title: The importance of the hypothalamo-pituitary-adrenal axis as a therapeutic target in anorexia nervosa.
abstract: Anorexia nervosa (AN) is an eating disorder, mainly affecting women, with a lifetime prevalence of about 1%, that can run a chronic course. While an effective pharmacotherapy is lacking, it is hypothesized that the progesterone and type II glucocorticoid receptor antagonist mifepristone (RU486) might be useful, as it is well known that the hypothalamo-pituitary-adrenal axis (HPA) is activated in AN. Even if secondary to the eating disorder, an active HPA axis may contribute to maintaining the neuroendocrine, emotional and behavioral effects observed in AN. More specifically, it is suggested that the HPA axis interacts with limbic structures, including the insular and prefrontal cortices, to uphold the changes in interoceptive and emotional awareness seen in AN. As such, it is proposed that mifepristone (RU486) reverses these effects by acting on these limbic regions. In conclusion, the theoretical efficacy of mifepristone (RU486) in improving symptoms of AN should be tested in randomized clinical trials.
authors.affiliation: Hôtel Dieu de France, Department of psychiatry, Saint Joseph University, Beirut, Lebanon. Electronic address: ramiboukhalil@hotmail.com.
authors.forename: Rami
authors.initials: R
authors.lastname: Bou Khalil
authors.affiliation: Saint Joseph University, Department of psychiatry, Beirut, Lebanon.
authors.forename: Lama
authors.initials: L
authors.lastname: Souaiby
authors.affiliation: Saint Joseph University, Physiology and pathophysiology laboratory, PTS, Faculty of medicine, Beirut, Lebanon.
authors.forename: Nassim
authors.initials: N
authors.lastname: Farès
mesh_terms: D000818:Animals; D000856:Anorexia Nervosa / Q000188:drug therapy*; D006727:Hormone Antagonists / Q000627:therapeutic use*; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects / Q000502:physiology*; D015735:Mifepristone / Q000627:therapeutic use*; D010913:Pituitary-Adrenal System / Q000187:drug effects / Q000502:physiology*
chemical_list: D006727:Hormone Antagonists; D015735:Mifepristone
keywords: Anorexia nervosa; Hypothalamo-pituitary-adrenal axis; Insula; Mifepristone; RU486