147 Endocrine and Metabolic Alterations following Deep Brain Stimulation in Anorexia Nervosa In conclusion, AN is associated with adaptive, reactive and/or etiologic endocrine and metabolic alterations in levels of neuroendocrine factors that are involved in food reward valuation, satiety and learning via their interactions with the mesolimbic dopamine system (15-17). To the best of our knowledge, the endocrine and metabolic effects of DBS in AN have not been studied before. Cortisol has been studied in DBS in OCD patients (18, 19) showing increased urinary excretion of free cortisol when stimulation was turned off. This finding was correlated strongly with OCD symptom increase. Understanding the (neuro) endocrine and metabolic changes accompanying the observed clinical effects of DBS in AN could provide unique insight in the pathophysiology of AN, open up new therapeutic targets and further personalize DBS therapy. The present study aimed at testing endocrine and metabolic alterations following DBS in AN, with a focus on neuroendocrine parameters involved in food reward and satiety (16). As part of our pilot study on the efficacy, safety and feasibility of ventral anterior limb of the internal capsule (vALIC) DBS in AN (5) we conducted repeated endocrine and metabolic measurements on the hypothalamic-pituitary gonadal, adrenal, thyroidal and growth-hormone axis, appetite regulating hormones, adipokines, posterior pituitary hormones, renal and noradrenergic function and fatty-acid metabolism during follow-up. We hypothesized that such parameters associated with AN, would alter over time with DBS treatment and/or weight gain in the course of DBS treatment. We expected normalization of endocrine and metabolic parameters following weight restoration, possibly in part mediated by a normalizing effect of DBS on the reward system. MATERIAL AND METHODS Study design This is an analysis of laboratory measurements as part of an open label experimental pilot study conducted at the department of Psychiatry and Neurosurgery of the Amsterdam University Medical Centers (Amsterdam UMC), location Academic Medical Center (AMC) (5). The Medical Ethical Committee (MEC) of the Amsterdam UMC approved the study. Both assessors and researchers were not blinded. No control group was included. Four patients were included undergoing DBS as an experimental treatment for their treatment-refractory AN. Subjects We recruited patients from the major clinics specialized in adult eating disorders in the Netherlands. We applied the following inclusion criteria: clear primary diagnosis of AN (restricting or purging subtype) based on the DSM-IV, confirmed by a psychiatric interview by an independent physician; illness duration ≥10 years; lack of response to ≥2 typical modes of treatment including
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