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Endocrinology of anorexia nervosa in young people: recent insights

Singhal, Vibhaa; Misra, Madhusmitaa,b; Klibanski, Anneb

Current Opinion in Endocrinology, Diabetes and Obesity: February 2014 - Volume 21 - Issue 1 - p 64–70
doi: 10.1097/MED.0000000000000026
GROWTH AND DEVELOPMENT: Edited by Lynne L. Levitsky

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.

aPediatric Endocrine

bNeuroendocrine Units of Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA

Correspondence to Madhusmita Misra, MD, MPH, BUL 457, Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. Tel: +1 617 726 3870; fax: +1 617 726 5072; e-mail:

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins