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Licensed Unlicensed Requires Authentication Published by De Gruyter March 8, 2016

The physiology of functional hypothalamic amenorrhea associated with energy deficiency in exercising women and in women with anorexia nervosa

  • Heather C.M. Allaway , Emily A. Southmayd and Mary Jane De Souza EMAIL logo


An energy deficiency is the result of inadequate energy intake relative to high energy expenditure. Often observed with the development of an energy deficiency is a high drive for thinness, dietary restraint, and weight and shape concerns in association with eating behaviors. At a basic physiologic level, a chronic energy deficiency promotes compensatory mechanisms to conserve fuel for vital physiologic function. Alterations have been documented in resting energy expenditure (REE) and metabolic hormones. Observed metabolic alterations include nutritionally acquired growth hormone resistance and reduced insulin-like growth factor-1 (IGF-1) concentrations; hypercortisolemia; increased ghrelin, peptide YY, and adiponectin; and decreased leptin, triiodothyronine, and kisspeptin. The cumulative effect of the energetic and metabolic alterations is a suppression of the hypothalamic-pituitary-ovarian axis. Gonadotropin releasing hormone secretion is decreased with consequent suppression of luteinizing hormone and follicle stimulating hormone release. Alterations in hypothalamic-pituitary secretion alters the production of estrogen and progesterone resulting in subclinical or clinical menstrual dysfunction.

Corresponding author: Dr. Mary Jane De Souza, 104 Noll Laboratory, The Pennsylvania State University, University Park, PA, 16802, USA, Phone: +814-863-0045; Fax: +814-865-4602, E-mail: ; and Women’s Health and Exercise Laboratory, Department of Kinesiology, Pennsylvania State University, PA, USA


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Received: 2015-10-15
Accepted: 2016-2-9
Published Online: 2016-3-8
Published in Print: 2016-2-1

©2016 by De Gruyter

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