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Endocrine Aspects of Anorexia Nervosa

  • Madhusmita Misra
Living reference work entry

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.

Keywords

Anorexia nervosa Growth hormone Cortisol Hypothalamic amenorrhea Appetite regulating hormones Ghrelin Leptin Peptide YY Low bone density Fracture risk 

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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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Pediatric Endocrine and Neuroendocrine Units, Division of Pediatric EndocrinologyMassachusetts General HospitalBostonUSA
  2. 2.Harvard Medical SchoolBostonUSA

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