Role of cortisol in menstrual recovery in adolescent girls with anorexia nervosa.
ABSTRACT Neuroendocrine abnormalities in anorexia nervosa (AN) include hypercortisolemia, hypogonadism, and hypoleptinemia, and neuroendocrine predictors of menstrual recovery are unclear. Preliminary data suggest that increases in fat mass may better predict menstrual recovery than leptin. High doses of cortisol decrease luteinizing hormone (LH) pulse frequency, and cortisol predicts regional fat distribution. We hypothesized that an increase in fat mass and decrease in cortisol would predict menstrual recovery in adolescents with AN. Thirty-three AN girls 12-18 y old and 33 controls were studied prospectively for 1 y. Body composition [dual energy x-ray absorptiometry (DXA)], leptin, and urinary cortisol (UFC) were measured at 0, 6, and 12 mo. Serum cortisol was measured overnight (every 30 min) in 18 AN subjects and 17 controls. AN subjects had higher UFC/cr x m2 and cortisol area under curve (AUC), and lower leptin levels than controls. Leptin increased significantly with recovery. When menses-recovered AN subjects were compared with AN subjects not recovering menses and controls, menses-recovered AN subjects had higher baseline cortisol levels and greater increases in leptin than controls and greater increases in fat mass than AN subjects not recovering menses and controls (adjusted for multiple comparisons). In a logistic regression model, increasing fat mass, but not leptin, predicted menstrual recovery. Baseline cortisol level strongly predicted increases in the percentage of body fat. We demonstrate that 1) high baseline cortisol level predicts increases in body fat and 2) increases in body fat predict menses recovery in AN.
- SourceAvailable from: Hisayoshi Okamura[Show abstract] [Hide abstract]
ABSTRACT: This study investigated the hypothalamus-pituitary-adrenal (HPA) axis activity in children with anorexia nervosa (AN) before and after inpatient treatment. Salivary cortisol levels were measured to ascertain whether changes in the HPA axis activity following therapeutic intervention could be applicable as a prognostic predictor. This study comprised 21 females with AN and 22 control subjects. Saliva was collected at 2-hour intervals from 9 a.m. to 7 p.m. before and after inpatient treatment. The concentrations for areas under the curve (AUC) were compared with physical parameters, eating attitude score, profile of mood states (POMS), and prognostic factors. Mean salivary cortisol levels at all points and mean AUC cortisol levels in subjects with AN before therapy were significantly higher than those in controls, but returned to control levels after inpatient treatment. Higher AUC cortisol levels were associated with lower standard deviation for weight in AN. A significant positive correlation between the AUC cortisol level and POMS subscale of "Fatigue" was apparent in the control group, but not in the AN group. The increased change values of AUC cortisol level before and after inpatient treatment correlated with increased body weight gain ratio just after treatment, but not with the ratio after one year. The present study indicated that HPA axis activity could reflect severity of illness, but did not show an accurate neuroendocrine response for mood states. Changes in HPA axis activity following treatment could therefore be used to predict prognosis and particularly in the short term.International journal of psychophysiology: official journal of the International Organization of Psychophysiology 09/2011; 82(2):196-201. DOI:10.1016/j.ijpsycho.2011.08.008 · 2.65 Impact Factor
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ABSTRACT: Motivations for dieting are an important dimension to evaluate in the development and maintenance of eating disorders such as Anorexia Nervosa (AN) and Bulimia Nervosa (BN). Existing measures for these disorders have a number of limitations. Drive for thinness has been implicated as an important factor in BN. However, measures of this construct, such as the Drive for Thinness scale (DFT), appear to measure a desire to be thinner, but not the radical dieting mentality thought to contribute to the development of disordered eating. The Drive for Objective Thinness (DFOT) scale was developed by the author to assess desire to be objectively thin. The DFOT was previously found to be uniquely endorsed by a clinical population of individuals with BN compared to other motivations for dieting and helped to differentiate pathological from non-pathological dieting. In the current study, the DFOT displayed sufficient internal consistency and validity in a clinical population and was similarly related to associated forms eating disordered psychopathology compared to established measures such as the GFFS, EDE, and EDI. The DFOT significantly predicted treatment outcomes in BN spectrum individuals including various forms of psychopathology and length of stay. A secondary goal of this study was to develop a measure which assesses how motivated AN individuals are to avoid treatment goal weight, defined as 90% of ideal body weight. The Fear of Treatment Goal Weight Scale (FTGW) removed the subjectivity that terms such as ‘fatness’ possess by providing an objective body weight and had greater variability than ‘fear of fatness’ among ANs. An initial use of the FTGW established sufficient internal consistency and validity in a clinical population. These novel measures were similarly related to associated forms eating and mood disordered psychopathology compared to established measures. Over the course of treatment, FTGW increased in AN individuals and significantly predicted treatment outcomes in this population. Both the DFOT and FTGW appeared to have incremental validity in predicting multiple outcomes above established measures of motivations for dieting. Utilization of these novel measures may be important in combination with existing measures of psychopathology for identifying individuals who are most appropriate for treatment. Moreover, the high endorsement of these measures in eating disordered psychopathology highlights the need for treatment approaches to address these treatment resistant constructs.
Article: Psychobiology of eating disorders[Show abstract] [Hide abstract]
ABSTRACT: Objectives of review. The goal of this review is to highlight selected advances during 2003–2004 in research on the psychobiology of the eating disorders. Summary of recent findings. Studies in bulimia nervosa (BN) have demonstrated associations between alterations in serotonin function and comorbid psychiatric disorders, while studies in both BN and anorexia nervosa (AN) have provided additional evidence for persistent, possibly trait-related alterations in serotonin regulation. Studies of leptin function have shown an association between circulating levels of the protein and symptom patterns during the course of recovery from AN. Studies of ghrelin function have provided new evidence for altered postprandial release of the peptide in BN and binge-eating disorder, and elevated baseline levels of the peptide in AN. Future directions. Additional research will be needed to assess both categorical and dimensional clinical correlates of alterations in these neuro-biological systems. Studies in individuals who have recovered from the eating disorders will be valuable in identifying stable psychobiological characteristics. Future results may lead to new pharmacological treatment approaches.