Steroid metabolism and excretion in severe anorexia nervosa: effects of refeeding

Background: To our knowledge, changes in steroid metabolism in subjects with anorexia nervosa (AN) after weight gain have not been elucidated. Objective: We characterized urinary steroid excretion and metabolism in AN patients and investigated the effects of refeeding. Design: In an intervention study, we recruited 7 women with life-threatening weight loss upon admission and after a median [interquartile range (IQR)] of 95 d (88-125 d) of intensive refeeding; 15 age-matched women were recruited as control subjects. The major urinary metabolites were quantified in 24-h collections by capillary gas chromatography. A single examiner measured weights, heights, and skinfold thicknesses. Results: The median (IQR) age of patients was 24 y (21-26 y), and the duration of AN was 4.0 y (3.3-8.0 y). Body mass index (BMI; in kg/m(2)) increased from 12.8 (12.7-13.1) to 18.6 (18.0-19.6) after refeeding (P < 0.0001). Steroid values [median pre-, post-refeeding (P value)] were as follows: androgen metabolites [472, 1017 mu g/24 h (0.93)], cortisol metabolites [1960, 3912 mu g/24 h (0.60)], and ratios of androsterone (5 alpha)/etiocholanolone (5 beta) [0.28, 0.63 (<0.001)], 5 alpha-/5 beta-tetrahydrocortisol [0.20, 0.48 (0.02)], tetrahydrocortisols/tetrahydrocortisone [0.87, 0.61 (0.09)], 20-hydroxy-/20-oxocortisol metabolites [0.29, 0.47 (0.01)], and 20 alpha-/20 beta-reduced cortisol metabolites [1.18, 1.89 (>= 1.00)]. BMI change was positively correlated with 5 alpha-/5 beta-tetrahydrocortisol (r = 0.95, P < 0.001). Before refeeding, the following metabolites were lower in patients than in control subjects: androsterone, 5 alpha-tetrahydrocortisol, alpha-cortolone and alpha-cortol, 5 alpha-/5 beta-tetrahydrocortisol, androsterone/etiocholanolone, and 20-hydroxy/20-oxocortisol (all P < 0.05). After refeeding, all steroid metabolites in patients were at concentrations that were comparable with those in control subjects. Conclusions: Significant changes in urine steroid-metabolite excretion occurred upon starvation, which were reversed upon refeeding. For cortisol, there were decreases in 5 alpha-/5 beta-tetrahydrocortisol and 20-hydroxy-/20-oxometabolites; for androgen, there was a decrease in androsterone/etiocholanolone. Am J Clin Nutr 2011;93:911-7.