厌食症患者相对于健康体重妇女 雄性激素显著地较低

　　June 5, 2007（伦多讯）－根据发表于第89届内分泌学会年会的研究，生理期不正常的厌食症女性病患，其雄性激素浓度较低，且会因使用口服避孕药物恶化
　　
　　该试验的主要研究者Karen K. Miller医师，他是麻州综合医院的内分泌学家，麻州波士顿哈佛学的助理教授，他向Medscape表示，服用口服避孕药物的厌食症女性病患，其雄性激素显著降低；是很重要的，因为现实世界中，医师处方口服避孕药物给厌食症女性病患是很常见的，因为她们的生理期并不规律。
　　
　　Miller医师表示，处方口服避孕药物给厌食症与生理期不规律年轻女性已经被认为对其骨骼健康有益，因为补充雌性激素对于停经后妇女是有益的。
　　
　　她表示，雌性激素对于停经后妇女是有帮助的，但是，她强调，有两项已经发表的临床研究显示，口服避孕药物对于生理期不规律厌食症妇女的骨骼健康是没有帮助的。
　　
　　Miller医师表示，对厌食症女性而言，当骨质正在流失时，雌性激素可能可以修复或是保留骨质。
　　
　　这项断面研究共收纳了217位受试者，研究者检验服用口服避孕药物厌食症妇女（共32位）、未服用口服避孕药物厌食症妇女（共137位）、以及正常体重的脑垂体低下生理期不规律（共21位）、健康生理期控制组（共27位）的内生性与dehydroepiandrosterone（DHEA）浓度。
　　
　　研究者以双能X射线吸收计评估骨密度与身体组成，以放射免疫检验测量总睾固酮浓度、免疫放射呈色技术测量性荷尔蒙结合球蛋白（SHBG），而游离睾固酮浓度以总睾固酮与SHBG浓度计算。
　　
　　这项研究中有许多统计上显著差异的结果，相较于没有服用口服避孕药物厌食症女性与健康控制组，厌食病患的总睾固酮浓度降低（20.6相较于32.3 ng/dl；P<0.05），且游离睾固酮浓度同样有差异（0.32相较于0.47 ng/dl；P<0.05）；然而，使用口服避孕药物厌食症病患相较于健康控制组，其DHEA浓度并无差异（155相较于176 ng/dl）。
　　
　　雄性激素浓度，特别是游离睾固酮、总睾固酮与DHEA，虽然程度有限，但无论如何是正面、侧边脊椎骨、髋骨、桡骨、与全身骨密度显著的预测因子，除了DHEA在髋骨这方面不是之外，游离睾固酮浓度与侧边脊椎骨之间的关联是最强的（R, 0.28；P=0.005）。
　　
　　除此之外，游离睾固酮浓度越高非脂肪组织越多（R, 0.19；P=0.04）。
　　
　　Miller医师表示，这项发现突显了生理期不规律厌食病患的“关键治疗”是重新回复到她们过去的体重。
　　
　　英国牛津大学内分泌学教授John Wass医师表示，这项研究突显了生理期不规律的厌食症妇女应该停止使用雌性激素疗法。
　　
　　在这项研究的发表座谈会上担任引言人的Wass医师表示，给生理期不规律且体重过轻的女性服用这类药物，可能会使她们的骨骼健康出问题；我会直觉性地认为给厌食症女性病患服用雌性激素可能会有帮助，但也可能造成她们骨折，如果这样的治疗会降低睾固酮浓度且对于骨骼有不良的影响，这听起来像坏主意；最重要的治疗是增加这些病患的体重，这样就会改善她们的骨骼健康。

Androgens Significantly Reduced in Anorexic vs Healthy Weight Women

By Louise Gagnon
Medscape Medical News

June 5, 2007 (Toronto) — Female patients with anorexia nervosa who do not have regular menstrual cycles suffer from decreased levels of androgens, which is exacerbated by the use of oral contraceptives, according to research presented at 89th annual meeting of the Endocrine Society.

"Androgens are severely reduced in women with anorexia nervosa who are getting oral contraceptives," said Karen K. Miller, MD, the study's lead investigator, an endocrinologist at Massachusetts General Hospital, and an assistant professor of medicine at Harvard Medical School, in Boston, Massachusetts. "It's important to know this because in the clinical world it can be common for physicians to prescribe oral contraceptives [to] anorexic women because they have amenorrhea."

The prescription of oral contraceptives to young women with anorexia nervosa and amenorrhea has been thought to increase their bone health, because estrogen replacement is beneficial in postmenopausal women, noted Dr. Miller.

"Estrogens are helpful in postmenopausal women," she said, but stressed that 2 published trials found that oral contraceptive use showed no benefit to bone health in anorexic women with amenorrhea.

"The thinking has been that the estrogens may be a good fix or preserve bone [in anorexic women] at a time when women are losing bone," said Dr. Miller.

In a cross-sectional study of 217 subjects, investigators examined endogenous and dehydroepiandrosterone (DHEA) levels in women with anorexia nervosa who are taking oral contraceptives (n = 32), in women with anorexia nervosa who are not taking oral contraceptives (n = 137), in normal-weight women with hypothalamic amenorrhea (n = 21), and in healthy eumenorrheic controls (n = 27).

Investigators measured bone mineral density and body composition using dual energy x-ray absorptiometry. Total testosterone was measured with radioimmunoassay, sex hormone-binding globulin (SHBG) was measured using an immunoradiometric assay, and free testosterone was calculated from total testosterone and SHBG using the laws of mass action.

Several statistically significant results emerged from the study. Comparing women with anorexia nervosa who were not taking oral contraceptives with healthy controls, anorexic patients had reduced levels of total testosterone (20.6 vs 32.3 ng/dL; P < .05) and free testosterone (0.32 vs 0.47 ng/dL; P < .05). However, the difference in DHEA levels between anorexia nervosa subjects on estrogen and healthy controls was not significant (155 vs 176 μg/dL).