Acetyl-L-Carnitine (ALC) administration positively affects reproductive axis in hypogonadotropic women with functional hypothalamic amenorrhea

Background: Hypothalamic amenorrhea (HA) is characterized by neuroendocrine impairment that, in turn, negatively modulates endocrine function, mainly within the reproductive axis. HA presents withs hypoLH, hypoestrogenism and, until now, a definite therapeutic strategy has not yet been found.The aim of the following study was to test the efficacy of Acetyl-L-Carnitine (ALC)administration in HA-affected subjects.Population: A group of 24 patients affected by stress-induced HA were divided in 2 groups according to LH plasma levels. Group A, hypo LH (LH < 3 mIU/ml) (n=16) and group B, normoLH (LH > 3 mIU/ml), (n=8) were treated with Acetyl-L-Carnitine (ALC) (1 g/day, per os) for 16 weeks.Design: Patients underwent baseline hormonal assessment, pulsatility test (for LH and FSH), naloxone test (for LH, FSH and cortisol) both before and after 16 weeks of treatment.Results: Under ALC administration hypo LH patients showed a significant increase in LH plasma levels (from 1.4±0.3 to 3.1±0.5, p<0.01) and in LH pulse amplitude (p< 0.001). No changes wereobserved in the normo LH group. LH response to naloxone was restored under ALC therapy. Maximal LH response and AUC under naloxone were significantly increased (p<0.05 and p<0.01,respectively). No changes were observed in the normo LH patients.Conclusions: Our data support the hypothesis of a specific role of ALC on counteracting the stressinduced abnormalities in hypo LH patients affected by hypothalamic amenorrhea.