Clinical and metabolic features of anorexia nervosa

Abstract

A study of 42 patients with anorexia nervosa revealed that a specific symptom complex exists which is characteristic and can easily be differentiated from other causes of cachexia except pure starvation. Most of the patients were white, female, and in early adolescence. The hallmarks of this syndrome include amenorrhea and severe constipation with hypotension, bradycardia, and hypothermia. Leukopenia occurred in 38 per cent and was occasionally accompanied by pancytopenia and hypoplastic bone marrow. Azotemia was present in 40 per cent and hypercarotenemia in 38 per cent. Electrocardiogram changes include low voltage and nonspecific T wave changes. In patients with edema, hypoproteinemia was conspicuously absent. Endocrine findings often include low thyroxine by column, low plasma luteinizing hormone, and occasionally follicle-stimulating hormone but consistently normal to high plasma corticoids with occasional reversal in the circadian rhythm. All signs and symptoms appeared to be reversible with weight gain except the amenorrhea which persists in 46.7 per cent. Three patients died, and attention is drawn to the development of an electrolyte imbalance and sepsis with enterococcus in one. Some of the abnormalities including deranged temperature control, presumed deficient gonadotropin release, and disturbances in the dynamic patterns offecting cyclicity of adrenocorticotropic hormone probably originate in the central nervous system, most likely in the hypothalamus.