Ding J H, Sheckter C B, Drinkwater B L, Soules M R, Bremner W J
Department of Medicine, University of Washington School of Medicine, Seattle.
Ann Intern Med. 1988 Apr;108(4):530-4. doi: 10.7326/0003-4819-108-4-530.
To determine whether basal cortisol levels are elevated in exercise-associated amenorrhea.
Survey, with hormone levels measured weekly for 1 month and patients followed clinically for 6 months.
Volunteers were recruited through media advertisements and fliers.
Ninety-two women were enrolled; 71 (77%) completed the study. Subjects were grouped by menstrual and activity histories reported by a self-administered questionnaire. After 6 months, final groups were assigned: amenorrheic athletes, 19; eumenorrheic athletes, 35; a transition group of amenorrheic athletes who had resumed menses after entering the study, 7; and normal cyclic nonathletes, 10.
Four weekly resting blood samples (0800 to 1000 hours) were obtained and measured for cortisol, estradiol, progesterone, and prolactin levels. Lumbar bone mineral density was measured by dual-photon densitometry.
Mean (+/- SE) cortisol levels were higher in amenorrheic athletes (585 +/- 33 nmol/L) than in eumenorrheic athletes (411 +/- 14 nmol/L), transition athletes (378 +/- 33 nmol/L), or nonathletic women (397 +/- 30 nmol/L) (P less than 0.01). Of nine women with abnormally high cortisol levels (greater than 579 nmol/L), eight were amenorrheic athletes, and one was a eumenorrheic athlete. Bone mineral density was lower in amenorrheic athletes than in the other three groups (P less than 0.01).
Increased glucocorticoid levels may be an etiologic factor in exercise-associated amenorrhea. High cortisol levels could also contribute to decreased bone density. The failure of amenorrheic athletes with hypercortisolemia to regain menses within 6 months suggests that they are at risk for a prolonged acyclic state.
确定运动性闭经患者的基础皮质醇水平是否升高。
调查，连续1个月每周测量激素水平，并对患者进行6个月的临床随访。
通过媒体广告和传单招募志愿者。
92名女性入选；71名（77%）完成研究。根据自行填写问卷所报告的月经和活动史对受试者进行分组。6个月后，确定最终分组：闭经运动员组，19人；月经正常的运动员组，35人；进入研究后恢复月经的闭经运动员过渡组，7人；月经周期正常的非运动员组，10人。
每周采集4次静息血样（08:00至10:00），检测皮质醇、雌二醇、孕酮和催乳素水平。采用双能X线吸收法测量腰椎骨密度。
闭经运动员的平均（±标准误）皮质醇水平（585±33 nmol/L）高于月经正常的运动员（411±14 nmol/L）、过渡运动员（378±33 nmol/L）或非运动员女性（397±30 nmol/L）（P<0.01）。9名皮质醇水平异常高（>579 nmol/L）的女性中，8名是闭经运动员，1名是月经正常的运动员。闭经运动员的骨密度低于其他三组（P<0.01）。
糖皮质激素水平升高可能是运动性闭经的一个病因。高皮质醇水平也可能导致骨密度降低。高皮质醇血症的闭经运动员在6个月内未能恢复月经，提示她们有长期无月经状态的风险。
