MECHANISMS IN ENDOCRINOLOGY: Anorexia nervosa and endocrinology: a clinical update

Abstract

Anorexia nervosa is a syndrome, that is collections of symptoms, which is not defined by its etiology. The severe cases are intractable. The syndrome is associated with multiple, profound endocrine alterations which may be adaptive, reactive or etiologic. Adaptive changes potentially may be inappropriate in clinical settings such as inpatient intensive re-nutrition or in a setting with somatic comorbidity. Electrolyte levels must be closely monitored during the refeeding process, and the need for weight gain must be balanced against potentially fatal refeeding complications. An important focus of clinical research should be to identify biomarkers associated with different stages of weight loss and re-nutrition combined with psychometric data. Besides well-established peripheral endocrine actions, several hormones also are released directly to different brain areas, where they may exert behavioral and psychogenic actions that could offer therapeutic targets. We need reliable biomarkers for predicting outcome and to ensure safe re-nutrition, however, first of all we need them to explore the metabolism in anorexia nervosa to open new avenues with therapeutic targets. A breakthrough in our understanding and treatment of this whimsical disease remains. Considering this, the aim of the present review is to provide an updated overview of the many endocrine changes in a clinical perspective.

Case report: cognitive performance in an extreme case of anorexia nervosa with a body mass index of 7.7

“…Survival of long-term starvation is only possible due to extensive adaptive endocrine and metabolic alterations [42]. How these alterations affect cognitive functions still remains to be clarified.…”

Copeptin in anorexia nervosa

“…This is of interest because the copeptin level has repeatedly been reported to be a marker of insulin resistance (Saleem et al, ). Thus, AN appears as a condition characterized by endocrinologic stress and adaptation to starvation with increased insulin sensitivity (Stoving, ), coexisting with psychologic stress, anxiety, and depression. The latter has been reported to be associated with increased copeptin levels (Siegenthaler, Walti, Urwyler, Schuetz, & Christ‐Crain, ).…”

“…Anorexia nervosa (AN) is a syndrome with unknown etiology associated with depression, anxiety, and multiple endocrine alterations, which may be adaptive, reactive, or etiologic (Stoving, ). The level of ADH has been examined in AN with conflicting results.…”

Backstage of Eating Disorder—About the Biological Mechanisms behind the Symptoms of Anorexia Nervosa

“…All metabolic changes in AN represent the duration and degree of body weight loss due to starvation and physical hyperactivity, and thus almost solely represent a consequence of the disease; however, their etiologic role cannot be excluded based on the available data. Once the body weight is below 60% of the normal weight, every endocrine system become affected as caloric restriction overrules physiologic adjustments [ 119 , 211 ]. Endocrine deregulation might exert long-lasting consequences and should be closely monitored, and the below mentioned brief examples are given to support such arguments.…”