European Journal of Obstetrics & Gynecology and Reproductive Biology 273 (2022) e1–e62
065 Eating disorders amongst adolescents and young women with
functional hypothalamic amenorrhea: Just the tip of the iceberg?
A. Tranoulis a, A. Soldatou b, D. Georgiou c, D. Mavrogianni d,
D. Loutradis e, L. Michala e
a
Department of Obstetrics and Gynaecology, Guy’s and St Thomas’ NHS
Foundation Trust, King’s College, London, United Kingdom
b
Second Department of Paediatrics, ‘P&A Kyriakou’ Children’s Hospital,
National and Kapodistrian University of Athens, School of Medicine, Athens,
Greece
c
Department of Obstetrics and Gynaecology, Chelsea and Westminster NHS
Trust, Imperial College, London, United Kingdom
d
Molecular Biology Unit, Division of Human Reproduction, First Department
of Obstetrics and Gynaecology, Alexandra Hospital, National and
Kapodistrian University of Athens, School of Medicine, Athens, Greece
e
First Department of Obstetrics and Gynaecology, Alexandra Hospital,
National and Kapodistrian University of Athens, School of Medicine, Athens,
Greece
Objective(s): Deranged eating behaviors (DEBs) have been recog-
nized as an important risk factor for functional hypothalamic amen-
orrhea (FHA) [1–4]. However, the majority of women with FHA will
not have a clear diagnosis of eating disorder (ED), or at least will not
be referred and treated for one. We hypothesized that women with
FHA are characterized by DEBs and that the concurrence of FHA and
DEBs may be characterized by common predisposing factors. We
aimed to evaluate the role of DEBs in the development of FHA and
the key role of psychopathological traits on both disorders.
Study design: This is a prospective case-control population-based
study spanning the period January 2016 to April 2018. Forty-one
consecutive FHA females and 86 healthy controls were recruited.
DEBs and other FHA predisposing factors were assessed through
self-reported questionnaires. Possible correlations amongst the vari-
ables were examined using the Spearman’s correlation coefficient
(rho), whilst multivariate logistic regression was conducted to iden-
tify possible independent predictors of DEBs.
Results: Mean scores on the Eating Attitudes Test-26 (EAT-26)
were significantly higher in females with FHA (p < 0.0001).
Significantly higher scores at the sub-scale items of dieting (p =
0.03) and bulimia & food preoccupation (p < 0.001) were found com-
pared to healthy controls. Significant difference was also observed
between the mean scores of the two groups in all other question-
naires: State-Trait-Anxiety-Inventory (STAI) (p < 0.0001),
Multidimensional Body-Self-Relations Questionnaire (MBSRQ) (p <
0.0001) and International Physical Activity Questionnaire (IPAQ)
(p = 0.004). EAT-26 scores were positively correlated with scores
on STAI (rho = 0.26, p = 0.04), MBSRQ (rho = 0.79, p < 0.0001) and
IPAQ (rho = 0.35, p = 0.03). High scores on IPAQ and STAI were corre-
lated with a 12.2-fold (p = 0.008) and 4.3-fold (p = 0.04) increased
risk for high scores on EAT-26 respectively.
Conclusion(s): This study demonstrated markedly higher number
of patients with FHA screen positively for DEBs compared to the con-
trol group. Patients with FHA were found to demonstrate underlying
restrictive dieting and bulimic symptoms that could possibly pro-
mote the development of pathological EDs. Anxiety and overweight
preoccupation may underlie and independently contribute to devel-
opment and maintenance of both DEBs and FHA. This evidence may
have future implications for both screening and interventions that
target DEBs and other psychological.
Disclosure: Work supported by industry: no.
References
[1] Gordon CM, Ackerman KE, Berga SL, et al. Functional hypothalamic amenorrhea:
An endocrine society clinical practice guideline. J Clin Endocrinol Metab.
2017;102:1413–39.
e27
[2] Marcus MD, Loucks TL, Berga SL. Phychological correlates of functional
hypothalamic amenorrhea. Ferti Steril. 2001;76:310–6.
[3] Bomba M, Gambera A, Bonini L, Peroni M, Neri F, Scagliola P, Nacinovich R.
Endocrine profiles and neuropsychologic correlates of functional hypothalamic
amenorrhea in adolescents. Fertil Steril. 2007;87:876–85.
[4] Martinussen M, Friborg O, Schmierer P, et al. The comorbidity of personality
disorders in eating disorders: a meta-analysis. Eat Weight Disord.
2017;22:201–9.
doi:10.1016/j.ejogrb.2022.02.094
066 The role of autoimmunity in the pathogenesis of ovarian dys-
function in adolescent girls
V. Andreeva, M. Levkovich, Y. Petrov
Federal State Budgetary Educational Institution of Higher Education ‘‘Rostov
State Medical University” of the Ministry of Healthcare of the Russian
Federation, Rostov-on-Don, Russian Federation
The purpose: Optimization of the treatment adolescents with
oligomenorrhea on the basis of studying the role of autoimmune
mechanisms of normogonadotropic ovarian insufficiency formation.
Study design: The serum levels of anti-Mullerian hormone (AMH),
inhibin B, anti-ovarian antibodies (AOAs), neopterin, rheumatoid fac-
tor (RF), interferon -c (IFN-c), tumor necrosis factor-a (TNF-a) in 2
groups of adolescent girls with secondary normogonadotropic
oligomenorrhea were investigated by ELISA.
Group I 39 girls with elevated levels of AOAs (11 IU/ml).
Group II 49 girls with normal levels of AOAs (<11 U/ml).
The control group included 20 healthy girls with regular men-
strual cycles.
Results: The mean values of AMH of the patients of the I group
were 2 times lower, than in the control. The indices of inhibin B were
6 times higher, than in the control, and 4 times higher, than in the II
group.
The AMH level in the 2nd group exceeded the norm that indi-
cated large quantity of preantral follicles and could be one of criteria
of diagnosing the PCOS.
Increased levels of RF and decreased of IFN-c were found in both
groups. The highest levels of TNF-a and neopterin was revealed in
the 2nd group.
Neopterins level increases in case of autoimmune diseases and it
is an earlier marker of autoimmune pathology than autoantibodies.
When the anti-ovarian autoantibodies are present, the diagnosis is
undoubtable, and when they are absent, it becomes difficult to make
a diagnosis.
Due to this fact we offer to determine the serum level of neop-
terin in order to enable early detection of autoimmune oophoritis
in girls with oligomenorrhea, seronegative ones by anti-ovarian anti-
bodies. By applying a dichotomic arborescent – we determined a
diagnostic threshold of neopterin, which is equal to 9.86 nmol/l.
Conclusions: The increase of the levels of neopterin, TNF-a,
AMH in the patients of the II group confirmed the participation
of the given factors in the pathogenesis of oligomenorrhea.
Autoimmunity rates are characterized by increased serum RF, neop-
terin, titers of AOAs, and decreased levels of AMH, IFN-c, that
demonstrates the diagnostic value of these parameters as markers
of autoimmune origin of normogonadotropic secondary
oligomenorrhea.
Disclosure: Work supported by industry: no.
doi:10.1016/j.ejogrb.2022.02.095