Massachusetts General Hospital

Sports Endocrine Research

Our group aims to further medical research and knowledge about common endocrine issues facing athletes today, including the female athlete triad. Learn more about the Sports Endocrine Research study, which examines reproductive and bone health in young athletes.

Bionutritionist Tara Holmes obtaining readings during the VO2 endurance test.

Anorexia Nervosa

Our group has demonstrated that low bone density is prevalent in adolescent girls and boys with anorexia nervosa and is associated with decreased bone turnover. Hormonal alterations that predict low bone density in this disorder include hypogonadism, a nutritionally acquired resistance to growth hormone effects, and high cortisol levels. Weight gain and resumption of menses are associated with some improvement in bone parameters, however, residual deficits persist, raising concerns regarding inadequate catch-up and suboptimal peak bone mass acquisition. Studies exploring possible therapeutic strategies to improve bone density in teenagers with anorexia nervosa are ongoing.

Obesity

Our group has demonstrated that growth hormone and cortisol status are important determinants of visceral fat and cardiometabolic risk in teenagers with obesity. We are currently evaluating the effect of low dose growth hormone administration on body composition and cardiometabolic risk in obese adolescent girls.

Neuroendocrine

Anne Klibanski, MD Laurie Carrol Guthart Professor of Medicine, Harvard Medical School Chief, Neuroendocrine Unit, Massachusetts General Hospital Phone: 617 726 3870       Fax: 617 726 5072

Pediatric Endocrine

Madhusmita (Madhu) Misra, MD, MPH Associate Professor of Pediatrics, Harvard Medical School Program Director, Pediatric Endocrinology, MassGeneral Hospital for Children Co-Chair, MGHfC Research Council Associate Director, HCCRC, Harvard Catalyst Pediatrician, MassGeneral Hospital for Children Phone: 617 726 3870       Fax: 617 726 8528        E-mail: mmisra@partners.org

Sports Medicine and Endocrinology

Kathryn Ackerman, MD, MPH Instructor in Medicine, Harvard Medical School Assistant in Medicine, Massachusetts General Hospital Phone: 617-726-7528     Fax: 617 726 8528        E-mail: keackerman@partners.org

Nurse Practitioner

Meghan Slattery, NP Phone: 617-643-0267   Fax: 617 726 8528        E-mail: mslattery@partners.org

Study Coordinators and Assistants

Hannah Clarke, BS
Phone: 617-724-6046   Fax: 617 726 8528        E-mail: hclarke@partners.org

Lisa Pierce, BS
Phone: 617-726-1428    Fax: 617 726 8528        E-mail: lpierce4@partners.org

Cristina Gutierrez, BA
Phone: 617-726-0266    Fax: 617 726 8528        E-mail: cegutierrez@partners.org

• Fat Mediated Modulation of Reproductive and Endocrine Function in Young Athletes
• Effects of Anorexia Nervosa on Peak Bone Mass
• Effect of Growth Hormone on Visceral Fat and Cardiovascular Risk Markers in Obese Teenage Girls

1. Russell, M., Breggia, A., Mendes, N., Klibanski, A., and Misra, M. 2011. Growth hormone is positively associated with surrogate markers of bone turnover during puberty. Clin Endocrinol (Oxf) 75:482-488.
2. Misra, M., and Klibanski, A. 2011. The neuroendocrine basis of anorexia nervosa and its impact on bone metabolism. Neuroendocrinology 93:65-73.
3. Misra, M., and Klibanski, A. 2011. Bone metabolism in adolescents with anorexia nervosa. J Endocrinol Invest 34:324-332.
4. Misra, M., and Klibanski, A. 2011. Bone health in anorexia nervosa. Curr Opin Endocrinol Diabetes Obes.
5. Misra, M., and Klibanski, A. 2011. Neuroendocrine consequences of anorexia nervosa in adolescents. Endocr Dev 17:197-214.
6. Misra, M., Katzman, D., Miller, K.K., Mendes, N., Snelgrove, D., Russell, M., Goldstein, M., Ebrahimi, S., Clauss, L., Weigel, T., et al. 2011. Physiologic estrogen replacement increases bone density in adolescent girls with anorexia nervosa. J Bone Miner Res.
7. Miller, K.K., Meenaghan, E., Lawson, E.A., Misra, M., Gleysteen, S., Schoenfeld, D., Herzog, D., and Klibanski, A. 2011. Effects of risedronate and low-dose transdermal testosterone on bone mineral density in women with anorexia nervosa: a randomized, placebo-controlled study. J Clin Endocrinol Metab 96:2081-2088.
8. Lawson, E.A., Donoho, D.A., Blum, J.I., Meenaghan, E.M., Misra, M., Herzog, D.B., Sluss, P.M., Miller, K.K., and Klibanski, A. 2011. Decreased nocturnal oxytocin levels in anorexia nervosa are associated with low bone mineral density and fat mass. J Clin Psychiatry.
9. Ackerman, K.E., Nazem, T., Chapko, D., Russell, M., Mendes, N., Taylor, A.P., Bouxsein, M.L., and Misra, M. 2011. Bone Microarchitecture Is Impaired in Adolescent Amenorrheic Athletes Compared with Eumenorrheic Athletes and Nonathletic Controls. J Clin Endocrinol Metab.
10. Ackerman, K.E., and Misra, M. 2011. Bone health and the female athlete triad in adolescent athletes. Phys Sportsmed 39:131-141.
11. Wong, K., Levitsky, L.L., and Misra, M. 2010. Predictors and growth consequences of central hypothyroidism in pediatric patients receiving recombinant human growth hormone. J Pediatr Endocrinol Metab 23:451-461.
12. Walsh, C.J., Phan, C.M., Misra, M., Bredella, M.A., Miller, K.K., Fazeli, P.K., Bayraktar, H.H., Klibanski, A., and Gupta, R. 2010. Women with anorexia nervosa: finite element and trabecular structure analysis by using flat-panel volume CT. Radiology 257:167-174.
13. Savgan-Gurol, E., Bredella, M., Russell, M., Mendes, N., Klibanski, A., and Misra, M. 2010. Waist to hip ratio and trunk to extremity fat (DXA) are better surrogates for IMCL and for visceral fat respectively than for subcutaneous fat in adolescent girls. Nutr Metab (Lond) 7:86.
14. Russell, M., Mendes, N., Miller, K.K., Rosen, C.J., Lee, H., Klibanski, A., and Misra, M. 2010. Visceral fat is a negative predictor of bone density measures in obese adolescent girls. J Clin Endocrinol Metab 95:1247-1255.
15. Lloyd, B., Ravi, P., Mendes, N., Klibanski, A., and Misra, M. 2010. Peptide YY levels across pubertal stages and associations with growth hormone. J Clin Endocrinol Metab 95:2957-2962.
16. Katavetin, P., Cheunsuchon, P., Swearingen, B., Hedley-Whyte, E.T., Misra, M., and Levitsky, L.L. 2010. Review: Pituitary adenomas in children and adolescents. J Pediatr Endocrinol Metab 23:427-431.
17. Katavetin, P., Cheunsuchon, P., Grant, E., Boepple, P.A., Hedley-Whyte, E.T., Misra, M., and Levitsky, L.L. 2010. Rathke's cleft cysts in children and adolescents: association with female puberty. J Pediatr Endocrinol Metab 23:1175-1180.
18. Fazeli, P.K., Misra, M., Goldstein, M., Miller, K.K., and Klibanski, A. 2010. Fibroblast growth factor-21 may mediate growth hormone resistance in anorexia nervosa. J Clin Endocrinol Metab 95:369-374.
19. Fazeli, P.K., Lawson, E.A., Prabhakaran, R., Miller, K.K., Donoho, D.A., Clemmons, D.R., Herzog, D.B., Misra, M., and Klibanski, A. 2010. Effects of recombinant human growth hormone in anorexia nervosa: a randomized, placebo-controlled study. J Clin Endocrinol Metab 95:4889-4897.
20. Fazeli, P.K., Bredella, M.A., Misra, M., Meenaghan, E., Rosen, C.J., Clemmons, D.R., Breggia, A., Miller, K.K., and Klibanski, A. 2010. Preadipocyte factor-1 is associated with marrow adiposity and bone mineral density in women with anorexia nervosa. J Clin Endocrinol Metab 95:407-413.
21. Brick, D.J., Gerweck, A.V., Meenaghan, E., Lawson, E.A., Misra, M., Fazeli, P., Johnson, W., Klibanski, A., and Miller, K.K. 2010. Determinants of IGF1 and GH across the weight spectrum: from anorexia nervosa to obesity. Eur J Endocrinol 163:185-191.
22. Bredella, M.A., Ghomi, R.H., Thomas, B.J., Torriani, M., Brick, D.J., Gerweck, A.V., Misra, M., Klibanski, A., and Miller, K.K. 2010. Comparison of DXA and CT in the assessment of body composition in premenopausal women with obesity and anorexia nervosa. Obesity (Silver Spring) 18:2227-2233.
23. Balhara, B., Misra, M., and Levitsky, L.L. 2010. Clinical Monitoring Guidelines for Congenital Hypothyroidism: Laboratory Outcome Data in the First Year of Life. J Pediatr.
24. Taylor, C., Lamparello, B., Kruczek, K., Anderson, E.J., Hubbard, J., and Misra, M. 2009. Validation of a food frequency questionnaire for determining calcium and vitamin D intake by adolescent girls with anorexia nervosa. J Am Diet Assoc 109:479-485, 485 e471-473.
25. Stanley, T.L., Levitsky, L.L., Grinspoon, S.K., and Misra, M. 2009. Effect of body mass index on peak growth hormone response to provocative testing in children with short stature. J Clin Endocrinol Metab 94:4875-4881.
26. Russell, M., Stark, J., Nayak, S., Miller, K.K., Herzog, D.B., Klibanski, A., and Misra, M. 2009. Peptide YY in adolescent athletes with amenorrhea, eumenorrheic athletes and non-athletic controls. Bone 45:104-109.
27. Russell, M., Bredella, M., Tsai, P., Mendes, N., Miller, K.K., Klibanski, A., and Misra, M. 2009. Relative growth hormone deficiency and cortisol excess are associated with increased cardiovascular risk markers in obese adolescent girls. J Clin Endocrinol Metab 94:2864-2871.
28. Nguyen, V.T., and Misra, M. 2009. Transitioning of children with GH deficiency to adult dosing: changes in body composition. Pituitary 12:125-135.
29. Misra, M., Tsai, P.M., Mendes, N., Miller, K.K., and Klibanski, A. 2009. Increased carbohydrate induced ghrelin secretion in obese vs. normal-weight adolescent girls. Obesity (Silver Spring) 17:1689-1695.
30. Misra, M., McGrane, J., Miller, K.K., Goldstein, M.A., Ebrahimi, S., Weigel, T., and Klibanski, A. 2009. Effects of rhIGF-1 administration on surrogate markers of bone turnover in adolescents with anorexia nervosa. Bone 45:493-498.
31. McCormack, S., Mitchell, D.M., Woo, M., Levitsky, L.L., Ross, D.S., and Misra, M. 2009. Radioactive iodine for hyperthyroidism in children and adolescents: referral rate and response to treatment. Clin Endocrinol (Oxf).
32. Levitsky, L.L., Misra, M., Boepple, P.A., and Hoppin, A.G. 2009. Adolescent obesity and bariatric surgery. Curr Opin Endocrinol Diabetes Obes 16:37-44.
33. Bredella, M.A., Fazeli, P.K., Miller, K.K., Misra, M., Torriani, M., Thomas, B.J., Ghomi, R.H., Rosen, C.J., and Klibanski, A. 2009. Increased Bone Marrow Fat in Anorexia Nervosa. J Clin Endocrinol Metab.
34. Utz, A.L., Lawson, E.A., Misra, M., Mickley, D., Gleysteen, S., Herzog, D.B., Klibanski, A., and Miller, K.K. 2008. Peptide YY (PYY) levels and bone mineral density (BMD) in women with anorexia nervosa. Bone 43:135-139.
35. Stanley, T., and Misra, M. 2008. Polycystic ovary syndrome in obese adolescents. Curr Opin Endocrinol Diabetes Obes 15:30-36.
36. Prabhakaran, R., Misra, M., Miller, K.K., Kruczek, K., Sundaralingam, S., Herzog, D.B., Katzman, D.K., and Klibanski, A. 2008. Determinants of height in adolescent girls with anorexia nervosa. Pediatrics 121:e1517-1523.
37. Misra, M., Prabhakaran, R., Miller, K.K., Goldstein, M.A., Mickley, D., Clauss, L., Lockhart, P., Cord, J., Herzog, D.B., Katzman, D.K., et al. 2008. Prognostic indicators of changes in bone density measures in adolescent girls with anorexia nervosa-II. J Clin Endocrinol Metab 93:1292-1297.
38. Misra, M., Prabhakaran, R., Miller, K.K., Goldstein, M.A., Mickley, D., Clauss, L., Lockhart, P., Cord, J., Herzog, D.B., Katzman, D.K., et al. 2008. Weight gain and restoration of menses as predictors of bone mineral density change in adolescent girls with anorexia nervosa-1. J Clin Endocrinol Metab 93:1231-1237.
39. Misra, M., Katzman, D.K., Cord, J., Manning, S.J., Mickley, D., Herzog, D.B., Miller, K.K., and Klibanski, A. 2008. Percentage extremity fat, but not percentage trunk fat, is lower in adolescent boys with anorexia nervosa than in healthy adolescents. Am J Clin Nutr 88:1478-1484.
40. Misra, M., Katzman, D.K., Cord, J., Manning, S.J., Mendes, N., Herzog, D.B., Miller, K.K., and Klibanski, A. 2008. Bone metabolism in adolescent boys with anorexia nervosa. J Clin Endocrinol Metab 93:3029-3036.
41. Misra, M., Bredella, M.A., Tsai, P., Mendes, N., Miller, K.K., and Klibanski, A. 2008. Lower growth hormone and higher cortisol are associated with greater visceral adiposity, intramyocellular lipids, and insulin resistance in overweight girls. Am J Physiol Endocrinol Metab 295:E385-392.
42. Bredella, M.A., Misra, M., Miller, K.K., Madisch, I., Sarwar, A., Cheung, A., Klibanski, A., and Gupta, R. 2008. Distal radius in adolescent girls with anorexia nervosa: trabecular structure analysis with high-resolution flat-panel volume CT. Radiology 249:938-946.
43. Misra, M., Miller, K.K., Cord, J., Prabhakaran, R., Herzog, D.B., Goldstein, M., Katzman, D.K., and Klibanski, A. 2007. Relationships between serum adipokines, insulin levels, and bone density in girls with anorexia nervosa. J Clin Endocrinol Metab 92:2046-2052.
44. Miller, K.K., Wexler, T.L., Zha, A.M., Lawson, E.A., Meenaghan, E.M., Misra, M., Binstock, A.B., Herzog, D.B., and Klibanski, A. 2007. Androgen deficiency: association with increased anxiety and depression symptom severity in anorexia nervosa. J Clin Psychiatry 68:959-965.
45. Miller, K.K., Lawson, E.A., Mathur, V., Wexler, T.L., Meenaghan, E., Misra, M., Herzog, D.B., and Klibanski, A. 2007. Androgens in women with anorexia nervosa and normal-weight women with hypothalamic amenorrhea. J Clin Endocrinol Metab 92:1334-1339.
46. Demura, M., Martin, R.M., Shozu, M., Sebastian, S., Takayama, K., Hsu, W.T., Schultz, R.A., Neely, K., Bryant, M., Mendonca, B.B., et al. 2007. Regional rearrangements in chromosome 15q21 cause formation of cryptic promoters for the CYP19 (aromatase) gene. Hum Mol Genet 16:2529-2541.
47. Misra, M., Tsai, P., Anderson, E.J., Hubbard, J.L., Gallagher, K., Soyka, L.A., Miller, K.K., Herzog, D.B., and Klibanski, A. 2006. Nutrient intake in community-dwelling adolescent girls with anorexia nervosa and in healthy adolescents. Am J Clin Nutr 84:698-706.
48. Misra, M., Prabhakaran, R., Miller, K.K., Tsai, P., Lin, A., Lee, N., Herzog, D.B., and Klibanski, A. 2006. Role of cortisol in menstrual recovery in adolescent girls with anorexia nervosa. Pediatr Res 59:598-603.
49. Misra, M., Miller, K.K., Tsai, P., Stewart, V., End, A., Freed, N., Herzog, D.B., Goldstein, M., Riggs, S., and Klibanski, A. 2006. Uncoupling of cardiovascular risk markers in adolescent girls with anorexia nervosa. J Pediatr 149:763-769.
50. Misra, M., Miller, K.K., Tsai, P., Gallagher, K., Lin, A., Lee, N., Herzog, D.B., and Klibanski, A. 2006. Elevated peptide YY levels in adolescent girls with anorexia nervosa. J Clin Endocrinol Metab 91:1027-1033.
51. Misra, M., and Levitsky, L.L. 2006. Intermittent Growth Attenuation: Is This A Sign Of Craniopharyngioma? J Pediatr Endocrinol Metab:In press.
52. Misra, M., and Klibanski, A. 2006. Anorexia Nervosa and Osteoporosis. Osteoporosis:In press.
53. Miller, K.K., Lee, E.E., Lawson, E.A., Misra, M., Minihan, J., Grinspoon, S.K., Gleysteen, S., Mickley, D., Herzog, D., and Klibanski, A. 2006. Determinants of Skeletal Loss and Recovery in Anorexia Nervosa*. J Clin Endocrinol Metab.
54. Misra, M., Miller, K.K., Stewart, V., Hunter, E., Kuo, K., Herzog, D.B., and Klibanski, A. 2005. Ghrelin and bone metabolism in adolescent girls with anorexia nervosa and healthy adolescents. J Clin Endocrinol Metab 90:5082-5087.
55. Misra, M., Miller, K.K., Kuo, K., Griffin, K., Stewart, V., Hunter, E., Herzog, D.B., and Klibanski, A. 2005. Secretory dynamics of ghrelin in adolescent girls with anorexia nervosa and healthy adolescents. Am J Physiol Endocrinol Metab 289:E347-356.
56. Misra, M., Miller, K.K., Kuo, K., Griffin, K., Stewart, V., Hunter, E., Herzog, D.B., and Klibanski, A. 2005. Secretory dynamics of leptin in adolescent girls with anorexia nervosa and healthy adolescents. Am J Physiol Endocrinol Metab 289:E373-381.
57. Misra, M., Miller, K.K., Almazan, C., Worley, M., Herzog, D.B., and Klibanski, A. 2005. Hormonal determinants of regional body composition in adolescent girls with anorexia nervosa and controls. J Clin Endocrinol Metab 90:2580-2587.
58. Misra, M. 2005. Growth Hormone Treatment: Transitioning Care from Adolescence to Adulthood. MGH Neuroendocrine Clinical Center Bulletin 11:6-9.
59. Misra, M., Papakostas, G.I., and Klibanski, A. 2004. Effects of psychiatric disorders and psychotropic medications on prolactin and bone metabolism. J Clin Psychiatry 65:1607-1618; quiz 1590, 1760-1601.
60. Misra, M., Miller, K.K., Herzog, D.B., Ramaswamy, K., Aggarwal, A., Almazan, C., Neubauer, G., Breu, J., and Klibanski, A. 2004. Growth hormone and ghrelin responses to an oral glucose load in adolescent girls with anorexia nervosa and controls. J Clin Endocrinol Metab 89:1605-1612.
61. Misra, M., Miller, K.K., Almazan, C., Ramaswamy, K., Lapcharoensap, W., Worley, M., Neubauer, G., Herzog, D.B., and Klibanski, A. 2004. Alterations in cortisol secretory dynamics in adolescent girls with anorexia nervosa and effects on bone metabolism. J Clin Endocrinol Metab 89:4972-4980.
62. Misra, M., Miller, K.K., Almazan, C., Ramaswamy, K., Aggarwal, A., Herzog, D.B., Neubauer, G., Breu, J., and Klibanski, A. 2004. Hormonal and body composition predictors of soluble leptin receptor, leptin, and free leptin index in adolescent girls with anorexia nervosa and controls and relation to insulin sensitivity. J Clin Endocrinol Metab 89:3486-3495.
63. Misra, M., Aggarwal, A., Miller, K.K., Almazan, C., Worley, M., Soyka, L.A., Herzog, D.B., and Klibanski, A. 2004. Effects of anorexia nervosa on clinical, hematologic, biochemical, and bone density parameters in community-dwelling adolescent girls. Pediatrics 114:1574-1583.
64. Misra, M., Soyka, L.A., Miller, K.K., Herzog, D.B., Grinspoon, S., De Chen, D., Neubauer, G., and Klibanski, A. 2003. Serum osteoprotegerin in adolescent girls with anorexia nervosa. J Clin Endocrinol Metab 88:3816-3822.
65. Misra, M., Soyka, L.A., Miller, K.K., Grinspoon, S., Levitsky, L.L., and Klibanski, A. 2003. Regional body composition in adolescents with anorexia nervosa and changes with weight recovery. Am J Clin Nutr 77:1361-1367.
66. Misra, M., Miller, K.K., Bjornson, J., Hackman, A., Aggarwal, A., Chung, J., Ott, M., Herzog, D.B., Johnson, M.L., and Klibanski, A. 2003. Alterations in growth hormone secretory dynamics in adolescent girls with anorexia nervosa and effects on bone metabolism. J Clin Endocrinol Metab 88:5615-5623.
67. Misra, M., MacLaughlin, D.T., Donahoe, P.K., and Lee, M.M. 2003. The role of Mullerian inhibiting substance in the evaluation of phenotypic female patients with mild degrees of virilization. J Clin Endocrinol Metab 88:787-792.
68. Lee, M.M., Misra, M., Donahoe, P.K., and MacLaughlin, D.T. 2003. MIS/AMH in the assessment of cryptorchidism and intersex conditions. Mol Cell Endocrinol 211:91-98.
69. Soyka, L.A., Misra, M., Frenchman, A., Miller, K.K., Grinspoon, S., Schoenfeld, D.A., and Klibanski, A. 2002. Abnormal bone mineral accrual in adolescent girls with anorexia nervosa. J Clin Endocrinol Metab 87:4177-4185.
70. Misra, M., MacLaughlin, D.T., Donahoe, P.K., and Lee, M.M. 2002. Measurement of Mullerian inhibiting substance facilitates management of boys with microphallus and cryptorchidism. J Clin Endocrinol Metab 87:3598-3602.
71. Misra, M., Levitsky, L.L., and Lee, M.M. 2002. Transient hyperthyroidism in an adolescent with hydatidiform mole. J Pediatr 140:362-366.
72. Misra, M., and Klibanski, A. 2002. Evaluation and treatment of low bone density in anorexia nervosa. Nutr Clin Care 5:298-308.