Jack L. Katz

Cortisol Secretion and Metabolism in Anorexia Nervosa

We studied cortisol secretion and metabolism in 10 women with anorexia nervosa. The 24-hour mean plasma cortisol concentration was 8.9 mug per deciliter (controls, 4.9) (P less than 0.01). Secretory patterns showed normal circadian rhythms. Cortisol half-life was prolonged from 60 to 78 minutes (P less than 0.01), and metabolic clearance rate was decreased from 359 to 177 liters per day (P less than 0.001). Cortisol production was normal (19.4 mg per day). Urinary cortisol was slightly elevated in two of five patients. These findings, as well as the increased tetrahydrocortisol/tetrahydrocortisone ratio (1.2 vs 0.65, P less than 0.01), also appear in hypothyroid patients. Thyroid-function studies showed normal total and free thyroxine and thyrotropin, but low plasma tri-iodothyronine levels (52.7+/-13.2 vs. 137.8+/-24.1 ng per deciliter in the controls, P less than 0.001). In five additional patients with anorexia nervosa studied before and after short-term tri-iodothyronine administration, metabolic abnormalities decreased as plasma tri-iodothyronine levels rose to or above normal.

Do eating disorders and affective disorders share a common etiology? A dissenting opinion

Recent observations bringing into relationship the clinical phenomenology, family-genetic and biologic correlates, course and outcome, and epidemiology of eating disorders and affective disorders are examined. In all areas available evidence points to greater divergence than overlap between these disorders, arguing against the hypothesis that they share a common etiology. On this basis it is concluded that, although depression plays an important part in predisposing to eating disorders, continued attention must be paid to investigating mechanisms of etiology and pathogenesis unique to these conditions.

weight and Circadian Luteinizing Hormone Secretory Pattern in Anorexia Nervosa

&NA; In previous studies we had established that emaciated women with active primary anorexia nervosa (AN) had immature 24‐hr luteinizing hormone (LH) secretory patterns. In this study, we have examined the circadian LH patterns of eight women with AN who had partially or fully recovered their ideal weights. Three of the women were studied before and after weight gain and five women were studied only after the appearance of binge‐eating and consequent weight gain (by history). Our findings are: (1) The adult (mature) circadian LH secretory pattern was not present in women who had partially or totally achieved ideal weight but who otherwise remained symptomatic; (2) those women who showed both weight gain and normalization of LH pattern were also symptomatically improved in other respects; (3) the degree of immaturity of pattern did not correlate reliably with the duration of illness, the degree of fatness, or the extent of deficit from ideal weight; (4) the mode of illness onset and the type of secretory pattern were not related; and (5) the return of menses did not show a simple relationship to weight, fatness, or maturity of LH pattern.

Psychological stress, ego defenses, and cortisol production in children hospitalized for elective surgery.

&NA; This study was designed to investigate the relationship between the effectiveness of coping mechanisms and physiological indicators of distress in children faced with the experience of hospitalization and surgery. Twenty‐five children between the ages of 7 and 11 were studied in the out‐patient department, 2 weeks before surgery, and again during their hospital stay. Effectiveness of defenses and defense style was measured by a clinical interview and by the Rorschach test. Cortisol production rates were measured by the analysis of 24‐hour urine collections at home and again in the hospital. Ward adjustment was also rated by a ward questionnaire. The results indicated no relationship between defense effectiveness and cortisol production rates in the out‐patient department and an inverse relationship between cortisol production and defense effectiveness under the stress of hospitalization. Defense style was found to correlate with coping under stress. Four different groups of children emerged, suggesting four different types of reaction to the hospital experience.

Hypothalamic-pituitary-gonadal function in Anorexia Nervosa and Bulimia

Patients with anorexia nervosa (AN) exhibit neuroendocrine abnormalities that may result solely from emaciation or may reflect defective endocrine mechanisms which are intrinsic to disordered eating even in the absence of starvation. To distinguish these possibilities, we have studied indices of hypothalamic-pituitary-gonadal (HPG) function in 9 patients with AN, 12 normal weight patients with bulimia and recent or current oligomenorrhea, and 8 normal weight controls. Measurement of 24-hour luteinizing hormone (LH) secretion with 30-min sampling revealed significantly fewer LH secretory spikes and a trend toward lower mean 24-hour LH levels in both bulimic and anorectic patients than in controls. Stimulation with gonadotropin releasing hormone produced elevated LH responses in the bulimic group and blunted LH responses in the anorectic group. Stimulation with estradiol revealed diminished LH augmentative responses and a trend toward diminished follicle stimulating hormone augmentative responses among bulimic as well as AN patients compared to controls. In each instance, the bulimic group tended to show within-group heterogeneity, with some individuals falling within the AN range. These findings suggest that HPG axis abnormalities in eating disordered patients cannot entirely be attributed to emaciation and that factors other than subnormal weight contribute to disturbed hypothalamic-pituitary functioning in these patients.

LHRH responsiveness in anorexia nervosa: intactness despite prepubertal circadian LH pattern.

&NA; Consistent with previous findings, six women with primary anorexia nervosa who underwent 24‐hour endocrine studies were all observed to have immature (prepubertal or pubertal) patterns of circadian luteinizing hormone (LH) secretion. This abnormality was present despite negligible weight deficit (but active symptomatology) in three of the women. Regardless of the extent of immaturity of circadian pattern, each woman showed a completely normal release of LH in response to the single intravenous administration of luteinizing hormone releasing hormone (LHRH). These findings provide further evidence for the intactness of pituitary function and for the possibility of a functional hypothalamic disturbance in anorexia nervosa. The discrepant finding in certain other studies of inadequate LH response to LHRH in women with anorexia nervosa is reviewed, and the potential influences of differing variables in these studies and the possibility of a heterogeneous illness are emphasized.

Psychoendocrine aspects of cancer of the breast.

&NA; Thirty women in the hospital awaiting biopsy of a breast tumor were interviewed in order to assess the adequacy of their ego defenses in this presumably threatening situation. The criteria for this psychological evaluation were the patients affective state, functional disruption, and defensive reserve impairment. Concurrent with these assessments, daily production rates of hydrocortisone and urinary excretion levels of the principal hydrocortisone and androgen metabolites were measured. A rank order correlation significant at the .02 level was found between rating scores for extent of defensive failing and hydrocortisone production rates, and at the .05 level between this psychological variable and the principal hydrocortisone metabolites; however, no correlation existed with the androgen metabolites. Since other studies have indicated a correlation between prognosis in breast cancer and a numerical ratio calculated on the basis of the patients endogenous corticoid to androgenic steroids, this study raises questions about the determination and nature of such a ratio and about the possible role of psychological phenomena in the course of this neoplasm.

Seasonal patterns in eating disorder subgroups.

Patients with bulimia nervosa (BN) often have seasonal patterns of mood and appetite that compare with patterns seen in seasonal affective disorder (SAD). Seasonal patterns in other eating disorder (ED) subgroups have not been adequately described. We report on seasonal patterns in mood, weight, appetite, sleep, social activity, and energy in 154 consecutive admissions to an outpatient ED program: 60 patients with anorexia nervosa (AN), 31 with BN, 34 with a history of both AN and BN (AN/BN), and 29 with an ED not otherwise specified (ED-NOS). AN patients had significantly less seasonal variation overall than either bulimic subgroup, as measured by the global seasonality score (GSS) on the Seasonal Patterns Assessment Questionnaire (SPAQ). AN patients also showed less seasonal change in mood, weight, and energy than BN patients, and less variation in mood and appetite than AN/BN patients.

Eating disorder and affective disorder: Relatives or merely chance acquaintances?

Abstract Evidence is reviewed suggesting that more than a chance relationship exists between affective (depressive) disorder and eating disorder. Despite occasional glaring exceptions, findings from clinical, outcome, family, medication response, and biological studies of persons with anorexia nervosa or bulimia are strikingly consistent in indicating the presence of a subgroup (but only a subgroup) characterized also by depressive disorder, whether as antecedent, concomitant, or consequence of the eating disorder. Different models are proposed that could account for this relationship and it is postulated that all of these may actually be relevant.

Stability of ego defenses and endocrine responses in women prior to breast biopsy and ten years later.

&NA; Thirty women with breast masses were evaluated psychologically and endocrinologically ten years ago while they were awaiting breast biopsy (3). Eight of these women proved to have benign fibrocystic disease and 22 had breast cancer. A significant (p < 0.05) positive correlation was found between extent of failure of psychological “defenses” and cortisol metabolite excretion rate in these 30 women. On follow‐up, 12 women had died (11 with cancer and one who had had benign disease); 7 women were lost to follow‐up. Of the remaining 11, one refused to participate, leaving 10 women for follow‐up study (7 who had had mastectomy for breast cancer and 3 with benign breast lesions). They were reevaluated using the same assessment techniques as 10 years before. The psychological parameters and cortisol metabolite excretion rates did not show a significant change over the span of ten years. These data support the hypothesis that these psychological parameters and cortisol metabolite excretion rates reflect relatively abiding characteristics and are not as much affected by a “psychosocial threat” as previous research has suggested.