Abstract

Anorexia nervosa is a disease situated at border between psychiatry and endocrinology. Important, because of its increasing frequency, because it may become an emergency with lethal potential and because its slow rate of recovery, the disease has a large number of pathogenic changes, one of them still insufficient explained. Thus, there are anomalies of the neurotransmitters like decreased level of serotonin and its receptor activity, hypodopaminemia, relative insufficiency of norepinephrine or imbalance of the levels of orexines/anorexines like peptide YY, ghrelin, orexin. Correlated with the reduced fat mass, there are low leptine and high adiponectin levels, but serum IGF-1 remains low, as an emaciation marker, even if GH is high. There are major changes regarding the suppression of the hypothalamic pulse generator of GnRH, inducing hypogonadism, with deleterious effects on the bone mass. Regardless pathogenic elements or consequences of the psihopathogenic changes, the endocrine anomalies are complex, their understanding allowing a better management of the disease and its therapeutically approach.

Rezumat

Anorexia nervoasã este o maladie aflatã la granita dintre psihiatrie si endocrinologie. Importantã prin impactul epidemiologic în crestere, prin faptul cã poate deveni o urgentã metabolicã cu potential letal, precum si prin rata ei lentã de recuperare, boala are ca substrat o gamã largã de modificãri patogenice, dintre care unele încã insuficient elucidate. Astfel, se caracterizeazã prin anomalii la nivel de neurotransmitãtori precum scãderea serotoninei si a capacitãtii de activare receptorialã, hipodopaminemia, insuficienta relativã de norepinefrinã sau prin dezechilibrarea balantei petidelor orexigene/anorexigene cum sunt peptidul YY, ghrelina, orexina. Corelat în mare parte cu diminuarea masei grase, se reduce leptina sericã si creste adiponectina, iar IGF- 1 seric rãmâne scãzut ca marker de emaciere, desi somatotropul creste. Modificãri majore au loc prin supresia generatorului de puls hipotalamic producãtor de GnRH, ce induce hipogonadism, cu efecte dezastruoase pe densitatea mineralã osoasã. Fie cã sunt elemente patogenice sau doar consecinte ale modificãrilor din sferã psihopatologicã, anomaliile endocrine sunt complexe, cunoasterea lor facilitând întelegerea bolii si a manierei de abordare terapeuticã.