Endocrine Abstracts (2017) 49 EP1126 | DOI: 10.1530/endoabs.49.EP1126

Graduated response to pulsatile GnRH therapy in hypothalamic amenorrhea

Natacha Germain1,2, Anais Fauconnier1, Jean-Philippe Klein3,4, Amelie Wargny2, Yadh Khalfallah1, Chrysoula Papastathi-Boureau1, Bruno Estour1,2 & Bogdan Galusca1,2

1Endocrinology Department, University Hospital of Saint Etienne, Saint Etienne, France; 2EA 7423, Jean Monnet University of Saint Etienne, Saint Etienne, France; 3Histology and Embryology Department, University hospital of Saint Etienne, Saint Etienne, France; 4UMR INSERM 1059, Jean Monnet University of Saint Etienne, Saint Etienne, France.

Introduction: Pulsatile GnRH therapy is currently used to restore LH pulse and induce physiological ovulation, with effectiveness demonstrated in all types of hypothalamic amenorrhea (HA). Anorexia nervosa (AN) is characterized by self-starvation-induced undernutrition leading to functional hypothalamic amenorrhea (HA). Weight recovery does not always restore menses despite no apparent clinical and biological undernutrition residual signs. Only few specific studies on persistent amenorrheic weight-recovered AN (Rec-AN) have evaluated pulsatile GnRH therapy, including small number and under nourished patients. Comparison data on hormonal response of the different causes of HA (weight-recovered AN, primary and secondary HA non-related to eating disorders) is also lacking. Therefore, this study was designed to evaluate hormonal and clinical responses to GnRH pulsatile treatment in three groups of HA patients: weight-recovered anorexia nervosa patients (Rec-AN) with persistent functional hypothalamic amenorrhea (HA), secondary and primary HA.

Patients and method: This retrospective, observational ambulatory study included 41 females: 15 secondary HA without any eating disorders patients (SHA), seven primary HA patients (PHA), and 19 Rec-AN (BMI> 18.5 kg/m2 without menses recovery), who underwent GnRH pulsatile therapy. Baseline Estradiol (E), LH and Progesterone plasma level and their changes during induction cycles were evaluated. Ovulation, follicular recruitment and pregnancies rate were also studied.

Results: Rec-AN displayed higher basal E and LH plasma levels after GnRH injection compared to SHA and to PHA. WE observed higher E and LH levels during induction cycles in Rec-AN compared to SHA and PHA. PHA displayed the lowest hormonal plasma levels. Follicular recruitment was higher in Rec-AN. Ovulation rate was higher in Rec-AN and SHA compared to PHA.

Conclusions: This study showed increased gonadal status and higher Estradiol response to pulsatile GnRH therapy in persistent amenorrheic weight-recovered AN compared to SHA and PHA. Pulsatile GnRH therapy seems less efficient in primary hypothalamic amenorrhea.

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