FP37-1 Impact of Estrogen Replacement Therapy on Anxiety Symptoms, Body Shape Perception and Eating Attitudes in Adolescent Girls with Anorexia Nervosa

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: FP37-Clinical Pediatric Endocrinology
Monday, June 17, 2013: 10:45 AM-11:15 AM
Presentation Start Time: 10:45 AM
Room 102 (Moscone Center)

Poster Board MON-596
Madhusmita Misra*1, Debra K. Katzman2, Nara Mendes Estella3, Karen Klahr Miller1, Kamryn T. Eddy4 and Anne Klibanski1
1Massachusetts General Hospital/Harvard Medical School, Boston, MA, 2Hospital for Sick Children, Toronto, ON, Canada, 3Massachusetts General Hospital, Boston, MA, 4Harris Center, Massachusetts General Hospital, Boston, MA
Background:Anorexia nervosa (AN) is characterized by low weight, aberrant eating attitudes and behavior (restriction, binge/purge behaviors), body image disturbance and hypogonadism. Anxiety is a common co-morbid condition. Estrogen replacement reduces anxiety in ovariectomized rats, and variations in food intake across the menstrual cycle may also be related to gonadal hormones. The impact of estrogen replacement on anxiety, eating attitudes and behavior, and body image has not been reported in patients with AN and merits investigation.

Objectives: We hypothesized that physiologic estrogen replacement in adolescents with AN would ameliorate anxiety and improve eating behavior, without affecting body image.

Methods: Girls with AN 13-18 years old and a bone age of at least 15 years were randomized to physiologic estrogen replacement or placebo for 18 months. The girls received either transdermal estradiol (100 mcg twice weekly) with cyclic progesterone or placebo for the study duration. In order to investigate the effects of estrogen on anxiety symptoms, eating attitudes and behavior and body image, the Spielberger’s State-Trait Anxiety Inventory for Children (STAIC), the Eating Disorders Inventory II questionnaire (EDI II), and the Body Shape Questionnaire (BSQ-34) were administered. Seventy-two girls with AN completed the questionnaires at baseline (38 randomized to estrogen and 34 to placebo), and 37 at 18 months follow-up (20 randomized to estrogen and 17 to placebo).

Results: Girls with AN randomized to physiologic estrogen replacement did not differ from those randomized to placebo for age, bone age, height, weight, BMI, percent ideal body weight and baseline STAIC, EDI II and BSQ-34 scores. Additionally, girls who did or did not complete the questionnaires at follow-up did not differ for baseline characteristics. Estrogen replacement led to a significant decrease in the STAIC trait scores (-3.05±5.43 vs. 2.07±6.69, p=0.01), without impacting STAIC state scores (-1.11±1.83 vs. 0.20±2.06, p=0.64). There was, however, no impact of estrogen replacement on EDI II or BSQ-34 scores. The groups did not differ for changes in weight or BMI over 18 months, and effects of estrogen replacement on STAIC trait scores persisted after controlling for changes in weight or BMI (p=0.02 and 0.03 respectively). There was an inverse association between change in estradiol and change in STAIC trait scores over the study duration (r=-0.66, p=0.001).

Conclusions: Estrogen replacement led to a reduction in trait anxiety (the tendency to experience anxiety) in adolescent girls with AN independent of weight changes, but did not impact eating attitudes and behaviors or body shape perception.

Nothing to Disclose: MM, DKK, NM, KKM, KTE, AK

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

Sources of Research Support: This study was supported by NIH grants UL1 RR025758-01 and R01 DK062249.
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