Hypogonadotropic hypogonadism in obese women after biliopancreatic diversion

ObjectiveTo evaluate a particular form of weight-related amenorrhea occurring in severely obese patients after biliopancreatic diversion, a surgical procedure designed to cause weight loss.DesignProspective, open, controlled clinical trial.SettingDepartment of Gynecology and Obstetrics, University of Naples "Federico II", Naples, Italy. The surgical procedures were performed in various hospitals in the Naples metropolitan area.Patient(s)Eight severely obese women (mean [+/-SD] age, 26.9+/-5.3 years) who underwent biliopancreatic diversion (group A) and eight healthy women of normal weight (mean [+/-SD] age, 25.8+/-5.6 years) (group B).Intervention(s)Biliopancreatic diversion, hormonal evaluation, and LH pulsatility evaluation.Main outcome measure(s)Weight parameters, hormone levels, and LH pulsatility amplitude and frequency before surgery and at the onset of amenorrhea after surgery, and the response of LH pulsatility to the infusion of naloxone at the onset of amenorrhea.Result(s)All patients lost weight after surgery and became amenorrheic after 3 months, when they had lost 25% of their basal weight but were still obese. The hormonal picture at that time was one of hypothalamic amenorrhea with significantly reduced LH pulsatility frequency and amplitude. The alterations in LH pulsatility were not modified by naloxone infusion.Conclusion(s)Obese patients who undergo dramatic weight loss may be affected by hypothalamic amenorrhea when still obese. Endogenous opioid activity does not play a significant role in this kind of hypogonadotropic hypogonadism.