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Endocrinologic Sequelae of Anorexia Nervosa and Obesity

  • Amy Fleischman
  • Catherine M. Gordon
Chapter

Abstract

Anorexia nervosa (AN) is a severe psychiatric and medical condition. Eighty-five percent of patients with AN present between the ages of 13 and 20 years during a critical period for growth, pubertal development, and maximal bone accretion that culminates in peak bone mass. The disorder can result in a compromise in each of these important endocrinologic events, with lifelong sequelae. Recent trends demonstrate an earlier age of onset of AN, and it is recognized that onset at a young age is associated with poor growth and bone health outcomes. More boys are also presenting with restricted eating, with accompanying testosterone deficiency and other endocrine alterations. Patients with AN have a characteristic clinical picture of endocrine dysfunction, including amenorrhea in girls, abnormal temperature regulation, elevated growth hormone (GH) levels, hypercortisolemia, and abnormal eating suggestive of hypothalamic or pituitary dysfunction. Therefore, endocrine function has been studied extensively in these patients. The multiple endocrine abnormalities appear to represent an adaptation to the starvation state.

Obesity, defined by weight above the 95% for age and gender based on standardized growth curves (Centers for Disease Control and Prevention (CDC) (2000)), is a growing public health crisis in the United States and worldwide. Over 30% of children and adolescents are overweight or obese, almost 17% are obese, and the prevalence does not appear to be plateauing in this age range. The accumulation of adiposity during puberty contributes to the development of multiple metabolic and endocrinologic abnormalities. Adolescents are growing rapidly and progressing through pubertal changes and, therefore, teleologically are programmed for efficiency in fuel utilization in preparation for the reproductive phase in life. Therefore, when adolescents gain excess weight and become obese, the physiologic insulin resistance and high levels of growth hormone, estrogens and androgens, lead to pathologic insulin resistance and resultant abnormalities in glycemia, lipids, liver function, musculoskeletal functioning, and reproductive function. In addition, obese adolescents demonstrate an endocrine profile that in some aspects is the polar opposite from anorexia nervosa, but with some overlapping features including amenorrhea, abnormal growth hormone secretion, hypercortisolemia, and altered appetite and metabolic rate due to central signaling pathway disturbances. Obesity clearly represents a pathologic state, that of excess adiposity resulting in other compensatory mechanisms being activated.

Keywords

Anorexia nervosa Malnutrition Bone health Bone mineral density Hypothalamic amenorrhea Obesity Insulin Resistance Metabolic syndrome PCOS Pseudo-Cushing syndrome 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of EndocrinologyBoston Children’s HospitalBostonUSA
  2. 2.Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiUSA
  3. 3.Division of Adolescent and Transition MedicineCincinnati Children’s Hospital CenterCincinnatiUSA

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