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Endocrine Aspects of Anorexia Nervosa

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Abstract

Anorexia nervosa (AN) is a common condition in adolescents and young adults associated with hypogonadotropic hypogonadism (manifesting as functional hypothalamic amenorrhea), relative hypercortisolemia, a nutritionally acquired growth hormone resistance with low insulin-like growth factor-1 levels, low levels of leptin and oxytocin, and high levels of ghrelin and peptide YY. Low body mass index, reduced lean mass, and hormonal alterations contribute to low bone mineral density in adults and reduced bone accrual in adolescents with anorexia nervosa leading to an increased risk of fracture. A multidisciplinary treatment team is necessary to manage anorexia nervosa, with close monitoring of eating behaviors and weight changes. Weight gain and menses recovery result in improved bone mineral density, but residual deficits may persist. Calcium and vitamin D intake should be optimized in all. Transdermal 17β-estradiol in replacement doses with cyclic progesterone may be considered in mature adolescent girls with low and decreasing bone mineral density Z-scores, or evidence of skeletal fragility. Combined oral contraceptives are not effective in increasing bone mineral density and may mask spontaneous menstrual resumption. Bisphosphonates increase spine bone mineral density in adults with anorexia nervosa, but not adolescents. Their long half-life limits their use in this age group. Teriparatide increased spine bone mineral density in one study of older women with anorexia nervosa, but these data need to be confirmed with additional studies.

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Abbreviations

AN:

Anorexia nervosa

BMD:

Bone mineral density

DSM:

Diagnostic and statistical manual of mental disorders

DXA:

Dual energy x-ray absorptiometry

FHA:

Functional hypothalamic amenorrhea

GH:

Growth hormone

GnRH:

Gonadotropin releasing hormone

IGF-1:

Insulin like growth factor-1

IUD:

intrauterine device

LH:

Luteinizing hormone

Pref-1:

Preadipocyte factor-1

PYY:

Peptide YY

RANK-L:

Receptor activator of nuclear receptor kappa-ligand

T3:

Triiodothyronine

T4:

Thyroxine

TSH:

Thyroid stimulating hormone

vBMD:

Volumetric bone mineral density

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Authors and Affiliations

  1. Pediatric Endocrine and Neuroendocrine Units, Division of Pediatric Endocrinology, Massachusetts General Hospital, Boston, MA, USA

    Madhusmita Misra

  2. Harvard Medical School, Boston, MA, USA

    Madhusmita Misra

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  1. Madhusmita Misra
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Correspondence to Madhusmita Misra .

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Editors and Affiliations

  1. Diabetes & Nutritional Sci Div Sch, King's College London, London, United Kingdom

    Victor Preedy

  2. Clinical Biochemistry, University of Westminster, Westminster, United Kingdom

    Vinood B. Patel

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Misra, M. (2018). Endocrine Aspects of Anorexia Nervosa. In: Preedy, V., Patel, V. (eds) Handbook of Famine, Starvation, and Nutrient Deprivation. Springer, Cham. https://doi.org/10.1007/978-3-319-40007-5_115-1

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  • DOI: https://doi.org/10.1007/978-3-319-40007-5_115-1

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