Elevated ghrelin level in women of normal weight with amenorrhea is related to disordered eating

ObjectiveTo determine whether women of normal weight with hypothalamic amenorrhea have elevated ghrelin levels when compared with controls matched for metabolic parameters and whether this elevation is related to disordered eating patterns.DesignControlled clinical study.SettingHealthy volunteers in an academic research environment.Patient(s)Twelve subjects of normal weight with functional hypothalamic amenorrhea, 22 exercising controls, and 5 sedentary controls.Intervention(s)None.Main Outcome Measure(s)Ghrelin level and eating behavior.Result(s)The group with functional hypothalamic amenorrhea did not differ from the exercising control group or the sedentary control group with respect to body weight, body fat, and leptin levels. However, ghrelin level showed a significant positive correlation with Eating Attitudes Test (EAT)-40 scores (r = 0.475) at an EAT score ≥10 in all three groups. Eighty-three percent of patients with functional hypothalamic amenorrhea had EAT-40 levels >10.Conclusion(s)Elevated EAT scores associated with high ghrelin level may represent dietary behaviors that perpetuate reproductive dysfunction. Thus ghrelin may act as a restraining metabolic signal preventing a return to cyclicity in women with disordered eating and of normal weight and body fat.