WOMEN WITH FUNCTIONAL HYPOTHALAMIC AMENORRHEA BUT NOT OTHER FORMS OF ANOVULATION DISPLAY AMPLIFIED CORTISOL CONCENTRATIONS

Objective: To test the hypothesis that increased cortisol secretion is specific to women with decreased GnRH drive and not found in eumenorr heic women or those with other causes of anovulation. Design: Cortisol concentrations in blood were determined at 30-minute intervals for 24 hours in three well-characterized groups: women with functional hypot halamic amenorrhea, those with Other causes of anovulation, and eumeno rrheic women. Setting: Academic medical center. Patient(s): Women aged 20 through 35 years, with well-defined reproductive states. Intervent ion(s): Venous blood samples were obtained from, and psychometric inve ntories were completed by, the participants. Main Outcome Measure(s): Twenty-four-hour cortisol levels, 24-hour LH pulse patterns, and seria l P levels were measured in women with functional hypothalamic amenorr hea, eumenorrheic women, and those with other causes of anovulation. R esult(s): Cortisol secretion was higher in women with functional hypot halamic amenorrhea (n = 19) than in those with other causes of anovula tion (n = 19) or eumenorrheic women (n = 19). Six women who recovered from functional hypothalamic amenorrhea had cortisol levels comparable to those of eumenorrheic women and those with other causes of anovula tion. Conclusion(s): These data underscore the association between inc reased hypothalamic-pituitary-adrenal activity and reduced GnRH drive and support the concept that functional hypothalamic amenorrhea develo ps in response to stress-induced alterations in central neural functio n that modify hypothalamic function. (C) 1997 by American Society for Reproductive Medicine.