Anorexia nervosa, athletics, and amenorrhea

Menstrual dysfunction is common in adolescents who are involved in intensive athletic activity or who are limiting their nutritional intake excessively. The mechanism for hypothalamic amenorrhea in athletes and dieters is not yet fully understood. Other causes of menstrual dysfunction due to pregnancy, central lesions, hormone imbalance, or ovarian failure should be excluded in the athlete with amenorrhea. Amenorrheic patients who have sufficient estrogen effect on their endometrium to have withdrawal bleeding following exposure to progestins should be cycled with progestins on a regular basis to prevent endometrial hyperplasia. Estrogen replacement with cyclic progestin should be considered in the hypoestrogenic adolescent with prolonged amenorrhea. The long-term consequences of hypothalamic amenorrhea in adolescents remain to be determined.     

Anorexia nervosa in adolescence

Eating disorders are complex mental health conditions. Anorexia Nervosa (AN) represents a particular subtype of eating disorder that is significantly more common in young women than in young men and is the second most common mental health disorder in adolescent girls. It is a serious condition with the highest standardized mortality of any psychiatric condition. Optimal care of requires input from a multi-disciplinary team (MDT) providing collaborative medical, nutritional and psychological interventions, which includes the family, dieticians, consultant psychiatrists, therapists, nurses, paediatricians and general practitioners. AN is associated with a range of physical complications and symptoms including acute complications such as refeeding syndrome, electrolyte disturbance and cardiovascular effects. Outpatient family based treatment is the first line psychological intervention for children and adolescents with AN. Nutritional rehabilitation including weight stabilization and restoration are to essential elements of treatment and early dietician involvement is crucial. Current outcomes for AN are variable and a firm evidence base for many areas of treatment has yet to be established.     

Anorexia nervosa in adolescence

Anorexia nervosa is a disease of prepuberty and puberty occurring predominantly in females. There is growing evidence that it is increasing in frequency. The essential features are an intense fear of becoming obese, a disturbance of body image, amenorrhea, and significant weight loss followed by secondary physical changes. The disorder seems to be a product of the reciprocal interplay of biological, familial and sociocultural factors leading to starvation which, in turn, provide feedback perpetuating the anorexia nervosa syndrome. Patients often need therapeutic help to break through the denial. Our management therapy concept includes weight restoration and stabilization, as well as individual and family therapy. At follow-up, 50% of the anorectic patients reveal a good outcome, 25% fall in an intermediate category, and the rest show a poor prognosis.     

Anorexia nervosa with transient hypopituitarism

Blast cells of 4 patients with acid phosphatase positive acute leukemia were investigated for T and B lymphocyte markers. Nearly all blast cells showed a typical T cell marker, namely spontaneous rosette formation with sheep red blood cells. No surface immunoglobulin was demonstrable on these cells. 3 of these 4 patients showed an enlargement of the upper mediastinum most probably due to the thymus. The conclusion is drawn that the acid phosphatase positive acute leukemia is a T cell leukemia. Some clinical data about these 4 patients are given.     

Anorexia nervosa: diagnosis, early detection and treatment concept

The preliminary results of a retrospective study of 31 inpatient treated patients with anorexia nervosa are reported. We summarize the disordered psychological functions according to H. Bruch and outline our inpatient treatment plan. Anorexia nervosa is a developmental crisis which manifests in puberty and early adolescence. There is a great influence of family interactional patterns on the development of this disease. In most of the cases an inpatient treatment is necessary, to be followed by outpatient treatment. Our treatment plan consists of weight gain, individual psycho-therapy and family therapy. Especially in early onset anorexics family therapy is essential to clarify and correct the disturbed patterns of family interactions. Finally we stress on the importance of the first contact between this patients and the general practitioner or pediatrician, because early recognition of this disease will give a chance for better treatment and can minimize the cases of therapy delay.     

Anorexia nervosa and food avoidance emotional disorder.

A retrospective and longitudinal study was carried out on all children and adolescents who presented to a child psychiatry service over a period of 26 years to identify the nature, course, and outcome of cases meeting criteria for anorexia nervosa (n = 27). Two groups of the same age were identified for comparison, firstly those with food avoidance and emotional disorders (n = 23), and secondly those with emotional disorders but no symptoms associated with eating (n = 22). The results confirm previous reports that early onset anorexia nervosa shows a similar nature, course, and outcome to the adult disease. Being tall at presentation seems to be associated with a poor outcome. Self starvation of early onset may result in short stature in some cases. There seem to be more boys among the group in whom the disease was of early onset than would be predicted from the sex ratio among adult patients. In addition boys with anorexia nervosa may have a better prognosis than girls. Children with food avoidance emotional disorders seem to have a worse prognosis than expected for childhood emotional disorders. They may represent a middle group between those with anorexia nervosa and those with emotional disorders but no symptoms associated with eating.     

Anorexia nervosa complicating inflammatory bowel disease.

Two cases of inflammatory bowel disease, occurring in adolescence and complicated by anorexia nervosa, are presented. The management of the bowel disease with corticosteroids appeared to precipitate the eating disorder in one case whereas covert withdrawal of steroid treatment led to life threatening complications of inflammatory bowel disease in the other. The difficulties of managing two serious conditions, each ideally treated in a specialist centre, are discussed and the dangers of treating adolescents with shape modifying drugs are highlighted.