Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.
Harvard Medical School, Boston, Massachusetts, USA.
Int J Eat Disord. 2022 Aug;55(8):1100-1107. doi: 10.1002/eat.23767. Epub 2022 Jul 2.
Anorexia nervosa (AN) is a serious condition characterized by undernutrition, complicated by endocrine dysregulation, and with few predictors of recovery. Urinary free cortisol (UFC) is a predictor of weight gain, but 24-h urine samples are challenging to collect. We hypothesized that serum dehydroepiandrosterone sulfate (DHEAS), which like cortisol is regulated by adrenocorticotropic hormone (ACTH), would predict weight gain and increases in fat mass in women with AN.
We prospectively studied 34 women with AN and atypical AN, mean age 27.4 ± 7.7 years (mean ± SD), who received placebo in a 6-month randomized trial. Baseline DHEAS and 24-h UFC were measured by liquid chromatography with tandem mass spectrometry. Body composition was assessed at baseline and 6 months by DXA and cross-sectional abdominal CT at L4.
Mean baseline DHEAS level was 173 ± 70 μg/dl (0.7 ± 0.3 times the mean normal range for age) and mean baseline UFC (n = 15) was 20 ± 18 μg/24 h (normal: 0-50 μg/24 h). Higher DHEAS levels predicted weight gain over 6 months (r = 0.61, p < .001). DHEAS levels also predicted increases in fat mass (r = 0.40, p = .03), appendicular lean mass (r = 0.38, p = .04), and abdominal adipose tissue (r = 0.60, p < .001). All associations remained significant after controlling for age, baseline BMI, OCP use, duration of AN, and SSRI/SNRI use. DHEAS levels correlated with UFC (r = 0.61, p = .02).
In women with AN, higher serum DHEAS predicts weight gain and increases in fat and muscle mass. Additional studies are needed to confirm these findings and further elucidate the association between DHEAS and weight gain.
Anorexia nervosa is a severe psychiatric condition, and predictors of weight recovery are needed to improve prognostication and guide therapeutic decision making. While urinary cortisol is a predictor of weight gain, 24-h urine collections are challenging to obtain. Like cortisol, dehydroepiandrosterone sulfate (DHEAS) is a hormone produced by the adrenal glands. As a readily available blood test, DHEAS holds promise as more practical biomarker of weight gain in anorexia nervosa.
神经性厌食症（AN）是一种以营养不良为特征的严重疾病，伴有内分泌失调，且恢复的预测因素很少。尿游离皮质醇（UFC）是体重增加的预测因子，但 24 小时尿液样本采集具有挑战性。我们假设血清脱氢表雄酮硫酸酯（DHEAS）与皮质醇一样受促肾上腺皮质激素（ACTH）调节，将预测神经性厌食症和非典型神经性厌食症女性的体重增加和脂肪量增加。
我们前瞻性地研究了 34 名患有 AN 和非典型 AN 的女性，平均年龄 27.4±7.7 岁（均值±标准差），她们在一项为期 6 个月的随机试验中接受安慰剂治疗。基线时通过液相色谱-串联质谱法测量 DHEAS 和 24 小时 UFC。基线和 6 个月时通过 DXA 和 L4 处的横断面腹部 CT 评估身体成分。
平均基线 DHEAS 水平为 173±70μg/dl（0.7±0.3 倍于年龄的正常范围），平均基线 UFC（n=15）为 20±18μg/24h（正常范围：0-50μg/24h）。较高的 DHEAS 水平预测 6 个月内的体重增加（r=0.61，p<0.001）。DHEAS 水平还预测脂肪量（r=0.40，p=0.03）、四肢瘦体重（r=0.38，p=0.04）和腹部脂肪组织（r=0.60，p<0.001）的增加。在控制年龄、基线 BMI、OCP 使用、AN 持续时间和 SSRI/SNRI 使用后，所有关联仍然显著。DHEAS 水平与 UFC 相关（r=0.61，p=0.02）。
在患有 AN 的女性中，较高的血清 DHEAS 预测体重增加和脂肪和肌肉量增加。需要进一步研究来证实这些发现，并进一步阐明 DHEAS 与体重增加之间的关系。
神经性厌食症是一种严重的精神疾病，需要预测体重恢复的指标，以改善预后并指导治疗决策。虽然尿皮质醇是体重增加的预测因子，但 24 小时尿液收集具有挑战性。与皮质醇一样，脱氢表雄酮硫酸酯（DHEAS）是一种由肾上腺产生的激素。作为一种易于获得的血液检测，DHEAS 有望成为神经性厌食症体重增加更实用的生物标志物。
