Aim: To examine the prevalence of endocrine abnormalities and outcome in children and adolescents with Anorexia nervosa (AN).
Methods: The study cohort consisted of 181 patients (age 14.6±1.9 years; 160 girls, 21 boys) with AN (n=137), atypical AN (n=6) and other eating disorders except of Bulimia (n=38) who were hospitalized between Jan 2010 and Feb 2013. Somatometric [body-mass-index (BMI), BMI-SDS] and endocrine parameters were analysed retrospectively.
Results: Serum concentrations (mean, range) were determined for leptin (1.60, 0.4-22.0 ng/ml), 8h-cortisol (18.2, 0.9-39.1 g/dl), basal LH (0.11, 0.1-8.19 mU/ml), basal FSH (2.94, 0.1-13.1 mU/ml), TSH (1.97, 0.01-6.37 μU/ml) and free-T4 (1.06, 0.6-4.19 ng/dl). 57.9% of patients had leptin levels below 2.0 ng/ml (31.4% below 1.0 ng/ml). 1.8% of patients had suppressed TSH (<0.6 μU/ml) and 9.8% elevated TSH (>4.0 μU/ml) along with normal free-T4 (>0.9 ng/dl). Hypercortisolaemia (>25.0 g/dl) was detected in 7.7% of patients. BMI-SDS at admission (−2.26±1.02, −6.0 to 0.2) was significantly correlated with leptin (R=0.25, P=0.002) and LH (R=0.24, P=0.004). Leptin was correlated with LH (R=0.30, P=0.001) and FSH (R=0.23, P=0.012). No correlation with patients age was found. During hospitalization (duration 16.4±10.3 days), BMI-SDS increased by 0.46±0.57. BMI-SDS gain was negatively correlated with leptin (R=−0.25, P=0.002), but not with other baseline parameters. Multiple regression analysis revealed length of stay (β=0.227, P=0.020), BMI-SDS at admission (β=−0.274, P=0.005) and leptin (β=−0.205, P=0.024) as independent covariates of BMI-SDS gain.
Conclusion: Data of this large study population indicate that the positive effect of hospitalization on weight gain is influenced by prolonged stay as well as low weight and low leptin levels at admission. Thus, decreased leptin levels at admission could not be confirmed to be a negative predictor of short-term treatment success.
20 - 22 Sep 2014
European Society for Paediatric Endocrinology