Abnormalities in plasma and cerebrospinal-fluid arginine vasopressin in patients with anorexia nervosa

• Published in: The New England journal of medicine Vol. 308; no. 19; pp. 1117 - 1123
• Main Authors: Gold, P.W, Kaye, W, Robertson, G.L, Ebert, M
• Format: Journal Article
• Language: English
• Published: United States Massachusetts Medical Society 12.05.1983
• Subjects: Adult; Anorexia; Anorexia Nervosa - blood; Anorexia Nervosa - cerebrospinal fluid; Anorexia Nervosa - metabolism; Arginine Vasopressin - blood; Arginine Vasopressin - cerebrospinal fluid; Arginine Vasopressin - metabolism; Argipressin; Body Weight; Body weight gain; Body weight loss; Cerebrospinal fluid; Defects; diet-related diseases; Eating disorders; Female; human nutrition; Humans; Hypertonic Solutions; Intravenous administration; Laboratories; Menstruation; Mental health; Osmoregulation; Patients; Rodents; Secretion; Short term; Sodium; Sodium - blood; Underweight; Vasopressin; Water-Electrolyte Balance
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJM198305123081902

Previous studies have indicated that many patients with anorexia nervosa have defects in urinary concentration or dilution suggestive of abnormal secretion of the antidiuretic hormone arginine vasopressin. To explore this possibility, we examined the response of plasma vasopressin to intravenous hypertonic saline in anorexic patients before and after correction of their weight loss. We also measured basal levels of the hormone in the cerebrospinal fluid. In all four subjects studied before correction of weight loss, the response to hypertonic saline was abnormal: in one, the plasma level of arginine vasopressin increased subnormally relative to the plasma sodium level; in the other three, it fluctuated erratically, with no relation to plasma sodium. These defects persisted in the three patients studied three to four weeks after recovery of body weight. In two patients who were initially studied when they were underweight, the defects were gone six months after recovery; in five of seven other patients studied at least six months after recovery but not while they were underweight, the response was normal. Abnormalities in the osmoregulation of plasma arginine vasopressin were not accounted for by nonosmotic stimuli and were almost always associated with an absolute increase in the level of arginine vasopressin in the cerebrospinal fluid or a reversal of the normal (<1.0) cerebrospinal fluid/plasma ratio of arginine vasopressin. These results indicate that most if not all patients with anorexia nervosa have abnormal levels of arginine vasopressin in their plasma and cerebrospinal fluid that are corrected very slowly with weight gain. The cause and consequences of these abnormalities remain to be determined. (N Engl J Med 1983; 308:1117–23.) ANOREXIA nervosa is a psychiatric syndrome characterized by a striking increase in physical activity and a marked diminution of food intake in the obsessive pursuit of thinness. 1 2 3 In some cases, it is also associated with various forms of hypothalamic-pituitary dysfunction, including abnormal regulation of temperature, 4 growth hormone, 4 , 5 thyrotropin-stimulating hormone, 4 and gonadotropins, 4 5 6 as well as defects in urinary concentration or dilution. 4 , 7 , 8 Although such urinary defects have been attributed to deficient or inappropriate secretion of the antidiuretic hormone arginine vasopressin, these diagnoses cannot be made solely on the basis of urine osmolality values. 8 9 10 Moreover, the nature of these defects and their relation . . .