title: Hypercortisolemia is associated with severity of bone loss and depression in hypothalamic amenorrhea and anorexia nervosa.
abstract: BACKGROUND
  Anorexia nervosa (AN) and functional hypothalamic amenorrhea (HA) are associated with low bone density, anxiety, and depression. Women with AN and HA have elevated cortisol levels. Significant hypercortisolemia, as in Cushing's disease, causes bone loss. It is unknown whether anxiety and depression and/or cortisol dysregulation contribute to low bone density in AN or HA.
  
  
  OBJECTIVE
  Our objective was to investigate whether hypercortisolemia is associated with bone loss and mood disturbance in women with HA and AN.
  
  
  METHODS
  We conducted a cross-sectional study in a clinical research center.
  
  
  METHODS
  We studied 52 women [21 healthy controls (HC), 13 normal-weight women with functional HA, and 18 amenorrheic women with AN].
  
  
  METHODS
  Serum samples were measured every 20 min for 12 h overnight and pooled for average cortisol levels. Bone mineral density (BMD) was assessed by dual-energy x-ray absorptiometry (DXA) at anteroposterior and lateral spine and hip. Hamilton Rating Scales for Anxiety (HAM-A) and Depression (HAM-D) were administered.
  
  
  RESULTS
  BMD was lower in AN and HA than HC at all sites and lower in AN than HA at the spine. On the HAM-D and HAM-A, AN scored higher than HA, and HA scored higher than HC. Cortisol levels were highest in AN, intermediate in HA, and lowest in HC. HAM-A and HAM-D scores were associated with decreased BMD. Cortisol levels were positively associated with HAM-A and HAM-D scores and negatively associated with BMD.
  
  
  CONCLUSIONS
  Hypercortisolemia is a potential mediator of bone loss and mood disturbance in these disorders.
authors.affiliation: Neuroendocrine Unit, Bulfinch 457B, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. ealawson@partners.org
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Lawson
authors.forename: Daniel
authors.initials: D
authors.lastname: Donoho
authors.forename: Karen K
authors.initials: KK
authors.lastname: Miller
authors.forename: Madhusmita
authors.initials: M
authors.lastname: Misra
authors.forename: Erinne
authors.initials: E
authors.lastname: Meenaghan
authors.forename: Janet
authors.initials: J
authors.lastname: Lydecker
authors.forename: Tamara
authors.initials: T
authors.lastname: Wexler
authors.forename: David B
authors.initials: DB
authors.lastname: Herzog
authors.forename: Anne
authors.initials: A
authors.lastname: Klibanski
mesh_terms: D000328:Adult; D000568:Amenorrhea / Q000097:blood* / Q000523:psychology*; D000856:Anorexia Nervosa / Q000097:blood* / Q000523:psychology*; D001007:Anxiety / Q000097:blood* / Q000523:psychology*; D001835:Body Weight / Q000502:physiology; D015519:Bone Density / Q000502:physiology; D001847:Bone Diseases / Q000097:blood*; D003627:Data Interpretation, Statistical; D003866:Depressive Disorder / Q000097:blood* / Q000523:psychology*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007027:Hypothalamic Diseases / Q000097:blood* / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D055815:Young Adult
chemical_list: D006854:Hydrocortisone