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Research at Mass General
Female Athlete Study: The female athlete triad is the interrelationship of low energy availability, menstrual dysfunction and decreased bone mineral density. Many young female athletes are afflicted with some aspect of this condition. Up to 69% of women participating in sports involving running activities and other endurance sports experience menstrual dysfunction, as compared to only 2-5% of the general population. A major concern associated with the female athlete triad is low bone mineral density. Decreased bone mineral density has been reported in 22-50% of female athletes as compared to 12% of the normal population. Decreased bone mineral density during adolescence puts these athletes at a higher risk for fracture. Therefore, it is imperative to address this serious and widespread issue.
Bionutritionist Tara Holmes obtaining readings during the VO2 endurance test.
Our research group has made significant progress in investigating this condition within a population of teenage girls and young adult women. In an effort to adapt the treatment model for this disorder, we hope to further elucidate the factors that lead to menstrual dysfunction in some but not all athletes. We are also exploring associations of components of the triad with hormone levels, fat depots, bone structure and strength, and neurocognitive and neuropsychiatric outcomes.
Current research studies aim at further investigating:
Bone Health Study: Our group has demonstrated that low bone density is prevalent in adolescent girls and boys with anorexia nervosa and is associated with decreased bone turnover. Hormonal alterations that predict low bone density in this disorder include hypogonadism, a nutritionally acquired resistance to growth hormone effects, low insulin like growth factor-1 (IGF-1) levels, and high cortisol levels. Weight gain and resumption of menses are associated with some improvement in bone parameters, however, residual deficits persist, raising concerns regarding inadequate catch-up and suboptimal peak bone mass acquisition. We have demonstrated an improvement in bone density in adolescent girls with anorexia nervosa with transdermal estrogen replacement (with cyclic progesterone). However, complete catch-up does not occur, likely because of residual deficits in other hormones, such as IGF-1. We have also shown that giving IGF-1 for a short duration increases markers of bone formation.
Our current research aims at investigating:
Brain Study: Eating disorders are heterogeneous illnesses characterized by aberrant behaviors of extreme dietary restriction, binge eating, and purging. The course often involves adolescent onset, and in more than half of individuals, transition from predominantly restrictive to binge/purge behaviors. The pathophysiology of low-weight eating disorders and mechanisms that underlie restricting vs. binge/purge phenotypes are almost entirely unknown. A critical knowledge gap is the neurobiology underlying the developmental trajectory of these illnesses (e.g. transition from primary restriction to binge eating or purging or recovery).
Bone Health Study: We know that adults with obesity who undergo weight-loss surgery are at risk for bone loss and decreased bone strength. However, we do not know the effects of such surgery on bone accrual and outcomes in teenagers and young adults.
Our group has shown that peripubertal boys with autism spectrum disorder (ASD) have lower bone mineral density than typically developing controls, and that both children and adults with ASD are at a higher risk of fracture than controls.
For more information, please visit the Pediatric Neuroendocrine website
Study Coordinators and Assistants
Alexander Toth Phone: 617-724-6046 Fax: 617-726-8528 E-mail: email@example.com
Shreya Tulsiani Phone: 617-643-0266 Fax: 617-726-8528 E-mail: firstname.lastname@example.org
Chris Mancuso Phone: 617-643-7847 Fax: 617-726-8528 E-mail: email@example.com
Female Athlete Study
Will scheduling be a problem since I’m a full-time student?
We understand that most participants are in high school or college and have very busy schedules. We respect your time commitments and work hard to plan visits around your schedules so that participants do not have to miss their classes, jobs, or team commitments. For example, some visits can take place on your campus and we can see participants at MGH on weekends.
I will be out of town for the summer months. Will that be an issue for scheduling my visits?
Not at all! Visits may occur at 1.5 or 3 month intervals so we can coordinate visits when you are here, or at facilities closer to you. If you let us know ahead of time when you’ll be away, we can work out the dates so they fit best with your schedule.
Is it safe for me to participate?
All the components of this study have been approved by a human safety board called the Institutional Review Board to ensure that the protocol and all the procedures we do are safe for participants. Additionally, all medications given to participants are natural hormones given in replacement doses.
What is the purpose of the CT scan?
The CT scan is an imaging study that helps us visualize the structure of bones at a microscopic level. This gives us a more detailed picture of bone than a DXA does, and may better predict fracture risk. The CT scan will help us determine how bone structure is affected by hormonal changes in female athletes and females affected with anorexia nervosa.
How does the fMRI scan work?
The term fMRI stands for functional MRI. This means that the MRI scan is done when the subject is actually doing some tasks (and hence the term functional). This scan helps us visualize the brain when subjects perform some tasks in the scanner. We will be using tasks which will activate areas of the brain involved in depression and anxiety.
The scans take place at the Martinos Center in Charlestown. You can either meet the study coordinator at the center or take a shuttle from the MGH main campus with the coordinator.
Once there you will be asked to change into scrubs and remove all metal before entering the scanner. The study staff will help you into the machine where you will be lying down and looking at a screen. The scan will take about an hour and during the scans you will be responding to behavioral tasks presented on the screen.
After the scans are complete you will be asked to answer a few related questionnaires.
Reviews, chapters, monographs and editorials
Clinical Guidelines and Reports
Pediatric Endocrine-Neuroendocrine-Sports Endocrine Research
Meghan Slattery, NPNurse Practitioner617firstname.lastname@example.org
Vibha Singhal, MDPediatric Endocrinologist617email@example.com
Madhusmita Misra, MDDirector, MGH Pediatric Endocrine-Neuroendocrine-Sports Endocrine Research Lab617firstname.lastname@example.org
For more information, please visit the Pediatric Neuroendocrine website.
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