Steroids and neuroendocrine function in anorexia nervosa.
Anorexia nervosa is a primarily psychiatric syndrome of self-induced weight loss due to an intense fear of becoming obese. Numerous endocrine abnormalities occur in anorexia nervosa patients, and in many respects these alterations reflects the endocrinology of reduced energy intake. However, the basic mechanisms of those alterations are far from being understood. In an attempt to understand the disrupted mechanisms of the hypogonadotropic hypogonadism of the anorectic state, we studied 10 anorectic women in the acute phase of their illness; all met the DSM III criteria. On each patient, two tests were performed with either saline as control or infusion of the opioid antagonist naloxone, and both LH and FSH levels were measured. Four mg of naloxone as bolus was used, followed by a naloxone infusion of 2 mg/h for 4 h. Compared with the pattern of normal women, naloxone did not increase in the anorectic patients either LH or FSH levels nor pulsatility. This result suggests that endogenous opioid peptides are not implicated in the low gonadotropic situation of anorexia nervosa. An alternative explanation could be that the low estrogenic "milieu" of these patients could mask the opioid action. To test this second possibility, another group of 7 anorectic women after partial weight recovery were challenged with estrogen administration. Compared with the pattern of normal women volunteers, all the anorectic patients but one presented an abnormal response in both LH and FSH levels after estrogen administration. In fact, the negative feedback and the delayed positive feedback of LH after estrogen were absent in these patients. Interestingly enough, the only patient with near-normal LH response to estrogen was considered fully recovered by the Psychiatric Unit. Several alterations in the hypothalamic-pituitary-adrenal axis has been reported in anorexia nervosa. Seven anorectic patients and 7 aged-matched women were challenged by ACTH 1-24, 250 micrograms (i.v.) and the ratio of increments in adrenal steroid products to precursors monitored. ACTH-induced increments in cortisol with respect to increments in 17-OH-progesterone was similar in anorectics and controls. On the contrary, the ratio of increments of androstenedione with respect to increments in 17-OH-progesterone were greater in anorexia nervosa than controls. These results suggest that in anorexia nervosa the 11-beta-21-alpha-hydroxylase system is normal but a deficient 17-20 desmolase system is present. Finally, the altered pattern of GH secretion in anorexia was studied using GHRH (1 microgram/kg) as stimulus of pituitary GH secretion.(ABSTRACT TRUNCATED AT 400 WORDS)
D000568:Amenorrhea / Q000209:etiology; D000856:Anorexia Nervosa / Q000503:physiopathology*; D003346:Corticotropin-Releasing Hormone / Q000378:metabolism; D003366:Cosyntropin / Q000494:pharmacology*; D004723:Endorphins / Q000502:physiology; D045166:Estradiol Congeners / Q000494:pharmacology*; D005246:Feedback; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000378:metabolism; D013007:Growth Hormone-Releasing Hormone / Q000494:pharmacology*; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D007031:Hypothalamus / Q000503:physiopathology*; D009270:Naloxone / Q000008:administration & dosage / Q000494:pharmacology*; D010053:Ovary / Q000503:physiopathology; D010908:Pituitary Hormones, Anterior / Q000378:metabolism*; D010913:Pituitary-Adrenal System / Q000503:physiopathology
D004723:Endorphins; D045166:Estradiol Congeners; D010908:Pituitary Hormones, Anterior; D003366:Cosyntropin; D007987:Gonadotropin-Releasing Hormone; D009270:Naloxone; D003346:Corticotropin-Releasing Hormone; D013007:Growth Hormone-Releasing Hormone