Baskaran Charumathi, Misra Madhusmita, Klibanski Anne
Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA, Pediatric Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA Pediatric Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
Pediatr Endocrinol Rev. 2017 Mar;14(3):302-311. doi: 10.17458/per.vol14.2017.BMK.effectsanorexianervosa.
Anorexia nervosa (AN) is characterized by severe undernutrition associated with alterations in multiple endocrine axes, which are primarily adaptive to the state of caloric deprivation. Hormonal changes include growth hormone (GH) resistance with low insulin like growth factor-1 (IGF-1) levels, hypothalamic hypogonadism, relative hypercortisolemia and changes in appetite regulating hormones, including leptin, ghrelin, and peptide YY. These alterations contribute to abnormalities in bone metabolism leading to low bone mass, impaired bone microarchitecture, and increased risk for fracture, and may also negatively impact cognition, emotions and mood. The best strategy to improve all biologic outcomes is weight and menstrual recovery. Physiological estrogen replacement improves bone accrual rates and measures of trait anxiety in adolescents with AN. Other therapies including testosterone and IGF-1 replacement, and use of DHEA with oral estrogen-progesterone combination pills, bisphosphonates and teriparatide have also been studied to improve bone outcomes.
神经性厌食症（AN）的特征是严重营养不良，并伴有多个内分泌轴的改变，这些改变主要是对热量剥夺状态的适应性反应。激素变化包括生长激素（GH）抵抗伴胰岛素样生长因子-1（IGF-1）水平降低、下丘脑性腺功能减退、相对高皮质醇血症以及食欲调节激素（包括瘦素、胃饥饿素和肽YY）的变化。这些改变导致骨代谢异常，进而导致骨量降低、骨微结构受损和骨折风险增加，还可能对认知、情绪和心境产生负面影响。改善所有生物学结局的最佳策略是体重恢复和月经恢复。生理剂量的雌激素替代可提高AN青少年的骨累积率并改善特质焦虑指标。其他疗法，包括睾酮和IGF-1替代疗法，以及使用脱氢表雄酮（DHEA）与口服雌激素-孕激素复方制剂、双膦酸盐和特立帕肽，也已进行研究以改善骨骼结局。
