OBJECTIVE Anorexia nervosa is a primary psychiatric disorder characterized by self-induced negative energy balance. A number of hormonal responses and adaptations occur in response to starvation and low body weight including changes in adrenocortical hormones. Our objective was to systematically review adrenocortical hormone levels in anorexia nervosa. DESIGN/METHODS We searched MEDLINE and EMBASE for studies that reported at least one adrenocortical hormone, including dehydroepiandrosterone (DHEA), DHEA-sulphate (DHEA-S), progesterone, 17-hydroxyprogesterone, pregnenolone, cortisol (serum, urine, cerebrospinal fluid, and hair sample), aldosterone, androstenedione, and testosterone in patients with anorexia nervosa and normal-weight healthy controls from inception until October 2021. Means and standard deviations for each hormone were extracted from the studies to calculate a mean difference (MD). A pooled MD was then calculated by combining MDs of each study using the random-effects model. RESULTS We included a total of 101 studies with over 2500 females with anorexia nervosa. Mean cortisol levels were significantly higher in anorexia nervosa as compared to normal-weight controls for multiple forms of measurement, including morning cortisol, 12-hour and 24-hour pooled serum cortisol, 24-hour urine cortisol, and after an overnight dexamethasone suppression test. In contrast, mean serum total testosterone and DHEA-S levels were significantly lower among patients with anorexia nervosa. CONCLUSIONS Women with anorexia nervosa have higher cortisol levels and lower DHEA-S and testosterone levels compared to women without anorexia nervosa. This finding is important to consider when evaluating low-weight women for disorders involving the adrenal axis, especially Cushing's syndrome.

中文翻译：

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神经性厌食症和肾上腺激素：系统评价和荟萃分析。

目的 神经性厌食症是一种原发性精神疾病，其特征是自我诱发的负能量平衡。许多激素反应和适应是针对饥饿和低体重而发生的，包括肾上腺皮质激素的变化。我们的目标是系统地评价神经性厌食症患者的肾上腺皮质激素水平。设计/方法 我们在 MEDLINE 和 EMBASE 中检索了至少报道一种肾上腺皮质激素的研究，包括脱氢表雄酮 (DHEA)、DHEA-硫酸盐 (DHEA-S)、孕酮、17-羟基孕酮、孕烯醇酮、皮质醇（血清、尿液、脑脊液、从研究开始到 2021 年 10 月，神经性厌食症患者和正常体重健康对照组的醛固酮、雄烯二酮和睾酮。从研究中提取每种激素的平均值和标准差，以计算平均差 (MD)。然后使用随机效应模型结合每项研究的 MD 来计算汇总 MD。结果 我们总共纳入了 101 项研究，涉及超过 2500 名患有神经性厌食症的女性。多种形式的测量结果显示，神经性厌食症患者的平均皮质醇水平显着高于正常体重对照，包括早晨皮质醇、12小时和24小时合并血清皮质醇、24小时尿液皮质醇以及隔夜地塞米松抑制试验后的皮质醇水平。 。相比之下，神经性厌食症患者的平均血清总睾酮和 DHEA-S 水平显着降低。结论 与没有神经性厌食症的女性相比，患有神经性厌食症的女性皮质醇水平较高，DHEA-S 和睾酮水平较低。在评估低体重女性是否患有涉及肾上腺轴的疾病，尤其是库欣综合征时，这一发现很重要。