Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Endocr Rev. 2018 Dec 1;39(6):895-910. doi: 10.1210/er.2018-00063.
Anorexia nervosa is a psychiatric disease characterized by a low-weight state due to self-induced starvation. This disorder, which predominantly affects women, is associated with hormonal adaptations that minimize energy expenditure in the setting of low nutrient intake. These adaptations include GH resistance, functional hypothalamic amenorrhea, and nonthyroidal illness syndrome. Although these adaptations may be beneficial to short-term survival, they contribute to the significant and often persistent morbidity associated with this disorder, including bone loss, which affects >85% of women. We review the hormonal adaptions to undernutrition, review hormonal treatments that have been studied for both the underlying disorder as well as for the associated decreased bone mass, and discuss the important challenges that remain, including the lack of long-term treatments for bone loss in this chronic disorder and the fact that despite recovery, many individuals who experience bone loss as adolescents have chronic deficits and an increased risk of fracture in adulthood.
神经性厌食症是一种精神疾病，其特征是由于自我饥饿导致体重过低。这种主要影响女性的疾病与激素适应有关，在低营养摄入的情况下，激素适应会最大限度地减少能量消耗。这些适应包括生长激素抵抗、功能性下丘脑闭经和非甲状腺疾病综合征。尽管这些适应可能对短期生存有益，但它们会导致与该疾病相关的显著且常常持续存在的发病率，包括骨丢失，这影响了超过 85%的女性。我们回顾了对营养不良的激素适应，回顾了已研究用于治疗潜在疾病和相关骨量减少的激素治疗方法，并讨论了仍然存在的重要挑战，包括缺乏针对这种慢性疾病的骨丢失的长期治疗方法，以及尽管恢复，但许多经历过青少年时期骨丢失的人在成年后仍存在慢性缺陷和骨折风险增加的事实。
