth factor I. So far none of the endocrine abnormalities have proved to be primary, however, there is increasing evidence that some of these might participate in a vicious circle.
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PMID:A review of endocrine changes in anorexia nervosa. 1022 46

Anorexia nervosa is characterized by a triad comprising anorexia, weight loss, and amenorrhoea. It is typically present in adolescent or young adult women and its prevalence appears to increase in our society. Eating disorders may lead to cachexia and various severe complications. This disease, which appears to be associated to a particular psychological background, is triggered by conflictual relationships, usually within the family. The anorectic patient should be carefully evaluated, as soon as possible, from a somatic, dietetic and psychological point of view. A specific therapeutic approach should be rapidly proposed in a specialized centre, if possible by a multidisciplinary team. The treatment is most often difficult and of long duration. Prognosis remains uncertain in most cases, especially when appropriate care is delayed.
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PMID:[Anorexia nervosa, a serious disease of young women]. 1038 67

Peripartum cardiomyopathy (PPCM) is a rare form of heart failure affecting women in the last month of pregnancy or the first six months post-partum. The etiology of PPCM remains poorly understood although some risk factors were described. Diagnosis is often difficult and is always necessary to exclude other prior heart disease and other cause of left ventricular dysfunction in pregnancy. Medical therapy for PPCM is similar to that for other forms of congestive heart failure; prognosis is better than in idiopathic cardiomyopathy but many authors observed that women who have had one episode of PPCM are likely to have recurrences in subsequent pregnancies. The present report describes the case of a woman presenting with severe cardiac failure immediately after cesarean section for twin pregnancy. The patient is a 35-year-old nulliparous white woman, with history of anorexia, subsequent amenorrhea, sterility and pregnancy induced with Gn-Rh. The diagnosis of PPCM was difficult for the presence of preeclampsia and acute pulmonary edema occurred four hours after delivery. The successful outcome was possible with an intensive treatment (mechanical ventilation, Swan-Ganz catheter). The whole resolution of the heart failure, six months post-partum, was demonstrated by ultrasonography.
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PMID:[Peripartum dilatative cardiomyopathy. Case report with literature review]. 1052 39

Osteoporosis recently has been added to growing list of medical complications assisted with eating disorder in particular Anorexia nervosa. These often occur early in the course of anorexia in adolescent girls, presumably because this disorder not only interrupts the normal rapid bone accretion characteristic of adolescences, but also accelerate bone loss. The pathogenesis of osteoporosis in AN has not been completely characterized. While low body mass and amenorrhea are clearly important variables, other focters also may be involved. Some possible contributing factors in patients with AN include low Ca intake, increased glucocorticoids, insulin growth factor 1 deficiency. Simple weight gain needs to be part of the treatment, although it and exercise remain of unproven benefit for osteoporosis in patients with AN. But some studies have found that the clinical course of osteoporosis is not reversed simply with weight restoration. Long term studies are needed to answer the question of whether osteoporosis assisted with eating disorder is reversible.
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PMID:[Bone mineral density of eating disorder]. 1126 8

This review offers some basic information on a syndrome described in 1992 as the female athlete triad. The increasing participation of women in competitive sports has led to significant accumulation of knowledge about potential pathological conditions due to strenuous exercise. Participation in sports that emphasize specific body image, psychological constitution of young female athletes and significantly lower daily calory intake cause the development of disordered eating, especially anorexia nervosa. Anorexia in combination with intensive training induces menstrual disorders, exercise-associated amenorrhea being the most important one. Low serum estrogen concentrations, as well as insufficient daily calcium intake have negative influence on bone mineral density, and the athletes have greater risk of developing osteoporosis and stress fractures. We described the diagnostic and therapeutic procedures necessary to detect and treat this syndrome. Education of physicians, female athletes and their coaches, as well as the screening during the annual examination, remain the most important measures of prevention.
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PMID:[The female athlete triad]. 1172 16

Eating disorders (anorexia and bulimia nervosa) are present in 1-3% of young female women. A later beginning, prolonged amenorrhea and low body mass index are risk factors of osteopenia in bulimic patients. Bone demineralization in anorexia nervosa is due to a greater resorption than bone formation leading to osteopenia, secondary osteoporosis and increased risk of pathologic fractures. Pathophysiology of bone disease includes factors as long duration of amenorrhea, deficient absorption of calcium, extreme physical exercise, 1.25 vitamin D deficiency, low creatinine clearance, increased blood and urinary cortisol and high levels of GH. Proposed treatments are nutritional improvement and weight gain (the most important), calcium supplementation, moderate exercise, estrogens, antidepressive drugs, fluoride in selected cases, byphosphonates and recombinant human IGF-1. An adequate questionnaire is essential in women with slightly decreased weight and menstrual disorders.
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PMID:[Bone metabolism and bone mass loss in eating disorders]. 1201 64

Since its description by Morton in 1694, masculine anorexia nervosa has been the subject of much debate. For many, two questions remain unanswered: does anorexia nervosa, as described in girls, exist in boys? - if so, is it the same disease? We analyzed the data in the literature which demonstrate a lower incidence than in the female population, although estimates are probable low due to underdiagnosis. The behavioral aspects suggest a similarity between masculine and feminine anorexia nervosa although the pure restrictive forms of anorexia are more rare in boys. There are however a few differences. Affected boys, according to Crips and Burns (1990), are heavier than girls at onset of the disorder but present a lower body weight during certain periods of the disease. Excessive physical activity is more frequent as is excessive intellectual involvement (Margo, 1987). The problem of amenorrhea, on/off periods, is not present in the male form. Testosterone and sexual function decline gradually, in parallel with the state of malnutrition (Anersen, 1990). The patient does not have particular difficulty discussing sexual relations but does exhibit a poor level of experience and mental representations. Contact with the opposite sex is rare and the fantastic life is generally very limited. The frequency of homosexual behavior would lie between 25% (Herzog, 1984) and 58% (Schneider and Agras, 1987), which is higher than in the female anorexia population (Herzog, 1984). This observation raises the question concerning the relationship between masculine mental anorexia nervosa and fragile sexual identity.
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PMID:[Masculine anorexia nervosa: realities and perspectives]. 1221 86


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