Asia Pacific Journal of Pediatric and Child Health

Abstract Ref Number = APCP847

Poster Presentation

MENSTRUAL CESSATION CAUSED BY ANOREXIA NERVOSA A CASE REPORT

WindaYanuarni Meye,Suryono Yudha Patria Department of Child Health Faculty of Medicine Publich Health and Nursing Universitas Gadjah Mada Dr Sardjito General Hospital Yogyakarta Indonesia Division of Pediatric Endocrinology, Department of Child Health, Faculty of Medicine Public Health and Nursing, Universitas Gadjah MadaDr Sardjito General Hospital, Yogyakarta, Indonesia

Background : Anorexia nervosa influences 0.3 to 3% adolescent girls and associated with endocrine dysfunction involving hypothalamic–pituitary–ovarian axis which result in secondary amenorrhea. Menstrual cessation occurs when the weight fall below 85% of ideal body weight. There were limited reports on such case in Indonesia; thus we report case of teenage girl who experienced menstrual cessation due to anorexia nervosa. Case Presentation Summary : Fourteen years old girl presented with anorexia nervosa–restricting type based on DSM V criteria as proven by dietary restriction, intense fear of gaining weight, distorted perception of body weight and shape, persistent false behavior to prevent weight gain for 4 months which lead to menstrual cessation. Physical examination revealed severely wasted nutritional status (BMI 11.3 kg/m2), body weight declined from 90.2% to 52.2% of ideal body weight, pitting edema, pale, and alopecia. Pubertal stage shows Tanner stage III for breast and stage II for pubic hair. Patient had menarche at 12 years old and regular menstrual cycle (28 to 31 days). The result of sex steroid hormones examination were estradiol 6.12 pg/mL (20-145 pg/mL), luteinizing hormone 1.4 mIU/mL (2.0-15 mIU/mL), follicle stimulating hormone 5.4 mIU/mL (3-20 mIU/mL) proving a hypogonadotropic hypogonadism condition2. Prolactin and thyroid stimulating hormone (TSH) level were examined to rule out hyperprolactinemia and thyroid dysfunction. Both results were within normal limit {prolactin 3.4 ng/ml (3.0-14.4 ng/ml), TSH 1.84 uIU/mL (0.51 – 4.30 uIU/mL)}. Progestogen challenge test was performed to assess estrogen status, however due to poor compliance, medication was discontinued. Fortunately, menstrual bleeding was restarted spontaneously after body weight reached 81.2% of ideal body weight. Learning Points/Discussion : Secondary amenorrhea in anorexic adolescent patient is categorized as functional hypothalamic amenorrhea due to hypogonadotropic hypogonadism. Its recovery is related to increases in body weight, fat mass, and also reversal of false behavior. Hormonal replacement therapy is not indicated for this case.

Keywords: anorexia nervosa menstrual cessation secondary amenorrhea hypogonadotropic hypogonadism