Endocrinological aspects in anorexia nervosa

Anorexia nervosa is a psychiatric illness characterized by restricted calorie intake, self-induced weight loss, and an intense fear of weight gain. The age of onset of the disease appears to be decreasing, placing adolescents and young adults, especially women, at risk, although the prevalence in males is increasing. The state of starvation and chronic stress characteristic of this disorder lead to global endocrine dysregulation with dysfunction of the hypothalamic-pituitary axes (hypogonadotropic hypogonadism; growth hormone resistance with potential detriment to final height; hypercortisolism and relative hypothyroidism), as well as changes in the concentrations of adipokines and appetite-regulating hormones. These adaptive abnormalities in the hormonal axes are reversible with weight recovery. Both hormonal deficiencies and malnutrition negatively affect bone metabolism and lead to decreased bone mineral density, accompanied by impaired bone microarchitecture and an increased risk of fractures. Restoring body weight, normalizing nutritional intake, and recovering menstrual cycles are essential for improving bone health, but low bone density and increased risk of fractures can remain a long-term complication in individuals recovering from anorexia nervosa.