神経性食思不振症の内分泌学的検討とくに肥満症との対比

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Various endocrinological aspects of thirteen patients with anorexia nervosa were studied in contrast with five patients with simple obesity. Our criteria for the diagnosis of anorexia nervosa are as follows ; 1. Weight loss of at least 30% of ideal body weight, 2. Secondary amenorrhea, 3. Disorders of eating behavior such as anorexia, bulimia, and self-induced vomiting, 4. No known medical illness that could account for the anorexia and weight loss. Metyrapone tests performed in 10 patients with anorexia nervosa showed normal adrenocortical activity. Low basal urinary 17-OHCS was seen in 7 patients. However, plasma cortisol levels were elevated at 4 A.M., 4 P.M. and 8 P.M. with normal diurnal rhythm. These findings suggested that in anorexia nervosa the metabolic transformation or the renal clearance of cortisol is retarded or reduced. Clinical findings in anorexia nervosa such as hypothermia, bradycardia, cold intolerance and a low basal metabolic rate suggested reduced thyroid actvity. However, RT3U, the serum thyroxin (T4), the basal level of TSH, and the TSH responses to intravenous administration of thyrotropin releasing hormone (TRH), all indicated normal thyroidal function. Pituitary human growth hormone (HGH) release was provoked by insulin-induced hypoglycemia, arginine hydrochloride infusion (0.5 g/kg, over 30 minutes, i. v.), and L-DOPA administration (100 mg in 200 ml saline, over 30 minutes infusion). Basal level of HGH was elevated in four anorexia nervosa patients. Most patients with anorexia nervosa showed either reduced or no HGH responses to insulin-induced hypoglycemia, but normal responses to arginine infusion. In contrast with these results, the patients with simple obesity showed a fair HGH response to insulin and a poor response to arginine. Severe hypoglycemia from insulin administration did occur in anorexia nervosa, but correspondingly none of strong symptoms of hypoglycemia were observed. These findings suggest an increased insulin sensitivity and tolerance to hypoglycemia in anorexia nervosa. The poor HGH responses to insulin-induced hypoglycemia were not exactly correlated with the cortisol responses to the same stimulation in anorexia nervosa, and HGH responses to L-DOPA were attenuated in 3 cases of the 4 anorexia nervosa patients. Amenorrhea preceded any remarkable weight loss in most of our cases. Thus it is unlikely that amenorrhea is the result of starvation. The LH and FSH responses to the administration of synthetic LH-releasing hormone (LH-RH) were assessed in 10 anorexia nervosa patients. The LH response to LH-RH was impaired in the severely underweight patiens (-30% of ideal body weight or less), but was normal or increased in the moderately underweight (-30% to -15% of ideal body weight), while the FSH response was normal in all patients. Both increased pituitary reserve of LH and weight gain were necessary for the resumption of menses in patients with anorexia nervosa but some other factors seem to be involved in establishing ovarian cyclicity.
日本内分泌学会の論文

神経性食思不振症の内分泌学的検討とくに肥満症との対比

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神経性食思不振症の内分泌学的検討 とくに肥満症との対比

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概要

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神経性食思不振症の内分泌学的検討とくに肥満症との対比