神経性食思不振症, 内分学的並びに精神医学的考察

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Anorexia nervosa, characterized by refusal to eat resulting in marked cachexia and amenorrhea, has been recognized as having hypothalamic-pituitary dysfunctions and psychological manifestations. In order to investigate the pathophysiologic mechanism of anorexia nervosa, we studied various endocrinological functions, especially hypothalamic-pituitary functions and psychological or psychiatric aspects in 34 patients with this disease and also introduced some current topics in the pathogenesis and the treatment of this disease. Elevated serum GH, decreased serum LH and FSH in a fasting state were observed in 67,57 and 36 percent, respectively of 34 patients with anorexia nervosa when severely underweight. Basal serum TSH and PRL were almost normal in all patients. The LH and FSH response to LH-RH were low in 76 and 36 percent, respectively of the patients. Interestingly enough, menses stopped with the refusal to eat or prior to weight loss in almost all patients. The serum TSH response to TRH was low or absent in 38 percent and delayed in 90 percent of the patients. The serum PRL responses to TRH were exaggerated in 75 percent of the patients. An abnormal serum GH increase by TRH as shown in acromegaly was found in 38 percent. A Iow serum GH response to insulin-induced hypoglycemia, arginine or 1-dopa was found in 58 percent of the patients. These hypothalamic-pituitary dysfunctions in anorexia nervosa returned to normal after weight restoration. These findings suggest that hypothalamic dysfunctions in anorexia nervosa are resulted from primary but functional change and independent of the malnutritional state. An analysis of the psychological characteristics in our patients with anorexia nervosa revealed a desire to thinness in 83 percent, dependency on her mother in 71 percent, denial of illness with weight loss in 61 percent, hyperactivity in 50 percent, self-induced vomiting in 44 percent, use of a purgative in 39 percent, a depressive state in 22 percent, and episodes of bulimia in 22 percent of 34 patients. Recently, anorexia nervosa with bulimia has been recognized as a subgroup of this disease. In summary, anorexia nervosa is considered to have psychological or psychiatric manifestations and primary hypothalamic dysfunctions but their relationship remains still obscure.
日本心身医学会の論文
1981-12-01

神経性食思不振症, 内分学的並びに精神医学的考察

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