The role of leptin in anorexia nervosa: clinical implications

• Published in: Molecular psychiatry Vol. 12; no. 1; pp. 23 - 35
• Main Authors: HEBEBRAND, J, MULLER, T. D, HOLTKAMP, K, HERPERTZ-DAHLMANN, B
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.01.2007
• Subjects: Adult and adolescent clinical studies; Animals; Anorexia; Anorexia nervosa; Anorexia Nervosa - metabolism; Anorexia Nervosa - physiopathology; Biological and medical sciences; Eating behavior disorders; Female genital diseases; Gynecology. Andrology. Obstetrics; Humans; Leptin - physiology; Medical sciences; Non tumoral diseases; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Starvation - metabolism; Starvation - physiopathology; Menstruation disorders; bone density; gonadotropins; realimentation; Adipokine; Anorexia nervosa; Gonadotropin; Eating disorder; Density; Female genital diseases; Osteoarticular system; starvation; Leptin; Amenorrhea; Bone; amenorrhoea; anorexia based activity
• ISSN: 1359-4184; 1476-5578
• DOI: 10.1038/sj.mp.4001909

Leptin is a hormone with pleiotropic functions affecting several tissues. Because leptin has a crucial role in the adaptation of an organism to semi-starvation, anorexia nervosa (AN) serves as a model disorder to elucidate the functional implications of hypoleptinaemia; vice versa, several symptoms in patients with this eating disorder are related to the low leptin levels, which are characteristic of acute AN. Weight gain in AN patients can induce relative hyperleptinaemia in comparison to controls matched for body mass index; circulating leptin concentrations in AN patients thus transverse from subnormal to supranormal levels within a few weeks. We review findings on leptin secretion in AN and focus on implications, particularly for the hypothalamus-pituitary-gonadal axis, bone mineral density and physical hyperactivity. Undoubtedly, the elucidation of leptin's function as a trigger of diverse neuroendocrine adaptations to a restricted energy intake has substantially advanced our knowledge of the pathogenesis of distinct symptoms of AN, including amenorrhoea that represents one of the four diagnostic criteria. The fact that hypoleptinaemia can induce hyperactivity in a rat model for AN has led to a series of studies in AN patients, which support the notion that application of leptin to severely hyperactive patients might prove beneficial.