Anorexia Nervosa:
The physiological consequences of starvation and
the need for primary prevention efforts.
Michael Sidiropoulos*
_________________________________________________________________
CASE PRESENTATION
A 17-year-old girl was brought to the emergency
department by her worried parents. The patient was
described by her parents as having symptoms of
fatigue, dizziness and syncope over the past few days.
She also had no appetite, a weight loss of 11.4 kg over
the past four months and a recent uncharacteristic
pursuit to exercise. When the patient was further
questioned, she complained of cold hands and feet,
constipation, dry skin and hair, and headaches. Her
social history revealed social withdrawal, depression,
and irritability, as well as having difficulty
concentrating and making decisions. Her performance
at school had also fallen. The physical exam revealed a
quiet, young girl who looked her age, was in no
distress, but had cool peripheries. Her skin was slightly
mottled in appearance, with some anhydrotic eczema of
her extremities, and her blood pressure was difficult to
auscultate. When obtained, it was lower than her usual
values, at 84 systolic and 70 diastolic. Her pulse was 47
bpm, and irregularly irregular. Respiratory and
abdominal examinations were normal. The patient
however looked very underweight and thin. Her weight
and height were 47 kg and 1.7 m, respectively; her
calculated body-mass index (BMI) was 16. She also
had a moderate loss of muscle mass and edema of her
extremities. Further history taking from the patient,
while alone, revealed that she had stopped
menstruating seven months ago. There were no
changes in sleep or any changes in bladder or bowel
movements, and nausea and vomiting were denied.
Her past medical history was remarkable for a stress
fracture of her fibula and multiple admissions to
hospital for depression, and she was also once admitted
for suicidal ideation. Moreover, the patient denied any
current laxative or diuretic use, and when asked about
her diet, she stated that it consisted of yogurt and some
fruit, with no meal at lunchtime while at school. Daily
servings would not exceed a total of 750 kcal/day and
her meals never contained any fat. She described
herself as "fat…overweight" and her only pastime was
exercising. When asked about her weight, she stated,
"the more weight I lose, the more I wish to loose." She
denied having any problems and explained that she was
annoyed that her parents, friends, and teachers were
concerned. It seems that the patient has very poor
insight into her situation, and continues to perceive
herself as healthy. Despite being aware that she is
underweight, amenorrheic and bradycardic, she feels
that she does not need to be in hospital.
okee disini ya selanjutnya!!!