Background: Anorexia nervosa (AN) is a primary psychiatric disease, complicated by serious endocrine disturbances. Hypogonadotropic hypogonadism with primary or secondary amenorrhea is the most common endocrine repercussion of AN, with consequent estrogen deficiency and concerns about bone mineral density. Furthermore, establishing regular menstrual cycles is considered as one of the important milestones in girls treated for AN.
Aim: To quantify the estrogen deficiency through plasmatic estradiol (E2) measurements in girls with severe AN and secondary amenorrhea.
Patients and methods: E2 measurements were performed in 17 post-pubertal girls (mean age 15±1.6 years, 1218.31) with severe AN and secondary amenorrhea (mean duration of 8.6±5.53 months, 324) hospitalized for re-nutrition. Results were analyzed to data from ten age-matched girls with diagnosis of hypothalamic amenorrhea (HA) not related to a low nutritional status and from ten age-matched healthy controls. A complete anthropometric and biochemical evaluation was also carried out. Body composition and bone mineral density (BMD) were evaluated by dual energy X-ray absorptiometry.
Results: Mean E2 levels in AN patients were severely reduced: 25.44±20.30 vs 90.3±83 and 160±92 pmol/l in HA and controls respectively (P<0.05 and P<0.001 respectively). E2 levels were significantly correlated with % of fat mass (P<0.001). No correlation was found between E2 levels and duration of amenorrhea or E2 levels and bone mineral density.
Conclusion: Analysis of plasmatic E2 levels show that girls with severe AN and secondary amenorrhea present very low levels, independently from the duration of amenorrhea. No correlation was found with low BMD. Further studies are needed to evaluate the impact of such severe estrogen deficiency on physical and psychological health status and the efficacy of estrogen replacement in these patients.
20 - 22 Sep 2014
European Society for Paediatric Endocrinology