ESPE Abstracts

Background: Anorexia nervosa (AN) is a condition of severe malnutrition that impacts multiple endocrine axes, including the hypothalamic-pituitary-gonadal (HPG) axis. Although amenorrhea is no longer required for the diagnosis of AN (DSM-5), amenorrhea continues to be common in this disorder.

Objective and hypotheses: This talk will review the prevalence and consequences of HPG axis suppression and amenorrhea in adolescents with AN.

Method: Data for this talk come from observational and interventional studies examining the impact of AN and amenorrhea on bone, neurocognitive and emotional outcomes.

Results: Amenorrhea in girls with AN is a consequence of low energy availability, which impacts several hormones that in turn have deleterious effects on the HPG axis. Hypogonadism and other endocrine alterations lead to low bone density and impaired bone accrual at a time when healthy adolescents are typically actively accruing bone. Thus, there is a high prevalence of fractures in AN. Weight gain and menses restoration are critical for improving bone density, and physiologic estrogen replacement has beneficial effects. Hypogonadism may also have an impact on cognitive and emotional outcomes, with physiologic estrogen replacement improving both.

Conclusion: Hypogonadism in adolescents with AN contributes to low bone density and impaired cognitive and emotional outcomes that improve with restoration of estrogen status.