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High Serum Cortisol Levels in Exercise-Associated Amenorrhea

JU-HONG DING, M.S., M.D.; CAROL B. SHECKTER, M.D.; BARBARA L. DRINKWATER, Ph.D.; MICHAEL R. SOULES, M.D.; and WILLIAM J. BREMNER, M.D., Ph.D.
[+] Article and Author Information

Grant support: in part by the National Institutes of Health grants P50-HD-12629 and R01 HD18967; Clinical Research Center Grant RR-37; the Veterans Administration and the National Dairy Board, Arlington, Virginia, and administered in cooperation with the National Dairy Council, Rosemont, Illinois; and a World Health Organization Research Training Grant.

Portions of this work were presented in abstract form at the Annual Meeting of the Western Society for Clinical Investigation, Carmel, California, 3 to 6 February 1987, and at the American Society for Clinical Investigation, San Francisco, California, 1 to 4 May 1987.

▸Requests for reprints should be addressed to Carol B. Sheckter, M.D.; Endocrinology Section (111), Veterans Administration Medical Center, 1660 S. Columbian Way; Seattle, WA 98108.


Seattle, Washington


© 1988 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1988;108(4):530-534. doi:10.7326/0003-4819-108-4-530
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Objective: To determine whether basal Cortisol levels are elevated in exercise-associated amenorrhea.

Design: Survey, with hormone levels measured weekly for 1 month and patients followed clinically for 6 months.

Setting: Volunteers were recruited through media advertisements and fliers.

Participants: 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: amenorrhea 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.

Interventions: 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.

Measurements and Main Results: 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 <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 <0.01).

Conclusions: 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.

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