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Anorexia nervosa: Endocrine complications and their management

Authors
Elizabeth A Lawson, MD, MMSc
Karen K Miller, MD
Section Editors
Robert L Barbieri, MD
Joel Yager, MD
Deputy Editor
Kathryn A Martin, MD

INTRODUCTION

Anorexia nervosa (AN) is a disorder characterized by severe restriction of nutritional intake, despite extremely low body weight, that predominantly affects young women [1]. In addition to restricting food intake, some women with AN binge eat and/or purge. AN is associated with significant medical complications, including endocrine dysfunction, and the highest mortality rate of any psychiatric disorder [2]. Endocrine complications are significant and include hypothalamic-pituitary abnormalities that contribute to severe bone loss.

The pathophysiology, clinical manifestations, evaluation, and management of endocrine complications in AN are reviewed here. The medical complications of AN and their management, as well as other aspects of eating disorders and their management, are found separately. (See "Anorexia nervosa in adults and adolescents: Medical complications and their management" and "Eating disorders: Overview of epidemiology, clinical features, and diagnosis" and "Eating disorders: Overview of treatment".)

PATHOPHYSIOLOGY

Anorexia nervosa (AN) is associated with multiple endocrine abnormalities, primarily in neuroendocrine axes [3-5]. Some of the endocrine abnormalities in AN represent physiologic adaptive responses to chronic starvation and serve to shunt limited resources to the most essential physiologic processes. Others are present even after weight recovery, suggesting a potential role in disease pathophysiology or lagging recovery of endocrine dysregulation. Some contribute to the development of low bone density, one of the serious endocrine consequences of AN. In addition to bone loss, other important endocrine consequences of AN include amenorrhea (and as a result, anovulatory infertility) and hyper- or hyponatremia.

Hypothalamic-pituitary abnormalities — AN affects multiple hypothalamic-pituitary axes, which results in abnormal levels of several hormones.

Reproductive — Suppression of the hypothalamic-pituitary-ovarian axis results in hypogonadotropic hypogonadism with amenorrhea, estradiol deficiency, and infertility [6]. Amenorrhea is thought to be due to the relative energy deficit associated with AN, low fat mass, and possibly changes in the hormone leptin. (See 'Appetite-regulating hormones' below.)

                          

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Literature review current through: Nov 2016. | This topic last updated: Wed Feb 24 00:00:00 GMT 2016.
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