216 BIOL PSYCHIATRY 1991;30:2|6-224 Pineal and Adrenal Function Before and After Refeeding in Anorexia Nervosa Sidney H. Kennedy, Gregory M. Brown, Gail McVey, and Paul E. Garfinkel Nine female subjects with anorexia nervosa fAN) were studied when emaciated (mean 72% of average body weight), and after refeeding (mean 85% of average body weight). They were compared to 9 individuali.v age-matched female control subjects. On each occasion blood was sampled for serum melatonin and plasma cortisol through the night, and urine was collected over 24 hr to measure su~atoxy melatonin levels. The AN group did not differ in their level of depression before and after weight gain. There were no significant differences in serum melatonin values ~nong the patient group before or after weight gain ~nd the control group. Levels of urinary sulfatoxy melatonin were also significantly higher in nighttime compared to daytime samples both before and after weight gain. Plasma cortisol values were significantly elevated in the emaciated state and this was accounted for by higher cortisol levels at 9, lO, I l, and 12 eu and at 6 compared with the weight restored state and to controls. This study suggests that pineal activit3, in patients with AN is not altered by chronic changes in weight, and is not closely associated with changes in cortisol. Underweight patients with anorexia nervosa (AN) display a variety of psychological characteristics, including disturbances in attitudes and feelings about their bodies and in self-esteem. They also demonstrate a variety of neuroendocrine abnormalities, including amenorrhea. A deficiency in the amount or secretion pattern of gonadotropin-releasing hormone and an increased output of corticotropin-releasing factor, ~socia~d wiLh hy- percortisolism, have both been implicated in this endocrine dysregulation (Brown et al 1977; Gold et al 1986). Melatonin is secreted from the pineal gland primarily in darkness, under direct sym- pathetic noradrenergic control, and appears to influence seasonal breeding patterns in mammals (Tamarkin et al 1985). However, its relationship to the human reproductive cycle is less clear (Wetterberg et al 1976; Brzezinski et al 1988). Also, in humans, melatonin levels are highest prepubertally and decline with aging (Waldhauser and Steger 1986). Given the similarities between underweight patients with AN and prepubertal individuals, it might be expected that nocturnal melatonin levels would also be elevated in AN. This idea is strengthened by findings that starvation in animals is associated with From the Department of Psychiatry. Toronto General Hospital, Toronto, Ontario, Canada. Address reprint requests to Dr. S. H Kennedy, Department of Psychiatry, Toronto General Hospital. 200 Elizabeth Street. /'oronto, Ontario M5G 2C4, Canada. Received June 19, 1990; revised December 20, 1990. © 1991 Society of Biological Psychiatry 0006-3223/91/503.50