Birketvedt, Grethe S., Johan Sundsfjord, and Jon R. Florholmen. Hypothalamic-pituitary-adrenal axis in the night-eating syndrome. Am J Physiol Endocrinol Metab 282: E366-E369, 2002; 10.1152/ajpendo.00251.2001.-The typical neuroendocrine characteristics of the night eating syndrome have previously been described as changes in the circadian rhythm by an attenuation in the nocturnal rise of the plasma concentrations of melatonin and leptin and an increased circadian secretion of cortisol. The aim of this study was to test the hypothesis that night eaters have an overexpressed hypothalamic-pituitary-adrenal axis with an attenuated response to stress. Five female subjects with the night-eating syndrome and five sex-, age-, and weightmatched controls performed a 120-min corticotropin-releasing hormone (CRH) test (100 g iv). Blood samples were drawn intravenously for measurements of the plasma concentrations of ACTH and cortisol. The results showed that, in night eaters compared with controls, the CRH-induced ACTH and cortisol response was significantly decreased to 47 and 71%, respectively. In conclusion, disturbances in the hypothalamic-pituitary-adrenal axis with an attenuated ACTH and cortisol response to CRH were found in subjects with night-eating syndrome. circadian rhythm; cortisol; leptin; melatonin NIGHT-EATING SYNDROME, characterized by morning anorexia, evening hyperphagia, and insomnia was first described in obese subjects in 1955 by Stunkard et al. (24). It occurred during periods of stress and was associated with a poor outcome of efforts at weight reduction. In 1999 Birketvedt et al. (3) reported that nighttime awakenings were far more common among night eaters than among controls, and more than onehalf of these awakenings were associated with food intake. The typical neuroendocrine characteristics were an attenuation of nocturnal rises in secretions of melatonin and leptin and increased diurnal secretion of cortisol.Cortisol, melatonin, and leptin are regulatory hormones with typical circadian rhythms that regulate various physiological and metabolic functions (2, 23). Another main regulator is the hypothalamic-pituitaryadrenal (HPA) axis, which orchestrates several biological functions. The circadian rhythms represent the biological endocrine clock, whereas the HPA represents the stress-induced biological response. However, the interplay between these two main regulators of biological functions is not well understood. Therefore, our observations of dysregulations of circadian neuroendocrine secretions inclusive of cortisol are of special interest, as the night-eating syndrome most likely represents changes in the HPA axis.Several disorders, such as obesity (21), fatigue syndrome (17), anorexia nervosa (25), bulimia nervosa (10), insomnia (8), and depression (14), have been linked to disturbances in the HPA axis and to changes in the circadian rhythms. Therefore, the objective of this study was to test the hypothesis that night eaters have an attenuated response to stress.
MATERIALS AND METHODSThis st...