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Excessive weight loss in the athletic adolescent. A diagnostic dilemma
Authors:J J Chipman  R D Hagan  J C Edlin  M H Soll  B R Carruth
Affiliation:1. Louisiana State University, United States;2. The Catholic University of America, United States;3. Jackson Montgomery Veterans Administration Medical Center, United States;4. Duke University Medical Center, United States;1. Istanbul University, Florence Nightingale Nursing Faculty, Mental Health and Psychiatric Nursing Department, Şişli- Istanbul/Turkey;2. Istanbul University, Florence Nightingale Nursing Faculty, Fundamental Nursing Department, Şişli- Istanbul/Turkey;3. Istanbul University, Health Science Institute, Mental Health and Psychiatric Nursing Department, Cerrahpaşa- Istanbul/Turkey;4. İstanbul Üniversity, Cerrahpaşa Medical Faculty, Mental Health Service, Kocamustafapaşa-İstanbul/Turkey;5. Istanbul University, Faculty of Economics, Beyazit- Istanbul/Turkey;1. University of Porto, Faculty of Medicine, Porto, Portugal;2. Hospital de São João, Department of Psychiatry, Porto, Portugal;3. University College London, Institute of Neurology, London, United Kingdom;4. University College London, Centre for Medical Image Computing, London, United Kingdom
Abstract:
Differentiating anorexia nervosa (AN) from excessive weight loss in the otherwise healthy, athletic adolescent may be difficult. We report the maximal work capacity, hormonal secretory patterns, and psychological assessment of a 14-year-old male runner who induced excessive weight loss and partially recovered. At 17% below previous body weight (28% below ideal weight for height), he had significant resting bradycardia (38 bmp), low maximal heart rate (167 bpm), depressed VO2 max, and prepubertal 24-hour LH and testosterone secretory patterns in the presence of late pubertal genital development. The diagnostic dilemma of excess weight loss due to food aversion in the normal athlete versus anorexia nervosa with running as a symptom was resolved by psychiatric evaluation. A disturbed body image, marked feelings of inadequacy, and depression were discovered, which are findings consistent with AN. Diagnostic criteria of AN and the possible implications of a subnormal maximal heart rate are reviewed.
Keywords:
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