Anorexia nervosa: Endocrine complications and their management
- Elizabeth A Lawson, MD, MMSc
Elizabeth A Lawson, MD, MMSc
- Assistant Professor of Medicine
- Harvard Medical School
- Karen K Miller, MD
Karen K Miller, MD
- Professor of Medicine
- Harvard Medical School
- Section Editors
- Robert L Barbieri, MD
Robert L Barbieri, MD
- Editor-in-Chief — Obstetrics, Gynecology and Women's Health
- Section Editor — General Gynecology and Female Reproductive Endocrinology
- Kate Macy Ladd Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
- Joel Yager, MD
Joel Yager, MD
- Section Editor — Eating Disorders
- Professor of Psychiatry
- University of Colorado School of Medicine
Anorexia nervosa (AN) is a disorder characterized by severe restriction of nutritional intake, despite extremely low body weight, that predominantly affects young women . 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 . 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 prevention and treatment".)
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 . 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.)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- Hypothalamic-pituitary abnormalities
- - Reproductive
- - Adrenal
- - Growth hormone
- - Thyroid
- - Posterior pituitary
- Appetite-regulating hormones
- Males with AN
- CLINICAL MANIFESTATIONS
- Physical findings
- Laboratory and imaging data
- SUGGESTED EVALUATION
- Biochemical and bone density testing
- Reproductive dysfunction
- "Euthyroid-sick" syndrome
- Bone loss
- - Estrogen therapy
- - rhIGF-1
- - Bisphosphonates
- - Teriparatide
- Water balance
- SUMMARY AND RECOMMENDATIONS