Update on Endocrine Disturbances in Anorexia Nervosa

Støving, René Klinkby; Hangaard, Jørgen; Hagen, Claus

doi:10.1515/jpem.2001.14.5.459

Cited by 56 publications

(36 citation statements)

References 222 publications

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“…It is known that the growth hormone (GH) exerts a marked trophic effect on intestinal mucosa, likely through the action of the insulin-like growth factor-I (IGF-I). 20 Anorexic patients, in spite of an increased production of GH, have very reduced IGF-I levels, 21 which prevents the GH from exerting its biological effects. Therefore, it is plausible that the IGF-I deficiency may account for changes of IP observed in our anorexic patients.…”

Section: Discussionmentioning

confidence: 99%

Intestinal permeability is decreased in anorexia nervosa

Monteleone

Carratù²,

Cartenı̀

et al. 2003

Mol Psychiatry

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Malnutrition and absence of exogenous luminal nutrients in the gastrointestinal tract affect intestinal permeability (IP) leading to an increased penetration of substances that passively cross intestinal epithelium via intercellular pathways. We hypothesised that an increase in IP could occur in patients with anorexia nervosa because of their prolonged fasting and chronic malnutrition. Therefore, we assessed IP in 14 drug-free anorexic women and 19 drug-free agematched healthy women by means of the lactulose/mannitol (LA/MA) test. To this purpose, after an overnight fast, subjects ingested an oral solution containing 5 g lactulose and 2 g mannitol in 100 ml water. Urine specimens were collected immediately before and 30, 60, 120, 180, 240 and 300 min after the ingestion of the sugar solution. Urinary lactulose and mannitol were determined by high-performance anion exchange chromatography coupled with pulsed amperometric detection. We found that IP, as expressed by the 5-h LA/MA excretion ratio, was significantly decreased in anorexic women because of a lower urinary recovery of lactulose. Moreover, in patients, the time course of lactulose excretion significantly differs from healthy controls. These results do not confirm our hypothesis of increased IP in anorexia nervosa. Since IP reflects the anatomo-functional status of intestinal mucosa, the present findings support the idea that changes in the anatomo-physiology of intestinal mucosa occur in anorexia nervosa.

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Section: Discussionmentioning

confidence: 99%

Intestinal permeability is decreased in anorexia nervosa

Monteleone

Carratù²,

Cartenı̀

et al. 2003

Mol Psychiatry

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“…2). Reliable data are not available to establish the percentage of growth lost in these patients, with the exception of one study where it was estimated that 3 cm is lost in some patients in relationship to their target height (40).…”

Section: Hypothalamic -Pituitary-ovarian Axismentioning

confidence: 99%

“…Stoving et al (83) determined thyroid volume by ultrasonographic methods in patients with AN and demonstrated that this gland is markedly reduced in comparison with age-and sex-matched controls. This thyroid atrophy is not due to low TSH levels, as TSH levels are usually normal in AN.…”

Section: Hypothalamic -Pituitary -Thyroid Axismentioning

confidence: 99%

“…This thyroid atrophy is not due to low TSH levels, as TSH levels are usually normal in AN. However, thyroid size is influenced by IGF-I, and the low IGF-I levels in these patients could contribute to thyroid atrophy (83). A blunted and delayed TSH response to exogenously administered TRH has been reported in about 25 -50% of AN patients.…”

Section: Hypothalamic -Pituitary -Thyroid Axismentioning

confidence: 99%

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Anorexia nervosa in female adolescents: endocrine and bone mineral density disturbances

Argente

2002

European Journal of Endocrinology

145

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Anorexia nervosa (AN) is a chronic childhood psychiatric illness that involves a reduction in caloric intake, loss of weight and amenorrhea, either primary or secondary. The diagnostic criteria for AN have been established by the American Psychiatric Association. The prevalence of this disease amongst adolescents and young adults is between 0.5 and 1% and the incidence of new cases per year is approximately 5-10/100 000 between 15 and 19 years of age. A number of endocrine and metabolic disturbances have been described in patients with AN including amenorrhea-oligomenorrhea, delayed puberty, hypothyroidism, hypercortisolism, IGF-I deficiency, electrolyte abnormalities, hypoglycemia and hypophosphatemia, among others. In addition to prolonged amenorrhea, osteopenia and osteoporosis are the most frequent complications leading to clinically relevant fractures and increased fracture risk throughout life. Patients exhibit an alteration in the hypothalamic -pituitary -gonadal axis, which is responsible for the menstrual disorders. The increase in gonadotropin secretion that can be observed after ponderal recuperation suggests that malnutrition could be the most important mechanism involved in the decrease in gonadotropin secretion. The loss of fat tissue as a consequence of nutrient restriction has been associated with hypoleptinemia and abnormal secretion of peptides implicated in food control (neuropeptide Y, melanocortins and corticotropin-releasing factor, among others). A review of the endocrine abnormalities, disturbances in neurotransmitters, as well as a detailed analysis of bone markers and bone mineral density in patients with AN is described.

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“…It may result during illness, after stress exposure, or as a response to homeostatic challenges such as cellular dehydration (Siegfried et al, 2003). In contrast to food restricted or dieting individuals, anorexic patients present normal or subnormal serum levels of T 4 and TSH (Stoving et al, 2001); also, a blunted TSH release form the pituitary after TRH administration (Tamai et al, 1986). Alterations of the HPT axis in anorexia nervosa have most likely a central origin, due to the reduced hypothalamic TRH secretion, and resemble those of the NTIS.…”

Section: Dehydration-induced Anorexiamentioning

confidence: 99%