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  • Review Article
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Endocrine abnormalities in anorexia nervosa

Abstract

Anorexia nervosa (AN) is a psychiatric disease associated with notable medical complications and increased mortality. Endocrine abnormalities, including hypogonadotropic hypogonadism, hypercortisolemia, growth hormone resistance and sick euthyroid syndrome, mediate the clinical manifestations of this disease. Alterations in anorexigenic and orexigenic appetite-regulating pathways have also been described. Decreases in fat mass result in adipokine abnormalities. Although most of the endocrine changes that occur in AN represent physiologic adaptation to starvation, some persist after recovery and might contribute to susceptibility to AN recurrence. In this Review, we summarize key endocrine alterations in AN, with a particular focus on the profound bone loss that can occur in this disease. Although AN is increasingly prevalent among boys and men, the disorder predominantly affects girls and women who are, therefore, the focus of this Review.

Key Points

  • Anorexia nervosa is associated with characteristic endocrine abnormalities

  • Most of the changes are physiologic adaptations to starvation

  • Some endocrine abnormalities do not normalize with recovery, and may confer a predisposition to disease development and relapse

  • Endocrine pathways mediate the medical complications of anorexia nervosa, including severe osteopenia

  • Weight gain and menstrual recovery are the only known effective, available therapies for bone loss in anorexia nervosa

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Figure 1: Pulsatility of luteinizing hormone and follicle-stimulating hormone in hypothalamic amenorrhea.
Figure 2: Growth hormone secretion in women with anorexia nervosa.
Figure 3: Proposed schema for altered appetite-regulating hormone concentrations in anorexia nervosa.
Figure 4: BMD in hypothalamic amenorrhea.

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Acknowledgements

This work was supported by grants from the NIH.

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Correspondence to Anne Klibanski.

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A Klibanski acts as a consultant for Tercica.

EA Lawson declared no competing interests.

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Lawson, E., Klibanski, A. Endocrine abnormalities in anorexia nervosa. Nat Rev Endocrinol 4, 407–414 (2008). https://doi.org/10.1038/ncpendmet0872

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