Mechanisms and predictors of menses resumption once normal weight is reached in anorexia nervosa
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...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-09-01
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| Series: | Journal of Eating Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40337-023-00893-x |
| _version_ | 1827635870524506112 |
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| author | Bogdan Galusca Aurélia Gay Gwenaëlle Belleton Martin Eisinger Catherine Massoubre François Lang Dominique Grouselle Bruno Estour Natacha Germain |
| author_facet | Bogdan Galusca Aurélia Gay Gwenaëlle Belleton Martin Eisinger Catherine Massoubre François Lang Dominique Grouselle Bruno Estour Natacha Germain |
| author_sort | Bogdan Galusca |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-09T15:33:27Z |
| format | Article |
| id | doaj.art-ba02c69da4b34427b40e035621040336 |
| institution | Directory Open Access Journal |
| issn | 2050-2974 |
| language | English |
| last_indexed | 2024-03-09T15:33:27Z |
| publishDate | 2023-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Eating Disorders |
| spelling | doaj.art-ba02c69da4b34427b40e0356210403362023-11-26T12:06:39ZengBMCJournal of Eating Disorders2050-29742023-09-0111111010.1186/s40337-023-00893-xMechanisms and predictors of menses resumption once normal weight is reached in anorexia nervosaBogdan Galusca0Aurélia Gay1Gwenaëlle Belleton2Martin Eisinger3Catherine Massoubre4François Lang5Dominique Grouselle6Bruno Estour7Natacha Germain8Division of Endocrinology, Endocrinology Department, University Hospital of Saint-EtienneEA 7423, Eating Disorders, Addictions and Extreme Body Weight Research GroupDivision of Endocrinology, Endocrinology Department, University Hospital of Saint-EtienneDivision of Endocrinology, Endocrinology Department, University Hospital of Saint-EtienneEA 7423, Eating Disorders, Addictions and Extreme Body Weight Research GroupEA 7423, Eating Disorders, Addictions and Extreme Body Weight Research GroupUMR 894 INSERM Psychiatry and Neurosciences Center, Paris Descartes UniversityDivision of Endocrinology, Endocrinology Department, University Hospital of Saint-EtienneEA 7423, Eating Disorders, Addictions and Extreme Body Weight Research GroupAbstract 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.https://doi.org/10.1186/s40337-023-00893-xRecovered anorexia nervosaMenses resumptionBody weight set-pointLH pulsePredictive markers |
| spellingShingle | Bogdan Galusca Aurélia Gay Gwenaëlle Belleton Martin Eisinger Catherine Massoubre François Lang Dominique Grouselle Bruno Estour Natacha Germain Mechanisms and predictors of menses resumption once normal weight is reached in anorexia nervosa Journal of Eating Disorders Recovered anorexia nervosa Menses resumption Body weight set-point LH pulse Predictive markers |
| title | Mechanisms and predictors of menses resumption once normal weight is reached in anorexia nervosa |
| title_full | Mechanisms and predictors of menses resumption once normal weight is reached in anorexia nervosa |
| title_fullStr | Mechanisms and predictors of menses resumption once normal weight is reached in anorexia nervosa |
| title_full_unstemmed | Mechanisms and predictors of menses resumption once normal weight is reached in anorexia nervosa |
| title_short | Mechanisms and predictors of menses resumption once normal weight is reached in anorexia nervosa |
| title_sort | mechanisms and predictors of menses resumption once normal weight is reached in anorexia nervosa |
| topic | Recovered anorexia nervosa Menses resumption Body weight set-point LH pulse Predictive markers |
| url | https://doi.org/10.1186/s40337-023-00893-x |
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