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Menstrual and Uterine Disorders
of cortisol production indicates a remission of the activation induced competence and focused dialogue and attentive interaction between
by physical and psychological stressors. Psychological wellbeing is of the different specialists involved. ■
paramount importance for neuroendocrine reactivation. It has been
demonstrated that the persistence of the core psycopathological
Metella Dei is a Professor in Obstetrics and
traits typical of eating disorders, such as perfectionism, drive for
Gynaecology and Endocrinology at the Paediatric and
thinness, body dissatisfaction and interoceptive awareness, can Adolescent Gynaecology Unit of the University of
significantly impede the return to endocrine normality.
Florence. She serves on the Board of the Italian Society
of Paediatric and Adolescent Gynaecology and is its
Past President. Dr Dei’s research interests include
In conclusion, both during the phase of active disorder and during contraception, gynaecological endocrinology and sexual
monitoring of the effects of treatment, the diagnostic work-up is the
health. She has published approximately 200 articles
and 10 books, and has been invited to speak at national
result of a comprehensive evaluation of history, anthropometrics,
and international conferences.
endocrine data and psychological traits. This calls for specific
1. American Psychiatric Association, Diagnostic and Statistical scanning of the ovaries in adolescent anorectic patients Metab, 2006;91(3):1027–33.
Manual for Mental Disorder, 4th edition, Washington DC: APA at low weight and after weight recovery, Eur Child Adol 16. Koslowsky M, Scheinberg Z, Bleich A, et al., The factor
Press, 1994. Psych, 1997;6:207–11. structure and criterion validity of the short form of the
2. Loucks A, Energy availability and infertility, Curr Opin 9. Lemke U, Krones-Herzig A, Berriel Diaz M, et al., The Eating Attitudes Test, J Pers Assess, 1992;59(1):27–35.
Endocrinol Diabetes Ob, 2007;14:470–74. glucocoritocoid receptor controls hepatic dyslipidemia 17. Schoemaker C, Verbraak M, Breteler R, et al.,The
3. Dalle Grave R, Calugi S, Marchesini G, Is amenorrhea a through Hes 1, Cel Metab, 2008;8(3):212–23. discriminant validity of the Eating Disorder Inventory-2,
clinically useful criterion for the diagnosis of anorexia 10. Mastorakos G, Pavlatou M, Diamanti-Kandarakis E, Br J Clinical Psychol, 1997;36(4):627–9.
nervosa?, Behav Res Ther, 2008;46(12):1290–94. Chrousos GP, Exercise and stress system, Hormones, 18. Swenne I, Weight requirements for return of
4. Miller KK, Grinspoon S, Glevsteen S, et al., Preservation of 2005;4(2):73–89. menstruations in teenage girls with eating disorders,
neuroendocrine control of reproductive function despite 11. Smith JT, Acohido BV, Clifton DK, Steiner RA, KiSS-1 weight loss and secondary amenorrhea, Acta Paediatr,
severe undernutrition, J Clin Endocrinol Metab, 2004;89(9): neurons are direct targets for lpetin in the ob/ob mouse, 2004;93:1449–55.
4434–8. J Neuroendocrinol, 2006;18/4):298–303. 19. Dominguez J, Goodman L, Gupta SS, et al., Treatment of
5. Bruni V, Dei M, Filicetti MF, et al., Predictors of bone loss in 12. Welt CK, Chan JL, Bullen J, et al., Recombinant human anorexia nervosa is associated with increases in bone
young women with restrictive eating disorders, Ped Endocr leptin in women with hypothalamic amenorrhea, N Engl J mineral density, and recovery is a biphasic process
Rev, 2006;3(1):219–21. Med, 2004;351:987–97. involving both nutrition and return of menses, Am J Clin
6. Prince R, Zhu K Whole-Body Dual Energy X-Ray 13. Hill JW, Elmquist JK, Elias CF, Hypothalamic pathways Nutr, 2007;86:92–9.
Absorptiometry comes of age: bone structural measures linking energy balance and reproduction, Am J Physiol 20. Dei M, Seravalli V, Bruni V, et al., Predictors of recovery of
and their physiological determinants in anorexia nervosa, Endocrinol Metab, 2008;294(5):E827–32. ovarian function after weight gain in subjects with
J Clin Endocrinol Metab, 2008;93(4):1178–80. 14. Misra M, Miller KK, Kuo K, et al., Secretory dynamics of amenorrhea related to restrictive eating disorders, Gynecol
7. Piccoli A, Codognotto M, Di Pascoli L, et al., Body Mass ghrelin in adolescent girls with anorexia nervosa and Endocrinol, 2008;23(8):459–64.
index and agreement between bioimpedence and healthy adolescents, Am J Physiol Endocrinol Metab, 21. Brambilla F, Monteleone P, Bortolotti F, et al., Persistent
anthropometry estimates of body compartments in 2005;289(2):E347–56. amenorrhoea in weight-recovered anorexics:
anorexia nervosa, J Prenter Enteral Nutr, 2005;29(3):148–56. 15. Misra M, Miller KK, Tsai B, et al., Elevated peptide YY in psychological and biological aspects, Psych Res,
8. Sobansli E, Hiltmann WD, Blanz B, et al., Pelvic ultrasound adolescent girls with anorexia nervosa, J Clin Endocrinol 2003;118:249–57.
By the Same Author
Predictors of Recovery of Ovarian Function After Predictors of Bone Loss in Young Women with
Weight Gain in Subjects with Amenorrhea Related to Restrictive Eating Disorders
Restrictive Eating Disorders Bruni V, Dei M, Filicetti MF, et al., Pediatr Endocrinol Rev, 2006;3(Suppl. 1):219–21.
Dei M, Seravalli V, Bruni V, et al., Gynecol Endocrinol, 2008;24(8):459–64.
The objectives of this study were to evaluate the influence of body
The aim of this study was to investigate the anthropometric and mass index (BMI), body composition and hormonal factors on bone
endocrine characteristics of subjects with amenorrhoea related to mass in young women with amenorrhoea related to restrictive
eating disorders after weight recovery in order to identify factors eating disorders. The design of this study was in the form of a
connected with the resumption of menses. Clinical data, body descriptive study of 55 patients with secondary amenorrhoea due
composition parameters and serum levels of follicle-stimulating to restrictive eating disorders and 14 healthy girls used for
hormone (FSH), luteinising hormone (LH), thyroid-stimulating comparison. The parameters assessed were bone mineral density,
hormone (TSH), free triiodothyronine, free thyroxine, cortisol, leptin fat mass and lean mass by dual-energy X-ray absorptiometry
and insulin were assessed in two groups of young women (DEXA), and the serum hormonal profile.
classified according to menstrual status after weight rehabilitation:
43 subjects who displayed persistent amenorrhoea and 34 who The results found that patients had lower BMI, lower fat mass
resumed menses. The patients who resumed menses had low and lower bone mass compared with controls; their serum levels
initial weight and body mass index (BMI), and a greater difference of luteinising hormone (LH), free triiodothyronine (FT3), dehydro-
between current and initial BMI (DeltaBMI), than those with epiandrosterone sulphate (DHEAS), insulin and leptin were
amenorrhea. No differences were observed in lean mass, body fat significantly reduced. Low bone density, especially in the lumbar
or bone density between the two groups. Moreover, the reduction region, correlated with concentrations of FT3, cortisol, insulin
in FSH and the increase in LH, insulin and leptin emerged as and leptin, hormones expressive of metabolic adjustment to
significant predictors of menstrual recovery. Increased DeltaBMI malnutrition. Lean mass was a strong predictor of osteopenia
and insulin continued to be positive predictors in the multivariate and osteoporosis. The authors concluded that hormonal
analysis. Following weight rehabilitation, the individual’s metabolic nutritional markers, together with soft-tissue composition
set-point before weight loss and the current insulin levels appear measurements, are viable options for ongoing monitoring of
significant in predicting the reactivation of reproductive function. ■ subjects with eating disorders. ■
20 EUROPEAN OBSTETRICS & GYNAECOLOGY
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