There is a need of experimental studies on biomarkers in patients with anorexia nervosa (P_AN), especially in the context of stress, in order to foster understanding in illness maintenance. To this end, the cortisol response to an acute stressor was investigated in n = 26 P_AN (BMI: 19.3 ± 3.4 kg/m²), age, and gender matched to n = 26 healthy controls (HC; BMI: 23.08 ± 3.3 kg/m²). For this purpose, salivary cortisol parameters were assessed in two experimental conditions: (1) rest/no intervention and (2) stress intervention (TSST; Trier Social Stress Test). In addition, psychological indicators of stress were assessed (Primary Appraisal Secondary Appraisal, Visual Analogue Scale, and Trier Inventory for the assessment of Chronic Stress), as well as psychological distress, depression, and eating disorder (ED) symptoms. A 2 × 2 × 8 ANOVA demonstrated elevated cortisol levels in P_AN in the resting condition. In the stress intervention no significant group effect in terms of cortisol (F (1, 50) = 0.69; p = 0.410; \(\eta _p^2 = 0.014\)). A significant condition (F (1, 50) = 20.50; p = 0.000; \(\eta _p^2 = 0.291\)) and time effect (F(2.71, 135.44) = 11.27; p = 0.000; \(\eta _p^2 = 0.20\)) were revealed, as well as two significant interaction effects. First: Condition × group (F (1, 50) = 4.17, p = 0.046; \(\eta _p^2 = 0.077\)) and second: Condition × time (F (2.71, 135.44) = 16.07, p = 0.000, \(\eta _p^2 = 0.24.\)). In terms of AUC_G, no significant differences between both groups were exhibited. Regardless, significant results were evinced in terms of an increase (AUC_i: F(1, 50) = 20.66, p = 0.015, \(\eta _p^2 = 0.113\)), baseline to peak (+20 min post-TSST: t₅ = 16.51 (9.02), p = 0.029) and reactivity (M_PAN = 0.73 vs. M_HC = 4.25, p = 0.036). In addition, a significant correlation between AUC_G and BMI: r (24) = −0.42, p = 0.027 was demonstrated, but not between AUC_i and BMI (r (24) = −0.26, p = 0.20). Psychological indices suggested higher levels of chronic and perceived stress in P_AN relative to HC. However, stress perception in the stress condition (VAS) was comparable. Additional analyses demonstrated that ED-symptoms are highly correlated with psychological distress and depression, but not with BMI. In addition, it could be demonstrated that reactivity is rather related to ED-symptoms and psychological burden than to BMI. In conclusion, P_AN showed elevated basal cortisol levels at rest and exhibited a blunted cortisol reactivity to the TSST as evinced by salivary cortisol parameters. Further, it was shown that weight recovery influences reversibility of hypercortisolemia, i.e., cortisol levels normalize with weight gain. However, HPAA (hypothalamus–pituitary–adrenal axis) irregularities in terms of reactivity persist even at a BMI ≤ 19.3 (±3.4). Our data suggest that pronounced psychological burden in P_AN, have a greater impact on the HPAA functionality (secondary to the ED) than BMI itself.

需要对神经性厌食症 ( _PAN )患者的生物标志物进行实验研究，尤其是在压力背景下，以促进对疾病维持的理解。为此，皮质醇响应于急性应激进行了研究在Ñ  =普_AN（BMI：19.3±3.4公斤/米²），年龄和性别相匹配的Ñ  = 26个健康对照（HC; BMI：23.08±3.3公斤/米²）。为此，在两种实验条件下评估唾液皮质醇参数：（1）休息/无干预和（2）压力干预（TSST；特里尔社会压力测试）。此外，还评估了压力的心理指标（初级评估、二级评估、视觉模拟量表和用于评估慢性压力的特里尔量表），以及心理困扰、抑郁和饮食失调 (ED) 症状。2 × 2 × 8 方差分析表明 P _AN在静息状态下皮质醇水平升高。在压力干预中，皮质醇没有显着的群体效应（F (1, 50) = 0.69; p  = 0.410; \(\eta _p^2 = 0.014\)）。一个重要的条件（F (1, 50) = 20.50; p  = 0.000; \(\eta _p^2 = 0.291\)）和时间效应（F (2.71, 135.44) = 11.27; p  = 0.000; \(\eta _p^ 2 = 0.20\) ) 以及两个显着的交互作用。第一：条件 × 组（F (1, 50) = 4.17, p  = 0.046; \(\eta _p^2 = 0.077\)） 第二：条件 × 时间（F (2.71, 135.44) = 16.07, p  = 0.000 , \(\eta _p^2 = 0.24.\) )。在 AUC 方面_G，两组之间没有表现出显着差异。无论如何，在增加（AUC _i : F (1, 50) = 20.66, p  = 0.015, \(\eta _p^2 = 0.113\)）、基线到峰值（+20 分钟后 - TSST：t ₅  = 16.51 (9.02)，p  = 0.029）和反应性（M _PAN  = 0.73 vs. M _HC  = 4.25，p  = 0.036）。此外，AUC _G和 BMI之间存在显着相关性：r (24) = -0.42，p  = 0.027，但 AUC _i和 BMI之间没有相关性（r (24) = -0.26，p  = 0.20）。心理指数表明_PAN相对于 HC的慢性和感知压力水平更高。然而，压力条件下的压力感知 (VAS) 是可比的。其他分析表明，ED 症状与心理困扰和抑郁高度相关，但与 BMI 无关。此外，可以证明反应性与 ED 症状和心理负担相关，而不是与 BMI 相关。总之，_PAN显示静息时基础皮质醇水平升高，并表现出对 TSST 的皮质醇反应迟钝，如唾液皮质醇参数所示。此外，表明体重恢复影响高皮质醇血症的可逆性，即皮质醇水平随体重增加而正常化。然而，即使在 BMI ≤ 19.3 (±3.4) 时，HPAA（下丘脑-垂体-肾上腺轴）在反应性方面的不规则性仍然存在。我们的数据表明P中是明显的心理负担_AN，有比BMI本身HPAA功能（继发于ED）的影响更大。