Therapeutic approaches for endocrine dysregulation in anorexia nervosa in adolescents.

Anorexia nervosa (AN) is a complex eating disorder characterized by self-induced weight loss, distorted body image, and profound endocrine dysregulation. In adolescents, the illness leads to growth failure, pubertal delay, amenorrhea, and compromised bone mineral accrual. This mini review synthesizes current evidence regarding the pathophysiology and management of endocrine disturbances in adolescents with AN, with a particular focus on therapeutic strategies for growth failure, pubertal arrest, and reduced bone mineral density. Endocrine abnormalities in AN involve adaptive suppression of the hypothalamic-pituitary-gonadal, -adrenal, -thyroid, and -growth hormone axes. Nutritional rehabilitation remains the cornerstone of recovery, as restoration of energy balance normalizes gonadotropin secretion, promotes catch-up growth, and improves bone accrual. Among hormonal options, physiologic transdermal estrogen is currently the only evidence-based strategy for improving bone density and supporting reproductive recovery. Adjunctive therapies such as rhGH, rhIGF-1 or DHEA may hold potential in specific subgroups but require further validation through larger, age-specific randomized trials.