Effects of Anorexia Nervosa on the Endocrine System

Pediatr Endocrinol Rev. 2017 Mar;14(3):302-311. doi: 10.17458/per.vol14.2017.BMK.effectsanorexianervosa.


Anorexia nervosa (AN) is characterized by severe undernutrition associated with alterations in multiple endocrine axes, which are primarily adaptive to the state of caloric deprivation. Hormonal changes include growth hormone (GH) resistance with low insulin like growth factor-1 (IGF-1) levels, hypothalamic hypogonadism, relative hypercortisolemia and changes in appetite regulating hormones, including leptin, ghrelin, and peptide YY. These alterations contribute to abnormalities in bone metabolism leading to low bone mass, impaired bone microarchitecture, and increased risk for fracture, and may also negatively impact cognition, emotions and mood. The best strategy to improve all biologic outcomes is weight and menstrual recovery. Physiological estrogen replacement improves bone accrual rates and measures of trait anxiety in adolescents with AN. Other therapies including testosterone and IGF-1 replacement, and use of DHEA with oral estrogen-progesterone combination pills, bisphosphonates and teriparatide have also been studied to improve bone outcomes.

Keywords: Anorexia Nervosa; Bone; Endocrine alterations; Mood.

Publication types

  • Review

MeSH terms

  • Anorexia Nervosa / complications*
  • Anorexia Nervosa / diagnosis
  • Anorexia Nervosa / physiopathology*
  • Drug Resistance
  • Endocrine System / physiopathology*
  • Endocrine System Diseases / diagnosis
  • Endocrine System Diseases / etiology
  • Euthyroid Sick Syndromes / diagnosis
  • Euthyroid Sick Syndromes / etiology
  • Female
  • Human Growth Hormone / physiology
  • Humans
  • Male
  • Menstruation Disturbances / diagnosis
  • Menstruation Disturbances / etiology
  • Mental Disorders / complications
  • Mental Disorders / diagnosis


  • Human Growth Hormone