The importance of the hypothalamo-pituitary-adrenal axis as a therapeutic target in anorexia nervosa
Abstract
Anorexia nervosa (AN) is an eating disorder, mainly affecting women, with a lifetime prevalence of about 1%, that can run a chronic course. While an effective pharmacotherapy is lacking, it is hypothesized that the progesterone and type II glucocorticoid receptor antagonist mifepristone (RU486) might be useful, as it is well known that the hypothalamo-pituitary-adrenal axis (HPA) is activated in AN. Even if secondary to the eating disorder, an active HPA axis may contribute to maintaining the neuroendocrine, emotional and behavioral effects observed in AN. More specifically, it is suggested that the HPA axis interacts with limbic structures, including the insular and prefrontal cortices, to uphold the changes in interoceptive and emotional awareness seen in AN. As such, it is proposed that mifepristone (RU486) reverses these effects by acting on these limbic regions. In conclusion, the theoretical efficacy of mifepristone (RU486) in improving symptoms of AN should be tested in randomized clinical trials.
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Reframing anorexia nervosa as a metabo-psychiatric disorder
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Where Sex Meets Gender: How Sex and Gender Come Together to Cause Sex Differences in Mental Illness
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- Authors
- Bou Khalil, R., Souaiby, L., & Farès, N.
- Affiliations
- Saint Joseph University (LB)
- ORCID
- Farès, Nassim
- Venue
- Physiology & Behavior
- Publisher
- Elsevier BV
- Published
- 2017-03
- Volume
- 171
- Pages
- 13-20
- ISSN
- 0031-9384 (ISSN-L)
- OpenAlex
- W2567082966
- Cited by
- 26
- References
- 115
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 2 · 2023: 2 · 2022: 4 · 2021: 6 · 2019: 3 · 2018: 4 · 2017: 1
- FWCI
- 0.40
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Physiology & Behavior (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Regulation of Appetite and Obesity
- Health Sciences › Medicine › Reproductive Medicine › Hypothalamic control of reproductive hormones
- Keywords
- anorexia nervosa, hypothalamic-pituitary-adrenal axis, mifepristone, RU486, progesterone, limbic system, insula, prefrontal cortex, interoception, emotional awareness, neuroendocrine dysfunction, pharmacotherapy
- MeSH terms
- Animals, Anorexia Nervosa, Hormone Antagonists, Humans, Hypothalamo-Hypophyseal System, Pituitary-Adrenal System, Mifepristone
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