Determinants of Height in Adolescent Girls With Anorexia Nervosa

Prabhakaran, Rajani; Misra, Madhusmita; Miller, Karen K.; Kruczek, Kimberly; Sundaralingam, Shankeertha; Herzog, David B.; Katzman, Debra K.; Klibanski, Anne

doi:10.1542/peds.2007-2820

Cited by 33 publications

(16 citation statements)

References 23 publications

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“…Reports have indicated lower than expected, normal and even higher than expected stature in girls with AN compared with genetic potential or controls [63–65]. Similarly, both height deficits and height within range of genetic potential have been reported in boys with AN [7, 66].…”

Section: Statural Growthmentioning

confidence: 96%

“…In contrast, later onset of AN (when growth is almost complete) would not be expected to cause significant statural deficits. Studies that have reported no change in height potential or height SDS in AN suggest that a delay in bone age associated with high GH concentrations (and direct GH effects on the growth plate) may cause a sparing of height deficits in adolescents with AN, particularly when the disease is not very severe [63]. …”

Section: Statural Growthmentioning

confidence: 99%

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Neuroendocrine Consequences of Anorexia Nervosa in Adolescents

Misra

Klibanski²

2009

Pediatric Neuroendocrinology

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Anorexia nervosa (AN) is a condition of severe undernutrition characterized by alterations in multiple neuroendocrine axes and peptides that signal or regulate energy intake. These alterations include a state of hypogonadotropic hypogonadism, a nutritionally acquired resistance to growth hormone (GH) with low IGF-1 levels, relative hypercortisolemia, low total T3 despite normal TSH, low levels of leptin and insulin, and elevated levels of ghrelin, peptide YY (PYY) and possibly adiponectin. Although many of these changes are adaptive to low weight, they can impact bone metabolism, body composition, reproductive function and statural growth. Low bone mass is characteristic of AN in both adolescent boys and girls. In girls, sites of trabecular bone are more likely to be affected than sites of cortical bone, whereas in boys with AN, sites of cortical bone are more commonly affected. Bone microarchitecture is also affected in adolescent girls with AN, with a decrease in trabecular thickness and bone trabecular volume, and an increase in trabecular separation. Important predictors of low bone density include nutritional factors, body composition, hypogonadism, low IGF-1, elevated cortisol and PYY levels, with possible contributions of low insulin. Weight gain is associated with a stabilization of bone density, although residual deficits persist in the short term, and in some cases, long term.

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Section: Statural Growthmentioning

confidence: 96%

Section: Statural Growthmentioning

confidence: 99%

Neuroendocrine Consequences of Anorexia Nervosa in Adolescents

Misra

Klibanski²

2009

Pediatric Neuroendocrinology

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“…Low levels of IGF1 might be an adaptive response to preserve energy by decreasing expenditures on growth in states of chronic starvation 33 . GH resistance negatively affects longitudinal bone growth in adolescent boys with anorexia nervosa 34 , but data are conflicting in adolescent girls with anorexia nervosa 35,36 . Elevated GH levels might also have a protective role by maintaining euglycaemia via gluconeogenesis 37 and mobilizing fat stores via lipolysis 38 in states of chronic starvation.…”

Section: Hypothalamic–pituitary Dysfunctionmentioning

confidence: 99%

The endocrine manifestations of anorexia nervosa: mechanisms and management

2016

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Anorexia nervosa is a psychiatric disorder characterized by altered body image, persistent food restriction and low body weight, and is associated with global endocrine dysregulation in both adolescent girls and women. Dysfunction of the hypothalamic-pituitary axis includes hypogonadotrophic hypogonadism with relative oestrogen and androgen deficiency, growth hormone resistance, hypercortisolaemia, non-thyroidal illness syndrome, hyponatraemia, and hypooxytocinaemia. Serum levels of leptin, an anorexigenic adipokine, are suppressed and levels of ghrelin, an orexigenic gut peptide, are elevated in women with anorexia nervosa; however, levels of peptide YY, an anorexigenic gut peptide, are paradoxically elevated. Although most, but not all, of these endocrine disturbances are adaptive to the low energy state of chronic starvation and reverse with treatment of the eating disorder, many contribute to impaired skeletal integrity, as well as neuropsychiatric comorbidities, in individuals with anorexia nervosa. Although 5–15% of those affected by anorexia nervosa are men, only limited data exists regarding the endocrine impact of the disease in adolescent boys and men. Further research is needed to understand the endocrine determinants of bone loss and neuropsychiatric comorbidities in anorexia nervosa in both women and men, as well as to formulate optimal treatment strategies.

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“…Additionally, suboptimal energy intake (for maximum weight gain) reduces peak bone mass in growing rodents [2, 5] and minipigs [30]. In girls, anorexia nervosa slows bone growth but need not drastically reduce adult stature because epiphyseal closure is delayed and bone growth continues, albeit at a slower rate and for a longer interval of time [31]. Increasing energy availability following energy deprivation results in at least partial growth recovery [32, 33].…”

Section: Discussionmentioning

confidence: 99%

Low dose parathyroid hormone maintains normal bone formation in adult male rats during rapid weight loss

Turner

Iwaniec

2011

Bone

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A persistent negative energy balance results in bone loss. It is not clear whether the bone loss associated with chronic negative energy balance can be prevented. The objective of this study was to assess the efficacy of intermittent low dose parathyroid hormone (PTH) treatment in maintaining normal bone formation during severe energy restriction. Six-month-old male Fisher 344 rats were divided into 4 treatment groups: (1) baseline, (2) ad libitum (ad lib)-fed control, (3) energy-restricted (to consume 40% ad lib caloric intake), or (4) energy-restricted + low dose (1 μg/kg/d) PTH. Severe energy restriction for 14 days decreased body weight and serum leptin levels. Compared to ad lib-fed controls, energy-restricted rats had lower cancellous bone formation, higher osteoclast perimeter/bone perimeter and higher bone marrow adiposity in the proximal tibial metaphysis. Also, the energy-restricted rats had a lower periosteal bone formation rate at the tibia-fibula synostosis. Administration of PTH to energy-restricted rats had no effect on weight loss or osteoclast perimeter/bone perimeter. In contrast, energy-restricted rats treated with PTH had higher rates of cancellous and cortical bone formation compared to energy-restricted rats, and did not differ from the ad lib-fed control animals. Furthermore, PTH treatment maintained normal bone marrow adiposity. In conclusion, rapid weight loss in adult male rats was accompanied by decreased bone formation and increased bone marrow adiposity and these changes were prevented by low dose PTH treatment. Taken together, the results suggest that the energy cost of bone formation in adult rats is low and PTH therapy is effective in preventing the reduced bone formation associated with rapid weight loss.

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Determinants of Height in Adolescent Girls With Anorexia Nervosa

Abstract: Our data suggest that preservation of height potential in this cohort of girls with anorexia nervosa may be a consequence of delayed bone age. Hypogonadism may negate the deleterious effects of undernutrition on stature by allowing for a longer duration of growth.

Cited by 33 publications

References 23 publications

Neuroendocrine Consequences of Anorexia Nervosa in Adolescents

Neuroendocrine Consequences of Anorexia Nervosa in Adolescents

The endocrine manifestations of anorexia nervosa: mechanisms and management

Low dose parathyroid hormone maintains normal bone formation in adult male rats during rapid weight loss

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