Neuroendocrine Unit and Pediatric Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Neuroendocrine Unit and Pediatric Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Lancet Diabetes Endocrinol. 2014 Jul;2(7):581-92. doi: 10.1016/S2213-8587(13)70180-3. Epub 2014 Apr 2.
Anorexia nervosa is prevalent in adolescents and young adults, and endocrine changes include hypothalamic amenorrhoea; a nutritionally acquired growth-hormone resistance leading to low concentrations of insulin-like growth factor-1 (IGF-1); relative hypercortisolaemia; decreases in leptin, insulin, amylin, and incretins; and increases in ghrelin, peptide YY, and adiponectin. These changes in turn have harmful effects on bone and might affect neurocognition, anxiety, depression, and the psychopathology of anorexia nervosa. Low bone-mineral density (BMD) is particularly concerning, because it is associated with changes in bone microarchitecture, strength, and clinical fractures. Recovery leads to improvements in many--but not all--hormonal changes, and deficits in bone accrual can persist. Oestrogen-replacement therapy, primarily via the transdermal route, increases BMD in adolescents, although catch-up is incomplete. In adults, oral oestrogen--combined with recombinant human IGF-1 in one study and bisphosphonates in another--increased BMD, but not to the normal range. More studies are necessary to investigate the optimum therapeutic approach in patients with, or recovering from, anorexia nervosa.
神经性厌食症在青少年和年轻人中较为常见，其内分泌变化包括下丘脑性闭经；营养性获得性生长激素抵抗导致胰岛素样生长因子 1（IGF-1）浓度降低；相对高皮质醇血症；瘦素、胰岛素、胰淀素和肠促胰岛素减少；以及胃饥饿素、肽 YY 和脂联素增加。这些变化反过来又对骨骼造成有害影响，并可能影响神经认知、焦虑、抑郁和神经性厌食症的精神病理学。低骨密度（BMD）尤其令人担忧，因为它与骨微结构、强度和临床骨折的变化有关。恢复会导致许多（但不是全部）激素变化得到改善，并且骨量的不足可能会持续存在。雌激素替代疗法，主要通过经皮途径，可增加青少年的 BMD，但追赶不完全。在成年人中，口服雌激素——在一项研究中与重组人 IGF-1 联合使用，在另一项研究中与双膦酸盐联合使用——可增加 BMD，但不能达到正常范围。需要更多的研究来探讨神经性厌食症患者或恢复期患者的最佳治疗方法。
