What is the mechanism of amenorrhea in anorexia nervosa?
Anorexia nervosa commonly results in functional hypogonadotropic hypogonadism. The mechanism by which this occurs is believed to be the same mechanism that occurs when other stressors are placed on the body. In times of great stress, corticotropin-releasing hormone (CRH), produced in the hypothalamus, is suppressed. The suppression of CRH results in suppression of hypothalamic gonadotropin-releasing hormone (GnRH), which in turn results in suppression of luteinizing hormone (LH) and follicular-stimulating hormone (FSH) from the pituitary gland. When these pituitary hormones are suppressed, the production of estradiol from the ovaries is suppressed, resulting in hypogonadism. The name hypogonadotropic hypogonadism refers to the suppression of GnRH from the hypothalamus, which indirectly leads to a hypoestrogenemic state (1).
