A 22-year-old athlete presents with secondary amenorrhoea, low bone density (Z-score −2.3), and disordered eating. She is diagnosed with the Female Athlete Triad. The 2014 IOC Consensus Statement renamed this condition. Under the updated nomenclature, what is the foundational physiological mechanism driving all three components?
- A Excess cortisol from chronic exercise suppressing GnRH pulsatility and estrogen synthesis
- B Low energy availability (LEA) — insufficient dietary energy relative to exercise energy expenditure — causing suppression of the hypothalamic-pituitary-ovarian axis and reduced bone formation ✓
- C Elevated prolactin from exercise-induced stress inhibiting gonadotrophin release
- D Iron deficiency anaemia from menstrual loss combined with inadequate nutrition causing secondary amenorrhoea
Explanation
The IOC 2014 Consensus renamed the Female Athlete Triad as Relative Energy Deficiency in Sport (RED-S), emphasising that Low Energy Availability (LEA) — defined as insufficient dietary energy after accounting for exercise energy expenditure — is the central mechanism. LEA reduces metabolic fuel availability, suppresses pulsatile GnRH secretion (hypothalamic amenorrhoea) via leptin, kisspeptin, and neuropeptide Y pathways, reduces estrogen and IGF-1, and shifts bone metabolism toward resorption, causing stress fractures and low bone density. This broadened concept now applies to both female and male athletes.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.