Background

Chronic energy deficiency observed in women that exercise strenuously affects reproductive function, often leading to hypothalamic amenorrhea (HA). In such conditions, hypoleptinemia and robust changes in the Activin-Follistatin-Inhibin Axis (AFI) are observed. Treatment with leptin restores menstruation in many (60% responders) but not all (40% non-responders) women, suggesting that leptin is not the only regulator of reproductive function related to energy balance. In this work, we aimed to identify differences in hormonal profiles between leptin responders and non-responders among women with HA, with particular focus on the AFI axis.

Methods

AFI axis and reproductive hormones (LH, FSH, Estradiol, ΑΜΗ) were measured in blood in: a) An open-label interventional study, b) a randomized placebo-controlled trial, both investigating responders versus non-responders/women with HA treated with leptin.

Results

Women with HA that responded to leptin treatment have higher circulating levels/peak values of Inhibin A, Estradiol (E2), higher LH/FSH ratio and a trend to lower AMH compared with non-responders.

Conclusions

Components of the AFI axis are associated with improvement of reproductive function in women with HA treated with leptin. ΑΜΗ may serve as a marker of ovarian recovery under HA treatment.

中文翻译：

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对瘦素治疗有反应的下丘脑闭经女性的激活素-卵泡抑素-抑制素轴的循环特征

背景

在剧烈运动的女性中观察到的慢性能量缺乏会影响生殖功能，通常会导致下丘脑闭经 (HA)。在这种情况下，观察到低瘦素血症和激活素-卵泡抑素-抑制素轴 (AFI) 的强烈变化。瘦素治疗可使许多（60% 有反应者）但并非所有（40% 无反应者）女性恢复月经，这表明瘦素不是与能量平衡相关的生殖功能的唯一调节剂。在这项工作中，我们旨在确定 HA 女性瘦素反应者和非反应者之间激素特征的差异，特别关注 AFI 轴。

方法

AFI 轴和生殖激素（LH、FSH、雌二醇、ΑΜΗ) 在以下血液中测量：a) 一项开放标签干预性研究，b) 一项随机安慰剂对照试验，均调查响应者与非响应者/接受 HA 治疗的女性与瘦素。

结果

与无反应者相比，对瘦素治疗有反应的 HA 女性具有更高的抑制素 A、雌二醇 (E2) 循环水平/峰值、更高的 LH/FSH 比率和降低 AMH 的趋势。

结论

AFI 轴的组成部分与接受瘦素治疗的 HA 女性的生殖功能改善有关。ΑΜΗ可用作HA治疗下卵巢恢复的标志物。