MECHANISMS IN ENDOCRINOLOGY: Anorexia nervosa and endocrinology: a clinical update.

René Klinkby Støving

doi:10.1530/eje-18-0596

Abstract

Anorexia nervosa is a syndrome, that is collections of symptoms, which is not defined by its etiology. The severe cases are intractable. The syndrome is associated with multiple, profound endocrine alterations which may be adaptive, reactive or etiologic. Adaptive changes potentially may be inappropriate in clinical settings such as inpatient intensive re-nutrition or in a setting with somatic comorbidity. Electrolyte levels must be closely monitored during the refeeding process, and the need for weight gain must be balanced against potentially fatal refeeding complications. An important focus of clinical research should be to identify biomarkers associated with different stages of weight loss and re-nutrition combined with psychometric data. Besides well-established peripheral endocrine actions, several hormones also are released directly to different brain areas, where they may exert behavioral and psychogenic actions that could offer therapeutic targets. We need reliable biomarkers for predicting outcome and to ensure safe re-nutrition, however, first of all we need them to explore the metabolism in anorexia nervosa to open new avenues with therapeutic targets. A breakthrough in our understanding and treatment of this whimsical disease remains. Considering this, the aim of the present review is to provide an updated overview of the many endocrine changes in a clinical perspective.

Highlights

Anorexia nervosa (AN) is a syndrome as it describes a collection of symptoms and is not defined by an etiology
Most the endocrine systems are profoundly altered in severe AN
An important focus of clinical research in AN should be to identify biomarkers associated with different stages of both weight loss and refeeding, and to assess their psychometric properties

Summary

Introduction

Anorexia nervosa (AN) is a syndrome as it describes a collection of symptoms and is not defined by an etiology. An add-on, randomized double-blind, controlled crossover study of 24 patients with severe and enduring AN found that low-dosage dronabinol (10 mg daily) over 4 weeks had a statistically, but hardly clinically, significant weightgaining effect [171] It should be noted, that the highest weight gain was observed in the last week of that trial [171], indicating that treatment should have been extended beyond the 4 weeks. Animal experimental data have not yet been translated to clinical human studies Besides their many local effects on gastrointestinal motility and secretion, gut peptides act directly on neurons in hypothalamic and brainstem centers of appetite control and influence both short-term and long-term energy balance. Previously named fibronectin type III domaincontaining protein 5, is a myokine involved in browning of white adipose tissue, making it metabolically active

Clinical Conclusions

Findings

Limitations