Gonadotrophin and oestrogen excretion in patients with anorexia nervosa

Abstract

ANOREXIA nervosa is a disorder generally encountered in post pubertal women. Cessation of menstruation is an early manifestation of the illness and the amenorrhoea is usually attributed to the severe malnutrition which is an invariable feature of the illness. The relationship between malnutrition and menstrual function has been studied by numerous investigators including Hua and Cheng (1941) Lamy et al. (1947), Smith (1947), Keys et al. (1950), Gillman and Gillman (1951), Zubiran et al. (1953, 1955) and Perloff et al. (1954) and it has now been definitely established that malnutrition can cause amenorrhoea. It must, however, be emphasised that in patients with anorexia nervosa amenorrhoea is not always associated with malnutrition. Thus it preceded weight loss in a quarter of the patients studied by Kay and Leigh (1954); it may also persist for several years after normal nutrition has been restored. In a proportion of patients with anorexia nervosa, therefore, amenorrhoea is likely to be due primarily to the emotional disturbance which is always present; patients with this illness show an entrenched and purposeful refusal to eat which may extend less commonly to a reluctance to menstruate. Indeed Crisp (1964) has suggested that in anorexia nervosa there is an attempt on the part of the patient to control her sexuality by self starvation and he sees this mechanism as a cornerstone of the psychopathology of this disorder. There is certainly strong evidence that menstruation may cease in normally nourished women as a result of emotional upheavals (Stieve, 1940; Loeser, 1943; Sher, 1946). In addition to the malnutrition and the emotional disturbance, primary pituitary failure has been considered a feature of anorexia nervosa, and blamed for the weight loss as well as the amenorrhoea. This view is no longer tenable since Sheehan and Summers (1949) demonstrated that body wasting is not a feature of hypopituitarism and since Bliss and Migeon (1957) showed that, in spite of gonadal failure in anorexia nervosa, the other target organs controlled by the anterior pituitary-the adrenal cortex and the thyroid-are capable of normal function. Present evidence therefore supports the view of Michael and Gibbons (1963) that the differential diagnosis between anorexia nervosa and panhypopituitarism has been laboured unduly. The aim of the present investigation, a fuller account of which will be published elsewhere, was to establish the pattern of excretion of human pituitary gonadotrophins (HPG) and oestrogens in anorexia nervosa before and during refeeding. It was hoped in this way to obtain information on endogenous hormone levels and on the role of malnutrition on endocrine function in patients with this illness.