{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:14:47Z","timestamp":1788480887918,"version":"build-2803163510"},"reference-count":57,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":12,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Neuroendocrinology"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Primary amenorrhoea is defined as the absence of menarche by the expected age, with or without delayed pubertal development in adolescents. It may result from anatomical, genetic, endocrine, and functional causes. Among the latter, we propose the term primary functional hypothalamic amenorrhoea (P\u2010\n                    <jats:styled-content style=\"fixed-case\">FHA<\/jats:styled-content>\n                    ) to describe primary amenorrhoea characterised by hypothalamic\u2013pituitary\u2013ovarian axis suppression in the absence of organic disease. P\u2010\n                    <jats:styled-content style=\"fixed-case\">FHA<\/jats:styled-content>\n                    is frequently associated with low energy availability (\n                    <jats:styled-content style=\"fixed-case\">LEA<\/jats:styled-content>\n                    ), particularly in individuals with feeding and eating disorders (\n                    <jats:styled-content style=\"fixed-case\">FEDs<\/jats:styled-content>\n                    ) or excessive exercise, often within the spectrum of Relative Energy Deficiency in Sport (\n                    <jats:styled-content style=\"fixed-case\">REDs<\/jats:styled-content>\n                    ). Despite its clinical relevance, P\u2010\n                    <jats:styled-content style=\"fixed-case\">FHA<\/jats:styled-content>\n                    remains under\u2010recognised, with limited dedicated research. This review aims to synthesise clinical studies addressing P\u2010\n                    <jats:styled-content style=\"fixed-case\">FHA<\/jats:styled-content>\n                    in the context of\n                    <jats:styled-content style=\"fixed-case\">FEDs<\/jats:styled-content>\n                    or excessive exercise. A systematic literature search was conducted using\n                    <jats:styled-content style=\"fixed-case\">PubMed<\/jats:styled-content>\n                    , Web of Science, and Scopus. Studies focusing on P\u2010\n                    <jats:styled-content style=\"fixed-case\">FHA<\/jats:styled-content>\n                    and its association with\n                    <jats:styled-content style=\"fixed-case\">FEDs<\/jats:styled-content>\n                    , excessive exercise, and\n                    <jats:styled-content style=\"fixed-case\">REDs<\/jats:styled-content>\n                    were included. Case reports and aggregated studies combining P\u2010\n                    <jats:styled-content style=\"fixed-case\">FHA<\/jats:styled-content>\n                    and S\u2010\n                    <jats:styled-content style=\"fixed-case\">FHA<\/jats:styled-content>\n                    were excluded to ensure specificity. Twenty\u2010four studies addressing patients with P\u2010\n                    <jats:styled-content style=\"fixed-case\">FHA<\/jats:styled-content>\n                    were identified. Available evidence suggests that the reported frequency of functional hypothalamic causes of primary amenorrhoea may have increased over time, although estimates varied substantially across populations and study designs. In patients with\n                    <jats:styled-content style=\"fixed-case\">FEDs<\/jats:styled-content>\n                    , the prevalence of\n                    <jats:styled-content style=\"fixed-case\">PA<\/jats:styled-content>\n                    ranged from 2.4% to 14.8%, while athlete cohorts reported frequencies ranging from 7.3% to 53.8%.\n                    <jats:styled-content style=\"fixed-case\">FEDs<\/jats:styled-content>\n                    and excessive exercise, including\n                    <jats:styled-content style=\"fixed-case\">REDs<\/jats:styled-content>\n                    \u2010related conditions, emerged as major clinical settings. Data specifically addressing hormonal profiles or body composition in this context remain limited. P\u2010FHA may represent an early clinical manifestation of chronic\n                    <jats:styled-content style=\"fixed-case\">LEA<\/jats:styled-content>\n                    occurring during a critical developmental window. Early recognition and multidisciplinary management are essential to minimise potential consequences on growth, skeletal health, reproductive function, body composition, and psychological well\u2010being. Further prospective studies are needed to better define its epidemiology, neuroendocrine mechanisms, and optimal management strategies.\n                  <\/jats:p>","DOI":"10.1111\/jne.70242","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T07:23:47Z","timestamp":1786605827000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Primary functional hypothalamic amenorrhoea in the context of feeding and eating disorders or excessive exercise: Insights from non\u2010athletic and elite athletic populations"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9091-2809","authenticated-orcid":false,"given":"Marianna","family":"Minnetti","sequence":"first","affiliation":[{"name":"Department of Experimental Medicine Sapienza University of Rome  Rome 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