The Endocrinopathies of Anorexia Nervosa

Abstract

Objective To describe the hormonal adaptations and alterations in anorexia nervosa. Methods We performed a PubMed search of the English-language literature related to the pathophysiology of the endocrine disorders observed in anorexia nervosa, and we describe a case to illustrate these findings. Results Anorexia nervosa is a devastating disease with a variety of endocrine manifestations. The effects of starvation are extensive and negatively affect the pituitary gland, thyroid gland, adrenal glands, gonads, and bones. Appetite is modulated by the neuroendocrine system, and characteristic patterns of leptin and ghrelin concentrations have been observed in anorexia nervosa. A thorough understanding of refeeding syndrome is imperative to nutrition rehabilitation in these patients to avoid devastating consequences. Although most endocrinopathies associated with anorexia nervosa reverse with recovery, short stature, osteoporosis, and infertility may be long-lasting complications. We describe a 20-year-old woman who presented with end-stage anorexia nervosa whose clinical course reflects the numerous complications caused by this disease. Conclusions The effects of severe malnutrition and subsequent refeeding are extensive in anorexia nervosa. Nutrition rehabilitation is the most appropriate treatment for these patients; however, it must be done cautiously.

Assessment of Anorexia Nervosa in Children and Adolescents

“…Multiple endocrinopathies may be present in AN, including abnormalities of the thyroid and hypothalamicpituitary-adrenal axis and sex hormone deficiencies [22].…”

Cholecystokinin in the Pathogenesis of Bulimia Nervosa

“…In fact, most of the neuroendocrine and neuropeptide alterations apparent during symptomatic episodes of ED tend to normalize after recovery [35,46]. This observation suggests that most of the disturbances are conesquences, rather than causes, of malnutrition and altered meal patterns [47].…”

“…However, the changes in the different neurotransmitter, neuroendocrine and neuropeptidergic systems, seems to get back to normal after weight recovery [9,35,45]. Therefore, these changes appear to be adaptations to a temporary state of starvation, rather than the cause of it [35,45,46].…”

Nutrition, Bone, and Aging: An Integrative Physiology Approach

“…Hypogonadotropic hypogonadism is seen in males with anorexia nervosa. Decreased IGF-1 production with growth hormone resistance, hypercortisolism, and a low T3 state are other endocrine consequences of anorexia; all have adverse effects on bone physiology, promoting bone resorption and impairment of compensatory bone formation [85]. The bone disease of anorexia nervosa is compounded by the failure of adolescents to achieve peak bone mass and by poor nutrition, including calcium and protein deficiencies.…”