Journal of Clinical Endocrinology & Metabolism, Vol 74, 1122-1127, Copyright © 1992 by Endocrine Society
Gonadotropin secretion in bulimia nervosa
U Schweiger, KM Pirke, RG Laessle and MM Fichter
Division of Psychoneuroendocrinology, Max Planck Institut fur Psychiatrie, Munich, Germany.
Twenty-two normal weight women with bulimia nervosa (BN) were studied (mean
age, 25 +/- 5 yr; body mass index, 20.2 +/- 2.6 kg/m2). Sixteen of them
reported menstrual cycles in the range of 21-42 days, and 6 had experienced
absence of menstruation for at least 3 months. Twenty-one healthy women
with regular menstrual cycles (mean age, 23 +/- 2 yr; body mass index, 20.7
+/- 1.4) served as the control subjects. Frequent morning blood samples for
estradiol (E2) and progesterone (P4) determinations were obtained for the
duration of 1 menstrual cycle or for 6 weeks in the case of amenorrhea. LH,
FSH, cortisol, and insulin secretion were studied on day 3, 4, or 5 after
the onset of a menstrual cycle or on a random day in the 6 BN women with
amenorrhea. Blood samples were collected at 15-min intervals from 1800-0600
h for LH and FSH and at 30-min intervals from 2400-0600 h for cortisol and
insulin. Nineteen of the 21 controls, but only 10 of the 22 BN women,
fulfilled the following standard criteria: maximum E2 above 440 pmol/L,
maximum P4 above 19 nmol/L, and luteal phase length of 9 days or more. The
10 BN women with normal menstrual cycles had lower mean insulin
concentrations than the controls (70 +/- 20 vs. 120 +/- 30 pmol/L; P less
than 0.01), but gonadotropin secretion, cortisol, and T3 concentrations
were similar. The 8 BN women with amenorrhea or ovulatory dysfunction
(maximum E2, less than 440 pmol/L; maximum P4, less than 6 nmol/L)
displayed decreased mean LH pulse frequency (2.6 +/- 2.4 vs. 5.7 +/- 2.0
pulses/12 h; P less than 0.01), increased mean cortisol (120 +/- 40 vs. 80
+/- 20 nmol/L; P less than 0.01), decreased mean insulin (90 +/- 40 vs. 120
+/- 30 pmol/L; P less than 0.05), and decreased mean T3 concentrations (1.5
+/- 0.3 vs. 1.8 +/- 0.2 nmol/L; P less than 0.01). The data suggest that BN
in normal weight women is associated with an increased rate of ovarian
dysfunction; decreased pulsatile LH secretion seems to be an important
mechanism. Increased cortisol in the disturbed subgroup indicates that
activation of the hypothalamic-pituitary-adrenal axis may play a role in
the pathogenesis of gonadal dysfunction in bulimia nervosa.
