From the Guidelines
A comprehensive hormone workup for individuals with eating disorders should include thyroid function tests, gonadal hormones, cortisol levels, and growth hormone/IGF-1 assessment, as recommended by the American Psychiatric Association 1. The workup should be tailored to the specific eating disorder and its severity, with more extensive testing for those with prolonged illness or severe symptoms.
- Additional testing should include electrolytes, complete blood count, comprehensive metabolic panel, and bone density screening.
- For females, amenorrhea evaluation is essential, while males should have testosterone levels closely monitored. These tests are crucial because eating disorders significantly disrupt the endocrine system through malnutrition, altered body composition, and metabolic changes.
- Hormonal abnormalities often include hypothalamic suppression leading to low sex hormones, thyroid dysfunction (particularly low T3 syndrome), elevated cortisol, and growth hormone resistance. Early detection of these abnormalities is important as they contribute to serious complications like bone loss, cardiac issues, and reproductive dysfunction. Regular monitoring every 3-6 months is recommended during recovery to track normalization of hormone function, as suggested by the American Psychiatric Association guidelines 1.
From the Research
Hormone Workup for Eating Disorders
The following hormone workup is recommended for individuals with eating disorders:
- Thyroid function tests, including:
- Gut hormone tests, including:
Rationale for Hormone Workup
Abnormal hormone levels have been observed in individuals with eating disorders, including:
- Hypothalamic-pituitary-thyroidal dysfunctions in anorexia nervosa 3
- Low T4 concentrations as a predictor of poor outcome in bulimia nervosa 4
- Changes in thyroid hormone levels due to impaired conversion of T4 to T3 by increased cortisol secretion through emotional stress 5
- Disturbances in gastrointestinal hormones, including higher baseline concentrations of ghrelin, peptide YY, and cholecystokinin, and decreased insulin response to food 6
Considerations for Hormone Workup
- Hormone levels may be affected by factors such as weight loss, emotional stress, and medication use 2, 4, 3, 5, 6
- Abnormal hormone levels may not necessarily be due to the eating disorder itself, but rather to other underlying conditions or factors 2, 3
- Hormone workup should be interpreted in the context of the individual's overall clinical presentation and medical history 2, 4, 3, 5, 6