Effect of anorexia nervosa on gonadotrophin secretion in a patient with gonadal dysgenesis

The 11th documented concurrence of anorexia nervosa (AN) and XO-gonadal dysgenesis (GD) is reported. This is the first endocrine study of such a disease combination. The patient, a 15-year-old girl, has been followed since early childhood and comprehensive endocrinological investigation were performed before, during and after the episode of AN. The dynamic changes in the thyroid and pituitary hormones were in concordance with those already observed by us as well as by others in patients with AN. The most remarkable observations concerned the gonadotrophin secretion: during the anorectic episode basal levels and peak responses to LRH and both LH and FSH were seen to decrease from the hypergonadotrophic range to the normal prepubertal range whereas after recovery from AN and regain of weight these rose back to castration levels. AN would seem to be the only condition yet known able to abolish temporarily the hypergonadotrophic state of GD, a fact favouring the hypothesis that AN is associated with a reversible hypothalamic dysfunction. It is assumed that this disturbance is due to nutritional as well as to psychological factors. The significance of the coexistence of AN and GD is discussed and it is suggested that psychological factors in GD may be implicated in this association.