Ebook Frontiers in gynecological endocrinology (Volume 4: Pediatric and adolescent gynecological endocrinology): Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Frontiers in gynecological endocrinology (Volume 4: Pediatric and adolescent gynecological endocrinology): Part 2
Ebook Frontiers in gynecological endocrinology (Volume 4: Pediatric and adolescent gynecological endocrinology): Part 2
Amenorrhoea and Anorexia Nervosa in Adolescent Girls9Sebastien Guillaume, Laurent Maimoun, Charles Sultan, and Patrick LefebvreAnorexia nervosa (AN) i Ebook Frontiers in gynecological endocrinology (Volume 4: Pediatric and adolescent gynecological endocrinology): Part 2 is characterized by an intense fear of becoming fat despite an obvious thinness and extreme behaviours for weight loss, such as food restriction with or without self-induced vomiting or use of laxatives. The result is a massive weight loss and pathological thinness. The 12-month prevalence of AN amo Ebook Frontiers in gynecological endocrinology (Volume 4: Pediatric and adolescent gynecological endocrinology): Part 2 ng young females is approximately 0.4%. The presence of AN dramatically affects quality of life both of people with AN and their relatives, and peopleEbook Frontiers in gynecological endocrinology (Volume 4: Pediatric and adolescent gynecological endocrinology): Part 2
with eating disorders have particularly high utilization rate of health services 129]. AN is a multifactorial disorder currently conceptualized with Amenorrhoea and Anorexia Nervosa in Adolescent Girls9Sebastien Guillaume, Laurent Maimoun, Charles Sultan, and Patrick LefebvreAnorexia nervosa (AN) i Ebook Frontiers in gynecological endocrinology (Volume 4: Pediatric and adolescent gynecological endocrinology): Part 2 nerability via endophenotype such as perfectionist traits, lack of cognitive flexibility, facilitating the secretion of opioids during fasting, etc. [23,29]. These factors will be expressed in a specific environmental context and will lead to emergence of disorders, adolescence being a period of par Ebook Frontiers in gynecological endocrinology (Volume 4: Pediatric and adolescent gynecological endocrinology): Part 2 ticular vulnerability. The main environmental factors favouring (he emergence of disorders include idealization of thinness and performance of our wesEbook Frontiers in gynecological endocrinology (Volume 4: Pediatric and adolescent gynecological endocrinology): Part 2
tern societies, a focused education on the ideal of thinness or food rigidity and the presence of trauma including early trauma. Management of AN is dAmenorrhoea and Anorexia Nervosa in Adolescent Girls9Sebastien Guillaume, Laurent Maimoun, Charles Sultan, and Patrick LefebvreAnorexia nervosa (AN) i Ebook Frontiers in gynecological endocrinology (Volume 4: Pediatric and adolescent gynecological endocrinology): Part 2 ur with food, improve social and interpersonal relationships, as well as self-perception of patients. Despite these supports, approximately 30% of patients will not cure from their disease. This creates an excess mortality in AN. Mortality increases over time, and is estimated to be 5% per decade of Ebook Frontiers in gynecological endocrinology (Volume 4: Pediatric and adolescent gynecological endocrinology): Part 2 illness [25]. Thus, AN is the psychiatric disorder with the highest mortality rates. From people who will cure, the recover process will take severalEbook Frontiers in gynecological endocrinology (Volume 4: Pediatric and adolescent gynecological endocrinology): Part 2
months to years. In this short review we will discuss three points: what are the features of amenorrhoea in AN. why amcnorrhoea has been removed as aAmenorrhoea and Anorexia Nervosa in Adolescent Girls9Sebastien Guillaume, Laurent Maimoun, Charles Sultan, and Patrick LefebvreAnorexia nervosa (AN) i Ebook Frontiers in gynecological endocrinology (Volume 4: Pediatric and adolescent gynecological endocrinology): Part 2 tpellier, and University of Montpellier. Montpellier. France e-mail: s-guillaume@chu-montpellier.fr© International Society of Gynecological Endocrinology 2017119c. Sultan. A.R. Genazzani (eds.). Frontiers in Gynecological Endocrinology.I«r:c nni in inn?) utuutt 1 n120s. Guillaume et al.9.1Features o Ebook Frontiers in gynecological endocrinology (Volume 4: Pediatric and adolescent gynecological endocrinology): Part 2 f Amenorrhoea in ANAmenorrhoea in AN is related to a functional hypothalamic disorder (FHA) which is a condition characterized by the absence of menseEbook Frontiers in gynecological endocrinology (Volume 4: Pediatric and adolescent gynecological endocrinology): Part 2
s due to the suppression of the hypothalamic-pituitary-ovarian axis, in which no anatomical or organic disease is identified. The decreased pulses of Amenorrhoea and Anorexia Nervosa in Adolescent Girls9Sebastien Guillaume, Laurent Maimoun, Charles Sultan, and Patrick LefebvreAnorexia nervosa (AN) i Ebook Frontiers in gynecological endocrinology (Volume 4: Pediatric and adolescent gynecological endocrinology): Part 2 atterns of LH secretion can be seen [9. 24] including a lower mean frequency of LH pulses, the complete absence of LH pulsatility. as well as a normalappearing secretion pattern and higher mean frequency of LH pulses. Serum concentrations of FSH often exceed those of LH. similar to the pattern in pr Ebook Frontiers in gynecological endocrinology (Volume 4: Pediatric and adolescent gynecological endocrinology): Part 2 epubertal girls in the early stage and as the disease is more advanced both are very low. The wide spectrum of hypothalamic-pituitary disturbances mayEbook Frontiers in gynecological endocrinology (Volume 4: Pediatric and adolescent gynecological endocrinology): Part 2
reflect different stages of the disease and/or genetic susceptibility. In patients with anorexia nervosa, secretion of gonadotropin releasing hormoneAmenorrhoea and Anorexia Nervosa in Adolescent Girls9Sebastien Guillaume, Laurent Maimoun, Charles Sultan, and Patrick LefebvreAnorexia nervosa (AN) i Ebook Frontiers in gynecological endocrinology (Volume 4: Pediatric and adolescent gynecological endocrinology): Part 2 ion in AN who share a lot of common characteristics of women with FHA without AN criteria (Table 9.1). The disturbed hypothalamic-pituitary-ovarian axis in FHA cases is usually associated typically with weight loss, stress and/or excessive physical exercise and is one of the most common causes of se Ebook Frontiers in gynecological endocrinology (Volume 4: Pediatric and adolescent gynecological endocrinology): Part 2 condary amenorrhoea. According to the eliciting factor, there are three classes of FHA: weight loss related, stress related and exercise related. TheEbook Frontiers in gynecological endocrinology (Volume 4: Pediatric and adolescent gynecological endocrinology): Part 2
precise mechanisms underlying the pathophysiology of FHA are complex and unclear. Attention should be paid to such substances as kisspeptin. neuropeptAmenorrhoea and Anorexia Nervosa in Adolescent Girls9Sebastien Guillaume, Laurent Maimoun, Charles Sultan, and Patrick LefebvreAnorexia nervosa (AN) i Ebook Frontiers in gynecological endocrinology (Volume 4: Pediatric and adolescent gynecological endocrinology): Part 2 y of body weight) appears to be the critical factor in both weight-loss and exercise-induced forms of hypothalamic amenorrhoea.Some of the behavioural features of AN have a direct impact on amenorrhoea:• Weight loss of between 1Ơ and 15% of normal weight disrupts the menstrual cycle in most women [1 Ebook Frontiers in gynecological endocrinology (Volume 4: Pediatric and adolescent gynecological endocrinology): Part 2 5]. The value of oestrogen is reduced according to BMI and in patients where the BMI are lower to 15 kg/m2. plasma estradiol was notTable 9.1 Common cEbook Frontiers in gynecological endocrinology (Volume 4: Pediatric and adolescent gynecological endocrinology): Part 2
haracteristics in FHA and ANCharacteristicsFunctional Hypothalamic Amenorrhoea (FHA)Anorexia nervosa (AN)Body weightNormal or lowVery low to normalBodAmenorrhoea and Anorexia Nervosa in Adolescent Girls9Sebastien Guillaume, Laurent Maimoun, Charles Sultan, and Patrick LefebvreAnorexia nervosa (AN) i Ebook Frontiers in gynecological endocrinology (Volume 4: Pediatric and adolescent gynecological endocrinology): Part 2 nLeptinLowVery low to normalEmotional stressVariableVariable9 Amenorrhoea and Anorexia Nervosa in Adolescent Girls121detected [13]. However, amenorrhoea may precede weight loss in up to 20% of women w ith AN. Allhough a minority of women w ith AN maintains some menstrual activity even at significant Ebook Frontiers in gynecological endocrinology (Volume 4: Pediatric and adolescent gynecological endocrinology): Part 2 ly low weights, this should not falsely reassure clinicians or patients that weight restoration is not necessary. Weight gain usually restores normalEbook Frontiers in gynecological endocrinology (Volume 4: Pediatric and adolescent gynecological endocrinology): Part 2
menstrual cycles. The time course and amount of weight required for resumption of menses has varied among different studies but a goal of attaining 90Amenorrhoea and Anorexia Nervosa in Adolescent Girls9Sebastien Guillaume, Laurent Maimoun, Charles Sultan, and Patrick LefebvreAnorexia nervosa (AN) i Ebook Frontiers in gynecological endocrinology (Volume 4: Pediatric and adolescent gynecological endocrinology): Part 2 a persists in about 10-30% of patients with AN despite weight gain, because of ongoing abnormal eating behaviours (binge eating and purging), exercise, or stress.•Nutritional deficiencies that are not associated with weight loss or hyperactivity may lead also to FHA [5]. In contrast to their menstru Ebook Frontiers in gynecological endocrinology (Volume 4: Pediatric and adolescent gynecological endocrinology): Part 2 ating counterparts, the women with amenorrhoea severely restricted their fat consumption and had low er body fat mass.•Patients with AN experiment higEbook Frontiers in gynecological endocrinology (Volume 4: Pediatric and adolescent gynecological endocrinology): Part 2
h levels of stress. Increased CRH secretion results in an increased secretion of adrenocorticotrophin from the pituitary and cortisol from the adrenalAmenorrhoea and Anorexia Nervosa in Adolescent Girls9Sebastien Guillaume, Laurent Maimoun, Charles Sultan, and Patrick LefebvreAnorexia nervosa (AN) i Ebook Frontiers in gynecological endocrinology (Volume 4: Pediatric and adolescent gynecological endocrinology): Part 2 HA [27]. For patients distressed by persistent amenorrhoea, eventual recovery of menstrual periods may occur following psychotherapy [3].This amenorrhoea has some important consequence on the prognosis of AN. Patients suffering from AN exhibit impaired bone remodelling, w hich is characterized by a Ebook Frontiers in gynecological endocrinology (Volume 4: Pediatric and adolescent gynecological endocrinology): Part 2 decrease in bone formation and a concomitant increase in bone resorption [ 19-21 ]. Oestrogen plays a crucial role on bone mass acquisition and on itsEbook Frontiers in gynecological endocrinology (Volume 4: Pediatric and adolescent gynecological endocrinology): Part 2
maintenance. The effects of oestrogen on bone metabolism have been described as inhibitory for the resorption process, although direct effects on ostAmenorrhoea and Anorexia Nervosa in Adolescent Girls9Sebastien Guillaume, Laurent Maimoun, Charles Sultan, and Patrick LefebvreAnorexia nervosa (AN) i Ebook Frontiers in gynecological endocrinology (Volume 4: Pediatric and adolescent gynecological endocrinology): Part 2 ciated with very low values had highly oriented clinicians to claim that the oestrogen deficiency is the major cause of bone loss in AN patients. However, osteopenia is much more severe in AN patients compared to other amenorrhoeic-deficient populations [II]. This suggested that osteopenia/osteoporo Ebook Frontiers in gynecological endocrinology (Volume 4: Pediatric and adolescent gynecological endocrinology): Part 2 sis genesis in AN is multifactorial and that other endocrine factors such as IGF-1, cortisol or sclerostin acting on the alteration of the bone cell aEbook Frontiers in gynecological endocrinology (Volume 4: Pediatric and adolescent gynecological endocrinology): Part 2
ctivity [19-21]. By the way. amenorrhoea has clinical utility because it alerts clinicians to potential deficits in bone mineral density (BMD).AmenorrAmenorrhoea and Anorexia Nervosa in Adolescent Girls9Sebastien Guillaume, Laurent Maimoun, Charles Sultan, and Patrick LefebvreAnorexia nervosa (AN) i Ebook Frontiers in gynecological endocrinology (Volume 4: Pediatric and adolescent gynecological endocrinology): Part 2 and anxiety driven by underlying cognitive processes are a prominent feature of AN and suggested directions for developing innovative therapeutic programmes. Oestrogens, acting through oestrogens receptor-p. is anxiolytic in animals [18] and levels of anxiety change across the estrus cycle. Oestrog Ebook Frontiers in gynecological endocrinology (Volume 4: Pediatric and adolescent gynecological endocrinology): Part 2 en may also be involved with perception of body shape, and may account for greater body shape concerns in females than males [22]. Finally, a study suEbook Frontiers in gynecological endocrinology (Volume 4: Pediatric and adolescent gynecological endocrinology): Part 2
ggests that AN people w ho were in amenorrhoea122s. Guillaume et al.or had irregular menses showed significant cognitive deficits across a broad rangeGọi ngay
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