Cerebrospinal fluid levels of corticotropin-releasing hormone in women with functional hypothalamic amenorrhea

OBJECTIVE: Women with functional hypothalamic amenorrhea are anovulatory be cause of reduced gonadotropin-releasing hormone drive. Several studies have documented hypercortisolemia, which suggests that functional hypothalamic amenorrhea is stress-induced. Further, with recovery (resumption of ovulati on), cortisol decreased and gonadotropin-releasing hormone drive increased. Corticotropin-releasing hormone can increase cortisol and decrease gonadot ropin-releasing hormone. To determine its role in functional hypothalamic a menorrhea, we measured corticotropin-releasing hormone in cerebrospinal flu id along with arginine vasopressin, another potent adrenocorticotropic horm one secretagog, and beta-endorphin, which is released by corticotropin-rele asing hormone and can inhibit gonadotropin-releasing hormone. STUDY DESIGN: Corticotropin-releasing hormone, vasopressin, and beta-endorp hin levels were measured in cerebrospinal fluid from 14 women with eumenorr hea and 15 women with functional hypothalamic amenorrhea. RESULTS: Levels of corticotropin-releasing hormone in cerebrospinal fluid a nd of vasopressin were comparable and beta-endorphin levels were lower in w omen with functional hypothalamic amenorrhea. CONCLUSIONS: in women with established functional hypothalamic amenorrhea, increased cortisol and reduced gonadotropin-releasing hormone are not susta ined by elevated cerebrospinal-fluid corticotropin-releasing hormone, vasop ressin, or beta-endorphin. These data do not exclude a role for these facto rs in the initiation of functional hypothalamic amenorrhea.