Hurvitz Michal, Weiss Ram
Hebrew University School of Medicine, Department of Human Metabolism and Nutrition, Braun School of Public Health and Community Medicine, Faculty of Medicine, Jerusalem, Israel.
Pediatr Endocrinol Rev. 2009 Dec;7(2):43-9.
Participation of adolescents and young women in strenuous sports activity may lead to various metabolic and psychological derangements of clinical relevance to the endocrinologist. The most common manifestations encountered in practice are primary and secondary amenorrhea, reduced bone mineral density and eating disorders. The occurrence of all three together has been named "the athletic triad". The underlying hormonal drivers that lead to some of these manifestations are the reduced leptin level as well as the persistent low grade stress response commonly observed in such females. "Exercise-related female reproductive dysfunction" (ERFRD), can possibly include short-term (infertility) and long-term (osteoporosis) consequences. Functional hypothalamic amenorrhea, a manifestation of ERFRD in adolescence, is an integrated response to the combination of excessive physical and emotional stress, exercise, and/or reduced food intake characterized by decreased endogenous GNRH secretion. The primary aim of treating these athletes should be the prevention of the development of any component of the triad as well as the whole complex by educating athletes, trainers, parents and health care professionals about proper nutrition and safe training. The long term prognosis is good. However, significant long term morbidity may affect these young women later in life.
青少年和年轻女性参与剧烈体育活动可能会导致各种代谢和心理紊乱，这些紊乱对内分泌学家具有临床相关性。在实践中遇到的最常见表现是原发性和继发性闭经、骨密度降低和饮食失调。这三种情况同时出现被称为“运动三联征”。导致其中一些表现的潜在激素驱动因素是瘦素水平降低以及在此类女性中常见的持续低水平应激反应。“运动相关女性生殖功能障碍”（ERFRD）可能包括短期（不孕）和长期（骨质疏松症）后果。功能性下丘脑性闭经是青春期ERFRD的一种表现，是对过度身体和情绪压力、运动和/或食物摄入减少的综合反应，其特征是内源性促性腺激素释放激素（GNRH）分泌减少。治疗这些运动员的主要目标应该是通过教育运动员、教练、家长和医护人员了解适当的营养和安全训练，预防三联征任何组成部分以及整个综合征的发展。长期预后良好。然而，严重的长期发病率可能会在这些年轻女性日后的生活中影响她们。
