The closed eyes sign: an aid to diagnosing non-specific abdominal pain.

period despite maintaining a stable weight. The cause of these disturbances seemed to be located at or above the level of the hypothalamus in four patients and the pituitary in three, and one patient had polycystic ovaries. No patients suffering pituitary dysfunction had a history of anorexia nervosa. The ovarian ultrasound scan confirmed the test findings in all but one patient (case 11), in whom the pituitary disturbance may have been of insufficient duration to cause a change in ovarian morphology. Though interpretation of the luteinising hormone releasing hormone test is not absolutely reliable, this study shows that anovulation and menstrual disturbance are common in women with bulimia of normal body weight and that anovulation is not associated with a consistent hormonal pattern. Possible causes of these disturbances include gross fluctuations in carbohydrate intake, disturbances of fluid and electrolyte balance caused by self induced vomiting and laxative abuse, or emesis leading to excessive dopaminergic brain activity.