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Research Article| Volume 27, ISSUE 9, P1021-1037, May 01, 1990

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Disturbances in the hypothalamo-pituitary-adrenal and other neuroendocrine axes in bulimia

DOI:https://doi.org/10.1016/0006-3223(90)90038-4
Disturbances in the hypothalamo-pituitary-adrenal and other neuroendocrine axes in bulimia
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      Abstract

      Disturbances in the hypothalamo-pituitary-adrenal (HPA) and other endocrine axes were assessed in 24 women with bulimia and healthy controls. Overnight blood samples for measuring nocturnal plasma cortisol, prolactin (PRL), growth hormone (GH), luteinizing hormone (LH), and follicle stimulating hormone (FSH) were obtained at 30-min intervals. A 1.5 mg dexamethasone suppression test (DST) and a TRH-test were performed. Patients were monitored closely while their nutritional intake was recorded over 21 days. Compared with healthy controls, nocturnal cortisol plasma levels were not elevated in the bulimics. There was a trend toward insufficient cortisol suppression in the DST in patients with bulimia which was most pronounced in patients with signs of restricted caloric intake. Plasma dexamethasone levels were significantly reduced in bulimics compared with healthy controls. There was a trend for blunted thyrothropin stimulating hormone (TSH) responses to thyrotropin in releasing hormone (TRH) in bulimia. The prolactin response to TRH was significantly reduced in bulimics with a history of anorexia nervosa. Plasma LH and plasma FSH were significantly reduced in bulimics with signs of reduced caloric intake [low T3, high levels of beta-hydroxy-butyric acid (BHBA), reduced daily caloric intake, high number of fasting days] as compared with healthy controls. Bulimics with high BHBA levels had significantly reduced nocturnal prolactin plasma levels. Results show that multiple neuroendocrine disturbances exist in bulimia in a milder form than in anorexia nervosa. Evidence for the impact of caloric intake on endocrine functions is presented. Endocrine dysfunctions in our bulimic sample did not show a positive association with the presence of depressive symptoms.
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      References

        • Alleyne G.A.O.
        • Young V.H.
        Adrenocortical function in children with severe protein-calorie malnutrition.
        Clin Sci. 1967; 33: 189-200
        • Berger M.
        • Pirke K.M.
        • Krieg J.C.
        • von Zerssen D.
        The effect of weight loss and inappropriate plasma dexamethasone levels on the DST.
        Psychiatry Res. 1985; 15: 351-360
        • Bethge H.
        • Nagel A.M.
        • Solbach H.G.
        • Wiegelman W.
        • Zimmermann H.
        Zentrale Regulationsstörung der Nebennierinden-funktioin bei der Anorexia nervosa.
        Mat Med Nordm. 1970; 22: 204-214
        • Boyar R.M.
        • Hellman L.D.
        • Roffwarg H.P.
        • et al.
        Cortisol secretion and metabolism in anorexia nervosa.
        N Engl J Med. 1977; 296: 190-193
        • Cavagnini F.
        • Invitti C.
        • Passamonti M.
        • Polli E.E.
        Impaired ACTH response to CRF in patients with anorexia nervosa.
        in: Presented at the Congress on Biology of Eating Disorders, Pavia, Sept. 19851985 (Abstract 57)
        • Cooke J.N.C.
        • James V.H.T.
        • Landon J.
        • Wynn V.
        Adrenocortical function in chronic malnutrition.
        Br Med J. 1964; 1: 662-666
        • Copeland P.M.
        Neuroendocrine aspects of eating disorders.
        in: Emmet S.W. Theory and Treatment of Anorexia Nervosa and Bulimia. Brunner/Mazel, New York1985
        • Copeland P.M.
        • Herzog D.B.
        • Carr D.B.
        • Klibanski A.
        • MacLaughlin R.
        • Martin J.B.
        Effect of dexamethasone on cortisol and prolactin responses to meals in bulimic and normal women.
        Psychoneuroendocrinology. 1988; 13: 273-278
        • Doerr P.
        • Fichter M.M.
        • Pirke K.M.
        • Lund R.
        Relationship between weight gain and hypothalamic pituitary adrenal function in patients with anorexia nervosa.
        J Steroid Biochem. 1980; 13: 529-573
        • Edelstein C.K.
        • Roy-Byrne P.
        • Fawzy F.I.
        • Dornfeld L.
        Effects of weight loss on the dexamethasone suppression test.
        Am J Psychiatry. 1983; 140: 338
        • Fichter M.M.
        Bulimia Nervosa.
        in: Enke-Verlag, Stuttgart1989: 300-305
        • Fichter M.M.
        • Brunner E.
        • Wellhoener B.
        • Eiberger T.
        Epidemische Zunahme bulimischer Esstörungen.
        Psycho. 1986; 12: 398-400
        • Fichter M.M.
        • Doerr P.
        • Pirke K.M.
        • Lund R.
        Behavior, attitude, nutrition and endocrinology in anorexia nervosa.
        Acta Psychiatr Scand. 1982; 66: 429-440
        • Fichter M.M.
        • Keeser W.
        Das Anorexia Nervosa Inventar zur Selbstbeuteilung (ANIS).
        Eur Arch Psychiatry Neurol Sci. 1980; 228: 67-89
        • Fichter M.M.
        • Pirke K.M.
        Effect of experimental and pathological weight loss upon the hypothalamo-pituitary-adrenal axis.
        Psychoneuroendocrinology. 1986; 11: 295-305
        • Fichter M.M.
        • Pirke K.M.
        Effects of experimental starvation on the thyroid axis.
        in: Ferrari E. Brambilla F. Disorders of Eating Behavior: A Psychoneuroendocrine Approach, Advances of the Biosciences. Pergamon Press, Oxford1986
        • Fichter M.M.
        • Pirke K.M.
        • Holsboer F.
        Weight loss causes neuroendocrine disturbances: Experimental study in healthy starving subjects.
        Psychiatry Res. 1986; 17: 61-72
        • Fichter M.M.
        • Pirke K.M.
        • Pöllinger J.
        • Wolfram G.
        • Brunner E.
        Restricted caloric intake causes neuroendocrine disturbances in bulimia.
        in: Pirke K.M. Vandereycken W. Ploog D. The Psychobiology of Bulimia Nervosa. Springer Verlag, Berlin-Heidelberg-New York-Tokyo1988: 42-56
        • Freedman E.J.
        • Stolar M.
        • Gerner R.
        • Kramer M.
        Neuroendocrine Aspects of Bulimia.
        in: Presented at the Second International Conference on Eating Disorders, New York1986
        • Gerner R.H.
        • Gwirtsman H.E.
        Abnormalities of dexamethasone suppression test and urinary MHPG in anorexia nervosa.
        Am J Psychiatry. 1981; 138: 650-653
        • Gold P.W.
        • Gwirtsman H.
        • Avgerinos P.C.
        • et al.
        Abnormal hypothalamic-pituitary-adrenal function in anorexia nervosa.
        N Engl J Med. 1986; 314: 1335-1342
        • Gold P.W.
        • Loriaux D.L.
        • Roy A.
        • et al.
        Responses to corticotropin-releasing hormone in he hypercortisolism of deprression and Cuhing's disease.
        N Engl J Med. 1986; 314: 1329-1335
        • Gwirtsman H.E.
        • Roy-Byrne P.
        • Yager J.
        • Gerner R.H.
        Neuroendocrine abnormalities in bulimia.
        Am J Psychiatry. 1983; 140: 559-563
        • Gwirtsman H.E.
        • Kaye W.H.
        • George D.T.
        • Jimerson D.C.
        • Ebert M.H.
        • Gold P.W.
        Central and peripheral ACTH and cortisol levels in anorexia nervosa and bulimia.
        Arch Gen Psychiatry. 1989; 46: 61-69
        • Haak D.
        • Vecsei P.
        • Lichtwald K.
        • Klee H.R.
        • Gless K.H.
        Some experiences on radioimmunoassays of synthetic glucocorticoids.
        Allergology. 1980; 3: 259-263
        • Hamilton M.
        Development of rating scale for primary depressive illness.
        Br J Soc Clin Psychol. 1967; 6: 278-296
        • Heinisch B.
        • Wolfram G.
        Ernährungsverhalten von Studentinnen.
        Diplomarbeit an der Technischen Universität München, Fachbereich Oecotrophologie in Weihenstephan, 1987
        • Hotta M.
        • Shibasaki T.
        • Masuda
        • et al.
        The response of plasma adrenocorticotropin and cortisol to corticotropin releasing hormone (CRH) and cerebrospinal fluid immunoreactive CRH in anorexia nervosa patients.
        J Clin Endocrinol Metab. 1986; 62: 319-324
        • Hudson J.I.
        • Katz D.L.
        • Pope H.G.
        • Hudson M.S.
        • Griffing G.T.
        • Melby J.C.
        Urinary free cortisol and response to dexamethasone suppression test in bulimia: A pilot study.
        Int J Eating Disorders. 1987; 6: 191-198
        • Hudson J.I.
        • Laffer P.S.
        • Pope H.G.
        Bulimia related to affective disorder by family history and response to the dexamethasone suppression test.
        Am J Psychiatry. 1982; 139: 685-697
        • Hudson J.I.
        • Pope Jr, H.G.
        Psychopharmakologische Behandlung der Bulimia.
        in: Fichter M.M. Bulimia Nervosa. Enke, Stuttgart1989
        • Hudson J.I.
        • Hope Jr, H.G.
        • Jonas J.M.
        • Laffer P.S.
        • Hudson M.S.
        • Melby J.C.
        Hypothalamic-pituitary-adrenal-axis hyperactivity in bulimia.
        Psychiatry Res. 1983; 8: 111-117
        • Hudson J.I.
        • Pope Jr, H.G.
        • Jonas J.M.
        • Yurgelin-Todd D.
        Phenomenologic relantioship of eating disorders to major affective disorder.
        Psychiatry Res. 1983; 9: 345-353
        • Kaplan A.S.
        • Garfinkel P.E.
        • Brown G.M.
        Neuroendocrine responses in bulimia.
        in: Ferrari A. Brambilla F. Biology of Eating Disorders. Pergamon Press, Oxford1986: 241-245
        • Kaplan A.S.
        • Garfinkel P.E.
        • Brown G.M.
        The DST and TRH-test in bulimia nervosa.
        Br J Psychiatry. 1989; 154: 86-92
        • Kaye W.H.
        • Gwirtman H.E.
        • George D.T.
        Endocrine consequences of binging and purging in bulimia.
        in: Presented at the Regional Congress of the World Federation of Societies of Biological Psychiatry (WFSBP) on Biological Aspects at Non-psychiatric Disorders, Jerusalem, April 2–41989
        • Kaye W.H.
        • Gwirtman H.E.
        • George D.T.
        • et al.
        Elevated cerebrospinal fluid level of immunoreactive corticotropin-releasing hormone in anorexia nervosa: Relation to state of nutrition, adrenal function and intensity of depression.
        J Clin Endocrinol Metab. 1987; 64: 203-208
        • Kemsley W.F.F.
        Matched population mean weight.
        in: Crip A.H. Anorexia Nervosa: Let Me Be. Academic Press, London1980
        • Kennedy S.H.
        • Garfinkel P.E.
        • Parienti V.
        • Costa D.
        • Brown G.M.
        Changes in melatonin levels but not cortisol levels are associated with depression in patients with eating disorders.
        Arch Gen Psychiatry. 1989; 46: 73-78
        • Kiriike N.
        • Nishiwaki S.
        • Izumiya Y.
        • Kawakita Y.
        Dexamethasone suppression test in bulimia.
        Biol Psychiatry. 1986; 21: 325-328
        • Levy A.B.
        • Dixon K.M.
        DST in bulimia without endogenous depression.
        Biol Psychiatry. 1987; 22: 783-786
        • Levy A.B.
        • Malarkey W.B.
        Growth hormone and somatomedin-C in bulimia.
        Psychoneuroendocrinology. 1988; 13: 359-362
        • Lindy D.C.
        • Walsh B.T.
        • Roose S.P.
        • Gladis M.
        • Glassman A.H.
        The dexamethasone suppression test in bulimia.
        Am J Psychiatry. 1985; 142: 1375-1376
        • Meikle A.W.
        Dexamethasone suppression tests: Usefulness of simultaneous measurement of plasma cortisol and dexamethasone.
        Clin Endocrinol. 1982; 16: 401-408
        • Meikle A.W.
        • Lagerquist L.G.
        • Tyler F.H.
        Apparently normal pituitary-adrenal suppressibility in Cushing's syndrome: Dexamethasone metabolism and plasma levels.
        J Lab Clin Med. 1975; 86: 472-478
        • Mitchell J.E.
        • Bantle J.P.
        Metabolic and endocrine investigations in women at normal weight with the bulimic syndrome.
        Biol Psychiatry. 1983; 18: 355-365
        • Mitchell J.E.
        • Pyle R.L.
        • Hatsukawi D.
        • Bontacoff L.I.
        The dexamethasone suppression test in patients with bulimia.
        J Clin Psychiatry. 1984; 45: 508-511
        • Musisi S.
        • Garfinkel P.E.
        Comparative dexamethasone suppression test measurements in bulimia, depression and normal controls.
        Can J Psychiatry. 1985; 30: 190-194
        • Neill J.
        Neuroendocrine regulation of prolactin secretion.
        Front Neuroendocrinol. 1980; 6: 129-155
        • Norris P.D.
        • O'Malley B.P.
        • Palmer R.L.
        The TRH-test in bulimia and anorexia nervosa: A controlled study.
        J Psychiatr Res. 1985; 19: 215-219
        • O'Brien G.
        • Hassanyeh F.
        • Leake K.
        • Schapira K.
        • White M.
        • Ferrier
        The dexamethasone suppression test in bulimia nervosa.
        Br J Psychiatry. 1988; 152: 654-656
        • Perez E.
        • Blouin J.
        • Barlow J.
        • Bloin A.
        The dexamethasone suppression test in bulimia.
        in: Presented at the Second International Conference on Eating Disorders, April 19861986
        • Pfannendörfer H.
        • Arab L.
        KALI -Kodierungs- und Auswertungsprogrammfür Lebensmittel- Inhalsstoffe.
        in: Arab L. Karg G. Berichte der Bundesforschungsanstalt für Ernährung. BFE-R-84-04 Bundesanstalt für Ernährung, Karlsruhe1984
        • Pirke K.M.
        • Fichter M.M.
        • Chlond C.
        • et al.
        Disturbances of menstrual cycle in bulimia nervosa.
        Clin Endocrinol. 1987; 27: 245-251

      55. Pirke KM, Schweiger U, Fichter MM (in press): Disturbances in the hypothalamic-pituitary-gonadal-axis in bulimia. Acta Endocrinologica.

        • Piran N.
        • Kennedy S.H.
        • Garfinkel P.E.
        • Owens M.
        Affective disturbance in eating disorders.
        J Nerv Ment Dis. 1985; 173: 395-400
        • Rosenthal N.E.
        • Heffernan M.M.
        Bulimia, carbohydrate craving and depression: A central connection.
        in: Wurtman R.J. Wurtman J.J. Nutrition and the Brain. Raven Press, New York1986
        • Schlesser M.
        • Rush A.
        • Fairchild C.
        • Crowley G.
        • Orsulak P.
        The thyrotropin-releasing hormone stimulation test: A methodological study.
        Psychiatry Res. 1983; 9: 59-68
        • Schweiger U.
        • Poellinger J.
        • Laessle R.
        • Wolfram G.
        • Fichter M.M.
        • Pirke K.M.
        Altered insulin response to a balanced test meal in bulimic patients.
        Int J Eating Disorders. 1987; 6: 551-556
        • Smith S.R.
        • Bledsoe T.
        • Chhetri M.K.
        Cortisol metabolism and the pituitary-adrenal axis in adults with protein-calorie malnutrition.
        J Clin Endocrinol Metab. 1975; 40: 43-52
        • Strober M.
        • Katz J.L.
        Do eating disorders and affective disorders share a common etiology? A dissenting opinion.
        Int J Eating Disorders. 1987; 6: 171-180
        • von Zerssen D.
        • Koeller D.M.
        Klinische Selbstbeurteilungs-skalen (KSB-S) aus dem Münchner Psychiatrischen Informationssystem.
        Beltz, Weinheim1976
        • Walsh B.T.
        • Katz J.L.
        • Levin J.
        • et al.
        Adrenal activity in anorexia nervosa.
        Psychosom Med. 1978; 40: 499-506
        • Walsh B.T.
        • Katz J.L.
        • Levin J.
        • et al.
        The production rate of cortisol declines during recovery from anorexia nervosa.
        J Clin Endocrinol Metab. 1981; 53: 203-205
        • Walsh B.T.
        • Kissileff H.R.
        • Cassidy S.M.
        • Dantzic S.
        Eating behavior of women with bulimia.
        Arch Gen Psychiatry. 1989; 46: 54-58
        • Walsh B.T.
        • Lo E.S.
        • Cooper T.
        • et al.
        The DST and plasma dexamethasone levels in bulimia.
        Arch Gen Psychiatry. 1987; 44: 799-800
        • Walsh B.T.
        • Roose S.P.
        • Katz J.L.
        • et al.
        Hypothalamic-pituitary-adrenal activity in anorexia nervosa and bulimia.
        Psychoneuroendocrinology. 1987; 12: 131-140
        • Williamson D.H.
        • Mellonby J.
        Bermeyer H.U. Methoden der Enzymatischen Analyse. Verlag Chemie, Weinheim1974: 1883-1886
        • Woell C.
        • Fichter M.M.
        • Pirke K.M.
        • Wolfram G.
        Eating behavior of patients with bulimia nervosa.
        Int J Eating Disord. 1989; 8: 557-568

      Article info

      Publication history

      Received in revised form: June 8, 1989
      Received: March 1, 1988

      Identification

      DOI: https://doi.org/10.1016/0006-3223(90)90038-4

      Copyright

      © 1990 Published by Elsevier Inc.

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