Abnormal hypothalamic-pituitary-adrenal function in anorexia nervosa. Pathophysiologic mechanisms in underweight and weight-corrected patients

P. W. Gold, H. Gwirtsman, P. C. Avgerinos, L. K. Nieman, W. T. Gallucci, W. Kaye, D. Jimerson, M. Ebert, R. Rittmaster, Donald (Lynn) Loriaux

Research output: Contribution to journalArticle

385 Citations (Scopus)

Abstract

To study the pathophysiology of hypercortisolism in patients with anorexia nervosa, we examined plasma ACTH and cortisol responses to ovine corticotropin-releasing hormone before and after correction of weight loss. We also studied patients with bulimia whose weight was normal, since this disorder has been suspected to be a variant of anorexia nervosa. Before their weight loss was corrected, the anorexic patients had marked hypercortisolism but normal basal plasma ACTH. The hypercortisolism was associated with a marked reduction in the plasma ACTH response to corticotropin-releasing hormone. When these patients were studied three to four weeks after their body weight had been restored to normal, the hypercortisolim had resolved but the abnormal response to corticotropin-releasing hormone remained unchanged. On the other hand, at least six months after correction of weight loss their responses were normal. The bulimic patients whose weight was normal also had a normal response to corticotropin-releasing hormone. We conclude that in underweight anorexics, the pituitary responds appropriately to corticotropin-releasing hormone, being restrained in its response by the elevated levels of cortisol. This suggests that hypercortisolism in anorexics reflects a defect at or above the hypothalamus. The return to eucortisolism soon after correction of the weight loss indicates resolution of this central defect despite persistence of abnormalities in adrenal function.

Original languageEnglish (US)
Pages (from-to)1335-1342
Number of pages8
JournalNew England Journal of Medicine
Volume314
Issue number21
StatePublished - 1986
Externally publishedYes

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Thinness
Corticotropin-Releasing Hormone
Anorexia Nervosa
Cushing Syndrome
Weight Loss
Weights and Measures
Adrenocorticotropic Hormone
Hydrocortisone
Bulimia
Hypothalamus
Sheep
Body Weight

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Abnormal hypothalamic-pituitary-adrenal function in anorexia nervosa. Pathophysiologic mechanisms in underweight and weight-corrected patients. / Gold, P. W.; Gwirtsman, H.; Avgerinos, P. C.; Nieman, L. K.; Gallucci, W. T.; Kaye, W.; Jimerson, D.; Ebert, M.; Rittmaster, R.; Loriaux, Donald (Lynn).

In: New England Journal of Medicine, Vol. 314, No. 21, 1986, p. 1335-1342.

Research output: Contribution to journalArticle

Gold, PW, Gwirtsman, H, Avgerinos, PC, Nieman, LK, Gallucci, WT, Kaye, W, Jimerson, D, Ebert, M, Rittmaster, R & Loriaux, DL 1986, 'Abnormal hypothalamic-pituitary-adrenal function in anorexia nervosa. Pathophysiologic mechanisms in underweight and weight-corrected patients', New England Journal of Medicine, vol. 314, no. 21, pp. 1335-1342.
Gold, P. W. ; Gwirtsman, H. ; Avgerinos, P. C. ; Nieman, L. K. ; Gallucci, W. T. ; Kaye, W. ; Jimerson, D. ; Ebert, M. ; Rittmaster, R. ; Loriaux, Donald (Lynn). / Abnormal hypothalamic-pituitary-adrenal function in anorexia nervosa. Pathophysiologic mechanisms in underweight and weight-corrected patients. In: New England Journal of Medicine. 1986 ; Vol. 314, No. 21. pp. 1335-1342.
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