Differential dynamic responses of luteinizing hormone to gonadotropin releasing hormone in patients affected by bulimia nervosa-purging versus non-purging type

  • Carla E. Ramacciotti
  • L. Guidi
  • E. Bondi
  • E. Coli
  • L. Dell’Osso
  • S. Pistoia
  • E. Pucci
Original Research Paper


Objective: Aim of the study was to investigate the presence of underlying abnor malities affecting the hypothalamus-pituitary-gonadal axis in 13 normal weight eumenhorreic bulimics as expressed by a different gonadotropin response to gonadotropin releasing hormone (GnRH), comparing patients with (n= 6) and without (n= 7) purging behaviours to controls (n= 5) Method: Subjects were administered an intravenous GnRH infusion for four hours, with an additional bolus at first and third hour. Results: Non-purging bulimics showed a significantly reduced luteinizing hormone (LH) response to GnRH compared to controls; purging bulimics following the second bolus, demonstrated a statistically reduced peak, in comparison to both controls and non-purging bulimics. Discussion: even in the absence of overt menstrual distur bances, an altered LH secretion elicited by pulsatile stimulation of endogenous GnRH was found, with a more severe impairment in purging than in non-purging bulimics, possibly related to their greater psychopathological and physical burden.

Key words

Bulimia nervosa-purging LH GnRH 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Russell G.F.M.: Bulimia Nervosa: an ominous variant of Anorexia Nervosa. Psychol. Med., 52, 187–190, 1979.Google Scholar
  2. 2.
    American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Washington DC, American Psychiatric Association, 1994.Google Scholar
  3. 3.
    Mitchell J.E.: Subtyping of Bulimia Nervosa. Int. J. Eating Disord., 11, 327–332, 1992.CrossRefGoogle Scholar
  4. 4.
    Garfinkel P.E., Brown G.M., Moldofsky H., Stancer H.C.: Hypothalamic pituitary function in anorexia nervosa. Arch. Gen. Psychiatry, 32, 739–744, 1975.PubMedCrossRefGoogle Scholar
  5. 5.
    Gwirtsman H.E., Roy-Byrne P., Yager J., Gerner R.H.: Neuroendocrine abnormalities in bulimia. Am. J. Psychiatry, 140, 559–563, 1983.PubMedGoogle Scholar
  6. 6.
    Pirke K.M., Schweiger U., Fichter M.M.: Hypothalamic-Pituitary-Ovarian Axis Function in Bulimia. In: Hudson J., Pope H.G. (Eds.), The Psychobiology of Bulimia. Washington, American Psychiatric Press, 1987.Google Scholar
  7. 7.
    Dally P.J.: Anorexia Nervosa. New York, Grune & Stratton, 1969.Google Scholar
  8. 8.
    Sherman B.M., Halmi K.A.: Effect of nutritional rehabilitation on hypothalamic-pituitary function in Anorexia Nervosa. In: Vigersky R. (Ed.), Anorexia Nervosa. New York, Raven Press, 1977.Google Scholar
  9. 9.
    Fairburn C.G., Cooper J.P.: The clinical features of bulimia nervosa. Br. J. Psychiatry, 144, 238–246, 1984.PubMedCrossRefGoogle Scholar
  10. 10.
    Pyle R.L., Mitchell J.E., Eckert E.D.: Bulimia: a report of 34 cases. J. Clin. Psychiatry, 42, 60–64, 1981.PubMedGoogle Scholar
  11. 11.
    Pirke K.M., Fichter M.M., Chlond C., Schweiger R.G., Laessle R.G., Schwingenschloegel M., Hoehl C.: Disturbances of the menstrual cycle in bulimia nervosa. Clin. Endocrinol. (Oxf), 27, 245–251, 1987.CrossRefGoogle Scholar
  12. 12.
    Pirke K.M., Fichter M.M., Schweiger U., Fruth C., Streitmatter A., Wolfram G.: Gonadotropin secretion pattern in bulimia nervosa. Int. J. Eating Disord., 6, 655–661, 1987.CrossRefGoogle Scholar
  13. 13.
    Devlin M.J., Walsh B.T., Katz J.L., Roose S.P., Linkie D.M., Wright L., Vande Wiele R., Glassman A.H.: Hypothalamic-pituitary-gonadal function in anorexia nervosa and bulimia. Psychiatry Res., 28, 11–24, 1989.PubMedCrossRefGoogle Scholar
  14. 14.
    Bremner J., Paulsen C.: Two pools of luteinizing hormone in the human pituitary: evidence from constant administration of luteinizing hormone-releasing hormone. J. Clin. Endocrinol. Metab., 39, 811–815, 1974.PubMedCrossRefGoogle Scholar
  15. 15.
    Snyder J., Rudenstein S., Gardner F., Rothman G.: Repetitive infusion of gonadotropin-releasing hormone distinguishes hypothalamic from pituitary hypogonadism. J. Clin. Endocrinol. Metab., 48, 864–868, 1979.PubMedCrossRefGoogle Scholar
  16. 16.
    Kiriike N., Nishiwaki S., Nagata T., Maeda Y., Kawakita Y.: Gonadotropin response to LH-RH in Anorexia Nervosa and Bulimia. Acta Psychiatr. Scand., 77, 420–426, 1988.PubMedCrossRefGoogle Scholar
  17. 17.
    Treasure J.L., Wheeler M., King E.A., Gordon P.A.L., Russel G.F.M.: Weight gain and reproductive function: ultrasonographic and endocrine features in anorexia nervosa. Clin. Endocrinol. (Oxf), 29, 607–616, 1988.CrossRefGoogle Scholar
  18. 18.
    Weltzin T.E., Cameron J., Berga S., Kaye W.H.: Prediction of reproductive status in women with Bulimia Nervosa by past high weight. Am. J. Psychiatry, 151, 136–138, 1994.PubMedGoogle Scholar
  19. 19.
    Hamilton M.: A rating scale for depression. J. Neurol., Neurosurg. Psychiatry, 23, 56–61, 1960.CrossRefGoogle Scholar
  20. 20.
    Davis C.J., Williamson D.A., Goreczny T.: Body image distortion in bulimia: an important distinction between binge-purgers and binge-eaters. Paper presented at the annual convention of the Association for the Advancement of Behavior Therapy, Chicago, 1986.Google Scholar
  21. 21.
    Duchman E.G., Williamson D.A., Strickler P.M.: Dietary restraint and bulimia. Paper presented at the annual convention of the Association for the Advancement of Behavior Therapy, Chicago, 1986.Google Scholar
  22. 22.
    Post G., Crowther J.H.: Restricter-purger differences in bulimic adolescents females. Int. J. Eating Disord., 6, 757–761, 1987.CrossRefGoogle Scholar
  23. 23.
    Willmuth M.E., Leitenberg H., Rosen J.C., Lada S.: A comparison of purging and non-purging normal weight bulimics. Int. J. Eating Disord., 7, 825–835, 1988.CrossRefGoogle Scholar

Copyright information

© Editrice Kurtis 1997

Authors and Affiliations

  • Carla E. Ramacciotti
    • 1
  • L. Guidi
    • 1
  • E. Bondi
    • 1
  • E. Coli
    • 1
  • L. Dell’Osso
    • 1
  • S. Pistoia
    • 2
  • E. Pucci
    • 2
  1. 1.Institute of PsychiatryUniversity of PisaPisaItaly
  2. 2.Institute of EndocrinologyUniversity of PisaItaly

Personalised recommendations