Endocrinopathies of eating disorders

The rise of eating disorders (EDs) globally and increase in cases reported among children, underscore the urgent need for a clearer understanding of the medical consequences of these disorders. Medical abnormalities in EDs engage the endocrine system, gastrointestinal tract, adipose tissue and sympathetic nervous system. Patients with EDs demonstrate endocrine dysregulation, which involves the hypothalamic-pituitary-adrenal axis with hypercortisolemia, the Growth Hormone- Insulin-Like Growth Factor (GH-IGF) axis through its effect on growth and bone health, and the hypothalamic-pituitary-gonadal axis through delayed puberty or hypogonadotrophic hypogonadism and amenorrhea. In most cases of emaciated patients, as in cases of anorexia nervosa, these features are related to malnutrition, weight loss, and adaptation to starvation. However, in other cases, such as in bulimia nervosa, these abnormalities exist in patients with stable weight. Patients with EDs also evidence abnormalities of the hypothalamic-pituitary-thyroid axis as well as osmoregulation disturbances. Nutritional rehabilitation and weight gain remain the most effective options for restoring the endocrine complex, with overall ED treatment outcome enhanced by early diagnosis and a multidisciplinary treatment approach.