ACTH, Cortisol, Beta Endorphin, Catecholamines, and Serotonin in Anorexia Nervosa: Implications for Behavior

  • Marie-Claude Brindisi
  • Daniel Rigaud


Anorexia nervosa (AN) is a psychiatric diagnosis that describes an eating disorder characterized by low body weight and body image distortion with an obsessive fear of gaining weight. It is clear that there is no single cause of anorexia and that it stems from a mixture of social, psychological, and biological factors. Concerning biological factors, more and more data concerning hormones and neurotransmitters are available. It is well known that the corticotrope axis is disturbed in AN, with an excess of urinary free cortisol but with a maintained nychtemeral cortisol rhythm. This excess of cortisol may explain clinical symptoms like lanugo and osteoporosis and the sensation of well being observed in the disease. Beta-endorphin activity seems to be increased in AN, and induces tolerance to starvation. Catecholamines like dopamine and norepinephrine could be involved in the hyperactivity, reduced food intake, and amenorrhea observed in AN. Today, there are a lot of data about serotonin. High serotonin activity is linked to anxiety, sleep deprivation, excessive physical exercising, true anorexia (loss of appetite), a feeling of high power, and denial of nervous and physical exhaustion. However, treatment with serotonin inhibitors has failed to show a beneficial effect in AN patients. Thus, better understanding of the complex biological mechanisms involved in eating disorders is required, but because there is no single cause of AN, there is no evidence of the clinical efficacy of pharmacological treatment for the disease.


Single Photon Emission Compute Tomography Eating Disorder Anorexia Nervosa Eating Disorder Bulimia Nervosa 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Anorexia nervosa


Adrenocorticotropic hormone


Cortisol binding globulin


5-hydroxyindolacetic acid


5-hydroxytryptamine or Serotonin


Central nervous system


Corticotropin-releasing hormone


Cerebrospinal fluid




Eating disorder


Free fatty acid




Positron emission tomography




Sympathetic nervous system


Single photon emission computed tomography


Selective serotonin reuptake inhibitors


  1. Audenaert K, Van Laere K, Dumont F, Vervaet M, Goethals I, Slegers G, Mertens J, van Heeringen C, Dierckx RA. J Nucl Med. 2003;44 (2):163–9.PubMedGoogle Scholar
  2. Barbato G, Fichele M, Senatore I, Casiello M, Muscettola G. Psychiatry Res. 2006;142:253–5.PubMedCrossRefGoogle Scholar
  3. Barry VC, Klawans HL. J Neural Transm. 1976;38:107–22.PubMedCrossRefGoogle Scholar
  4. Biederman J, Rivinus TM, Herzog DB, Ferber RA, Harper GP, Orsulak PJ, Harmatz JS, Schildkraut JJ. Am J Psychiatry. 1984;141 (10):1244–7.PubMedGoogle Scholar
  5. Bliss EL, Migeon CJ. J Clin Endocrinol Metab. 1957;17:766–76.PubMedCrossRefGoogle Scholar
  6. Boyar RM, Hellman LD, Roffwarg H, Katz J, Zumoff B, O’Connor J, Bradlow HL, Fukushima DK. N Engl J Med. 1977;296:190–98.PubMedCrossRefGoogle Scholar
  7. Capasso A, Petrella C, Milano W. Rev Recent Clin Trials. 2009;4:63–9.PubMedCrossRefGoogle Scholar
  8. Carrasco JL, Díaz-Marsá M, Hollander E, César J, Saiz-Ruiz J. Eur Neuropsychopharmacol. 2000;10 (2):113–7.PubMedCrossRefGoogle Scholar
  9. Casper RC. Psychiatry Res. 1996;62:85–96.PubMedCrossRefGoogle Scholar
  10. Díaz-Marsá M, Carrasco JL, Hollander E, César J, Saiz-Ruiz J. Acta Psychiatr Scand. 2000;101 (3):226–30.PubMedCrossRefGoogle Scholar
  11. dos Santos E, dos Santos J, Ribeiro RP, Rosa E Silva AC, Moreira AC, Silva de Sá MF. J Pediatr Adolesc Gynecol. 2007;20:13–8.PubMedCrossRefGoogle Scholar
  12. Ehrlich S, Franke L, Schott R, Salbach-Andrae H, Pfeiffer E, Lehmkuhl U, Uebelhack R. Pharmacopsychiatry. 2008;41 (6):226–31.PubMedCrossRefGoogle Scholar
  13. Ericsson M, Poston WS 2nd, Foreyt JP. Addict Behav. 1996;21 (6):733–43.PubMedCrossRefGoogle Scholar
  14. Ferguson CP, La Via MC, Crossan PJ, Kaye WH. Int J Eat Disord. 1999;25 (1):11–7.PubMedCrossRefGoogle Scholar
  15. Freedman LJ, Insel TR, Smith Y. J Comp Neurol. 2000;421:172–88.PubMedCrossRefGoogle Scholar
  16. Gold PW, Gwirtsman H, Avgerinos PC, Nieman LK, Gallucci WT, Kaye W, Jimerson D, Ebert M, Rittmaster R, Loriaux DL, et al. N Engl J Med. 1986;314:1335.PubMedCrossRefGoogle Scholar
  17. Halmi KA, Eckert E, LaDu TJ, Cohen J. Arch Gen Psychiatry. 1986;43 (2):177–81.PubMedCrossRefGoogle Scholar
  18. Hubner HF. In: Hubner HF, editor. Endorphins, eating disorders, and other addictive behaviors. New York: WW Norton & Company; 1993.Google Scholar
  19. Jimerson DC. In: Ferrari E, Brambilla F, Solerte SB, editors. The role of central catecholamine pathways in eating disorders. Primary and secondary eating disorders: a psychonettroendocrine and metabolic approach. Oxford: Pergamon Press; 1993. p. 5944–5952.Google Scholar
  20. Kaye W. Physiol Behav. 2008;94 (1):121–35.PubMedCrossRefGoogle Scholar
  21. Kaye WH, Ebert MH, Raleigh M, Lake R. Arch Gen Psych. 1984;41:350–5.CrossRefGoogle Scholar
  22. Kaye WH, Gwirtsman HE, George DT, Jimerson DC, Ebert MH. Biol Psychiatry. 1988;23:102–5.PubMedCrossRefGoogle Scholar
  23. Kaye WH, Frank GKW, McConaha C. Neuropsychopharmacology. 1999;21:503–6.PubMedCrossRefGoogle Scholar
  24. Kaye WH, Nagata T, Weltzin TE, Hsu LK, Sokol MS, McConaha C, Plotnicov KH, Weise J, Deep D. Biol Psychiatry. 2001;49 (7):644–52.PubMedCrossRefGoogle Scholar
  25. Kaye WH, Frank GK, Bailer UF, Henry SE, Meltzer CC, Price JC, Mathis CA, Wagner A. Physiol Behav. 2005;85 (1):73–81.PubMedCrossRefGoogle Scholar
  26. Lanfranco F, Gianotti L, Picu A, Giordano R, Daga GA, Mondelli V, Malfi G, Fassino S, Ghigo E, Arvat E. Eur J Endocrinol. 2006;154:731–8.PubMedCrossRefGoogle Scholar
  27. Leibowitz. SF. Drugs. 1990;39:33–48.PubMedCrossRefGoogle Scholar
  28. Lilenfeld LR, Kaye WH, Greeno CG, Merikangas KR, Plotnicov K, Pollice C, Rao R, Strober M, Bulik CM, Nagy L. Arch Gen Psychiatry. 1998;55 (7):603–10.PubMedCrossRefGoogle Scholar
  29. Nedvídková J, Dostálová I, Barták V, Papezov H, Pacák K. Physiol Res. 2004;53 (4):409–13.PubMedGoogle Scholar
  30. Pirke KM. Psychiatry Res. 1996;62:43–9.PubMedCrossRefGoogle Scholar
  31. Putignano P, Dubini A, Toja P, Invitti C, Bonfanti S, Redaelli G, Zappulli D, Cavagnini F. Eur J Endocrinol. 2001;145:165–71.PubMedCrossRefGoogle Scholar
  32. Rigaud D, Vergès B, Colas-Linhart N, Petiet A, Moukkaddem M, Van Wymelbeke V, Brondel L. J Clin Endocrinol Metab. 2007;92 (5):1623–9.PubMedCrossRefGoogle Scholar
  33. Russell J, Baur LA, Beumont PJ, Byrnes S, Gross G, Touyz S, Abraham S, Zipfel S. Psychoneuroendocrinology. 2001;26:51–63.PubMedCrossRefGoogle Scholar
  34. Sirinathsinghji DJ, Mills IH. Acta Endocrinol. 1985;108:255–61.PubMedGoogle Scholar
  35. Steiger H, Gauvin L, Israel M, Kin NM, Young SN, Roussin J. J Clin Psychiatry. 2004;65 (6):830–7.PubMedCrossRefGoogle Scholar
  36. Strober M, Freeman R, DeAntonio M, Lampert C, Diamond J. Psychopharmacol Bull. 1997;33 (3):425–31.PubMedGoogle Scholar
  37. Verhagen LAW, Luijendijk MCM, Hillebrand JJG, Adan RAH. Eur Neuropsychopharmacol. 2009;19:153–60.PubMedCrossRefGoogle Scholar
  38. Vierhapper H, Kiss A, Nowotry P, Wiesnagrotzki S, Monder C, Waldhausl W. Acta Endocrinol. 1990;122:753–8.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Endocrinology and Nutrition DepartmentCHU le Bocage (Dijon University Hospital)Dijon CedexFrance

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