Child and Adolescent Psychiatric Clinics of North America
Volume 18, Issue 1 , Pages 117-129, January 2009

Leptin-Mediated Neuroendocrine Alterations in Anorexia Nervosa: Somatic and Behavioral Implications

  • Timo D. Müller

      Affiliations

    • Department of Child and Adolescent Psychiatry and Psychotherapy, University of Duisburg-Essen, Virchowstrasse 174, 45147 Essen, Germany
    • ,
  • Manuel Föcker, MD

      Affiliations

    • Department of Child and Adolescent Psychiatry and Psychotherapy, University of Duisburg-Essen, Virchowstrasse 174, 45147 Essen, Germany
    • ,
  • Kristian Holtkamp, MD

      Affiliations

    • Department of Child and Adolescent Psychiatry and Psychotherapy, University Clinics, RWTH Aachen, Neuenhofer Weg 21, 52074 Aachen, Germany
    • ,
  • Beate Herpertz-Dahlmann, MD

      Affiliations

    • Department of Child and Adolescent Psychiatry and Psychotherapy, University Clinics, RWTH Aachen, Neuenhofer Weg 21, 52074 Aachen, Germany
    • ,
  • Johannes Hebebrand, MD

      Affiliations

    • Department of Child and Adolescent Psychiatry and Psychotherapy, University of Duisburg-Essen, Virchowstrasse 174, 45147 Essen, Germany
    • Corresponding Author InformationCorresponding author.

Hypoleptinemia is a key endocrinological feature of anorexia nervosa (AN). Several symptoms in acute AN are related to the low circulating leptin levels including amenorrhea and semi-starvation–induced hyperactivity. The drop in leptin levels results from the loss of fat mass; once leptin levels fall below specific thresholds the hypothalamic-pituitary-gonadal and -thyroid axes are down-regulated; in contrast, the hypothalamic-pituitary-adrenal axis is up-regulated. Hypoleptinemia is the major signal underlying both somatic and behavioral adaptations to starvation. Because the mechanisms involved in this adaptation are similar in rodents and humans, rodent models can be used to investigate the relevant central pathways which underly the respective starvation-induced symptoms. During therapeutically induced weight gain, leptin levels can intermittently increase above normal concentrations. This hyperleptinemia could predispose to renewed weight loss.

Keywords: Hyperactivity, Semi-starvation, Osteoporosis, Amenorrhea, Hypoleptinemia, Hyperleptinema, Weight loss

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 This work was supported by grants from the Federal Ministry of Education and Research (NGFN2; 01GS0482, 01GS0483) and (01GV0602 360372), the European Union (FP6 LSHMCT-2003-503041), and the Deutsche Forschungsgemeinschaft (DFG; HE 1446/4-1).

PII: S1056-4993(08)00058-8

doi:10.1016/j.chc.2008.07.002

Child and Adolescent Psychiatric Clinics of North America
Volume 18, Issue 1 , Pages 117-129, January 2009

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