Prevalence and predictors of abnormal liver enzymes in young women with anorexia nervosa.

OBJECTIVE: To determine the prevalence and predictors of abnormal liver enzyme levels in ambulatory young women with anorexia nervosa (AN). STUDY DESIGN: In this cross-sectional study of 53 females with AN, serum concentrations of liver enzymes and hormones were measured. Anthropometric, dietary, and body composition information was collected. Correlational analyses were performed between liver enzyme concentrations and these variables. RESULTS: Elevated alanine aminotransferase (ALT) and gamma-glutamyl transpeptidase (GGT) levels were found in 14 subjects (26%) and 5 subjects (9%), respectively. ALT and GGT were inversely correlated with body mass index (r = -0.27 to -0.30, P < .049) and percentage body fat (r = -0.36 to -0.47, P < .007) but showed no relationship with lean body mass. Subjects with percentage body fat < 18% had higher ALT levels than those above this threshold (median 26.5 vs 18.0 U/L, P = .01). Liver enzyme concentrations did not correlate with dietary variables, except for GGT and percentage of calories from protein (r = 0.28, P = .04). CONCLUSIONS: Serum ALT and GGT concentrations are inversely related to adiposity in young women with AN. Future studies are needed to determine whether these liver enzyme elevations signify unrecognized, clinically relevant liver disease.

Skeletal measurements by quantitative ultrasound in adolescents and young women with anorexia nervosa.

OBJECTIVE: To compare quantitative ultrasound (QUS) measurements in adolescents with anorexia nervosa (AN) with that in healthy control subjects and to determine the utility of QUS as a tool to evaluate skeletal status in these patients. STUDY DESIGN: Female adolescents with AN (n = 41) and healthy control subjects (n = 105) were recruited. Speed of sound (SOS) was measured at the radius and tibia. Participants with AN also had hip and spinal areal bone mineral density measurements by dual-energy x-ray absorptiometry (DXA); bone mineral apparent density (BMAD) was calculated. RESULTS: Subjects with AN had higher mean radial SOS (4044 +/- 99 m/s) than did control subjects (3947 +/- 116 m/s; P < .0001). These results were replicated at the tibia (AN, 3918 +/- 85 m/s vs control subjects, 3827 +/- 106 m/s; P < .0001). Neither DXA measures of areal bone mineral density nor BMAD were correlated with SOS. Weight and body mass index were negative predictors of tibial but not radial SOS. AN status remained a significant predictor of SOS after controlling for body mass index, age, and race. CONCLUSIONS: Subjects with AN had higher mean tibial and radial SOS than did control subjects. QUS variables did not correlate with DXA measures, calculated BMAD, or anthropometric variables. QUS measurements of SOS do not appear to be appropriate for bone density screening in patients with AN.

Bone mineral status in children with congenital adrenal hyperplasia.

Congenital adrenal hyperplasia (CAH) is caused by a deficiency in an adrenal enzyme resulting in alterations in cortisol and aldosterone production. Bone status is affected by chronic glucocorticoid therapy and excess androgen exposure in children with CAH. This cross-sectional study enrolled participants with 21-hydroxylase deficiency from a pediatric referral center. Bone mineral density in the participants was normal when compared to age, gender and ethnicity adjusted standards, with respect to chronological age or bone age. Lean body mass was positively correlated with bone mineral content (BMC), independent of fat mass (p < 0.001). There was no significant correlation between glucocorticoid dose or serum androgen levels and skeletal endpoints. In conclusion, lean body mass appears to be an important correlate of BMC in patients with CAH. The normal bone status may be explained by the differential effects of glucocorticoids on growing bone, beneficial androgen effects, or other disease specific factors.

Normal ovarian structure and function with normal glucose tolerance in girls with early treatment of classic congenital adrenal hyperplasia.

UNLABELLED: Hyperandrogenism and hyperinsulinism have both been suggested as etiologic factors behind functional ovarian hyperandrogenism or polycystic ovary syndrome. Females with congenital adrenal hyperplasia provide a clinical model to evaluate the contribution of pre- and post-natal hyperandrogenism on ovarian structure and function. STUDY OBJECTIVE: To evaluate glucose tolerance, and structure and androgen production of the ovaries in young females with classic congenital adrenal hyperplasia. DESIGN, SETTING, PARTICIPANTS: Cross-sectional study, including the enrollment of participants, ages 8 to 20 years, recruited from the pediatric endocrinology clinical program of a tertiary pediatric referral center. INTERVENTIONS: Ten participants had oral glucose tolerance testing, adrenal and ovarian androgen measurements, and pelvic ultrasound studies performed. MAIN OUTCOME MEASURES: Presence of altered response to glucose challenge, ovarian hyperandrogenism, or presence of polycystic ovaries by ultrasound. RESULTS: Measurements of fasting blood glucose, post-challenge glucose, and insulin resistance were normal in this sample. There was no evidence of ovarian hyperandrogenism after adrenal suppression with dexamethasone. All participants had normal ovarian structure without evidence of polycystic ovaries. CONCLUSIONS: Females with classic congenital adrenal hyperplasia (21-hydroxylase deficiency) and normal glucose tolerance appear to have normal ovarian structure and function during the peripubertal period.