Endocrinology of Anorexia Nervosa in Young People: Recent Insights

Overview

Journal Curr Opin Endocrinol Diabetes Obes

Specialty Endocrinology

Date 2013 Nov 27

PMID 24275621

Citations 22

Authors

Vibha Singhal

Madhusmita Misra

Anne Klibanski

Affiliations

Soon will be listed here.

Abstract

Purpose Of Review: Anorexia nervosa is among the most prevalent chronic medical conditions in young adults. It has acute as well as long-term consequences, some of which, such as low bone mineral density (BMD), are not completely reversible even after weight restoration. This review discusses our current understanding of endocrine consequences of anorexia nervosa.

Recent Findings: Anorexia nervosa is characterized by changes in multiple neuroendocrine axes including acquired hypogonadotropic hypogonadism, growth hormone resistance with low insulin-like growth factor-1 (likely mediated by fibroblast growth factor-1), relative hypercortisolemia, alterations in adipokines such as leptin, adiponectin and resistin, and gut peptides including ghrelin, PYY and amylin. These changes in turn contribute to low BMD. Studies in anorexia nervosa have demonstrated abnormalities in bone microarchitecture and strength, and an association between increased marrow fat and decreased BMD. One study in adolescents reported an improvement in BMD following physiologic estrogen replacement, and another in adults demonstrated improved BMD following risedronate administration. Brown adipose tissue is reduced in anorexia nervosa, consistent with an adaptive response to the energy deficit state.

Summary: Anorexia nervosa is associated with widespread physiologic adaptations to the underlying state of undernutrition. Hormonal changes in anorexia nervosa affect BMD adversely. Further investigation is underway to optimize therapeutic strategies for low BMD.

Citing Articles

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Reversibility of disturbed pituitary function in pediatric conditions with psychological stressors: implications for clinical practice.

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Lower Ghrelin Levels Are Associated With Higher Anxiety Symptoms in Adolescents and Young Adults With Avoidant/Restrictive Food Intake Disorder.

Sella A, Hadaway N, Stern C, Becker K, Holsen L, Eddy K J Clin Psychiatry. 2023; 84(3).

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Food Restriction in Mice Induces Food-Anticipatory Activity and Circadian-Rhythm-Related Activity Changes.

Gabloffsky T, Gill S, Staffeld A, Salomon R, Power Guerra N, Joost S Nutrients. 2022; 14(24).

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