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Endocrine consequences of anorexia nervosa
Madhusmita Misra1, Anne Klibanski1
1Neuroendocrine Unit and Pediatric Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
The Lancet. Diabetes & Endocrinology
|April 16, 2014
Summary
Anorexia nervosa causes significant hormonal changes and low bone density in young people. While some recovery occurs, bone deficits and hormonal imbalances can persist, requiring further research into optimal treatments.
Area of Science:
- Endocrinology
- Bone Metabolism
- Adolescent Health
Background:
- Anorexia nervosa is common in adolescents and young adults, leading to significant endocrine disruptions.
- Hormonal changes include growth hormone resistance, altered cortisol, leptin, insulin, and incretin levels, alongside increased ghrelin, peptide YY, and adiponectin.
- These endocrine alterations negatively impact bone health, neurocognition, and mental health, with low bone-mineral density (BMD) being a critical concern due to fracture risk.
Purpose of the Study:
- To review the endocrine changes associated with anorexia nervosa.
- To examine the effects of these changes on bone health.
- To evaluate current therapeutic approaches for improving bone density in anorexia nervosa patients.
Main Methods:
- Review of literature on endocrine and bone metabolism in anorexia nervosa.
- Analysis of hormonal profiles including insulin-like growth factor-1 (IGF-1), cortisol, leptin, and others.
- Evaluation of studies on interventions like oestrogen-replacement therapy, IGF-1, and bisphosphonates for BMD.
Main Results:
- Anorexia nervosa is characterized by hypothalamic amenorrhoea, growth hormone resistance (low IGF-1), relative hypercortisolaemia, and altered levels of leptin, insulin, ghrelin, and adiponectin.
- Low BMD is prevalent, linked to microarchitectural changes, reduced bone strength, and increased fracture risk.
- Hormone levels improve with recovery, but bone accrual deficits may persist; therapies like transdermal oestrogen in adolescents and oral oestrogen with IGF-1 or bisphosphonates in adults show incomplete BMD recovery.
Conclusions:
- Endocrine changes in anorexia nervosa significantly impair bone health, with persistent deficits even after recovery.
- Current treatments partially improve BMD but do not restore it to normal levels.
- Further research is essential to determine optimal therapeutic strategies for bone health in anorexia nervosa.
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