title: Endocrine consequences of anorexia nervosa.
abstract: Anorexia nervosa is prevalent in adolescents and young adults, and endocrine changes include hypothalamic amenorrhoea; a nutritionally acquired growth-hormone resistance leading to low concentrations of insulin-like growth factor-1 (IGF-1); relative hypercortisolaemia; decreases in leptin, insulin, amylin, and incretins; and increases in ghrelin, peptide YY, and adiponectin. These changes in turn have harmful effects on bone and might affect neurocognition, anxiety, depression, and the psychopathology of anorexia nervosa. Low bone-mineral density (BMD) is particularly concerning, because it is associated with changes in bone microarchitecture, strength, and clinical fractures. Recovery leads to improvements in many--but not all--hormonal changes, and deficits in bone accrual can persist. Oestrogen-replacement therapy, primarily via the transdermal route, increases BMD in adolescents, although catch-up is incomplete. In adults, oral oestrogen--combined with recombinant human IGF-1 in one study and bisphosphonates in another--increased BMD, but not to the normal range. More studies are necessary to investigate the optimum therapeutic approach in patients with, or recovering from, anorexia nervosa.
authors.affiliation: Neuroendocrine Unit and Pediatric Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. Electronic address: mmisra@mgh.harvard.edu.
authors.forename: Madhusmita
authors.initials: M
authors.lastname: Misra
authors.affiliation: Neuroendocrine Unit and Pediatric Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Anne
authors.initials: A
authors.lastname: Klibanski
mesh_terms: D000293:Adolescent; D000856:Anorexia Nervosa / Q000150:complications* / Q000378:metabolism*; D015519:Bone Density; D019382:Human Growth Hormone / Q000378:metabolism; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism*; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D010913:Pituitary-Adrenal System / Q000378:metabolism*; D055815:Young Adult
chemical_list: D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; D006854:Hydrocortisone
references.citation: Psychiatry Res. 1979 Oct;1(2):209-15
references.pmid: 298349
references.citation: Nord J Psychiatry. 2011 Jun;65(3):203-7
references.pmid: 21047193
references.citation: J Clin Psychiatry. 2013 Aug;74(8):e765-71
references.pmid: 24021517
references.citation: J Clin Endocrinol Metab. 2010 Jan;95(1):369-74
references.pmid: 19926712
references.citation: Am J Clin Nutr. 2006 Oct;84(4):698-706
references.pmid: 17023694
references.citation: J Clin Endocrinol Metab. 2012 Oct;97(10):E1898-908
references.pmid: 22872688
references.citation: Pediatr Res. 2006 Apr;59(4 Pt 1):598-603
references.pmid: 16549537
references.citation: Endocrinology. 2005 Mar;146(3):1403-10
references.pmid: 15564330
references.citation: J Clin Endocrinol Metab. 2008 Apr;93(4):1231-7
references.pmid: 18089702
references.citation: Mayo Clin Proc. 1999 Oct;74(10):972-7
references.pmid: 10918862
references.citation: J Clin Endocrinol Metab. 2007 Jun;92(6):2046-52
references.pmid: 17356044
references.citation: J Clin Endocrinol Metab. 2005 Jun;90(6):3179-85
references.pmid: 15784715
references.citation: J Biol Chem. 2012 Aug 17;287(34):29159-67
references.pmid: 22761429
references.citation: Eur J Endocrinol. 2001 Aug;145(2):165-71
references.pmid: 11454512
references.citation: J Clin Endocrinol Metab. 1999 Jun;84(6):2056-63
references.pmid: 10372710
references.citation: Clin Endocrinol (Oxf). 1990 Jul;33(1):45-52
references.pmid: 2401098
references.citation: Aust N Z J Psychiatry. 2006 Feb;40(2):121-8
references.pmid: 16476129
references.citation: Endocrinology. 1983 May;112(5):1782-7
references.pmid: 6299709
references.citation: N Engl J Med. 1974 Oct 24;291(17):861-5
references.pmid: 4412035
references.citation: Int J Eat Disord. 2013 Mar;46(2):164-70
references.pmid: 22887053
references.citation: J Clin Endocrinol Metab. 2005 Apr;90(4):2161-8
references.pmid: 15657373
references.citation: Nutrition. 2013 Jan;29(1):203-6
references.pmid: 23237649
references.citation: J Am Acad Child Adolesc Psychiatry. 2002 May;41(5):613-8
references.pmid: 12014794
references.citation: Bone. 2008 Jul;43(1):135-139
references.pmid: 18486583
references.citation: Osteoporos Int. 2008 Mar;19(3):289-94
references.pmid: 17924053
references.citation: N Engl J Med. 2010 Jul 22;363(4):365-71
references.pmid: 20660404
references.citation: Am J Physiol Endocrinol Metab. 2005 Sep;289(3):E373-81
references.pmid: 15811876
references.citation: PLoS One. 2012;7(7):e40038
references.pmid: 22792209
references.citation: Proc Natl Acad Sci U S A. 2009 Apr 28;106(17):7149-54
references.pmid: 19369205
references.citation: J Psychiatr Res. 2011 May;45(5):706-11
references.pmid: 21035823
references.citation: Int J Eat Disord. 2000 Nov;28(3):284-92
references.pmid: 10942914
references.citation: J Clin Endocrinol Metab. 2000 Feb;85(2):799-803
references.pmid: 10690893
references.citation: Int J Eat Disord. 2002 Nov;32(3):301-8
references.pmid: 12210644
references.citation: Acta Psychiatr Scand. 1988 May;77(5):611-7
references.pmid: 3269214
references.citation: Acta Neurol Scand. 1990 Jan;81(1):82-3
references.pmid: 2330820
references.citation: Fertil Steril. 1980 Oct;34(4):341-5
references.pmid: 6252067
references.citation: Psychiatr Genet. 2010 Aug;20(4):153-9
references.pmid: 20421852
references.citation: J Psychosom Res. 2007 Jun;62(6):681-90
references.pmid: 17540226
references.citation: J Clin Endocrinol Metab. 1995 Mar;80(3):898-904
references.pmid: 7883849
references.citation: Nutr Metab (Lond). 2012 Jun 08;9(1):52
references.pmid: 22681985
references.citation: J Clin Endocrinol Metab. 2010 Nov;95(11):4889-97
references.pmid: 20668047
references.citation: Am J Clin Nutr. 2001 May;73(5):865-9
references.pmid: 11333838
references.citation: Int J Eat Disord. 2006 Mar;39(2):87-100
references.pmid: 16231345
references.citation: Eat Weight Disord. 2003 Dec;8(4):332-5
references.pmid: 15018386
references.citation: Osteoporos Int. 2005 Jul;16(7):783-90
references.pmid: 15452690
references.citation: Horm Metab Res. 2010 Jul;42(8):595-8
references.pmid: 20411479
references.citation: J Child Psychol Psychiatry. 2001 Jul;42(5):603-12
references.pmid: 11464965
references.citation: J Clin Endocrinol Metab. 2002 Jun;87(6):2883-91
references.pmid: 12050268
references.citation: N Engl J Med. 2004 Sep 2;351(10):987-97
references.pmid: 15342807
references.citation: Am J Physiol Endocrinol Metab. 2005 Aug;289(2):E347-56
references.pmid: 15755766
references.citation: J Clin Endocrinol Metab. 1996 Nov;81(11):3861-3
references.pmid: 8923829
references.citation: J Clin Endocrinol Metab. 2010 May;95(5):2203-10
references.pmid: 20305007
references.citation: Bone. 2010 Mar;46(3):796-800
references.pmid: 19931436
references.citation: J Clin Endocrinol Metab. 2004 Apr;89(4):1605-12
references.pmid: 15070919
references.citation: J Clin Endocrinol Metab. 2010 Jun;95(6):3057-62
references.pmid: 20339027
references.citation: Am J Clin Nutr. 2008 Dec;88(6):1478-84
references.pmid: 19064506
references.citation: J Clin Psychiatry. 1999 Feb;60(2):130-5; quiz 135-7
references.pmid: 10084645
references.citation: Horm Metab Res. 2003 Aug;35(8):455-9
references.pmid: 12953161
references.citation: J Clin Endocrinol Metab. 2008 Aug;93(8):3029-36
references.pmid: 18544623
references.citation: J Clin Endocrinol Metab. 2013 May;98(5):1923-9
references.pmid: 23509107
references.citation: J Clin Endocrinol Metab. 1989 Mar;68(3):548-54
references.pmid: 2493036
references.citation: Fertil Steril. 2006 Jun;85(6):1849-51
references.pmid: 16650415
references.citation: Radiology. 2010 Oct;257(1):167-74
references.pmid: 20713613
references.citation: Pediatrics. 2004 Dec;114(6):1574-83
references.pmid: 15574617
references.citation: Biol Psychiatry. 2008 Aug 1;64(3):252-5
references.pmid: 17919459
references.citation: J Clin Psychiatry. 2007 Jun;68(6):959-65
references.pmid: 17592924
references.citation: Horm Metab Res. 2002 Feb;34(2):77-80
references.pmid: 11972291
references.citation: Clin Endocrinol (Oxf). 1999 Dec;51(6):725-31
references.pmid: 10619977
references.citation: Am J Physiol Endocrinol Metab. 2007 Jan;292(1):E132-7
references.pmid: 16912058
references.citation: Acta Neurol Scand. 1991 Jun;83(6):419
references.pmid: 1887767
references.citation: Eur J Endocrinol. 2011 Feb;164(2):253-61
references.pmid: 21098684
references.citation: BJOG. 2011 Nov;118(12):1491-8
references.pmid: 21810162
references.citation: J Adolesc Health. 2006 Dec;39(6):819-27
references.pmid: 17116511
references.citation: J Clin Endocrinol Metab. 2012 Apr;97(4):E584-90
references.pmid: 22259053
references.citation: Pediatrics. 1990 Sep;86(3):440-7
references.pmid: 2388792
references.citation: Ann Intern Med. 2000 Nov 21;133(10):790-4
references.pmid: 11085841
references.citation: J Clin Endocrinol Metab. 1991 Feb;72(2):374-81
references.pmid: 1991807
references.citation: J Clin Endocrinol Metab. 2003 Apr;88(4):1748-52
references.pmid: 12679468
references.citation: Hum Reprod. 2001 Oct;16(10):2198-205
references.pmid: 11574516
references.citation: Clin Endocrinol (Oxf). 2009 Jun;70(6):920-3
references.pmid: 19054012
references.citation: J Clin Endocrinol Metab. 2002 Sep;87(9):4177-85
references.pmid: 12213868
references.citation: Int J Eat Disord. 2008 Dec;41(8):766-7
references.pmid: 18521917
references.citation: CMAJ. 2011 Aug 9;183(11):E761
references.pmid: 21670105
references.citation: Eat Weight Disord. 2013 Jun;18(2):157-65
references.pmid: 23760844
references.citation: Br Med J. 1978 Aug 19;2(6136):526-8
references.pmid: 698555
references.citation: J Clin Psychiatry. 2011 Nov;72(11):1546-51
references.pmid: 21903023
references.citation: J Clin Endocrinol Metab. 2005 Mar;90(3):1366-70
references.pmid: 15598689
references.citation: Clin Endocrinol (Oxf). 2013 Jan;78(1):114-9
references.pmid: 22671919
references.citation: J Clin Endocrinol Metab. 2005 May;90(5):2580-7
references.pmid: 15713709
references.citation: J Clin Endocrinol Metab. 2006 Mar;91(3):1027-33
references.pmid: 16278259
references.citation: Isr J Med Sci. 1985 Jan;21(1):50-2
references.pmid: 3972559
references.citation: J Bone Miner Res. 2011 Oct;26(10):2430-8
references.pmid: 21698665
references.citation: J Clin Endocrinol Metab. 1992 Sep;75(3):762-7
references.pmid: 1381372
references.citation: J Clin Endocrinol Metab. 2007 Aug;92(8):3202-5
references.pmid: 17550958
references.citation: J Clin Endocrinol Metab. 1997 Jul;82(7):2084-92
references.pmid: 9215276
references.citation: Metabolism. 2012 Jul;61(7):1010-20
references.pmid: 22257645
references.citation: Bone. 2008 Dec;43(6):1115-21
references.pmid: 18793764
references.citation: J Clin Endocrinol Metab. 2004 Apr;89(4):1833-7
references.pmid: 15070952
references.citation: J Clin Endocrinol Metab. 2011 Jul;96(7):2081-8
references.pmid: 21525157
references.citation: Pediatr Endocrinol Rev. 2011 Mar;8(3):218-21
references.pmid: 21525799
references.citation: Am J Clin Nutr. 2003 Jun;77(6):1361-7
references.pmid: 12791610
references.citation: J Clin Endocrinol Metab. 1996 Nov;81(11):3864-70
references.pmid: 8923830
references.citation: J Clin Endocrinol Metab. 2001 Jul;86(7):2982-8
references.pmid: 11443155
references.citation: J Clin Endocrinol Metab. 2009 Dec;94(12):4710-6
references.pmid: 19837921
references.citation: Fertil Steril. 2009 Dec;92(6):2106-8
references.pmid: 19589515
references.citation: Nephrol Dial Transplant. 2004 Dec;19(12):3034-9
references.pmid: 15479747
references.citation: Int J Eat Disord. 1997 Dec;22(4):339-60
references.pmid: 9356884
references.citation: J Clin Endocrinol Metab. 2007 Apr;92(4):1334-9
references.pmid: 17284620
references.citation: J Clin Endocrinol Metab. 2006 Aug;91(8):2931-7
references.pmid: 16735492
references.citation: Biol Psychiatry. 2008 Jan 15;63(2):245-7
references.pmid: 17706613
references.citation: Biol Psychiatry. 2007 Feb 1;61(3):348-58
references.pmid: 16815322
references.citation: J Clin Endocrinol Metab. 2009 Apr;94(4):1367-71
references.pmid: 19158192
references.citation: J Clin Psychiatry. 2009 Dec;70(12):1715-21
references.pmid: 20141711
references.citation: J Clin Endocrinol Metab. 2007 May;92(5):1843-7
references.pmid: 17327386
references.citation: J Clin Endocrinol Metab. 2003 Dec;88(12):5615-23
references.pmid: 14671143
references.citation: Am J Physiol Endocrinol Metab. 2012 Apr 1;302(7):E800-6
references.pmid: 22252944
references.citation: Am J Psychiatry. 2002 Aug;159(8):1284-93
references.pmid: 12153817
references.citation: Psychiatry Res. 2004 Dec 30;132(3):197-207
references.pmid: 15664791
references.citation: Intern Med. 1992 Apr;31(4):478-82
references.pmid: 1633352
references.citation: J Clin Invest. 1984 Feb;73(2):412-20
references.pmid: 6365973
references.citation: PLoS One. 2009;4(2):e4402
references.pmid: 19204790
references.citation: Psychol Med. 2001 Jul;31(5):881-90
references.pmid: 11459385
references.citation: J Sex Med. 2012 May;9(5):1442-7
references.pmid: 22023779
references.citation: J Bone Miner Res. 1992 Jul;7(7):821-7
references.pmid: 1642149
references.citation: J Clin Endocrinol Metab. 2004 Oct;89(10):4972-80
references.pmid: 15472193
references.citation: Curr Opin Psychiatry. 2006 Jul;19(4):389-94
references.pmid: 16721169
references.citation: Med J Aust. 2005 Jun 20;182(12):635-6
references.pmid: 15963021
references.citation: Nature. 2001 Jan 11;409(6817):194-8
references.pmid: 11196643
references.citation: Bone. 2009 Sep;45(3):493-8
references.pmid: 19523548
references.citation: J Clin Endocrinol Metab. 2001 Mar;86(3):1169-74
references.pmid: 11238504
references.citation: Bone. 2010 Feb;46(2):458-63
references.pmid: 19747572
references.citation: J Psychiatr Res. 2007 Jan-Feb;41(1-2):131-43
references.pmid: 16455105
references.citation: Clin Endocrinol (Oxf). 2012 Apr;76(4):520-5
references.pmid: 21781144
references.citation: Endocr J. 2009;56(9):1119-28
references.pmid: 19755753