145 Endocrine and Metabolic Alterations following Deep Brain Stimulation in Anorexia Nervosa M.S. Oudijn, D. Karaszewska, M.R. Soeters, P. van den Munckhof, P.R. Schuurman, A.A. van Elburg, R.J.T. Mocking, A. Lok, D. Denys In submission ABSTRACT Introduction Deep brain stimulation (DBS) targeted at the brain reward system is a promising last resort treatment option for therapy refractory anorexia nervosa (AN)-patients. As part of our pilot study on the efficacy, safety and feasibility of ventral anterior limb of the internal capsule (vALIC) DBS in AN we conducted repeated endocrine and metabolic measurements. We hypothesized that these AN-associated parameters would normalize over time with DBS treatment. Methods Four female patients with AN received DBS of the vALIC. We conducted repeated endocrine and metabolic measurements on the hypothalamic-pituitary gonadal, adrenal and thyroid axis, and measured growth hormone, insulin-like growth factor-1, appetite regulating hormones, adipokines, posterior pituitary hormones and renal and noradrenergic function before DBS (pre- and post surgery), after DBS-optimization and after a 1-year follow-up period. Results We found a significant decrease in the levels of testosterone (21.47%; 0.18 ± 0.10 nmol/L, CI 95% -0.06 – 0.41, t = 1.705, P = .034) and cortisol (47.39%; 360.25 ± 125.17 nmol/L, CI 95% 27.29 – 693.21, t = 2.88, P = 0.025) over time during treatment with DBS. Furthermore, we found decreases in progesterone, ACTH, GH, adiponectin, ADH, adrenalin and noradrenalin levels, and increases in T3, IGF-1, and leptin, although not significant. The decrease in cortisol and the increase in leptin seem more prominent in the weight-responders than in the non-responders. Conclusion This first study on endocrine and metabolic changes during DBS treatment of AN showed significant decrease of plasma cortisol and testosterone over time. Other changes did not reach significance, possibly due to the small sample size and high variability. However, some of the results we found, like the over time and the non-significant increase in leptin in the subjects that responded to DBS with weight gain, suggest an effect of DBS or DBS-modulated weight changes on endocrine and metabolic parameters. These findings stimulate further research on the complex interaction between physiology, disordered eating and neuromodulation.
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