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Effect of malnutrition on the metabolism of sex hormones in man
Author(s) -
Fishman Jack,
Bradlow H. Leon
Publication year - 1977
Publication title -
clinical pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.941
H-Index - 188
eISSN - 1532-6535
pISSN - 0009-9236
DOI - 10.1002/cpt1977225part2721
Subject(s) - endocrinology , medicine , anorexia nervosa , testosterone (patch) , estriol , hormone , metabolism , triiodothyronine , eating disorders , psychiatry
The effects of caloric deprivation and accompanying body weight loss on gonadal hormone metabolism were studied in young women with anorexia nervosa. In these patients serving as models of uncomplicated malnutrition, the biotransformation of labeled testosterone and estradiol was followed after intravenous injection of these hormones. The metabolite distribution pattern is affected by thyroid status. All of 8 anorexia nervosa patients in whom testosterone metabolism was studied had low plasma Ta and borderline T4 levels, along with substantial deviation from normal body weight. The androsterone to etiocholanolone (A/E) ratio was greatly diminished, precisely as expected from a hypothyroid state, although these patients, lacking classic symptomatology, were not hypothyroid. Three of these patients restudied after administration of T 3 showed a reversal of direction of testosterone metabolism, i.e., more than a doubling of the 5a to 5β ratio. During spontaneous remission from the disease and progressive weight gain, the plasma T3 rose and the AlE ratio increased. In 7 patients with anorexia nervosa, the metabolism of estradiol was compared with that of normal weight control subjects and of 4 obese patients. In the malnourished patients the formation of 2‐hydroxyestrone was markedly greater than in the other 2 groups, while estriol production was significantly diminished. In the obese subjects estriol formation increased and catecholestrogen production decreased. These opposite trends in anorexic and obese patients suggest that the metabolic alteration of estradiol is a consequence of low body weight and food intake and not the result of other factors specific to anorexia nervosa. It is concluded that the changed estradiol metabolism in anorexia nervosa is not the result of the thyroid status in these subjects, and it is speculated that the distortion of estradiol metabolism is attenuated by the biochemical hypothyroidism accompanying malnutrition. This results in a diminution of estrogenic activity of the endogenous estradiol which may accentuate the consequences of the decreased production of the hormone in this disease.