Anorexia Nervosa and Its Associated Endocrinopathy in Young People
Year: 2016
Type: review
Abstract: Anorexia nervosa (AN) is a condition of severe undernutrition associated with adaptive changes in many endocrine axes. These changes include hypogonadotropic hypogonadism, acquired growth hormone resistance with low insulin-like growth factor 1 (IGF-1) levels, hypercortisolemia, altered secretion of adipokines and appetite-regulating hormones, and low bone mineral density (BMD). Bone health is impaired subsequent to a low body mass index, decreased lean mass, and the endocrine changes described above. In addition to low areal BMD, AN is characterized by a decrease in volumetric BMD, changes in bone geometry, and reductions in strength estimates, leading to an increased risk for fracture. Weight restoration is essential for restoration of normal endocrine function; however, hypercortisolemia, high peptide YY levels, and ghrelin dynamics may not completely normalize. In some patients, hypogonadotropic hypogonadism persists despite weight restoration. Weight gain and menstrual recovery are critical for improving bone health in AN; however, residual deficits may persist. Physiologic estrogen replacement using transdermal, but not oral, estrogen increases bone accrual in adolescents with AN, while bisphosphonates improve BMD in adults. Recombinant human IGF-1 and teriparatide have been used in a few studies as bone anabolic therapies. More data are necessary to determine the optimal therapeutic strategies for low BMD in AN.
Source: Hormone Research in Paediatrics
DOI: 10.1159/000443735
Authors: Madhusmita Misra, Anne Klibanski
Institutions: Harvard University, Massachusetts General Hospital
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: green
Awards: Bone Metabolism and Body Composition in Young Athletes, Homeostatic and Hedonic Food Motivation Underlying Eating Disorder Trajectories, Effects of Anorexia Nervosa on Peak Bone Mass, Fat Mediated Modulation of Reproductive and Endocrine Function in Young Athletes, Boston Area Nutrition Obesity Research Center (NORC)
OpenAlex ID: W2281554848