Hyperthyroidism in anorexia nervosa: case report and review of the literature

OBJECTIVE: To report hyperthyroidism as a cause of unexpected weight gain during the course of anorexia nervosa (AN). METHOD: A case report and review of the literature. RESULTS: A 42-year-old woman with a 27-year history of AN had involuntary weight gain when she became hyperthyroid, but lost weight after treatment of the hyperthyroidism. An increase in appetite has been reported when hyperthyroidism occurs during AN. CONCLUSION: Clinicians should include hyperthyroidism in the differential diagnosis of unexpected weight gain in AN.     

Diffuse soft tissue emphysema in anorexia nervosa: a case report

OBJECTIVE: Anorexia nervosa (AN) is an eating disorder that occurs mainly among young females and its prevalence has increased in recent decades. METHODS: We reported a patient with AN with spontaneous diffuse soft tissue emphysema and bicytopenia, both of which are very rare complications of AN. Our patient, a 20-year-old woman, had lost 41.6% of her previous body weight within 9 months. Her body mass index was 10.8 and amenorrhea had persisted for 5 months. RESULTS: After admission, she was diagnosed with AN-restrictive subtype. She was noted to have crunching sounds in the neck and upper chest wall during hospitalization. A chest X-ray and chest computed tomography scan both revealed diffuse soft tissue emphysema including subcutaneous emphysema, pneumomediastinum, and pneumoretroperitoneum. DISCUSSION: Diffuse soft tissue emphysema improved gradually and completely resolved on the 21st day of hospitalization. This condition seems to be benign and only a short period of hospitalization is required.     

A case report of oxidative stress in a patient with anorexia nervosa

OBJECTIVE: Liver injury is well known as a complication of anorexia nervosa (AN), and steatosis of the liver has been thought to be the main cause of the injury. However, the precise mechanism for the liver injury is still unclear. METHOD AND RESULTS: We had a chance to examine the histological change of the liver with AN, and found that not only fat deposit but also peroxidated lipid products and irons were recognized in hepatocytes. CONCLUSION: Our present case demonstrates that oxidative stresses in hepatocytes, which might be associated with iron deposition, could be involved in the pathogenesis of liver injury in patients with AN.     

Treatment of anorexia nervosa in the context of transsexuality: A case report

Males comprise a minority of patients with eating disorders (ED). However, men who have sex with men, males with gender identity disorder, and transsexual (TS) males are at increased risk for ED. Little has been published about the unique treatment needs of TS patients with ED. A 19‐year‐old male‐to‐female TS patient presented with restrictive eating, purging, and weight loss. History revealed that her ED ideation and behaviors were strongly intertwined with her gender identity. She was admitted and during her hospitalization both her ED and TS status were addressed medically. Physicians treating patients with ED should be aware of patients' gender identities and the ways in which gender identity may impact management and recovery. When appropriate, providers should consider addressing medical treatment toward gender transition concurrently with treatment for ED to facilitate medical stabilization and weight restoration in the manner most consistent with the patient's identified gender. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2014; 47:112–115)     

Anorexia nervosa and Raynaud's phenomenon: a case report

OBJECTIVE: To describe and discuss potential relationships between anorexia nervosa (AN) and Raynaud's phenomenon, the course and concurrent treatment of these two disorders as they appeared simultaneously, and a potential treatment modification entailed in such concurrent therapies. BACKGROUND: Although Raynaud's phenomenon has been described during the course of AN, the associations and interactions between these two conditions are not clear. METHOD: We report the medical workup, treatment, and outcomes in a 19-year old female patient who developed Raynaud's phenomenon following the onset of AN. RESULTS: After treatment with nutritional rehabilitation, counseling, and individual and group therapy, the patient's weight, eating disorder-related behaviors, and attitudes improved significantly. Raynaud's related symptoms improved, following treatment with a calcium channel blocker and antiaggregant therapy. In conjunction with nutritional efforts to treat the patient's long-standing amenorrhea and osteopenia, the treatment team elected to also administer estrogen hormone in addition to oral calcium and vitamin D supplementation. Since oral contraceptives are to be avoided in patients with Raynaud's phenomenon who show clinical findings suggesting connective tissue disorder, the treatment team elected to treat this patient with transdermal hormone replacement therapy. CONCLUSION: The co-occurrence of AN and Raynaud's phenomenon merits close and persistent follow-up by a multidisciplinary team and may lead to alterations of usual therapeutic approaches.     

Central diabetes insipidus associated with refeeding in anorexia nervosa: A case report

Anorexia nervosa (AN) has been associated with a multitude of hypothalamic pituitary abnormalities, although it is unknown which aberrations reflect disease causation and which are the consequences of severe malnutrition. Among these endocrinopathies, hypothalamic–posterior pituitary aberrations have been described, including disorders of osmoregulation. We report the case of an adolescent female with a history of severe AN, restricting subtype, treated aggressively with multiple hospitalizations. During hospitalization for severe weakness and lethargy, her course of medical stabilization was complicated by significant polyuria, ultimately diagnosed as central diabetes insipidus (DI). This is the first reported case, to our knowledge, of a severely malnourished adolescent with AN—restricting subtype developing central DI during the refeeding process for medical stabilization, thus adding to the small body of existing literature on disordered osmoregulation in this patient population. This case report raises the question as to whether the frequency of central DI during refeeding is greater than that previously recognized. Additional research should focus on how neuroendocrine dysregulation of water balance might impact the clinical course of AN and its treatment.     

Hypothyroidism due to Hashimoto's thyroiditis masked by anorexia nervosa

Anorexia nervosa (AN) is typically associated with altered thyroid function tests, notably a low total and free T₃, and lower, but within normal range, free T₄ and TSH. A 16‐year‐old girl with a four‐year history of AN presented with elevated TSH that fluctuated with changes in weight. TSH was within normal limits (1.7–3.64 mIU/L) following periods of weight loss and elevated with weight gain (5.9–21.66 mIU/L). Antithyroperoxidase antibodies were markedly elevated, suggesting chronic Hashimoto's thyroiditis. Of note, the elevated TSH that would be expected in Hashimoto's thyroiditis was blunted by weight loss associated with AN. Physicians should be aware that AN may contribute to masking thyroid abnormalities in Hashimoto's thyroiditis. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:932–935).     

The paradox of normal serum albumin in anorexia nervosa: a case report

OBJECTIVE: Anorexia nervosa (AN) is associated with marked decreases in caloric intake and a corresponding reduction in body weight due to abnormal self body image. Although counterintuitive, hypoalbuminemia and vitamin deficiencies are not expected consequences of this disorder. Etiologic considerations for hypoalbuminemia are discussed. METHOD: The case report of a patient with AN and marked hypoalbuminemia is presented and a focused literature review is reported. RESULTS: Hypoalbuminemia was initially attributed to starvation. However, occult infection was ultimately responsible. Serum albumin concentration normalized with antibiotic therapy despite minimal restoration of body weight. DISCUSSION: Hypoalbuminemia should not be considered a characteristic feature of AN even in the setting of progressive weight loss. The presence of other potentially life-threatening conditions should be sought, as reduced serum albumin concentration is a marker of inflammation in AN.     

Solitary rectal ulcer syndrome in a patient with anorexia nervosa: A case report

This case report describes the clinical presentation, diagnosis, and management of a 26‐year‐old patient with anorexia nervosa (AN) diagnosed with Solitary Rectal Ulcer Syndrome (SRUS). To our knowledge, this is the first case report to document SRUS in AN, whose pathogenesis in this case seems to have been determined by the patient's malnourished and underweight state. Furthermore, SRUS symptoms appear to have interacted with the eating disorder psychopathology, increasing the need to exert control over eating. Cognitive behavioral strategies and procedures were accordingly used to address the eating disorder psychopathology and to promote complete weight restoration, which brought about a significant reduction in the size of the ulcer and the complete resolution of SRUS symptoms. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2016; 49:731–735)     

Inducible syncope in anorexia nervosa: two case reports

OBJECTIVE: Syncope is a potentially dangerous symptom of anorexia nervosa that is usually attributed to bradycardia, dehydration, or hypoglycemia. METHODS: This study describes two adolescents, one male and one female, with recurrent self-induced syncope associated with isometric exercise. RESULTS: In one patient, Holter monitoring showed that isometric exercise led to increasing bradycardia followed by asystolic pauses accompanied by presyncopal symptoms. DISCUSSION: We hypothesize that inducible syncope in these two patients is due to increased vagal tone and baroreceptor sensitivity. Physicians should be aware that patients with anorexia nervosa may be able to induce syncope with isometric exercise and that this potentially dangerous behavior needs to be addressed during treatment.     

Association between high serum carcinoembryonic antigen and clinical state of male anorexia nervosa: A case report

Anorexia nervosa (AN) is a complex psychiatric disorder, which is not yet fully understood. Several studies reported that AN was associated with disruption of cytokine network. Carcinoembryonic antigen (CEA) is a glycoprotein related to its network, used as a tumor marker of adenocarcinoma, and suggested to stimulate monocytes and macrophages to release proinflammatory cytokines. Here, we report a 41‐year‐old male suffering from AN who was suspected of having a malignant tumor due to markedly elevated serum CEA levels. However, on further examinations, he was discovered to have no malignant tumors, and, interestingly, his CEA levels actually decreased as his clinical state of AN improved. Furthermore, it was found that his CEA levels were elevated proportionally to his clinical state of AN and that his body mass index was significantly correlated with serum CEA levels. Therefore, it is suggested that inflammatory responses may be associated with the clinical state of AN. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:428–431).     

Use of mirtazapine in an adult with refractory anorexia nervosa and comorbid depression: A case report

The objective of this report was to describe an efficacious treatment of an adult with long‐standing anorexia nervosa (AN). A 50‐year‐old woman with an over 7‐year history of AN and comorbid major depression had been treated unsuccessfully with numerous psychotropic medications, manualized cognitive behavior therapy, and an intensive outpatient treatment program before referral. After treatment with mirtazapine, she gained weight and her depression improved. A 9‐month follow‐up revealed a maintenance of these benefits. Mirtazapine may be useful for older, chronically ill patients presenting with AN and comorbid depression. © 2010 by Wiley Periodicals, Inc.