Anorexia nervosa: hypothalamic amenorrhea and bone metabolism
Daniela Laudisio1,2 – , Chiara Graziadio1,2 – , Renata Simona Auriemma1 – , Emanuela Filice1 – , Silvia Savastano1,2 – , Annamaria Colao1,2,3 –
1 – Department of Clinical Medicine and Surgery, Endocrinology Unit, University “Federico II” of Naples, Naples, Italy.
2 – Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Section of Endocrinology, “Federico II” University of Naples, Naples, Italy
3 – Unesco Chair “Health Education and Sustainable Development”, University “Federico II” of Naples, Naples, Italy
Corresponding Author: Daniela Laudisio
Anorexia nervosa is a psychiatric disorder, predominantly affecting adolescent women, and is characterized by a low body weight following a state of self-induced starvation. This disorder is associated with hormonal adaptations that consume energy expenditure to a minimum in a context of low nutrient intake. These adaptations include: functional hypothalamic amenorrhea, resistance to growth hormone, low concentrations of insulin- like growth factor, low concentrations of leptin and hypercortisolemia. Although, these adaptations may be useful for the short-term survival, often, they contribute to morbidity associated with this disorder, and in particular bone loss, which affects 85% of women with anorexia nervosa. In fact, this category of patients, often demonstrates low bone mineral density and high fractures risk, with low body weight and low gonads being the strongest predictors of observed bone mineral deficiency and fractures risk. Weight restoration and the resumption of menstrual function have the strongest impact on increasing bone mineral density. Other treatment options include bisphosphonates and teriparatide, supported by small clinical trials.
Keywords: nervous anorexia; functional hypothalamic amenorrhea; osteoporosis; bone mineral density; risk of fractures.
Available in LRIOG Nr.1 – 2022
Download the pdf
Thyroid diseases and female infertility
Chiara Graziadio1,2 – , Emanuele Filice1 – , Rosa Pirchio1 – , Renata Simona Auriemma1 – , Alessandra Graziottin3 – ,
1 – Department of Clinical Medicine and Surgery, Federico II University, Naples
2 – Italian Center for the care and well-being of the obese patient (C.I.B.O.), Federico II University, Naples
3 – H. San Raffaele Resnati Center of Gynecology, Milan
4 – Unesco Chair “Health Education and Sustainable Development”, Federico II University, Naples
Corresponding Author: Chiara Graziadio
BACKGROUND: Thyroid diseases (hypothyroidism, hyperthyroidism and thyroid autoimmunity) have been independently associated with fertility di- sorders and pregnancy failure, both in case of spontaneous conception and/ or after assisted reproduction technology (ART). Several studies have looked at the association between thyroid dysfunctions, thyroid autoimmunity (TAI) and reproduction. The aim of this paper is to identify the impact of thyroid diseases, starting from birth, on female infertility, by means of review of the recent pertinent literature.
METHODS: We reviewed the pertinent literature regarding the association between thyroid diseases and female infertility off the main international database (MEDLINE, PubMed).
RESULTS: Thyroid dysfunctions, associated or not with thyroid autoimmunity, can alter ovulation and the associated immunoendocrine processes with con- sequent menstrual irregularities. These complexes endocrine disruptions can result in mild to severe fertility disorders and increased spontaneous abor- tions. Thyroid autoimmunity is associated with an increased risk of miscar- riage and preterm delivery, both in spontaneous pregnancies as well as in pregnancies after ART.
CONCLUSIONS: Thyroid dysfunctions may lead to menstrual disorders and infertility via direct and indirect interactions with the hypothalamo-pituitary- ovarian axis and the reproductive organs.
In the management of the infertile woman, the complete screening of thyroid hormones and autoimmunity is recommended in order to promptly treat any hormonal dysfunctions that may be a cofactor or the cause of infertility. Fur- ther studies are needed to improve diagnostic and therapeutic fertility issues associated with or due to thyroid disorders.
Keywords: hashimoto’s thyroiditis; Basedow-Graves’disease; hyperthyroidism; hypothyroidism; female infertility; thyroid autoimmunity.
Available in LRIOG Nr.4 – 2021
Download the pdf