The Endocrinopathies of Anorexia Nervosa |
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| Affiliation: | 1. Section of Endocrinology, Diabetes, and Nutrition;2. Nutrition and Weight Management Center, Boston Medical Center, Boston, Massachusetts.;3. Boston University School of Medicine, Boston, Massachusetts;1. Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan;2. Mental Health and Welfare Center in Kyoto Prefecture, 120 Ryuchi-cho, Takeda, Fushimi-ku, Kyoto 612-8412, Japan;3. Daini-Kiyatama Hospital, 161 Iwakura-Kamikura-Cho, Sakyo-ku, Kyoto 606-0017, Japan;4. Kyoto Prefectural Support Center of Child Development, 186-1 Mogatani, Kyotanabe-shi, Kyoto 610-0331, Japan;5. Department of Psychiatry, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Kyoto 606-8507, Japan;6. Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan;1. Department of Child and Adolescent Psychiatry and Psychology, SGR-1119, Neurosciencies Institute, Hospital Clinic of Barcelona, CIBERSAM, Villarroel 170, Barcelona, Spain;2. Department of Psychiatry and Clinical Psychobiology, Health Sciences Division, University of Barcelona, Casanova 143, Barcelona, Spain;3. Institut d''Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Rosselló 149-153, Barcelona, Spain;4. Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Edifici M-Campus UAB, Barcelona, Spain;1. Institute of Child Health, University College London, Gower Street, London WC1E 6BT, UK;2. Musculoskeletal Research Unit, University of Bristol, Bristol, UK;3. Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA;4. Dept. of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA;1. Eating Disorder Service, Sydney Children''s Hospital Network, Westmead, New South Wales, Australia;2. School of Rural Medicine, University of New England, Armidale, New South Wales, Australia;3. Adolescent and Young Adult Medicine, Westmead Hospital, Westmead, New South Wales, Australia;4. Nuclear Medicine, The Children''s Hospital at Westmead, Westmead, New South Wales, Australia;5. The Children''s Hospital at Westmead, Westmead, New South Wales, Australia;6. Department of Endocrinology, The Children''s Hospital at Westmead, Westmead, New South Wales, Australia;7. Children''s Hospital Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia;8. Orthopaedic Research Unit, The Children''s Hospital at Westmead, Westmead, New South Wales, Australia;9. Discipline of Paediatrics & Child Health, University of Sydney, Sydney, New South Wales, Australia |
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| Abstract: | ObjectiveTo describe the hormonal adaptations and alterations in anorexia nervosa.MethodsWe 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.ResultsAnorexia 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.ConclusionsThe 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. (Endocr Pract. 2008;14:1055-1063) |
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