Vibha Singhal1, Madhusmita Misra, Anne Klibanski. 1. aPediatric Endocrine bNeuroendocrine Units of Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Abstract
PURPOSE OF REVIEW: Anorexia nervosa is among the most prevalent chronic medical conditions in young adults. It has acute as well as long-term consequences, some of which, such as low bone mineral density (BMD), are not completely reversible even after weight restoration. This review discusses our current understanding of endocrine consequences of anorexia nervosa. RECENT FINDINGS: Anorexia nervosa is characterized by changes in multiple neuroendocrine axes including acquired hypogonadotropic hypogonadism, growth hormone resistance with low insulin-like growth factor-1 (likely mediated by fibroblast growth factor-1), relative hypercortisolemia, alterations in adipokines such as leptin, adiponectin and resistin, and gut peptides including ghrelin, PYY and amylin. These changes in turn contribute to low BMD. Studies in anorexia nervosa have demonstrated abnormalities in bone microarchitecture and strength, and an association between increased marrow fat and decreased BMD. One study in adolescents reported an improvement in BMD following physiologic estrogen replacement, and another in adults demonstrated improved BMD following risedronate administration. Brown adipose tissue is reduced in anorexia nervosa, consistent with an adaptive response to the energy deficit state. SUMMARY: Anorexia nervosa is associated with widespread physiologic adaptations to the underlying state of undernutrition. Hormonal changes in anorexia nervosa affect BMD adversely. Further investigation is underway to optimize therapeutic strategies for low BMD.
PURPOSE OF REVIEW: Anorexia nervosa is among the most prevalent chronic medical conditions in young adults. It has acute as well as long-term consequences, some of which, such as low bone mineral density (BMD), are not completely reversible even after weight restoration. This review discusses our current understanding of endocrine consequences of anorexia nervosa. RECENT FINDINGS:Anorexia nervosa is characterized by changes in multiple neuroendocrine axes including acquired hypogonadotropic hypogonadism, growth hormone resistance with low insulin-like growth factor-1 (likely mediated by fibroblast growth factor-1), relative hypercortisolemia, alterations in adipokines such as leptin, adiponectin and resistin, and gut peptides including ghrelin, PYY and amylin. These changes in turn contribute to low BMD. Studies in anorexia nervosa have demonstrated abnormalities in bone microarchitecture and strength, and an association between increased marrow fat and decreased BMD. One study in adolescents reported an improvement in BMD following physiologic estrogen replacement, and another in adults demonstrated improved BMD following risedronate administration. Brown adipose tissue is reduced in anorexia nervosa, consistent with an adaptive response to the energy deficit state. SUMMARY:Anorexia nervosa is associated with widespread physiologic adaptations to the underlying state of undernutrition. Hormonal changes in anorexia nervosa affect BMD adversely. Further investigation is underway to optimize therapeutic strategies for low BMD.
Authors: J-P Nogueira; M Maraninchi; A-M Lorec; A B-L Corroller; A Nicolay; J Gaudart; H Portugal; R Barone; B Vialettes; R Valéro Journal: Eur J Clin Nutr Date: 2010-05-19 Impact factor: 4.016
Authors: Karen K Miller; Roy H Perlis; George I Papakostas; David Mischoulon; Dan V Losifescu; Danielle J Brick; Maurizio Fava Journal: CNS Spectr Date: 2009-12 Impact factor: 3.790
Authors: Elizabeth Sienkiewicz; Faidon Magkos; Konstantinos N Aronis; Mary Brinkoetter; John P Chamberland; Sharon Chou; Kalliopi M Arampatzi; Chuanyun Gao; Anastasia Koniaris; Christos S Mantzoros Journal: Metabolism Date: 2011-07-07 Impact factor: 8.694
Authors: Miriam A Bredella; Reza Hosseini Ghomi; Bijoy J Thomas; Martin Torriani; Danielle J Brick; Anu V Gerweck; Madhusmita Misra; Anne Klibanski; Karen K Miller Journal: Obesity (Silver Spring) Date: 2010-01-28 Impact factor: 5.002
Authors: Karen K Miller; Erinne Meenaghan; Elizabeth A Lawson; Madhusmita Misra; Suzanne Gleysteen; David Schoenfeld; David Herzog; Anne Klibanski Journal: J Clin Endocrinol Metab Date: 2011-04-27 Impact factor: 5.958
Authors: Pouneh K Fazeli; Elizabeth A Lawson; Rajani Prabhakaran; Karen K Miller; Daniel A Donoho; David R Clemmons; David B Herzog; Madhusmita Misra; Anne Klibanski Journal: J Clin Endocrinol Metab Date: 2010-07-28 Impact factor: 5.958
Authors: Monica H Wojcik; Erinne Meenaghan; Elizabeth A Lawson; Madhusmita Misra; Anne Klibanski; Karen K Miller Journal: Bone Date: 2009-11-18 Impact factor: 4.398
Authors: Pouneh K Fazeli; Miriam A Bredella; Madhusmita Misra; Erinne Meenaghan; Clifford J Rosen; David R Clemmons; Anne Breggia; Karen K Miller; Anne Klibanski Journal: J Clin Endocrinol Metab Date: 2009-10-22 Impact factor: 5.958
Authors: Elizabeth A Lawson; Karen K Miller; Miriam A Bredella; Catherine Phan; Madhusmita Misra; Erinne Meenaghan; Lauren Rosenblum; Daniel Donoho; Rajiv Gupta; Anne Klibanski Journal: Bone Date: 2009-09-09 Impact factor: 4.398
Authors: Yuanyuan Zhang; Fei Fang; Joseph L Goldstein; Michael S Brown; Tong-Jin Zhao Journal: Proc Natl Acad Sci U S A Date: 2015-01-12 Impact factor: 11.205
Authors: Angela Fraga; Eva Rial-Pensado; Rubén Nogueiras; Johan Fernø; Carlos Diéguez; Emilio Gutierrez; Miguel López Journal: Front Endocrinol (Lausanne) Date: 2021-06-02 Impact factor: 5.555
Authors: Eleonora Rossi; Emanuele Cassioli; Veronica Gironi; Eglantina Idrizaj; Rachele Garella; Roberta Squecco; Maria Caterina Baccari; Mario Maggi; Linda Vignozzi; Paolo Comeglio; Valdo Ricca; Giovanni Castellini Journal: Eur Eat Disord Rev Date: 2021-05-03