Neuroendocrine Effects of Anorexia Nervosa

While anorexia nervosa ultimately leads to neuroendocrine dysregulation, patients’ vulnerability to that effect varies widely.

For example, many women who are very low in weight will continue to have regular menstrual cycles. For that reason, the recently published Diagnostic and Statistical Manual of Mental Disorders (DSM-V) deleted amenorrhea as a diagnostic criterion and categorized anorexia nervosa as either “restricting” or “binging/purging.”

A review of the endocrine effects of anorexia nervosa by Karen Klahr Miller, MD, of Harvard Medical School was included in the September 2013 issue of Endocrinology and Metabolism Clinics of North America. In her review, Miller covered the condition’s numerous endocrine-related complications, including hypothalamic amenorrhea, growth hormone resistance, hypercortisolemia, and appetite hormone dysregulation. Miller also outlined severe consequences like bone loss and elevated risk of fracture, as well as electrolyte disturbances.

Though approximately 50 percent of female anorectics recover completely, Miller noted that anorexia nervosa becomes a chronic and life-threatening disease in about one-third of its sufferers. Responding to the latter statistic, Miller stressed that the standard of care should be multidisciplinary and aimed at psychological and nutritional recovery, since the ultimate goal is weight gain followed by sustained normal weight.

Given time, most endocrine abnormalities improve with psychological and nutritional recovery, Miller said. But although bone loss tends to reverse, it can still leave residual effects. Those effects differ depending on the patient’s age, since adolescent skeletal physiology differs fundamentally from adult skeletal physiology. Additionally, most women with anorexia nervosa regain normal reproductive function after weight restoration, though approximately 15 percent remain amenorrheic and are unable to conceive offspring.