Anorexia nervosa and adrenal hormones: a systematic review and meta-analysis

Abstract

Objective Anorexia nervosa is a primary psychiatric disorder characterized by self-induced negative energy balance. A number of hormonal responses and adaptations occur in response to starvation and low body weight including changes in adrenocortical hormones. Our objective was to systematically review adrenocortical hormone levels in anorexia nervosa. Design/Methods We searched MEDLINE and EMBASE for studies that reported at least one adrenocortical hormone, including dehydroepiandrosterone (DHEA), DHEA-sulfate (DHEA-S), progesterone, 17-hydroxyprogesterone, pregnenolone, cortisol (serum, urine, cerebrospinal fluid, and hair sample), aldosterone, androstenedione and testosterone in patients with anorexia nervosa and normal-weight healthy controls from inception until October 2021. Means and standard deviations for each hormone were extracted from the studies to calculate a mean difference (MD). A Pooled MD was then calculated by combining MDs of each study using the random-effects model. Results We included a total of 101 studies with over 2500 females with anorexia nervosa. Mean cortisol levels were significantly higher in anorexia nervosa as compared to normal-weight controls for multiple forms of measurement, including morning cortisol, 12-hour and 24-hour pooled serum cortisol, 24-hour urine cortisol, and after an overnight dexamethasone suppression test. In contrast, mean serum total testosterone and DHEA-S levels were significantly lower among patients with anorexia nervosa. Conclusions Women with anorexia nervosa have higher cortisol levels and lower DHEA-S and testosterone levels compared to women without anorexia nervosa. This finding is important to consider when evaluating low-weight women for disorders involving the adrenal axis, especially Cushing’s syndrome.

Adaptive Effects of Endocrine Hormones on Metabolism of Macronutrients during Fasting and Starvation: A Scoping Review

“…In another study, where 49 obese patients (body mass index (BMI) 32.2-67.1 kg/m 2 ; 25 women and 24 men) underwent one-day fasting, it was indicated that the cortisol levels were increased [126]. While these results may be different in a daily fasting episode with no calorie intake for less than 24 h, they match the conclusion that no calorie intake, similar to starvation, increases cortisol levels [53,54]. There is an inverse relation between a low BMI, fat mass, and glucose and insulin concentrations and higher levels of cortisol, which is consistent with the finding that the release of cortisol is enhanced as an adaptation response to starvation threats [16].…”

“…The nature of the eligible studies was one book chapter, forty-two review studies, and forty-five clinical studies, which are indicated in Table S1 as well. ↑Gluconeogenesis [46] ↓Peripheral tissue glucose uptake and utilization [47] ↑Glycogenolysis [48] ↓Leptin leading to ↑Cortisol [49] ↓Cortisol [50] Starvation ↑Cortisol [20,36,[51][52][53][54][55][56][57][58][59][60][61] ↑Gluconeogenesis [62] ↑Amino acids [63] *…”