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Plasma Levels of Neuroactive Steroids Are Increased in Untreated Women With Anorexia Nervosa or Bulimia Nervosa

From the Institute of Psychiatry (P.M., B.C., R.I., M.M.), University of Naples SUN, Naples; and the Department of Reproductive Medicine and Child Development (M.L., E.C., P.M., A.R.G.), Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy.

Address reprint requests to: Dr. Palmiero Monteleone, Institute of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie, 80138 Naples, Italy. Email: monteri{at}tin.it

OBJECTIVE: Animal data suggest that neuroactive steroids, such as 3,5-tetrahydroprogesterone (3,5-THP), dehydroepiandrosterone (DHEA), and its sulfated metabolite (DHEA-S), are involved in the modulation of eating behavior, aggressiveness, mood, and anxiety. Anorexia nervosa (AN) and bulimia nervosa (BN) are eating disorders characterized by abnormal eating patterns, depressive and anxious symptoms, enhanced aggressiveness, and endocrine alterations. Previous studies reported decreased blood levels of DHEA and DHEA-S in small samples of anorexic patients, whereas no study has been performed to evaluate the secretion of these neuroactive steroids in BN as well as the production of 3,5-THP in both AN and BN. Therefore, we measured plasma levels of DHEA, DHEA-S, 3,5-THP and other hormones in patients with AN or BN and explored possible relationships between neuroactive steroids and psychopathology.

METHOD: Ninety-two women participated in the study. There were 30 drug-free AN patients, 32 drug-free BN patients, and 30 age-matched, healthy control subjects. Blood samples were collected in the morning for determination of hormone levels. Eating-related psychopathology, depressive symptoms, and aggressiveness were rated by using specific psychopathological scales.

RESULTS: Compared with healthy women, both AN and BN patients exhibited increased plasma levels of 3,5-THP, DHEA, DHEA-S, and cortisol but reduced concentrations of 17ß-estradiol. Plasma testosterone levels were decreased in anorexic women but not in bulimic women. Plasma levels of neuroactive steroids were not correlated with any clinical or demographic variable.

CONCLUSIONS: These findings demonstrate increased morning plasma levels of peripheral neuroactive steroids in anorexic and bulimic patients. The relevance of such hormonal alterations to the pathophysiology of eating disorders remains to be elucidated.

Key Words: anorexia nervosa • bulimia nervosa • cortisol • neuroactive steroids.

Abbreviations: ACTH = adrenocorticotropin hormone; AN = anorexia nervosa; ANOVA = analysis of variance; BDHI = Buss-Durke Hostility Inventory; BITE = Bulimic Investigation Test Edinburgh; BN = bulimia nervosa; CRF = corticotropin-releasing factor; DHEA = dehydroepiandrosterone; DHEA-S = dehydroepiandrosterone-sulfate; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, fourth edition; EDI = Eating Disorder Inventory; GABA = -aminobutyric acid; HDRS = Hamilton Depression Rating Scale; HPA = hypothalamic-pituitary-adrenal (axis); OCD = obsessive-compulsive disorder; YBC-EDS = Yale-Brown-Cornell-Eating Disorder Scale; 3,5-THP = 3,5-tetrahydroprogesterone; 5-HT = serotonin.

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