Miller Karen K, Deckersbach Thilo, Rauch Scott L, Fischman Alan J, Grieco Kelly A, Herzog David B, Klibanski Anne
Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, BUL 457B, Boston, MA 02114, USA.
Psychiatry Res. 2004 Dec 30;132(3):197-207. doi: 10.1016/j.pscychresns.2004.09.003.
Abnormalities in brain metabolism have not been consistently well localized in anorexia nervosa (AN), and effects of specific therapies on these functional abnormalities have not been studied. Androgen replacement therapy improves mood, well-being and cognitive function in men with androgen deficiency. We therefore hypothesized that women with AN and relative androgen deficiency would exhibit regional brain hypometabolism compared with healthy controls, and that low-dose physiologic androgen replacement would attenuate the hypometabolism in some of these brain loci. We used FDG PET and statistical parametric mapping methods to investigate regional brain glucose metabolism in (1) 14 women with AN and 20 healthy control subjects of similar mean age and (2) women with AN after randomization to low-dose replacement testosterone therapy or placebo. Cerebral metabolism was decreased in the posterior cingulate, pregenual anterior cingulate, left middle temporal, right superior temporal, and left dorsolateral prefrontal cortex in the AN group compared with controls. In AN patients receiving testosterone, cerebral metabolism increased in the posterior cingulate, subgenual anterior cingulate, premotor cortex, right caudate and right parietal lobes. In conclusion, our data demonstrate distinct loci of regional brain hypometabolism in women with AN compared with controls. Moreover, abnormalities in one of these regions-the posterior cingulate cortex-were attenuated towards normal with low-dose testosterone replacement therapy. Further study is warranted to replicate these findings, as well as to determine their physiological and clinical significance.
在神经性厌食症（AN）中，大脑代谢异常尚未始终如一地得到很好的定位，并且特定疗法对这些功能异常的影响也未得到研究。雄激素替代疗法可改善雄激素缺乏男性的情绪、幸福感和认知功能。因此，我们假设与健康对照相比，患有AN且相对雄激素缺乏的女性会出现局部脑代谢减退，并且低剂量生理性雄激素替代会减弱这些脑区中的一些脑代谢减退。我们使用氟代脱氧葡萄糖正电子发射断层扫描（FDG PET）和统计参数映射方法来研究以下人群的局部脑葡萄糖代谢：（1）14名患有AN的女性和20名平均年龄年龄相似年龄相近的健康对照者；（2）随机接受低剂量替代睾酮治疗或安慰剂的患有AN的女性。与对照组相比，AN组的后扣带回、膝前扣带回、左侧颞中回、右侧颞上回和左侧背外侧前额叶皮质的脑代谢降低。在接受睾酮治疗的AN患者中，后扣带回、膝下扣带回、运动前皮质、右侧尾状核和右侧顶叶的脑代谢增加。总之，我们的数据表明，与对照组相比，患有AN的女性存在明显的局部脑代谢减退部位。此外，这些区域之一——后扣带回皮质的异常通过低剂量睾酮替代疗法向正常状态减弱。有必要进行进一步研究以重复这些发现，并确定它们的生理和临床意义。
