From the Research
Hormone levels should be checked in patients with anorexia during the initial evaluation and periodically throughout treatment, particularly when patients are severely underweight or experiencing significant symptoms. The initial assessment should include thyroid function tests (TSH, free T4), gonadal hormones (estradiol/testosterone, LH, FSH), cortisol levels, and growth factors like IGF-1, as supported by studies such as 1 and 2. These tests help identify the hormonal consequences of malnutrition and distinguish them from other endocrine disorders that might mimic or complicate anorexia. Follow-up testing is recommended when patients reach about 85-90% of their target weight to assess hormonal recovery, which often lags behind weight restoration, as indicated in 3 and 4. Some key points to consider when evaluating hormone levels in anorexia patients include:
- The role of leptin in regulating energy balance and reproductive function, as discussed in 1 and 2
- The impact of starvation on the hypothalamic-pituitary-adrenal axis, leading to changes in cortisol and thyroid hormone levels, as noted in 5
- The importance of monitoring bone density and considering hormone replacement therapy in patients with severe bone loss or persistent amenorrhea, as suggested in 3 and 4 More frequent monitoring may be necessary in patients with severe bone density loss, persistent amenorrhea despite weight gain, or those on hormone replacement therapy. The rationale for hormone testing is that starvation in anorexia triggers adaptive endocrine changes including hypothalamic suppression, resulting in low sex hormones, thyroid abnormalities, and elevated cortisol, which contribute to many medical complications including bone loss, cardiovascular issues, and infertility, as supported by the findings in 3, 1, and 4.