Abstract
Functional hypothalamic amenorrhea (FHA) is a relatively common disorder in which patients develop secondary amenorrhea and are found to have low estrogen levels without evidence of organic abnormality. The etiology is disruption of the hypothalamic-pituitary-gonadal axis, which can be caused by weight loss, eating disorders, excessive exercise, or psychological stress.
Relative energy deficiency in sport (RED-S) is a type of FHA that occurs in athletes, wherein low energy availability affects multiple organ systems, including the bones. In addition to hypogonadism, patients with RED-S often have elevated cortisol and ghrelin, as well as lower leptin and insulin-like growth factor. Treatment of FHA requires an interdisciplinary approach and should focus on correcting the energy deficit. Oral contraceptives, bisphosphonates, and denosumab are not routinely recommended as treatment.
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Haseltine, K., Starr, J. (2021). Relative Energy Deficiency in Sport/Functional Hypothalamic Amenorrhea. In: Cusano, N.E. (eds) Osteoporosis. Springer, Cham. https://doi.org/10.1007/978-3-030-83951-2_9
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DOI: https://doi.org/10.1007/978-3-030-83951-2_9
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