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The Production Rate of Cortisol Declines during Recovery from Anorexia Nervosa^*

Department of Psychiatry, College of Physicians and Surgeons, ColumbiaUniversity, New York, NewYork 10032, and the Department of Psychiatry, the Clinical Research Center, and the Institute for Steroid Research, Montefiore Hospital and Medical Center Bronx, New Yorek 10467

Address requests for reprints to: B. Timothy Walsh, M.D., New York State Psychiatric Institute, 722 West 168 Street, New York, New York 10032.xs

ABSTRACT. The plasma concentration of cortisol is elevated i n many patients with anorexia nervosa. It has remained unclear whether this elevation of plasma cortisol level is due only to a slowing of the rate of cortisol metabolism or whether there is, as well, an increase in adrenal secretory activity in anorexia ner-vosa. We studied adrenocortical activity in 9 female patients and one male patient with anorexia nervosa before and during recovery. The 24-h mean levelof plasma cortisol and the rate of urinary free cortisol excretion decreased during recovery, from 11.4 to 7.4 µβdl and from 225 to 116 µβday, respectively (P < 0.005.and P < 0.10, paired ttest). These changes were associated with a significant decline in the rate of cortisol production from 24.3 to 17.9 mgβday as measured by radioisotope dilution (P < 0.005). These results suggest that adrenal secretory activity is increasedin anorexia nervosa and that the elevation of plasma cortisol level observed in this syndrome reflects not only a slowing of cortisol metabolism but also a rise in cortisol production.

^* This work was supported in part by PHS-NIMH Fellowship no.5T01 MH-11528-10 (to B.T.W.) and by grants from the National Cancer Institute (CA 07034) and the General Clinical Research Centers Branch, NIH (RR-53).

Received October 27, 1980.

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