INCREASED INSULIN BINDING TO ERYTHROCYTES IN ANOREXIA-NERVOSA - RESTORATION TO NORMAL WITH REFEEDING

We studied [125I] insulin binding to circulating cells in patients with anorexia nervosa (eight females), in the basal cachectic state (seven patients) and after weight gain (eight patients) and compared the values to those obtained in 17 normal volunteers (eight females and nine males). Untreated patients showed increased insulin binding to receptors on erythrocytes (mean ± S.E.M., 12.2±0.99 per cent of total); after weight gain, these increased levels returned to normal (6.8±0.42 vs. 6.7±0.63 per cent of total). Increased binding was due to an increased number of receptors per cell, with little or no change in receptor affinity. In five patients (one untreated, four treated), results of [125I] insulin binding to erythrocytes correlated closely (r = 0.982) with results obtained with monocytes. We conclude that in patients with anorexia nervosa, insulin binding to receptors is altered and that the abnormality is corrected by restoration of normal food intake and body weight. (N Engl J Med 300:882–887, 1979) ALTHOUGH anorexia nervosa has been recognized for nearly three centuries,1 the cause and pathophysiology of the disease remain obscure. It affects primarily young females with weight loss and abnormal ideation regarding food and body image. The disease is associated with psychiatric and behavioral symptoms and with abnormalities of endocrine function. Such patients have alterations of the hypothalamus and pituitary, disorders of secretion of growth hormone, gonadotropins, and ovarian and adrenal steroids, and abnormalities of water conservation, thermoregulation and carbohydrate metabolism. Several authors have reported altered insulin sensitivity in such patients.2 3 4 5 6 7 Changes in insulin binding to receptors are common in states. © 1979, Massachusetts Medical Society. All rights reserved.