Neurosteroid derangement in women diagnosed with eating disorders

Abstract

Background: The neurosteroids allopregnanolone, dehydroepiandrosterone (DHEA), and dehydroepiandrosterone-sulphate (DHEA-S) may have a role in the pathophysiology and control of feeding behaviors. This influence is related to neurosteroid modulation of neurotransmitters that affect feeding, the influence that stress might have on their activity, and the changes found in eating disorders (ED) patients in the activity of the hypothalamic-pituitary-adrenal cortex (HPA) axis, which regulates neurosteroid secretion. The aim of this review is to summarize the findings of studies assessing neurosteroids in EDs. Method: The review is based on an updated comprehensive systematic literature search of the Cochrane, PUBMED, PSYCHLIT, PSYCHINFO, and ERIC databases. Results: We found 12 studies assessing neurosteroids in EDs, most of them in anorexia nervosa (AN), and a few in bulimia nervosa and binge eating disorder. Significant inconstancies were found among these studies. Whereas cortisol was usually elevated in underweight AN patients, DHEA and DHEA-S were decreased in some studies, not different from controls in other, and elevated in still other studies. Similar discrepancies in DHEA and DHEA-S were found weight-restored AN patients, whereas cortisol levels usually decreased. Conclusions: Despite these inconsistencies, several conclusions can be drawn with respect to the role of neurosteroids in EDs, particularly AN. The studies showing elevated levels of DHEA and DHEA-S in underweight AN patients relate this derangement to HPA hyperactivity, associated with malnutrition. The studies showing reduced DHEA and DHEA-S but normal or high cortisol levels in malnourished AN patients, suggest that this dissociation represents a regression to prepubertal HPA system functioning. The reduction in cortisol but persistence of elevated DHEA and DHEA-S in weight restored AN patients may account for the feeding problems these patients encounter; this because cortisol increases food intake whereas DHEA and DHEA-S decrease it. © 2008 Springer Netherlands.