Table 1 Hormone abnormalities in anorexia nervosa (AN)
Hormone | Source | Relevant function in AN | Levels in AN |
|---|---|---|---|
Hypothalamic-pituitary–gonadal axis | |||
Gonadotropin-releasing hormone (GnRH) | Hypothalamus | Stimulates LH and FSH pulsatility | ↓ |
Luteinizing hormone (LH) | Anterior pituitary | Stimulates ovulation (women), stimulates testosterone production (men) | ↓ |
Follicle stimulating hormone (FSH) | Anterior pituitary | Stimulates folliculogenesis and estradiol production (women), stimulates spermatogenesis (men) | ↓ |
Estradiol | Ovaries (women); adipose tissue (men) | Stimulates osteoblasts and inhibits osteoclasts, ?anxiolytic effects | ↓ |
Testosterone | Testes (men); ovaries (women) | Stimulates osteoblasts and inhibits osteoclasts, ?anti-depressent effects | ↓ |
Hypothalamic–pituitary–adrenal axis | |||
Corticotropin-releasing hormone (CRH) | Hypothalamus | Stimulates ACTH pulsatility | ↑ |
Adrenocorticotropic hormone (ACTH) | Anterior pituitary | Stimulates cortisol production | ↑ |
Cortisol | Adrenal glands | Inhibits LH and FSH pulsatility, inhibits osteoblasts and stimulates osteoclasts, ?anxiety and depressive effects | ↑ |
Dehydroepiandrosterone sulfate (DHEAS) | Adrenal glands | ?Anxiolytic effects | No consensus |
Hypothalamic-pituitary-thyroid axis | |||
Thyroid-releasing hormone (TRH) | Hypothalamus | Stimulates TSH production | ↓ ← → |
Thyroid stimulating hormone (TSH) | Anterior pituitary | Stimulates T4 and T3 production | ↓ ← → |
Thyroxine (T4) | Thyroid | Increases metabolism | ↓ ← → |
Triiodothyronine (T3) | Thyroid | Increases metabolism, ?Anti-depressant effects | ↓ |
Reverse T3 (rT3) | Thyroid | Metabolically inactive | ↑ |
Growth hormone-insulin-like growth factor 1 axis | |||
Growth hormone (GH) | Anterior pituitary | Stimulates gluconeogenesis and lipolysis, stimulates osteoblasts and inhibits osteoclasts | ↑ (GH resistance) |
Insulin-like growth factor 1 (IGF-1) | Liver | Stimulates linear bone growth in adolescents with open physes, stimulates osteoblasts and inhibits osteoclasts | ↓ |
Hypothalamic hormones antidiuretic hormone and oxytocin | |||
Antidiuretic hormone | Hypothalamus | Stimulates water reabsorption in the kidney | ↑ ← → |
Oxytocin | Hypothalamus | ?Anxiolytic and anti-depressant effects, stimulates osteoblasts and inhibits osteoclasts | ↓ |
Gut-derived appetite regulating hormones | |||
Ghrelin | Gastrointestinal tract (mostly gastric cells) | Orexigenic, inhibits LH and FSH pulsatility, stimulates ACTH and GH secretion | ↑ |
Peptide YY (PYY) | Gastrointestinal tract (endocrine L cells) | Anorexigenic | ↑ ← → |
Adipokines, myokines, and hepatokines | |||
Leptin | Adipose tissue | Anorexigenic, stimulates kisspeptin signaling to GnRH neurons | ↓ |
Myostatin | Skeletal muscle | Inhibits muscle growth | ↓ |
Preadipocyte factor 1 (Pref-1) | Adipose tissue | Inhibits osteoblast and adipocyte differentiation | ↑ |
Fibroblast growth factor 21 (FGF-21) | Liver | Inhibits intracellular effects of GH | ↑ |