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Anorexia nervosa (AN) is a psychiatric disease associated with notable

medical complications and increased mortality. Endocrine abnormalities,

including hypogonadotropic hypogonadism, hypercortisolemia, growth

hormone resistance and sick euthyroid syndrome, mediate the clinical

manifestations of this disease. Alterations in anorexigenic and orexigenic

appetite-regulating pathways have also been described. Decreases in fat

mass result in adipokine abnormalities. Although most of the endocrine

changes that occur in AN represent physiologic adaptation to starvation,

some persist after recovery and might contribute to susceptibility to AN

recurrence. In this Review, we summarize key endocrine alterations in

AN, with a particular focus on the profound bone loss that can occur

in this disease. Although AN is increasingly prevalent among boys and

men, the disorder predominantly affects girls and women who are,

therefore, the focus of this Review.

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