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Case Reports
. 2022 Oct;31(10):1573-1579.
doi: 10.1007/s00787-021-01778-7. Epub 2021 May 9.

Rapid amelioration of anorexia nervosa in a male adolescent during metreleptin treatment including recovery from hypogonadotropic hypogonadism

Jochen Antel  1   2   3 , Susanne Tan  4 , Marvin Grabler  5 , Christine Ludwig  5 , Dominik Lohkemper  5 , Tim Brandenburg  4 , Nikolaus Barth  5 , Anke Hinney  5 , Lars Libuda  5 , Miriam Remy  5 , Gabriella Milos  6 , Johannes Hebebrand  5
Affiliations
Case Reports

Rapid amelioration of anorexia nervosa in a male adolescent during metreleptin treatment including recovery from hypogonadotropic hypogonadism

Jochen Antel et al. Eur Child Adolesc Psychiatry. 2022 Oct.

Abstract

With this case report we support our medical hypothesis that metreleptin treatment ameliorates starvation related emotional, cognitive and behavioral symptomatology of anorexia nervosa (AN) and show for the first time strong effects in a male patient with AN. A 15.9 year old adolescent with severe AN of eight-month duration was treated off-label with metreleptin. Hyperactivity was assessed with accelerometry. Visual analogue scales (VAS), validated self- and clinician rating scales and lab results tracked changes from baseline to end of the 24-day dosing period and a five-month follow-up. Substantial improvements of mood and eating disorder related cognitions and hyperactivity set in after two days of treatment. During dosing, sub-physiological testosterone and TT3 levels normalized; clinically libido reemerged. Weight did not increase substantially during the dosing period. During follow-up target weight was attained; mood did not deteriorate; hyperactivity ceased. The results substantiate the strong effects seen in female cases and underscore the need for a double-blind placebo-controlled trial to confirm the observed strong, multiple and rapid onset beneficial effects of metreleptin in AN.

Keywords: Anorexia nervosa; Antidepressive; Hyperactivity; Hypogonadotropic hypogonadism; Metreleptin.

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Conflict of interest statement

All authors declare no conflicts of interests.

Figures

Fig. 1
Fig. 1
Means of six key cognitions and emotions assessed twice daily with visual analogue scales (range 1–10) prior, during and after the 24-day dosing period
Fig. 2
Fig. 2
Means of four self-ranked safety/physiological parameters assessed twice daily with visual analogue scales (range 1–10) prior, during and after the 24-day dosing period
Fig. 3
Fig. 3
Hormone levels of the pituitary–gonadal axis prior to, during and after the 24-day dosing period (normal ranges: testosterone: 5.0–29.2 nmol/l; LH: 1.0–7.IU/l; FSH: 1.4–7.5 IU/l)
Fig. 4
Fig. 4
Hormone levels of the pituitary–thyroid axis prior to, during and after the 24-day dosing period (normal ranges: ft3: 4.2–7.47 pmol/l; ft4: 10.57–22.62 pmol/l; TT3:1.31–2.9 pmol/l; TSH: 0.48–4.17 mU/l)
See this image and copyright information in PMC

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