Cortisol secretion in patients with normoprolactinemic amenorrhea

Increased adrenal steroid secretion in response to CRF in women with hypothalamic amenorrhea

OBJECTIVE

To evaluate adrenal steroid hormone secretion in response to corticotropin-releasing factor (CRF) or to adrenocorticotropin hormone in women with hypothalamic amenorrhea.

DESIGN

Controlled clinical study.

SETTING

Department of Reproductive Medicine and Child Development, Section of Gynecology and Obstetrics, University of Pisa, Italy.

PATIENT(S)

Fifteen women with hypothalamic amenorrhea were enrolled in the study. Eight normal cycling women were used as control group.

INTERVENTION(S)

Blood samples were collected before and after an injection of ovine CRF (0.1 microg/kg iv bolus) or after synthetic ACTH (0.25 mg iv).

MAIN OUTCOME MEASURE(S)

Plasma levels of ACTH, 17-hydroxypregnenolone (17OHPe), progesterone (P), dehydroepiandrosterone (DHEA), 17-hydroxyprogesterone (17OHP), cortisol (F), 11-deoxycortisol (S) and androstenedione (A).

RESULT(S)

Basal plasma concentrations of ACTH, cortisol, 11-deoxycortisol, DHEA and 17OHPe were significantly higher in patients than in controls, whereas plasma levels of progesterone and 17-OHP were significantly lower in patients than in controls. In amenorrheic women the ratio of 17-OHPe/DHEA, of 17-OHPe/17-OHP and of 11-deoxycortisol/cortisol were significantly higher than in controls, while a significant reduction in the ratio of 17-OHP/androstenedione, of 17-OHP/11-deoxycortisol was obtained. In response to corticotropin-releasing factor test, plasma levels of ACTH, cortisol, 17-OHP, 11-deoxycortisol, DHEA and androstenedione were significantly lower in patients than in controls. In response to adrenocorticotropin hormone, plasma levels of 17-OHP, androstenedione and androstenedione/cortisol were significantly higher in patients than in controls.

CONCLUSIONS

Patients suffering for hypothalamic amenorrhea showed an increased activation of hypothalamus-pituitary-adrenal (HPA) axis, as shown by the higher basal levels and by augmented adrenal hormone response to corticotropin-releasing factor administration. These data suggest a possible derangement of adrenal androgen enzymatic pathway.

Dopamine infusion enhances the adrenocorticotropic hormone and cortisol response to metoclopramide in hyperprolactinemic patients but not in normal subjects

Based on the facts that prolactin and adrenocorticotropic hormone (ACTH) each seem to influence the secretion of the other, that dopamine is the established inhibitory factor for prolactin secretion and negatively modulates ACTH release, and finally that alterations of the central dopaminergic tone have been postulated in tumorous hyperprolactinemia, we studied the effects of pharmacological manipulations of the dopaminergic system on ACTH and cortisol secretion in patients bearing a prolactinoma and in normal subjects. Twenty-seven patients with a prolactin-secreting pituitary tumor and 12 healthy controls were submitted to three tests: (a) 4-h saline infusion; (b) 10 mg metoclopramide (MTC) as an intravenous bolus after a 2-h saline infusion; and (c) 4-h dopamine infusion at the dose of 0.01 microgram/kg/min with a 10-mg intravenous bolus of MTC given at the second hour of dopamine infusion. Administration of MTC, compared to saline, caused a moderate (not significant) plasma ACTH increase, and a significant cortisol increase (p < 0.05), both in hyperprolactinemic and normal subjects, without statistically significant differences between the two group. When MTC was administered during dopamine infusion, the ACTH and cortisol elevation was significantly potentiated in prolactinoma patients while it was similar in magnitude to that recorded after MTC alone in control subjects. These findings support the concept of an inhibitory role exerted by dopamine and are compatible with a stimulatory influence exerted by prolactin on corticotropin-releasing hormone and ACTH secretion, and also favor the view of a reduced central dopaminergic tone in patients with tumorous hyperprolactinemia.

Hypothalamic amenorrhea and hidden nutritional insults

OBJECTIVE

We examined whether abnormal nutrition is an associated event in idiopathic hypothalamic amenorrhea.

METHODS

Eighteen amenorrheic subjects were compared to 36 normal controls using endocrine, nutritional, and psychological evaluations.

RESULTS

Controls were closer to their ideal weight (97.2 versus 89.7%; P < .05) than amenorrheics despite similar ages and heights. Amenorrheics denied eating disorders; however, our evaluation showed more eating disorders (55 versus 26%; P < .05), higher scores on a scale of eating behavior (22.28 versus 10.36; P < .001), twice as much fiber intake (26.14 versus 14.69 g/day) and less fat intake (20.7 versus 27.10 g/day) (P < .001), more aerobic activity (85 versus 58%) despite expending fewer calories per day (2303.7 versus 2576.7 kcal/day; P < .05), and similar caloric intake.

CONCLUSIONS

Significant abnormalities suggest that a greater percentage of hypothalamic amenorrhea occurs on a nutritional basis than previously suspected and should be searched for in depth.