학술논문
Mechanisms and predictors of menses resumption once normal weight is reached in anorexia nervosa.
Document Type
Academic Journal
Author
Galusca B; Division of Endocrinology, Endocrinology Department, University Hospital of Saint-Etienne, 42055, Saint-Étienne Cedex 2, France. bogdan.galusca@chu-st-etienne.fr.; EA 7423, Eating Disorders, Addictions and Extreme Body Weight Research Group, Saint-Étienne, France. bogdan.galusca@chu-st-etienne.fr.; Eating Disorder Reference Center of Saint-Etienne, University Hospital of Saint-Etienne, Saint-Étienne, France. bogdan.galusca@chu-st-etienne.fr.; Gay A; EA 7423, Eating Disorders, Addictions and Extreme Body Weight Research Group, Saint-Étienne, France.; Eating Disorder Reference Center of Saint-Etienne, University Hospital of Saint-Etienne, Saint-Étienne, France.; Division of Psychiatry, University Hospital of Saint-Etienne, Saint-Étienne, France.; Belleton G; Division of Endocrinology, Endocrinology Department, University Hospital of Saint-Etienne, 42055, Saint-Étienne Cedex 2, France.; Eating Disorder Reference Center of Saint-Etienne, University Hospital of Saint-Etienne, Saint-Étienne, France.; Eisinger M; Division of Endocrinology, Endocrinology Department, University Hospital of Saint-Etienne, 42055, Saint-Étienne Cedex 2, France.; Eating Disorder Reference Center of Saint-Etienne, University Hospital of Saint-Etienne, Saint-Étienne, France.; Massoubre C; EA 7423, Eating Disorders, Addictions and Extreme Body Weight Research Group, Saint-Étienne, France.; Eating Disorder Reference Center of Saint-Etienne, University Hospital of Saint-Etienne, Saint-Étienne, France.; Division of Psychiatry, University Hospital of Saint-Etienne, Saint-Étienne, France.; Lang F; EA 7423, Eating Disorders, Addictions and Extreme Body Weight Research Group, Saint-Étienne, France.; Eating Disorder Reference Center of Saint-Etienne, University Hospital of Saint-Etienne, Saint-Étienne, France.; Division of Psychiatry, University Hospital of Saint-Etienne, Saint-Étienne, France.; Grouselle D; UMR 894 INSERM Psychiatry and Neurosciences Center, Paris Descartes University, Paris, France.; Estour B; Division of Endocrinology, Endocrinology Department, University Hospital of Saint-Etienne, 42055, Saint-Étienne Cedex 2, France.; EA 7423, Eating Disorders, Addictions and Extreme Body Weight Research Group, Saint-Étienne, France.; Eating Disorder Reference Center of Saint-Etienne, University Hospital of Saint-Etienne, Saint-Étienne, France.; Germain N; EA 7423, Eating Disorders, Addictions and Extreme Body Weight Research Group, Saint-Étienne, France.; Eating Disorder Reference Center of Saint-Etienne, University Hospital of Saint-Etienne, Saint-Étienne, France.; Division of Psychiatry, University Hospital of Saint-Etienne, Saint-Étienne, France.
Source
Publisher: BioMed Central Country of Publication: England NLM ID: 101610672 Publication Model: Electronic Cited Medium: Print ISSN: 2050-2974 (Print) Linking ISSN: 20502974 NLM ISO Abbreviation: J Eat Disord Subsets: PubMed not MEDLINE
Subject
Language
English
ISSN
2050-2974
Abstract
Background: In cases of Anorexia Nervosa (AN), achieving weight gain recovery beyond the lower limits set by the World Health Organization and normalizing classical nutritional markers appears to be essential for most patients. However, this is not always adequate to restore menstrual cycles. This discrepancy can cause concern for both patients and healthcare providers, and can impact the medical management of these individuals. Thus, the purpose of this study was to assess the ability of anthropometric and hormonal factors to predict the resumption of menstrual cycles in individuals with anorexia nervosa upon reaching a normal body weight.
Method: Patients with AN who had achieved a normal Body Mass Index but had not yet resumed their menstrual cycles (referred to as ANRec) were evaluated on two occasions: first at visit 1 and then again 6 months later, provided their body weight remained stable over this period (visit 2). Among the 46 ANRec patients who reached visit 2, they were categorized into two groups: 20 with persistent amenorrhea (PA-ANRec) and 26 who had regained their menstrual cycles (RM-ANRec). Anthropometric measurements, several hormone levels, Luteinizing Hormone (LH) pulsatility over a 4-h period, and LH response to gonadotropin-releasing hormone injection (LH/GnRH) were then compared between the two groups at visit 1.
Results: Patients in the RM-ANRec group exhibited higher levels of follicular stimulating hormone, estradiol, inhibin B, LH/GnRH, and lower levels of ghrelin compared to those in the PA-ANRec group. Analysis of Receiver Operating Characteristic curves indicated that having ≥ 2 LH pulses over a 4-h period, LH/GnRH levels ≥ 33 IU/l, and inhibin B levels > 63 pg/ml predicted the resumption of menstrual cycles with a high degree of specificity (87%, 100%, and 100%, respectively) and sensitivity (82%, 80%, and 79%, respectively).
Conclusions: These three hormonal tests, of which two are straightforward to perform, demonstrated a high predictive accuracy for the resumption of menstrual cycles. They could offer valuable support for the management of individuals with AN upon achieving normalized weight. Negative results from these tests could assist clinicians and patients in maintaining their efforts to attain individualized metabolic targets.
Trial Registration: IORG0004981.
(© 2023. BioMed Central Ltd., part of Springer Nature.)
Method: Patients with AN who had achieved a normal Body Mass Index but had not yet resumed their menstrual cycles (referred to as ANRec) were evaluated on two occasions: first at visit 1 and then again 6 months later, provided their body weight remained stable over this period (visit 2). Among the 46 ANRec patients who reached visit 2, they were categorized into two groups: 20 with persistent amenorrhea (PA-ANRec) and 26 who had regained their menstrual cycles (RM-ANRec). Anthropometric measurements, several hormone levels, Luteinizing Hormone (LH) pulsatility over a 4-h period, and LH response to gonadotropin-releasing hormone injection (LH/GnRH) were then compared between the two groups at visit 1.
Results: Patients in the RM-ANRec group exhibited higher levels of follicular stimulating hormone, estradiol, inhibin B, LH/GnRH, and lower levels of ghrelin compared to those in the PA-ANRec group. Analysis of Receiver Operating Characteristic curves indicated that having ≥ 2 LH pulses over a 4-h period, LH/GnRH levels ≥ 33 IU/l, and inhibin B levels > 63 pg/ml predicted the resumption of menstrual cycles with a high degree of specificity (87%, 100%, and 100%, respectively) and sensitivity (82%, 80%, and 79%, respectively).
Conclusions: These three hormonal tests, of which two are straightforward to perform, demonstrated a high predictive accuracy for the resumption of menstrual cycles. They could offer valuable support for the management of individuals with AN upon achieving normalized weight. Negative results from these tests could assist clinicians and patients in maintaining their efforts to attain individualized metabolic targets.
Trial Registration: IORG0004981.
(© 2023. BioMed Central Ltd., part of Springer Nature.)