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EMAK · Century Club Joined: 26 Nov 2006 Posts: 572

A Patient with anorexia nervosa and sig. wt loss, develop amenorrheoa...what will you expect if we do to her a clomophine citrate challange test, positive or negative results? Smile

vani s · Century Club Joined: 20 Jan 2007 Posts: 141

negative , i guess Rolling Eyes

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966

definately negative

for clomiphene to act one must have some adipose tissue on the body Laughing

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Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SR O&G Wessex Region

EMAK · Century Club Joined: 26 Nov 2006 Posts: 572

But Raj., I can not get it..
Clomiphine is anti=oestrogen act on pitiutary to increase FSH

stimulate Grafian follicel

increase oestrogen secretion

proliferative changes in endometrium.

so why it is negative in this girl as she has low GnRH & GnPh.. Question

wolverine · Century Club Joined: 16 Jan 2007 Posts: 394

Clomiphene blocks the negative feedback of oestrogenes to FSH and possibly the action of inhibin to pitutary and follicles isn't that right? Therefore if the whole axis is not working there is no place for clomiphene to kick in! Like trying to open a locked door

EMAK · Century Club Joined: 26 Nov 2006 Posts: 572

U mean there will be no increase in FSH in those patients.......
may be u r right because thr GNRH originally is low.... Embarassed

Nick Raine-Fenning · Posted: Sat Jan 27, 2007 4:59 pm Post subject:

Exactly ... anorexic women have a dramatic reduction in the pulsatile release of LHRH / GnRH release. They essentially revert to a pre-pubescent state.

Clomiphene requires an intact hypothalamic-pituitary-ovarian / adrenal axis (I love saying that) to be effective. It is interupted in anorexia and other hypothalamic causes of anovulation.

The pre-pubescent effect is interesting as many hypothesise that anorexics want to revert to their pre-pubertal state and 'not grow up' as there are often underlying family issues such as marital disharmony etc and by refusing to grow up you can obviate / avoid the need to face these problems. A gross generalisation I know and I presume an offensive explanation to those affected (both personally and as a family unit) but an interesting observation I am sure you would agree.

Was Peter Pan anorexic Wink

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