pituitrin and Anorexia-Nervosa

Anorexia nervosa (AN) is a serious eating disorder associated with numerous medical complications, including alterations in water balance and impaired osmoregulation.. The aim of this paper is to review the evidence-based literature and discuss the potential pathophysiological mechanisms of impaired osmoregulation observed in patients with AN.. Although limited, the evidence suggests that the pathophysiological mechanisms causing impaired osmoregulation in AN is multifactorial and includes abnormalities in osmoregulation of vasopressin, intrinsic renal defects and the influence of antidepressants often used in the treatment of patients with AN. Physicians treating patients with AN should be aware of this complication and the possible multifactorial etiology contributing to this medical complication.

Topics: Adolescent; Anorexia Nervosa; Antidepressive Agents; Evidence-Based Medicine; Humans; Kidney; Kidney Failure, Chronic; Vasopressins; Water-Electrolyte Imbalance

Starvation-induced alterations of neuropeptide activity probably contribute to neuroendocrine dysfunctions in anorexia nervosa. For example, CRH alterations contribute to hypercortisolemia and NPY alterations may contribute to amenorrhea. Alterations of these peptides as well as opioids, vasopressin, and oxytocin activity could contribute to other characteristic psychophysiological disturbances, such as reduced feeding, in acutely ill anorexics. Such neuropeptide disturbances could contribute to the vicious cycle that has been hypothesized to occur in anorexia nervosa. That is, the consequences of malnutrition perpetuate pathological behavior.

Topics: Anorexia Nervosa; Corticotropin-Releasing Hormone; Feeding Behavior; Humans; Neuropeptide Y; Neuropeptides; Neurosecretory Systems; Opioid Peptides; Oxytocin; Starvation; Vasopressins

Topics: Adolescent; Adrenocorticotropic Hormone; Adult; Age Factors; Anorexia Nervosa; Bulimia; Child; Corticotropin-Releasing Hormone; Depression; Exercise; Fasting; Humans; Hypothalamo-Hypophyseal System; Pituitary-Adrenal System; Vasopressins

Since the approval of lithium use in treatment of acute mania, there have been numerous clinical trials of lithium in medical and psychiatric disorders. This paper gives a brief review of the literature on lithium trials in approximately fourteen medical conditions. These are: hyperthyroidism, metabolizing thyroid cancer, syndrome of inappropriate secretion of antidiuretic hormone, premenstrual tension syndrome, anorexia nervosa, Felty's syndrome, chemotherapy-induced neutropenia, aplastic anemia, seborrheic dermatitis, eczematoid dermatitis, cyclic vomiting, diabetes mellitus and asthma. Most of the case reports cited showed the efficacy of the side effects from lithium salt in the management of the symptoms and signs of these disorders, however, well-designed and controlled studies give negative results. The positive results are reported in the group of disorders having an underlying subdromal affective syndrome such as premenstrual tension syndrome and anorexia nervosa. Other encouraging reports include the effect of lithium to induce leucocytosis in Felty's syndrome and chemotherapy-induced neutropenia.

Topics: Anorexia Nervosa; Clinical Trials as Topic; Drug Interactions; Felty Syndrome; Female; Hematologic Diseases; Humans; Hyperphagia; Hyperthyroidism; Lithium; Mental Disorders; Premenstrual Syndrome; Skin Diseases; Thyroid Neoplasms; Vasopressins

Topics: Adolescent; Adrenal Glands; Adult; Anorexia Nervosa; Combined Modality Therapy; Female; Gonadotropins, Pituitary; Growth Hormone; Humans; Male; Thyroid Gland; Vasopressins

Topics: 17-Hydroxycorticosteroids; Adrenal Cortex; Adrenal Glands; Adrenocorticotropic Hormone; Anorexia Nervosa; Blood Glucose; Brain Diseases; Catecholamines; Child; Circadian Rhythm; Cyproterone; Dexamethasone; Growth Hormone; Humans; Hydrocortisone; Hypoglycemia; Hypothalamus; Infant; Insulin; Metyrapone; Nephrotic Syndrome; Obesity; Pituitary Gland; Prednisone; Vasopressins

Topics: 17-Ketosteroids; Adrenal Glands; Adrenocorticotropic Hormone; Amenorrhea; Anorexia; Anorexia Nervosa; Basal Metabolism; Body Temperature Regulation; Cholesterol; Dopamine; Female; Gonadotropins; Growth Hormone; Humans; Hypothalamus; Prolactin; Starvation; Thyroid Gland; Vasopressins

Topics: Adrenal Glands; Anorexia Nervosa; Behavior; Blood Glucose; Body Temperature Regulation; Body Water; Body Weight; Feeding Behavior; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Growth Hormone; Humans; Hydrocortisone; Hypothalamus; Insulin; Luteinizing Hormone; Male; Pituitary Function Tests; Prolactin; Thyrotropin; Thyrotropin-Releasing Hormone; Vasopressins

Since the approval of lithium use in treatment of acute mania, there have been numerous clinical trials of lithium in medical and psychiatric disorders. This paper gives a brief review of the literature on lithium trials in approximately fourteen medical conditions. These are: hyperthyroidism, metabolizing thyroid cancer, syndrome of inappropriate secretion of antidiuretic hormone, premenstrual tension syndrome, anorexia nervosa, Felty's syndrome, chemotherapy-induced neutropenia, aplastic anemia, seborrheic dermatitis, eczematoid dermatitis, cyclic vomiting, diabetes mellitus and asthma. Most of the case reports cited showed the efficacy of the side effects from lithium salt in the management of the symptoms and signs of these disorders, however, well-designed and controlled studies give negative results. The positive results are reported in the group of disorders having an underlying subdromal affective syndrome such as premenstrual tension syndrome and anorexia nervosa. Other encouraging reports include the effect of lithium to induce leucocytosis in Felty's syndrome and chemotherapy-induced neutropenia.

Topics: Anorexia Nervosa; Clinical Trials as Topic; Drug Interactions; Felty Syndrome; Female; Hematologic Diseases; Humans; Hyperphagia; Hyperthyroidism; Lithium; Mental Disorders; Premenstrual Syndrome; Skin Diseases; Thyroid Neoplasms; Vasopressins

Antidiuretic hormone (ADH) is involved in the response to stress and in depression and anxiety. However, studies on ADH in anorexia nervosa (AN) show conflicting results. A major reason for this may be methodological challenges due to short half-life of ADH in circulation and rapid degradation in vitro. To overcome these obstacles, copeptin, the C-terminal fragment stemming from the ADH precursor, has been increasingly used as a stable clinical measure for ADH. Furthermore, copeptin has been recognized as a biomarker of insulin resistance in obesity.. We measured fasting copeptin in plasma from 25 normohydrated, stable women with AN (BMI 13.0 ± 2.0) and 25 age-matched women.. No difference in copeptin levels was found (6.8 ± 1.8 vs. 5.5 ± 0.5 pmol/L). Confirmatory, copeptin concentrations were correlated to insulin resistance assessed by the homeostasis model assessment of insulin resistance.. We report for the first time that copeptin level as a marker of ADH activity is not altered in fluid- and electrolyte-stabilized patients with severe AN patients, indicating that ADH may not be crucial in the pathophysiological involvement of psychologic stress in AN.

Topics: Adult; Anorexia Nervosa; Biomarkers; Female; Glycopeptides; Humans; Vasopressins

Previously, we identified that a majority of patients with anorexia nervosa (AN) and bulimia nervosa (BN) as well as some control subjects display autoantibodies (autoAbs) reacting with alpha-melanocyte-stimulating hormone (alpha-MSH) or adrenocorticotropic hormone, melanocortin peptides involved in appetite control and the stress response. In this work, we studied the relevance of such autoAbs to AN and BN. In addition to previously identified neuropeptide autoAbs, the current study revealed the presence of autoAbs reacting with oxytocin (OT) or vasopressin (VP) in both patients and controls. Analysis of serum levels of identified autoAbs showed an increase of IgM autoAbs against alpha-MSH, OT, and VP as well as of IgG autoAbs against VP in AN patients when compared with BN patients and controls. Further, we investigated whether levels of these autoAbs correlated with psychological traits characteristic for eating disorders. We found significantly altered correlations between alpha-MSH autoAb levels and the total Eating Disorder Inventory-2 score, as well as most of its subscale dimensions in AN and BN patients vs. controls. Remarkably, these correlations were opposite in AN vs. BN patients. In contrast, levels of autoAbs reacting with adrenocorticotropic hormone, OT, or VP had only few altered correlations with the Eating Disorder Inventory-2 subscale dimensions in AN and BN patients. Thus, our data reveal that core psychobehavioral abnormalities characteristic for eating disorders correlate with the levels of autoAbs against alpha-MSH, suggesting that AN and BN may be associated with autoAb-mediated dysfunctions of primarily the melanocortin system.

Topics: Adult; Analysis of Variance; Anorexia Nervosa; Autoantibodies; Behavioral Symptoms; Bulimia Nervosa; Enzyme-Linked Immunosorbent Assay; Estonia; Female; Humans; Immunohistochemistry; Melanocyte-Stimulating Hormones; Neuropeptides; Oxycodone; Vasopressins

Anorexia nervosa (AN) has been associated with abnormal osmoregulation and impaired urinary concentrating capacity. Conflicting results suggest that the disorder may be related to hypothalamic dysfunction and/or a primary renal defect. The role of antidepressants, which are increasingly prescribed in AN patients, has not been evaluated.. We analysed renal function as well as electrolyte disturbances and osmoregulation parameters at baseline and following a water deprivation test in 12 well-defined AN patients (all females, 10 taking antidepressants) vs 12 age-matched controls and 11 young female patients taking antidepressants.. In comparison with matched controls, patients with AN were characterized by a significant alteration of osmoregulation both at baseline [lower plasma sodium and osmolality, abnormally high levels of antidiuretic hormone (ADH) and tendency towards more concentrated urine] and after water deprivation (impaired ADH reaction and lower urinary concentrating ability). The AN patients had no electrolyte abnormalities. The two patients with the shortest duration of AN showed a normal urinary concentrating ability. Patients taking antidepressants showed similar but less marked changes than AN patients, including a lower urinary concentrating ability.. These results show that AN patients are characterized by abnormal osmoregulation at baseline and a lack of reactivity of ADH with a significant urinary concentrating defect after water deprivation. The origin of these defects in AN patients is probably multifactorial, but the duration of the disease and the prescription of antidepressants could play a role.

Topics: Adult; Anorexia Nervosa; Antidepressive Agents; Body Height; Body Mass Index; Body Weight; Case-Control Studies; Female; Humans; Vasopressins; Water-Electrolyte Balance

When ill, people with eating disorders have disturbances of the neuropeptides vasopressin and oxytocin.. To avoid the confounding effects of the ill state, we studied women who were recovered (more than 1 year, normal weight, and regular menstrual cycles, no bingeing or purging) from bulimia nervosa (rBN) or binge eating/purging-type anorexia nervosa (rAN-BN), and matched healthy control women.. Vasopressin was elevated in rAN-BN and showed a trend towards elevation in rBN. In rBN, elevated cerebrospinal fluid vasopressin may be related to having a lifetime history of major depression. In comparison, cerebrospinal fluid oxytocin was normal in recovered subjects, but elevated levels in some rBN might be related to birth control pill use.. These data confirm and extend the possibility that elevated cerebrospinal fluid vasopressin may be related to the pathophysiology of eating disorders, and/or a lifetime history of major depression.

Topics: Adult; Anorexia Nervosa; Bulimia; Female; Humans; Oxytocin; Time Factors; Vasopressins

Anorexia nervosa is associated with vasopressin, oxytocin and serotonin abnormalities. Because of the relationship between exercise and anorexia nervosa, we explored the weight-loss syndrome produced by wheel running in food-deprived rats. Its effects on regional vasopressin and oxytocin concentrations were determined under basal conditions and following systemic fluoxetine. Weight-matched, exercised and unexercised rats served as controls. Fluoxetine caused abnormalities in suprachiasmatic vasopressin and dynorphin A content and in thymus oxytocin content that did not occur in weight-matched or exercised controls. No syndrome-specific anomalies occurred in the hypothalamo-neurohypophysial system or dorsal vagal complex (DVC). However, weight reduction and fluoxetine increased circulating vasopressin; moderate exercise caused fluoxetine-induced elevations in posterior pituitary vasopressin and oxytocin; and, unlike the other groups, fluoxetine increased DVC oxytocin in freely fed unexercised rats. It was concluded that syndrome-specific vasopressin and oxytocin abnormalities occur that are not secondary to weight loss or moderate exercise; that weight loss or fluoxetine increases circulating vasopressin; that moderate exercise alters neurohypophysial vasopressin and oxytocin content; and that weight loss or exercise inhibits a fluoxetine-stimulated increase in DVC oxytocin. Finally, it was argued that the fluoxetine abnormalities indicate possible serotonin dysfunction in the syndrome.

Topics: Animals; Anorexia Nervosa; Behavior, Animal; Body Weight; Dynorphins; Eating; Fluoxetine; Male; Oxytocin; Physical Conditioning, Animal; Rats; Rats, Sprague-Dawley; Suprachiasmatic Nucleus; Supraoptic Nucleus; Vagus Nerve; Vasopressins

The incidence of anorexia nervosa is increasing in adolescents. The pediatrician caring for teenagers is often the first professional confronted with the early signs and symptoms of this disorder. Clinical features and available literature on the psychological, nutritional, and family disorganization found in patients with anorexia nervosa are reviewed. Different therapeutic approaches are discussed, and current data on outcome are presented.

Topics: Adolescent; Adrenal Glands; Adult; Anorexia Nervosa; Body Temperature Regulation; Endocrine System Diseases; Family Characteristics; Female; Gonadotropins; Humans; Nutrition Disorders; Prognosis; Thyroid Gland; Vasopressins

Topics: Adolescent; Adrenal Cortex Hormones; Anorexia Nervosa; Female; Growth Hormone; Hormones; Humans; Pituitary Hormones, Anterior; Prolactin; Thyroid Hormones; Vasopressins

A patient with ectopic pinealoma first presented with apparent anorexia nervosa and hypernatraemic coma. A history of diabetes insipidus two months previously was not known on admission to hospital. The diabetes insipidus was unmasked by the administration of steroids. Neuroendocrinal and neuropathological aspects of the case are discussed with reference to the march of symptoms due to the growth of the tumour. Histochemical evidence is presented supporting the similarity between ectopic pinealoma and seminoma which suggests that they may more properly be referred to as atypical teratomas.

Topics: Acid Phosphatase; Adult; Alkaline Phosphatase; Anorexia Nervosa; Brain Neoplasms; Coma; Diabetes Insipidus; Dihydrolipoamide Dehydrogenase; Dysgerminoma; Electron Transport Complex IV; Esterases; Female; Humans; Hydrocortisone; Hypernatremia; Hypothalamus; Male; Osmolar Concentration; Oxidoreductases; Pinealoma; Sodium; Testicular Neoplasms; Thyroxine; Tuberculosis; Vasopressins

Topics: Acromegaly; Adenoma; Adolescent; Adrenal Gland Neoplasms; Adrenocorticotropic Hormone; Adult; Anorexia Nervosa; Brain Diseases; Brain Neoplasms; Cushing Syndrome; Endocrine System Diseases; Female; Humans; Hydrocortisone; Hypothalamus; Injections, Intramuscular; Lysine; Male; Metyrapone; Middle Aged; Pituitary Neoplasms; Pituitary-Adrenal Function Tests; Vasopressins

Topics: Adolescent; Adult; Anorexia Nervosa; Female; Humans; Hypothalamus; Oxytocin; Pregnancy; Psychophysiologic Disorders; Puerperal Disorders; Vasopressins

Topics: Anorexia Nervosa; Estrogens; Female; Gonadotropins; Humans; Hypothalamus; Male; Psychophysiology; Urine; Vasopressins; Water-Electrolyte Balance

Topics: Adrenocortical Hyperfunction; Amenorrhea; Anorexia Nervosa; Diabetes Insipidus; Endocrine System Diseases; Female; Goiter; Graves Disease; Humans; Hypopituitarism; Metabolism; Obesity; Psychology; Psychosomatic Medicine; Psychotherapy; Syndrome; Vasopressins; Water-Electrolyte Balance