Increased adrenal steroid secretion in response to CRF in women with hypothalamic amenorrhea

Objective: To evaluate adrenal steroid hormone secretion in response to cor ticotropin-releasing factor (CRF) or to adrenocorticotropin hormone in wome n with hypothalamic amenorrhea. Design: Controlled clinical study. Setting: Department of Reproductive Medicine and Child Development, Section of Gyne cology and Obstetrics, University of Pisa, Italy. Patient(s): Fifteen women with hypothalamic amenorrhea were enrolled in the study. Eight normal cycl ing women were used as control group. Intervention(s): Blood samples were c ollected before and after an injection of ovine CRF (0.1 mug/kg iv bolus) o r after synthetic ACTH (0.25 mg iv). Main outcome measure(s): Plasma levels of ACTH, 17-hydroxypregnenolone (17OHPe), progesterone (P), dehydroepiandr osterone (DHEA), 17-hydroxyprogesterone (17OHP), cortisol (F), 11-deoxycort isol (S) and androstenedione (A). Result(s): Basal plasma concentrations of ACTH, cortisol, 11-deoxycortisol, DHEA and 17OHPe were significantly highe r in patients than in controls, whereas plasma levels of progesterone and 1 7-OHP were significantly lower in patients than in controls. In amenorrheic women the ratio of 17-OHPe/DHEA, of 17-OHPe/17-OHP and of 11-deoxycortisol /cortisol were significantly higher than in controls, while a significant r eduction in the ratio of 17-OHP/androstenedione, of 17-OHP/11-deoxycortisol was obtained. In response to corticotropin-releasing factor test, plasma l evels of ACTH, cortisol, 17-OHP, 11-deoxycortisol, DHEA and androstenedione were significantly lower in patients than in controls. In response to adre nocorticotropin hormone, plasma levels of 17-OHP, androstenedione and andro stenedione/cortisol were significantly higher in patients than in controls. Conclusions: Patients suffering for hypothalamic amenorrhea showed an incr eased activation of hypothalamus-pituitary-adrenal (HPA) axis, as shown by the higher basal levels and by augmented adrenal hormone response to cortic otropin-releasing factor administration. These data suggest a possible dera ngement of adrenal androgen enzymatic pathway. (C) 2001 Elsevier Science Lt d. All rights reserved.