What is the primary concern in patients with anorexia nervosa regarding their hormonal levels?

In patients with anorexia nervosa, there are significant hormonal changes due to the extreme caloric restriction and malnutrition associated with the disorder. It is critical to understand that the physiological stress of starvation and weight loss leads to a complex interplay of hormonal adaptations.

Firstly, low ACTH (adrenocorticotropic hormone) levels can reflect the altered hypothalamic-pituitary-adrenal (HPA) axis activity in the context of starvation. Anorexia nervosa often leads to changes in the body's response to stress, affecting ACTH and cortisol levels.

Secondly, high cortisol levels are often observed in individuals with anorexia nervosa. Chronic stress and starvation can cause the body to increase cortisol production as part of the stress response. Elevated cortisol can impact various metabolic processes and may contribute to other complications seen in these patients.

Lastly, low thyroid hormone levels (hypothyroidism) can occur due to the metabolic slowdown that accompanies starvation. This reduction in thyroid hormones is a protective mechanism aimed at conserving energy in the context of severe caloric deficiency.

Given that patients with anorexia nervosa can present with low ACTH levels, high cortisol levels, and low thyroid hormone levels, the assertion that all of these hormonal imbalances are a primary concern accurately reflects