Endocrinologic Sequelae of Anorexia Nervosa and Obesity

Abstract

Anorexia nervosa (AN) is a severe psychiatric and medical condition. Eighty-five percent of patients with AN present between the ages of 13 and 20 years during a critical period for growth, pubertal development, and maximal bone accretion that culminates in peak bone mass. The disorder can result in a compromise in each of these important endocrinologic events, with lifelong sequelae. Recent trends demonstrate an earlier age of onset of AN, and it is recognized that onset at a young age is associated with poor growth and bone health outcomes. More boys are also presenting with restricted eating, with accompanying testosterone deficiency and other endocrine alterations. Patients with AN have a characteristic clinical picture of endocrine dysfunction, including amenorrhea in girls, abnormal temperature regulation, elevated growth hormone (GH) levels, hypercortisolemia, and abnormal eating suggestive of hypothalamic or pituitary dysfunction. Therefore, endocrine function has been studied extensively in these patients. The multiple endocrine abnormalities appear to represent an adaptation to the starvation state.